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2/17/2014 mcu pgc '10 2

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2/17/2014 mcu pgc '10 3

The first central concept ofstandardized intrapartum FHR

interpretation is that all clinically

significant FHR decelerations(variable, late, or prolonged) reflect

interruption of the pathway of oxygen

transfer from the environment to thefetus at 1 or more points .

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2/17/2014 mcu pgc '10 5

The third central concept of

intrapartum FHR interpretation is

that moderate (normal)

variability and / or accelerations

reliably predict the absence of

fetal metabolic acidemia at the

time they are observed.

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Category I: NORMAL FHR tracings includeALLof the following:

Baseline rate: 110160 beats per minute (bpm)

Baseline FHR variability: moderate Late or variable decelerations: absent

Early decelerations: present or absent

Accelerations: present or absent Strongly predictive of normalacid-base status at time

of observation.

Routine care; no specific action required

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Category III: ABNORMAL FHR tracings include EITHERof the ff:

Absent baseline FHR variability andany of the ff:

Recurrent late decelerations

Recurrent variable decelerations

Bradycardia

Sinusoidal pattern

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Category II: INDETERMINATE includes all FHR tracings NOTcategorized as

Category I or III.

NOT predictive of either normal or abnormal fetalacid-base status.

requires continued surveillance and re-evaluation-second recommendation is incomplete

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2/17/2014 mcu pgc '10 10

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Grades of fluctuation are based on amplitude range(peak minustrough):

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BASELINE FHR PATTERNS

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2/17/2014 15mcu pgc '10

http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Brady.jpg

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110 BPM

2/17/2014 16mcu pgc '10

http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Brady.jpghttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Brady.jpghttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Brady.jpghttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Brady.jpghttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Brady.jpg

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From the onset of the deceleration to

the beginning of the FHR nadir of

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Variable Decelerations Severe

60 seconds in duration & < 70 beats/min OR

2 mins in duration & < 80 beats/min

Moderate

30-60 sec in duration & < 70 beats/min OR

60 sec in duration & < 80 beats/min

Mild All other decelerations are mild

2/17/2014 20mcu pgc '10

http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Variable.jpg

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2/17/2014 21mcu pgc '10

http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Variable.jpghttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Variable.jpghttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Variable.jpghttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Variable.jpg

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Variable Decelerations - Notice that the decelerations are not related to the contraction,beginning well before the contraction even begins.2/17/2014 22mcu pgc '10

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from the onset to the nadir of the

deceleration of 30 seconds.

The nadir of the deceleration occurring

after the peak of the contraction.

In most cases, the onset, nadir, and

recovery of the deceleration occur after

the beginning, peak, and ending of the

contraction, respectively.

2/17/2014 24mcu pgc '10

http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Late.jpg

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2/17/2014 25mcu pgc '10

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Late Deceleration with Absent Variability

Notice the decrease in the fetal heart rate only begins to decline after the contractionpeaks.2/17/2014 26mcu pgc '10

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from the onset to the FHR nadir of 30seconds.

The nadir of the deceleration occurs at

the same time as the peak of the

contraction.

n most cases the onset, nadir, and

recovery of the deceleration are

coincident with the beginning, peak,

and ending of the contraction,

respectively.

2/17/2014 28mcu pgc '10

http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Early.jpg

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2/17/2014 29mcu pgc '10

http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Early.jpghttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Early.jpghttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Early.jpghttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Early.jpghttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Prolonged.jpg

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2/17/2014 30mcu pgc '10

http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Prolonged.jpghttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Prolonged.jpghttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Prolonged.jpghttp://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/EFM/Prolonged.jpg

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2/17/2014 32mcu pgc '10

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Pseudo-sinusoidal Pattern2/17/2014 33mcu pgc '10

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Thank you