We would like to thank Dr Sholapurkar for his comments regarding our recent editorial. Dr Sholapurkar makes 4 points.

First, Dr Sholapurkar agrees that studies on longitudinal fetal heart rate (FHR) are desirable, and he believes that such studies should be retrospective in nature but they may be problematic if the study methodology is imprecise and subjective. We agree. In our editorial, we emphasized that such studies can be difficult to perform for a number of reasons including difficulty in choosing the appropriate outcome or outcomes. To that end, we suggested that cord blood gases at birth may be a reasonable gold standard, as outcome, and that the predictor should be the longitudinal FHR changes as depicted in the figure of our editorial. We believe that the longitudinal FHR changes that we described in our editorial, if used correctly, can remove much of the imprecision and subjectivity in the methodology of such future studies. We also would not disregard the benefits of a prospective study that is designed to rigorously capture information on longitudinal FHR tracing interpretation, clinical context, and clinical decision making, which are difficult to assess with an analysis of retrospective data.

The second issue raised by Dr Sholapurkar is that the distinction between absent and minimal (reduced) FHR variability may be difficult and clinically unimportant. We agree and we made this very clear in our editorial. We also agree that a fetal stimulation test may be helpful in decreasing false-positive results, but we doubt the value of fetal scalp blood sampling because this has its own drawbacks and lack of evidence in improving outcome.

The third point has to do with the clinical significance of postdeceleration overshoots and that FHR decelerations during the second stage are common and do not warrant intervention. We agree with the inconclusive evidence about postdeceleration overshoots. However, we need to make an important distinction here between the postdeceleration overshoots and what we emphasized in our editorial, which was “the rise of FHR baseline with frequent episodes of tachycardia or continuous tachycardia” in response to decelerations. We agree that decelerations during the second stage of labor may not always warrant intervention, but we should also keep in mind that repetitive prolonged decelerations during the last 30 minutes prior to birth have the highest predictive ability for fetal acidemia.

The fourth point is that most babies born with a pH <7.0 have normal FHR variability and that a less strict definition of gradual and abrupt for early and variable decelerations, respectively, may serve us better. It is true that some of the gradual or abrupt definitions may not encompass all early or variable decelerations, but such definitions correctly identify the majority of decelerations and at the same time provide the framework for creating standard nomenclature and management.