To construct algorithms with a sequential decision analysis pathway for monitoring of the fetal heart rate and managing fetal heart ratebradycardia, late decelerations and tachycardia during labour.
PopulationLow-risk pregnant women in labour with singleton cephalic term pregnancies.
SettingInstitutional births in low-and middle-income countries.
Search strategyWe sought relevant published clinical algorithms, guidelines and randomized trials/reviews by searching the Cochrane Library, PubMed and Google on the terms:"fetal AND heart AND rate AND algorithm AND (labour OR intrapartum)", up to March 2020.
Case scenariosThe two scenarios included were fetal heart rate bradycardia or late decelerations (potentially related to uterine rupture, placental abruption, cord prolapse, maternal hypotension, uterine hyperstimulation, or unexplained) and fetal heart rate tachycardia (potentially related to maternal hyperthermia, infection, dehydration, or unexplained). The algorithms provided pathways for definition, assessment, diagnosis, interventions to correct the abnormalities and ongoing monitoring leading to mode of birth, and linking to other algorithms in the series.
ConclusionsThe algorithms provide a framework for monitoring and managing fetal heart rate bradycardia, late decelerations and tachycardia during labour. We emphasize the inherent diagnostic inaccuracy of fetal heart rate monitoring, the tendency to over-diagnose fetal compromise, the need to consider fetal heart rate information in the context of other clinical features and the need to engage in informed, shared, family-centred decision-making. We note the need for further research on methods of fetal assessment during labour including clinical fetal arousal testing and the rapid biophysical profile test.