Electronic fetal heart rate monitoring is commonly used to assess fetal wel
l-being during labor. Although detection of fetal compromise is one benefit
of fetal monitoring, there are also risks, including false-positive tests
that may result in unnecessary surgical intervention. Since variable and in
consistent interpretation of fetal heart rate tracings may affect managemen
t, a systematic approach to interpreting the patterns is important. The fet
al heart rate undergoes constant and minute adjustments in response to the
fetal environment and stimuli. Fetal heart rate patterns are classified as
reassuring, nonreassuring or ominous. Nonreassuring patterns such as fetal
tachycardia, bradycardia and late decelerations with good short-term variab
ility require intervention to rule out fetal acidosis. Ominous patterns req
uire emergency intrauterine fetal resuscitation and immediate delivery. Dif
ferentiating between a reassuring and nonreassuring fetal heart rate patter
n is the essence of accurate interpretation, which is essential to guide ap
propriate triage decisions.