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

Histological Chorioamnionitis as a Risk Factor for Preterm Birth without Disturbing Fetal Heart Rate: A Case-Control Study

“…For example, minimal or undetectable FHR variability in the presence of recurrent late decelerations or variable decelerations is a specific FHR pattern that is associated with the presence of fetal academia (Williams and Galerneau 2003;Parer et al 2006); medical intervention is then required depending on the progress of labor (Clark et al 2013). However, the relationship between a specific FHR pattern considering the patient's clinical background and histological CAM is yet to be established.…”

“…Electronic fetal heart rate (FHR) monitoring has been clinically used since the 1960s and is now a standard management technique to assess fetal well-being during the intrapartum period (American College of Obstetricians and Gynecologists 2010) and provide the obstetric management techniques for the healthcare provided (Clark et al 2013). For example, minimal or undetectable FHR variability in the presence of recurrent late decelerations or variable decelerations is a specific FHR pattern that is associated with the presence of fetal academia (Williams and Galerneau 2003;Parer et al 2006); medical intervention is then required depending on the progress of labor (Clark et al 2013).…”

Interpretation of British experts’ illustrations of fetal heart rate (FHR) decelerations by Consultant Obstetricians, registrars and midwives: A prospective study—Reasons for major disagreement with experts and implications for clinical practice

“…Moreover, good evidence has emerged in USA that a system with "variable" decelerations as vast majority leads to loss of information or discriminatory capacity of FHR decelerations [5,6,9]. The resultant dysfunction of the 3 tier system has led a group of American experts to propose a complex "algorithm" to which the vast majority (>80%) of laboring women will be subjected in addition to the 3 tier system [36]. However, besides many unanswered questions, there is no estimate of sensitivity of this "algorithm" in picking up cases of fetal hypoxemia or acidemia and it seems to be a leap of faith or belief.…”

Standardization of fetal heart rate pattern management: Is international consensus possible?

“…Recognizing the lack of utility of the NICHD Category II for actual labor management, Clark et al 11) suggested a further algorithm based on presence or absence of normal FHR variability, labor progress and stage of labor, and used certain duration-of-pattern recommendations for when to intervene with delivery. This algorithm was accompanied by numerous qualifiers and is currently undergoing study.…”