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NeoReviews Vol.10 No.11 2009 e567
© 2009 American Academy of Pediatrics

Strip of the Month

November 2009

Maurice L. Druzin, MD^*
Nancy Peterson, RNC, PNNP, MSN, IBLC

^* Charles B. and Ann L. Johnson Professor of Obstetrics; Chief, Division of Maternal-Fetal Medicine; Co-Medical Director, Mid-Coastal California Perinatal Outreach Program, Stanford University School of Medicine, Palo Alto, Calif
Director of Perinatal Outreach, Stanford University, Palo Alto, Calif

The first 300 words of the full text of this article appear below.

	Electronic Fetal Monitoring Case Review Series

 
Electronic fetal monitoring (EFM) is a popular technology used to establish fetal well-being. Despite its widespread use, terminology used to describe patterns seen on the monitor has not been consistent until recently. In 1997, the National Institute of Child Health and Human Development (NICHD) Research Planning Workshop published guidelines for interpretation of fetal tracings. This publication was the culmination of 2 years of work by a panel of experts in the field of fetal monitoring and was endorsed in 2005 by both the American College of Obstetricians and Gynecologists (ACOG) and the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). In 2008, ACOG, NICHD, and the Society for Maternal-Fetal Medicine reviewed and updated the definitions for fetal heart rate patterns, interpretation, and research recommendations. Following is a summary of the terminology definitions and assumptions found in the 2008 NICHD workshop report. Normal values for arterial umbilical cord gas values and indications of acidosis are defined in Table 1.

Table 1. Arterial Umbilical Cord Gas Values

pH Pco2 (mm Hg) Po2 (mm Hg) Base Excess Normal* 7.20 (7.15 to 7.38) <60 (35 to 70) 20 –10 (–2.0 to –9.0) Respiratory Acidosis <7.20 >60 Variable –10 Metabolic Acidosis <7.20 <60 Variable –10 Mixed Acidosis <7.20 >60 Variable –10

^* Normal ranges from Obstet Gynecol Clin North Am. 1999;26:695

     Assumptions from the NICHD Workshop

• Definitions are developed for visual interpretation, assuming that both the fetal heart rate (FHR) and uterine activity recordings are of adequate quality
  
• Definitions apply to tracings generated by internal or external monitoring devices
  
• Periodic patterns are differentiated based on waveform, abrupt or gradual (eg, late decelerations have a gradual onset and variable decelerations have an abrupt onset)
  
• Long- and short-term variability are evaluated visually as a unit
  
• Gestational age of the fetus is considered when evaluating patterns
  
• Components of fetal heart rate FHR do not occur alone and generally evolve over time
  

     Definitions
Baseline Fetal Heart Rate

• Approximate mean FHR rounded to increments of 5 beats/min in a 10-minute segment of tracing, excluding accelerations and decelerations, periods of marked variability, and segments of baseline that differ by >25 beats/min
  
• In . . . [Full Text of this Article]

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