A framework for standardized management of intrapartum fetal heart rate patterns

The purpose of this study was to classify fetal heart rate (FHR) monitor patterns according to risk of fetal acidemia and risk of evolution to a more serious pattern and to use this information to construct a standardized process for FHR pattern management, with the ultimate aim of minimizing newborn infant acidemia without excessive obstetric intervention.

We have identified 134 FHR patterns that have been classified by baseline rate, baseline variability, and type of deceleration. Based on the best available evidence, we have assigned a risk of newborn infant acidemia or low 5-minute Apgar score to these patterns. We have also evaluated each pattern for the risk that the pattern would evolve further into a pattern with a higher risk of acidemia.

Each FHR pattern has been color-coded, from no threat of fetal acidemia (green, no intervention required) to severe threat of acidemia (red, rapid delivery recommended). Three intermediate categories (blue, yellow, and orange) require escalated informing of appropriate individuals for intervention and resuscitation (obstetrician, anesthesiologist, and neonatal resuscitator) and preparation for urgent delivery (eg, staff and surgical suite availability and conservative techniques to ameliorate the FHR patterns).

This framework is applicable potentially to the institutions where it was developed and will need to be modified for other situations, depending on the logistics, facilities, and personnel available. This may provide a framework for developing algorithms for the standardized management of FHR patterns during labor, which can be tested for validity.