(1)
Department of Family Medicine, University of California, Riverside, Riverside, CA, USA
Key Points
1.
The common use of continuous fetal heart rate monitoring requires that providers be aware of the interpretation of variations in fetal heart tracings.
2.
Normal fetal heart rate is 120–160 beats per minute (bpm) with evidence of short-and long-term variability.
3.
Fetal heart rate acceleration must be distinguished from fetal tachycardia and is generally considered a favorable finding.
4.
Abnormalities of fetal heart tracings may be related to either rate or deceleration.
Background
The advent of electronic fetal heart rate monitoring has dramatically changed intrapartum management within the United States. The almost universal presence of such monitoring during the course of most deliveries presents providers with a variety of challenges. Controversy exists concerning the clinical benefit of continuous electronic fetal monitoring. Such controversy, however, does not eliminate the need for obstetrical providers to be familiar with the basics of electronic fetal monitoring, normal and abnormal findings, and appropriate management for abnormal tracings.
Normal Fetal Heart Tracings
Routine fetal heart tracing should be evaluated for baseline heart rate as well as variation from that baseline rate. Normal baseline fetal heart rate during pregnancy is between 120 and 160 bpm. The baseline heart rate may be determined by examining a fetal heart tracing of sufficient length to determine the heart rate to which the tracing consistently returns. It may be helpful to use a ruler or other straight edge along the course of a fetal heart rate tracing to help determine the baseline value. Fetal heart rate tracing should demonstrate a degree of variability over the course of time. A fetal heart rate tracing with little evidence of variability requires careful monitoring and evaluation if persistent.
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