Fetal Heart Monitoring During Labor

Choosing the Monitoring Method

The American Academy of Family Physicians recommends that for low-risk pregnancies, structured intermittent auscultation is equivalent to continuous electronic fetal monitoring (EFM) in detecting fetal compromise, while continuous EFM increases cesarean sections and instrumental deliveries without improving most neonatal outcomes except for reducing neonatal seizures 1, 2
The American Academy of Family Physicians suggests that structured intermittent auscultation is appropriate for low-risk patients and requires a 1:1 nurse-to-patient ratio with established institutional protocols 3
The frequency of auscultation should be every 15-30 minutes during the active phase of first stage of labor and every 5 minutes during second stage of labor with pushing 2, 4

The American Academy of Family Physicians recommends using the systematic DR C BRAVADO mnemonic for interpretation of continuous EFM, which includes determining risk, assessing contractions, baseline rate, variability, accelerations, decelerations, and overall assessment 2, 3
The American Academy of Family Physicians defines normal contractions as ≤5 contractions per 10-minute period, averaged over 30 minutes, and more than 5 contractions per 10 minutes is classified as tachysystole 2, 6

The American Academy of Family Physicians categorizes fetal heart rate tracings into three categories: Category I (normal), Category II (indeterminate), and Category III (abnormal) 5
Category I tracings are characterized by moderate baseline FHR variability, no late or variable decelerations, and indicate normal pH and fetal well-being 5
Category II tracings require clinical judgment and may indicate medications, sleep cycle, monitoring technique issues, or possible fetal hypoxia 5
Category III tracings are characterized by absent baseline FHR variability with recurrent decelerations and/or bradycardia, and indicate uteroplacental insufficiency, fetal hypoxia or acidemia 5

The American Academy of Family Physicians recommends that fetal electrocardiography analysis added to EFM reduces operative vaginal deliveries and fetal scalp sampling 1
The American Academy of Family Physicians does not recommend fetal pulse oximetry as it has not shown reduction in cesarean delivery rates 1

The American Academy of Family Physicians recommends continuous fetal heart rate monitoring throughout labor when using neuraxial analgesia or intrathecal catheters due to increased risk of fetal bradycardia with intrathecal opioids 4, 7