Fetal Heart Rate Pattern Notification Guidelines and Suggested Management Algorithm for Intrapartum Electronic Fetal Heart Rate Monitoring

Abstract
Context: Numerous randomized controlled trials have demonstrated limited efficacy of intrapartum fetal heart rate monitoring in improving fetal outcome. A potential reason is the wide variability in clinical decision making seen with its use. Standardizing management of variant intrapartum fetal heart rate tracings may reduce this variability and lead to improvement in fetal outcome.

Objective: To develop “Notification Guidelines” and a “Management Algorithm” for variant intrapartum fetal heart rate tracings that improve fetal outcome and do not increase the operative delivery rate.

Design: The use of our “Notification Guidelines” and “Management Algorithm” over a 6 month period (1181 deliveries) was compared to historical controls (2247 deliveries).

Main Outcome Measures: Apgar score < 7 and operative delivery rate.

Results: No change in fetal outcome or operative delivery rate.

Conclusion: Our “Notification Guidelines” and “Management Algorithm” are safe and do not increase the operative delivery rate. A large multi-center trial is needed to demonstrate improvement in fetal outcome.