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Fetal Heart Rate Monitoring: Interpretation and Collaborative Management


  • * CNMs/CMs and midwives as used herein refers to those midwifery practitioners who are certified by the American College of Nurse Midwives (ACNM) or the ACNM Certification Council Inc.; Midwifery refers to the profession as practiced in accordance with the standards promulgated by the ACNM.

University of California at San Francisco, Faculty OB/GYN Group, Box 0346, 400 Parnassus, San Francisco, CA 94143-0346.


Effective intrapartum fetal heart rate (FHR) monitoring requires ongoing collaboration among health care providers. Nurses, midwives, and physicians must have a shared understanding of 1) how FHR tracings are interpreted, 2) which FHR patterns are associated with actual or impending fetal acidemia, 3) when and within what time frame the physician or the midwife should be notified of variant FHR patterns, 4) how quickly physicians and midwives should respond when notified of variant patterns, and 5) the indications for and optimal timing of interventions such as operative delivery. This article reviews the literature on FHR monitoring and includes a discussion of the advantages and limitations of different monitoring modalities. An overview of those FHR patterns are associated with presumed fetal acidemia is presented, as well as sample multidisciplinary FHR monitoring guidelines and an exercise in intrapartum FHR pattern evaluation that can be used to initiate development of local FHR monitoring patterns.