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Intrapartum Fetal Heart Rate Monitoring
Previously, fetal heart tracings were interpreted, as we have previously posted, in connection with variability, baseline, return to baseline, accelerations, and decelerations.
After an evaluation of these traits, the tracing was given an overall assessment as to whether the fetus was tolerating labor and classified as reassuring, indeterminate, non-reassuring, and sometimes, ominous.
Ostensibly, in an effort to standardize the different terminology used to provide an overall assessment of a tracing, the descriptive terminology now in use by ACOG is "Category 1," "Category 2," or "Category 3" tracing.
A Category 1 is considered “normal." A Category 2 is “indeterminate” and a Category 3 is "abnormal." In the case of a Category 3 tracing, depending upon the clinical situation, if the interventions do not improve or resolve the underlying cause of the abnormal fetal heart rate pattern, emergency intervention may be necessary. It remains to be seen if the new categories lead to better care or are simply an effort by ACOG to neutralize the perceived impact on juries in birth injury cases of inaction or a delay in the face of a “non-reassuring” fetal heart rate pattern.
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