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The first central concept of standardized intrapartum FHR interpretation is that all clinically significant FHR decelerations (variable, late, or prolonged) reflect interruption of the pathway of oxygen transfer from the environment to the fetus at 1 or more points .

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The second central concept of standardized intrapartum FHR interpretation is that intrapartum interruption of fetal oxygenation does not result in CP unless the fetal response progresses to the stage of significant fetal metabolic acidemia (umbilical artery pH <7.0 and base deficit 12 mmol/L).
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The third central concept of intrapartum FHR interpretation is that moderate (normal) variability and / or accelerations reliably predict the absence of fetal metabolic acidemia at the time they are observed.

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Category I: NORMAL
FHR tracings include ALL of the following: Baseline rate: 110160 beats per minute (bpm) Baseline FHR variability: moderate Late or variable decelerations: absent Early decelerations: present or absent Accelerations: present or absent Strongly predictive of normal acid-base status at time

of observation. Routine care; no specific action required


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Category III: ABNORMAL


FHR tracings include EITHER of the ff: Absent baseline FHR variability and any of the ff:

Recurrent late decelerations Recurrent variable decelerations Bradycardia

Sinusoidal pattern

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Category II: INDETERMINATE


includes all FHR tracings NOT categorized as

Category I or III. NOT predictive of either normal or abnormal fetal acid-base status. requires continued surveillance and re-evaluationsecond recommendation is incomplete

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Grades of fluctuation are based on amplitude range

(peak minus trough):

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Classifications of Variability
Absent: amplitude range undetectable. Minimal: amplitude range 5 bpm.

Moderate: amplitude range 6-25 bpm.


Marked: amplitude range >25 bpm.

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BASELINE FHR PATTERNS

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110 BPM

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160 BPM

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From the onset of the deceleration to the beginning of the FHR nadir of <30 seconds.

The decrease in FHR is 15 beats per minute, lasting 15 seconds, and <2 minutes in duration

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Variable Decelerations
Severe 60 seconds in duration & < 70 beats/min OR 2 mins in duration & < 80 beats/min Moderate 30-60 sec in duration & < 70 beats/min OR 60 sec in duration & < 80 beats/min Mild All other decelerations are mild

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Variable Decelerations - Notice that the decelerations are not related to the contraction, 2/17/2014 well before the mcu pgc '10 22 beginning contraction even begins.

from the onset to the nadir of the deceleration of 30 seconds.

The nadir of the deceleration occurring after the peak of the contraction. In most cases, the onset, nadir, and recovery of the deceleration occur after the beginning, peak, and ending of the contraction, respectively.
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Late Deceleration with Absent Variability Notice the decrease in the fetal heart rate only begins to decline after the contraction 2/17/2014 mcu pgc '10 26 peaks.

from the onset to the FHR nadir of 30 seconds.

The nadir of the deceleration occurs at the same time as the peak of the contraction.

n most cases the onset, nadir, and recovery of the deceleration are coincident with the beginning, peak, and ending of the contraction, respectively.
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Pseudo-sinusoidal Pattern
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Thank you!