Category Ii Fetal Heart Tracing

Fetal heart rate NICHD. Towards standardization of care There is currently no standard national approach to the management of category II fetal heart rate FHR patterns yet such patterns occur in the majority of fetuses in labor.

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Usually managed with close observation and sometimes intrauterine resuscitative efforts Category III associated with abnormal fetal acidbase status.

Category ii fetal heart tracing. Intrapartum management of category II fetal heart rate tracings. Intrapartum electronic fetal monitoring EFM is used for most women who give birth in the United States. Sinusoidal pattern OR absent variability with recurrent late decelerations recurrent variable decelerations or bradycardia.

Guidelines for evaluating fetal heart rate tracings exist there is still a gray area present in the Class II fetal heart tracings and how to manage the fetal heart tracings in the context of the patient. Most common fetal heart rate tracing characteristic associated with Category II 85 of the patients with adverse outcome had more than one FHR tracing characteristic associated with Category II Decelerations with minimal variability were the characteristics most often associated with a pH 710. We estimated whether the presence of meconium increased the risk of adverse neonatal outcomes.

Category II not predictive of abnormal fetal acidbase status but do not fit criteria for category I or III. However a category II FHR tracing is considered. The label of Cat-II tracing is given to all FHR patterns that cannot be assigned to Cat I or Cat III.

Intrapartum management of category IIfetalheartratetracingstoward standardizationofcare. Require intervention resolve the pattern as soon as possible. The management of specific types of category II fetal heart rate tracings is discussed below.

Kathleen Rice Simpson is a Perinatal Clinical Nurse Specialist in St. Category II FHR tracings are indeterminate. The fetal heart rate tracing shows EITHER of the following.

Normal acid-base status ーCategory III. Intrapartum management of category IIfetalheartratetracingstoward standardizationofcare. AmJ Obstet Gynecol2013209289-97Reprinted with permission Graphic reprinted with permission.

For those who are aware of the recommendations this gray area of management still leads to variability in how delivery may ensue. Present or absent Accelerations. If FHR accelerations or moderate variability are detected the fetus is unlikely to be currently acidemic.

Management of the category II fetal heart rate FHR tracing presents a common challenge in obstetrics. The purpose of this document is to provide obstetric care providers with a framework for evaluation and management of intrapartum EFM patterns based on the new three-tiered categorization. Category II FHR tracings require evaluation and contin-ued surveillance and reevaluation taking into account.

110-160 beats per minute Baseline FHR variability. ACCME Objectives Review the pathophysiology of fetal heart rate tracing changes. Thus improved risk stratification of category II FHR tracings is needed.

Algorithm for Management of category II fetal heart rate tracings Clark SL Nageotte MP Garite TJ et al. Category II fetal heart rate FHR tracings are considered indeterminate. Category II FHR tracings are not predictive of abnormal fetal acidbase status yet presently there is not adequate evi-dence to classify these as Category I or Category III.

National Institute of Child Health and Human Development Fetal heart rate FHR tracings are classified into 3 categories per the National Institute of Child Health and Human Development guidelines. Relation to Fetal Metabolic Acidosis. There exists broad consensus on the recognition and management of categories I and III.

Present or absent Category Il. Management of the category II fetal heart rate FHR tracing presents a common challenge in obstetrics. A Cat-II tracing is neither normal nor definitively abnormal.

If fetal heart accelerations are absent and variability is absent or minimal the risk of fetal acidemia increases. As such clinicians are faced daily with the management of fetal heart rate FHR tracings. Louis MO and the Editor-in-Chief of MCN.

This conference will discuss the management of Category II fetal heart rate tracing FHT pathophysiology review of the FHT and identification of the fetus at risk for asphyxia. Clinical OBGYN 20115274-82 Normal fetal heart rate tracing Metabolic acidemia and potential injury Recurrent decelerations. Up to 80 of women will have a category II FHR tracing at some point during labor.

A Cat-II tracing is neither normal nor definitively abnormal. At some point during labor category I patterns were observed in over 99 percent of tracings category II patterns were observed in 84 percent of tracings and category III patterns were observed in 01 percent of. Category II fetal heart rate FHR tracings are considered indeterminate thus improved risk stratification of category II FHR tracings is needed.

Managing an Indeterminate Category II Fetal Heart Rate Tracing During Labor. The great gray zoneCategory II. For a fetus with a BE of -12 it would take 2 hours for BE to normalize if undelivered and the insult is completely abated.

Category I and Category III are well correlated with acidbase status at birth ーCategory I. Significant risk of metabolic acidemia that is associated with adverse neurologic outcomes 5-tier system that has 3 intermediate categories correlates better with acid-base status at birth than does the 3-tier. Here we propose a management algorithm to identify specific features of the FHR tracing that correlate with risk.

Simpson Kathleen Rice PhD RNC FAAN. If FHR accelerations or moderate variability are detected the. AmJ Obstet Gynecol2013209289-97Reprinted with permissionGraphic reprinted with permission.

Predictive of abnormal fetal-acid base status at the time of observation. Three-Tiered Fetal Heart Rate Interpretation System Category I Category I tracings include all of the following. Up to 80 of women will have a category II FHR tracing at some point during labor.

Moderate Late or variable decelerations. We estimated whether the presence of meconium increased the risk of adverse neonatal outcomes. Algorithm for Management of category II fetal heart rate tracings Clark SL Nageotte MP Garite TJ et al.

Recurrent late decelerations Recurrent late decelerations are caused by a reflex central nervous system response to fetal hypoxia and acidemia as well as direct myocardial depression and humoral factors 19. Ross M Labor and fetal heart rate decelerations. Here we propose a management algorithm to identify specific features of the FHR tracing that correlate with risk for fetal acidemia target interventions to address FHR decelerations and guide clinicians about when to.

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