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The 2008 National Institute of Child Health and Human Development Report on Fetal Heart Rate Monitoring

Parer, Julian T. MD, PhD1; Ikeda, Tomoaki MD, PhD2; King, Tekoa L. CNM, MPH1

doi: 10.1097/AOG.0b013e3181ab475f
Current Commentary

Standardization of fetal heart rate (FHR) interpretation and management guidelines has been elusive, and no system is currently widely accepted in the United States. The recently summarized 2008 Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop proposed a three-tier system of interpretation of FHR patterns, but left management recommendations to the professional associations. The middle tier, called indeterminate Category II, which contains the variant FHR patterns seen most frequently, is vast and heterogeneous. We propose that this category can be subcategorized at least tentatively, based on evidence available from previously published studies. Such subcategorization will allow the organizations proposing management recommendations to more readily set up guidelines for graded interventions and clinical responses to the spectrum of FHR patterns, with the aim of minimizing fetal acidemia without excessive obstetric intervention. Such management algorithms will need to be tested by appropriately designed clinical studies.

Subcategorizing the “indeterminate” category of fetal heart rate pattern into at least three groups based on current evidence will allow management proposals to be more readily studied.

From the 1Division of Maternal–Fetal Medicine, University of California San Francisco, San Francisco, California; and 2Department of Perinatology, National Cardiovascular Center, Osaka, Japan.

Corresponding author: J. T. Parer, MD, PhD, Division of Maternal–Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 505 Parnassus Avenue, Room M-1489, Box 0132, San Francisco, CA 94143-0132; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists.