![Page 1: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/1.jpg)
Fetal Heart Rate Monitoring
Paul G. Tomich, M.D.
Department of Obstetrics and Gynecology
University of Nebraska College of Medicine
![Page 2: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/2.jpg)
Learning Objectives
EvolutionExamplesDescriptions
– Reassuring patterns– Concerning patterns
Definitions of Category I, II, and III tracings– Discuss action needed
Non-stress Test (NST)Biophysical Profile (BPP)
![Page 3: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/3.jpg)
“Evolution” of FHR Monitoring
Monitoring fetus in laborFHR 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
![Page 4: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/4.jpg)
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
![Page 5: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/5.jpg)
Uterine contractionsFetal heart rate (FHR)
Ways to Monitor
![Page 6: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/6.jpg)
Uterine contractionsFetal heart rate (FHR)
Ways to Monitor
![Page 7: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/7.jpg)
Features to DescribeFetal heart rate (FHR)
– Top line on monitor stripUterine contractions
– Bottom line on
monitor strip
![Page 8: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/8.jpg)
Features to DescribeBaselineVariabilityAccelerationsDecelerationsTrends over timeInterpret into 1 of 3 categories
![Page 9: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/9.jpg)
Baseline
Mean fetal heart rate– Rounded to increments of 5– During a 10 minute period– Excluding accelerations and decelerations
Normal baseline– 100-160 BPM
![Page 10: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/10.jpg)
Baseline is RED LINE
![Page 11: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/11.jpg)
Bradycardia<100 BPM
Tachycardia>160 BPM
Indeterminate– less than 2 minutes of baseline is present
Baseline
![Page 12: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/12.jpg)
![Page 13: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/13.jpg)
Fetal Tachycardia
Normal variant– prematurity
Intra-amniotic infectionFetal anemiaFetal cardiac arrhythmia (SVT)Fetal hypoxia
![Page 14: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/14.jpg)
Features to DescribeBaselineVariabilityAccelerationsDecelerationsTrends over timeInterpret into 1 of 3 categories
![Page 15: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/15.jpg)
Variability
Fluctuations in FHR– Over 10 minutes
Descriptors are:– Absent: undetectable amplitude range– Minimal: undetectable up to 5 BPM– Moderate: amplitude range 6 to 25 BPM– Marked: amplitude range greater than 25 BPM
![Page 16: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/16.jpg)
![Page 17: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/17.jpg)
Variability
![Page 18: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/18.jpg)
![Page 19: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/19.jpg)
![Page 20: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/20.jpg)
Features to DescribeBaselineVariabilityAccelerationsDecelerationsTrends over timeInterpret into 1 of 3 categories
![Page 21: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/21.jpg)
Accelerations
Abrupt increase in FHR– 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
![Page 22: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/22.jpg)
>15 beats above baseline15 seconds to 2 minutes in length
![Page 23: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/23.jpg)
![Page 24: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/24.jpg)
![Page 25: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/25.jpg)
Features to DescribeBaselineVariabilityAccelerationsDecelerationsTrends over timeInterpret into 1 of 3 categories
![Page 26: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/26.jpg)
Decelerations
Decrease in baseline3 Types
– Early– Variable– Late
![Page 27: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/27.jpg)
Deceleration
Decrease in FHR
![Page 28: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/28.jpg)
Early Deceleration
Symmetrical to contraction
Mirror image of contraction
Gradual decrease in FHR– 30 secs or more from
onset to nadir
![Page 29: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/29.jpg)
EARLY DECELERATION
Gradual FHR decrease Onset to nadir 30 seconds or more Nadir of deceleration occurs with peak of
contraction Mirror contraction
![Page 30: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/30.jpg)
Late Decelerations
Deceleration is delayed in timing – Occurs after the contraction
A gradual FHR decrease– Onset to nadir > 30 second
![Page 31: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/31.jpg)
Late Decelerations
![Page 32: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/32.jpg)
Variable Decelerations
Abrupt decrease in fetal heart rate– Onset to nadir less than
30 secondsDecrease in FHR
– 15 BPM or more– Lasting 15 seconds to 2
mins
![Page 33: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/33.jpg)
Variable Declerations
Pathophysiology– umbilical cord
compression
![Page 34: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/34.jpg)
![Page 35: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/35.jpg)
![Page 36: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/36.jpg)
![Page 37: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/37.jpg)
DecelerationsProlonged deceleration
– Decrease of 15 BPM– Lasts 2-10 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
![Page 38: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/38.jpg)
![Page 39: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/39.jpg)
![Page 40: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/40.jpg)
![Page 41: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/41.jpg)
![Page 42: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/42.jpg)
![Page 43: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/43.jpg)
Sinusoidal Pattern
Smooth sin-wave patternCycle frequency 3-5 minsPersists for 20 minutes or
longer
![Page 44: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/44.jpg)
Sinusoidal Pattern
![Page 45: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/45.jpg)
Uterine Contractions
Number of contractions in 10 minutes– averaged over thirty minutes
Document– Frequency– Intensity– Duration– Relaxation
time between contractions
![Page 46: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/46.jpg)
Monitoring of Contractions
![Page 47: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/47.jpg)
![Page 48: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/48.jpg)
Tachysystole
>5 contractions in 10 mins– Averaged over 30 mins
![Page 49: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/49.jpg)
Categorization of FHR Patterns
An evaluation of the fetus at a particular point in time
Categories I, II, and III
![Page 50: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/50.jpg)
3 Categories
![Page 51: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/51.jpg)
Category I
Normal baseline– 110-160 BPM
FHR Variability – moderate
Late or Variable decelerations– none
![Page 52: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/52.jpg)
Category II
Not enough evidence to place into either Category I or III
![Page 53: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/53.jpg)
Category III
Abnormal tracingPredictive of abnormal fetal acid-base statusRequires prompt intervention
![Page 54: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/54.jpg)
The ABCD’s of Fetal Monitoring
![Page 55: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/55.jpg)
Examples of Tracings
![Page 56: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/56.jpg)
![Page 57: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/57.jpg)
![Page 58: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/58.jpg)
![Page 59: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/59.jpg)
![Page 60: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/60.jpg)
![Page 61: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/61.jpg)
![Page 62: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/62.jpg)
![Page 63: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/63.jpg)
Non-Stress Test
•Reactive•2 or more accelerations in 20 mins•Acceleration
•At least 15 beats above baseline•Lasting for at least 15 seconds
•Non-reactive
![Page 64: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/64.jpg)
![Page 65: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/65.jpg)
Reactive NST
![Page 66: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/66.jpg)
NST + ultrasound markersScore linearly correlated with fetal pHRisk of fetal death within one week of normal
BPP is 1:1300
Biophysical Profile (BPP)
![Page 67: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/67.jpg)
Biophysical Profile
•Zero or 2 points for each•Fetal heart beat monitor•Fetal breathing•Fetal movements•Amniotic Fluid Volume•Flexion/Extension
•Fetal Monitoring 4 accelerations in 40 minutes•Fetal Breathing 30 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
![Page 68: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/68.jpg)
Modified Biophysical Profile
•Combination of NST and AFI only•If less than 4/4
•more evaluation is done
![Page 69: Fetal Heart Rate Monitoring Paul G. Tomich, M.D. Department of Obstetrics and Gynecology University of Nebraska College of Medicine](https://reader033.vdocument.in/reader033/viewer/2022052304/56649cb45503460f94977f6b/html5/thumbnails/69.jpg)
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