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Fetal Heart Rate Monitoring

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Presentation on theme: "Fetal Heart Rate Monitoring"— Presentation transcript:

1 Fetal Heart Rate Monitoring
Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine

2 Learning Objectives Evolution Examples Descriptions
Reassuring patterns Concerning patterns Definitions of Category I, II, and III tracings Discuss action needed Non-stress Test (NST) Biophysical Profile (BPP)

3 “Evolution” of FHR Monitoring
Monitoring fetus in labor FHR patterns Good outcomes Poor outcomes Contraction Stress Test (CST) Non Stress Test (NST) Biophysical profile (BPP) Categorization of FHR Tracing into Category I, II, and III

4 Categorization of FHR Tracings
Recommendation of three-tiered system April 2008 More standardized interpretation Concept: Interpretation of a FHR monitor strip is a dynamic process, with determination of whether a particular strip is reassuring and what action plans should be taken… and then to evaluate at a later time

5 Ways to Monitor Uterine contractions Fetal heart rate (FHR)

6 Ways to Monitor Uterine contractions Fetal heart rate (FHR)

7 Features to Describe Fetal heart rate (FHR) Uterine contractions
Top line on monitor strip Uterine contractions Bottom line on monitor strip

8 Features to Describe Baseline Variability Accelerations Decelerations
Trends over time Interpret into 1 of 3 categories

9 Baseline Mean fetal heart rate Normal baseline
Rounded to increments of 5 During a 10 minute period Excluding accelerations and decelerations Normal baseline BPM

10 Baseline is RED LINE

11 Baseline Bradycardia Tachycardia Indeterminate <100 BPM >160 BPM
less than 2 minutes of baseline is present


13 Fetal Tachycardia Normal variant Intra-amniotic infection Fetal anemia
prematurity Intra-amniotic infection Fetal anemia Fetal cardiac arrhythmia (SVT) Fetal hypoxia

14 Features to Describe Baseline Variability Accelerations Decelerations
Trends over time Interpret into 1 of 3 categories

15 Variability Fluctuations in FHR Descriptors are: Over 10 minutes
Absent: undetectable amplitude range Minimal: undetectable up to 5 BPM Moderate: amplitude range 6 to 25 BPM Marked: amplitude range greater than 25 BPM


17 Variability



20 Features to Describe Baseline Variability Accelerations Decelerations
Trends over time Interpret into 1 of 3 categories

21 Accelerations Abrupt increase in FHR Duration Prolonged accelerations
At least 15 BPM above baseline Duration Must last 15 seconds to 2 minutes Prolonged accelerations Last 2 minutes to 10 minutes Baseline change Acceleration lasting 10 mins or longer

22 >15 beats above baseline
15 seconds to 2 minutes in length



25 Features to Describe Decelerations Baseline Variability Accelerations
Trends over time Interpret into 1 of 3 categories

26 Decelerations Decrease in baseline 3 Types Early Variable Late

27 Deceleration Decrease in FHR

28 Early Deceleration Symmetrical to contraction
Mirror image of contraction Gradual decrease in FHR 30 secs or more from onset to nadir

29 EARLY DECELERATION Gradual FHR decrease
Onset to nadir 30 seconds or more Nadir of deceleration occurs with peak of contraction Mirror contraction

30 Late Decelerations Deceleration is delayed in timing
Occurs after the contraction A gradual FHR decrease Onset to nadir > 30 second

31 Late Decelerations

32 Variable Decelerations
Abrupt decrease in fetal heart rate Onset to nadir less than 30 seconds Decrease in FHR 15 BPM or more Lasting 15 seconds to 2 mins

33 Variable Declerations
Pathophysiology umbilical cord compression




37 Decelerations Prolonged deceleration Baseline change Description
Decrease of 15 BPM Lasts minutes Baseline change Deceleration lasting at least 10 mins Description Intermittent Less than 50% of contractions in 20 minutes Recurrent More than 50 % of contractions in 20 minutes






43 Sinusoidal Pattern Smooth sin-wave pattern Cycle frequency 3-5 mins
Persists for 20 minutes or longer

44 Sinusoidal Pattern

45 Uterine Contractions Number of contractions in 10 minutes Document
averaged over thirty minutes Document Frequency Intensity Duration Relaxation time between contractions

46 Monitoring of Contractions


48 Tachysystole >5 contractions in 10 mins Averaged over 30 mins

49 Categorization of FHR Patterns
An evaluation of the fetus at a particular point in time Categories I, II, and III

50 3 Categories

51 Category I Normal baseline FHR Variability
BPM FHR Variability moderate Late or Variable decelerations none

52 Category II Not enough evidence to place into either Category I or III

53 Category III Abnormal tracing
Predictive of abnormal fetal acid-base status Requires prompt intervention

54 The ABCD’s of Fetal Monitoring

55 Examples of Tracings

56 Minimal to moderate variability
Baseline 140 earlies


58 Baseline rate 150 Baseline variability (min, avg. marked) min Presence of accelerations none Periodic or episodic decelerations: lates Uterine activity q 3 (2 contx) Interventions: maximize O2, maximize uterine blood flow, reduce uterine activity Outcome: not given

59 Late deceleration Minimal variability

60 Late deceleration Minimal variability

61 Variable decelerations
Mod variability


63 Non-Stress Test Reactive 2 or more accelerations in 20 mins
At least 15 beats above baseline Lasting for at least 15 seconds Non-reactive


65 Reactive NST

66 Biophysical Profile (BPP)
NST + ultrasound markers Score linearly correlated with fetal pH Risk of fetal death within one week of normal BPP is 1:1300

67 Biophysical Profile Zero or 2 points for each
Fetal heart beat monitor Fetal breathing Fetal movements Amniotic Fluid Volume Flexion/Extension Fetal Monitoring accelerations in 40 minutes Fetal Breathing seconds Fetal Movements Truncal Flexion/Extension Arm/leg activity Amniotic Fluid AFI > 5.0 cm BPP of 8/10 or 10/10 is “normal” or “reassuring” BPP of 6/10 requires some sort of intervention

68 Modified Biophysical Profile
Combination of NST and AFI only If less than 4/4 more evaluation is done

69 Guidelines for Reviewing FHR Monitoring
normal patient reviewed every 30 min in the first stage of labor every 15 minutes in the second stage complicated patients every 15 minutes in first stage Every 5 mins in second stage

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