Fetal heart rate pattern notification guidelines and suggested management algorithm for intrapartum electronic fetal heart rate monitoring.

CONTEXT Numerous randomized controlled trials have demonstrated limited efficacy of intrapartum fetal heart rate monitoring in improving fetal outcome. A potential reason is the wide variability in clinical decision making seen with its use. Standardizing management of variant intrapartum fetal heart rate tracings may reduce this variability and lead to improvement in fetal outcome. OBJECTIVE We sought to develop notification guidelines and a management algorithm for variant intrapartum fetal heart rate tracings that improve fetal outcome and do not increase the operative delivery rate. DESIGN Outcomes for cases involving the use of our notification guidelines and management algorithm over six months (1181 deliveries) were compared with outcomes for historical control subjects (2247 deliveries). MAIN OUTCOME MEASURES The main outcome measures were Apgar scores <7 and the operative delivery rate. RESULTS We found no change in fetal outcome or operative delivery rate. CONCLUSION Our notification guidelines and management algorithm are safe and do not increase the operative delivery rate. A large multicenter trial is needed to demonstrate improvement in fetal outcome.