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Fetal heart rate monitoring.

At the turn of the century, obstetric care was primarily a hands-on-only field. The hands would assess the fetal size and the fetal growth, and the mother would report fetal movements or the lack thereof. These were among the very imprecise indicators used to assess fetal life and, indirectly, fetal well-being. Subsequently, the fetoscope was introduced to listen to the fetal heart rate intermittently, sometimes weeks or months apart.

Electronic fetal heart rate monitoring transformed the whole field, giving us a method by which we could continuously assess fetal heart rate over some finite period of time. Over the years, we have been refining fetal heart rate interpretation. We have started to "quantify" the heart rate pattern qualitatively. Now, we're at a point where the correlation of fetal heart rate patterns with the likelihood of fetal acidemia and fetal compromise has become increasingly important.

Classifications for fetal heart rate patterns were developed 4 years ago in an effort to bring more clarity and meaning to the interpretation of fetal heart rate tracings. Most recently, an American College of Obstetricians and Gynecologists--sponsored committee of experts (including physicians, neonatal nurses, and nurse-midwives) delved into management issues and the uncertainties of the new classification system, ultimately developing a framework for evaluating and managing fetal heart rate patterns based on the classifications.

It is important that the obstetrical community be familiar with these changes and able to operationalize them within clinical practice. For this reason, we have invited Dr. George A. Macones to discuss the management of fetal heart rate tracings and the implications of the various categories on fetal wellbeing or the lack thereof.

Dr. Macones is the Mitchell and Elaine Yanow professor and chair of the department of obstetrics and gynecology at Washington University in St. Louis, and was involved in both major efforts in fetal heart rate monitoring--the development of the classification system for tracing interpretation and the development of ACOG's practice bulletin on managing fetal heart rate tracings.

As Dr. Macones explains, category II tracings represent a diverse spectrum of abnormal fetal heart rate patterns and require thorough evaluation, surveillance, and targeted management approaches. With regard to management of category III tracings, he explains, the traditional 30-minute rule for the timing of delivery is no longer the best guideline.


DR. REECE, who specializes in maternal-fetal medicine, is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. Dr. Reece said he had no relevant financial disclosures. He is the medical editor of this column. Contact him at
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Title Annotation:MASTER CLASS
Author:Reece, Albert E.
Publication:OB GYN News
Date:Nov 1, 2012
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