Fetal heart rate monitoring: Interpretation and collaborative management

Effective intrapartum fetal heart rate (FHR) monitoring requires ongoing co llaboration among health care providers. Nurses, midwives, and physicians m ust have a shared understanding of 1)how FHR tracings are interpreted, 2) w hich FHR patterns are associated with actual or impending fetal acidemia, 3 ) when and within what time frame the physician or the midwife should be no tified of variant FHR patterns, 4) how quickly physicians and midwives shou ld respond when notified of variant patterns, and 5) the indications for an d optimal timing of interventions such as operative delivery. This article reviews the literature on FHR monitoring and includes a discussion of the a dvantages and limitations of different monitoring modalities. An overview o f those FHR patterns are associated with presumed fetal acidemia is present ed, as well as sample multidisciplinary FHR monitoring guidelines and an ex ercise in intrapartum FHR pattern evaluation that can be used to initiate d evelopment of local FHR monitoring patterns. (C) 2000 by the American Colle ge of Nurse-Midwives.