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Chapter 195. Fetal HR Monitoring

Ruchir Gupta, MD

See following table.

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DecelerationEtiologyClinical situationAppearance
EarlyFetal head compression
  • During sterile vaginal examinations
  • In second stage of labor when pushing
  • During application of internal FHR electrode
  • CPD
  • After rupture of amniotic sac
  • Vertex presentations
image
VariableCord compression
image
LateUteroplacental insufficiency
  • Excessive uterine contractions
  • Maternal hypotension
  • Maternal hypoxemia (asthma, pneumonia)
  • Reduced placental exchange as in:
    • Hypertensive disorders, diabetes, IUGR abruption
image

Reproduced from Hon EH. An Atlas of Fetal Heart Rate Patterns. New Haven: Harty Press; 1968.

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Significance of the Various Patterns
Reassuring patterns (positive outcomes, fetal well-being)
  • Mild variable decelerations (<30 s with rapid return to baseline)
  • Early decelerations
  • Accelerations without any other significant changes
Nonreassuring, or “warning,” patterns suggest decreasing fetal capacity to cope with the stress of labor
  • Decrease in baseline variability
  • Progressively worsening tachycardia (>160 bpm)
  • Decrease baseline FHR
  • Intermittent late decelerations with good variability
Patterns suggesting fetal compromise
  • Persistent late decelerations, with decreasing variability
  • Variable decelerations with loss of variability, tachycardia, or late return to baseline
  • Absence of variability
  • Profound bradycardia

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