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Intrapartum management of category II fetal heart rate tracings: towards standardization of care

2013; Elsevier BV; Volume: 209; Issue: 2 Linguagem: Inglês

10.1016/j.ajog.2013.04.030

1097-6868

Steven L. Clark, Michael P. Nageotte, Thomas J. Garite, Roger K. Freeman, David A. Miller, Kathleen Rice Simpson, Michael A. Belfort, Gary A. Dildy, Julian T. Parer, Richard L. Berkowitz, Mary E. D’Alton, Dwight J. Rouse, Larry C. Gilstrap, Anthony M. Vintzileos, J. Peter Van Dorsten, Frank H. Boehm, Lisa A. Miller, Gary D.V. Hankins,

Cardiac Arrest and Resuscitation

There is currently no standard national approach to the management of category II fetal heart rate (FHR) patterns, yet such patterns occur in the majority of fetuses in labor. Under such circumstances, it would be difficult to demonstrate the clinical efficacy of FHR monitoring even if this technique had immense intrinsic value, since there has never been a standard hypothesis to test dealing with interpretation and management of these abnormal patterns. We present an algorithm for the management of category II FHR patterns that reflects a synthesis of available evidence and current scientific thought. Use of this algorithm represents one way for the clinician to comply with the standard of care, and may enhance our overall ability to define the benefits of intrapartum FHR monitoring. There is currently no standard national approach to the management of category II fetal heart rate (FHR) patterns, yet such patterns occur in the majority of fetuses in labor. Under such circumstances, it would be difficult to demonstrate the clinical efficacy of FHR monitoring even if this technique had immense intrinsic value, since there has never been a standard hypothesis to test dealing with interpretation and management of these abnormal patterns. We present an algorithm for the management of category II FHR patterns that reflects a synthesis of available evidence and current scientific thought. Use of this algorithm represents one way for the clinician to comply with the standard of care, and may enhance our overall ability to define the benefits of intrapartum FHR monitoring. Algorithm for management of category II fetal heart rate tracings: a standardization of right sort?American Journal of Obstetrics & GynecologyVol. 210Issue 2PreviewThis well-intended expert consensus-based algorithm1 has been presented as one of the options of management to prevent most cases of birth asphyxia but needs an in-depth analysis. Clark et al1 hypothesize that the different types of decelerations have unique etiologies. However, the majority of variable (rapid) decelerations during contractions cannot be explained by the cord compression hypothesis2 and several US authorities have attributed these to head compression instead, and they should really be called "early decelerations."2,3 A more scientific approach may be to correct the distorted (and fundamentally flawed?) categorization of fetal heart rate (FHR) decelerations first, which is the main underlying reason for the large confusing category II FHR patterns. Full-Text PDF