11. Interpreting Intrapartum Fetal Heart Tracings

  1. John T. Queenan MD2,
  2. Catherine Y. Spong MD3 and
  3. Charles J. Lockwood MD4
  1. Michael Nageotte MD

Published Online: 4 JAN 2012

DOI: 10.1002/9781119963783.ch11

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

How to Cite

Nageotte, M. (2012) Interpreting Intrapartum Fetal Heart Tracings, in Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition (eds J. T. Queenan, C. Y. Spong and C. J. Lockwood), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119963783.ch11

Editor Information

  1. 2

    Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA

  2. 3

    Bethesda, MD, USA

  3. 4

    Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Author Information

  1. Department of Obstetrics and Gynecology, University of California, Irvine, CA, USA

Publication History

  1. Published Online: 4 JAN 2012
  2. Published Print: 24 FEB 2012

ISBN Information

Print ISBN: 9780470655764

Online ISBN: 9781119963783

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Keywords:

  • interpreting intrapartum fetal heart tracings;
  • electronic fetal heart rate monitoring (EFM);
  • monitoring of FHR;
  • FHR assessment, during active labor;
  • fetal heart rate pattern;
  • fetal resuscitation;
  • maternal hypotension and changes, in FHR;
  • amnio-infusion in recurrent variable decelerations of FHR

Summary

Over the past 30 years, electronic fetal heart rate monitoring has become an accepted means of assessing fetal status during labor. More than 85% of livebirths in the USA are so monitored despite a frequent lack of agreement on strip interpretation and management decisions. This has resulted in an increased rate of cesarean delivery in patients monitored with electronic fetal heart rate monitoring accompanied by a lack of clear evidence of efficacy. Electronic fetal heart rate monitoring is unquestionably a labor-saving device for nurses and is unlikely to be displaced from what is an accepted standard obstetric practice. Further, monitoring of the fetal heart rate is a highly reliable modality in identifying the well-oxgenated fetus. This is because the brain controls the heart rate and changes in both cerebral blood flow and blood oxygenation in turn affect the fetal heart rate. Certain patterns in the heart rate of the fetus can be used to determine oxygen status with excellent concordance between normal fetal oxygenation and the presence of normal baseline fetal heart rate accompanied by fetal heart rate accelerations. While the concordance between normal oxygenation and the presence of fetal heart rate accelerations provides clinical reassurance, the absence of accelerations does not necessarily predict abnormality in fetal oxygenation. In fact, the correlation between abnormalities of the fetal heart rate (e.g. late or variable decelerations, elevated baseline) and adverse neonatal outcomes is at best tenuous. That is to say, the positive predictive value of an abnormal fetal heart rate pattern to predict adverse outcome is very poor. Consequently, electronic fetal heart rate monitoring should be understood and employed cautiously and used only as a diagnostic tool in the management of a woman's labor. It is only with the correct interpretation of the information provided from such a modality that appropriate management decisions can be made.