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Intrapartum electronic fetal monitoring (EFM) is used for most women who give birth in the United States. As such,clinicians are faced daily with the management of fetal heart rate (FHR) tracings. The purpose of this document is toprovide obstetric care providers with a framework for evaluation and management of intrapartum EFM patterns basedon the new three-tiered categorization.
Background
In 2008, a workshop sponsored by the American Collegeof Obstetricians and Gynecologists, the Eunice KennedyShriver National Institute of Child Health and HumanDevelopment, and the Society for Maternal–Fetal Med-icine focused on updating EFM nomenclature, recom -mending an interpretative system, and setting researchpriorities. Nomenclature for baseline FHR and FHRvariability, accelerations, and decelerations were reaf-firmed (Table 1). New terminology was recommendedfor the desc**tion and quantification of uterine contrac-tions. Normal uterine activity was defined as five or fewercontractions in 10 minutes, averaged over a 30-minutewindow. Tachysystole was defined as more than fivecontractions in 10 minutes, averaged over 30 minutes andshould be categorized by the presence or absence of FHRdecelerations. Tachysystole can be applied to spontaneousor induced labor. The terms hyperstimulation and hyper-contractility were abandoned.
A three-tiered system for intrapartum EFM interpre-tation also was recommended (Box 1), with the nomen-clature and interpretation described elsewhere. Thissecond Practice Bulletin on intrapartum FHR tracingsreviews the management of heart rate patterns based onthe three-tiered classification system (Figure 1).
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