Intrapartum electronic fetal monitoring (EFM) is used for most women who give birth in the United States. As such,clinicians are faced daily with the management of fetal heart rate (FHR) tracings. The purpose of this document is toprovide obstetric care providers with a framework for evaluation and management of intrapartum EFM patterns basedon the new three-tiered categorization.
Background
    In 2008, a workshop sponsored by the American Collegeof Obstetricians and Gynecologists, the Eunice KennedyShriver   National  Institute  of  Child  Health  and  HumanDevelopment,  and  the  Society  for  Maternal–Fetal  Med-icine  focused  on  updating  EFM  nomenclature,  recom -mending  an  interpretative  system,  and  setting  researchpriorities.  Nomenclature  for  baseline  FHR  and  FHRvariability,  accelerations,  and  decelerations  were  reaf-firmed  (Table  1).  New  terminology  was  recommendedfor  the  desc**tion  and  quantification  of  uterine  contrac-tions.  Normal uterine activity was defined as five or fewercontractions  in 10  minutes,  averaged  over  a  30-minutewindow.  Tachysystole  was  defined  as  more  than  fivecontractions in 10 minutes, averaged over 30 minutes andshould be categorized by the presence or absence of FHRdecelerations. Tachysystole can be applied to spontaneousor induced labor. The terms hyperstimulation and hyper-contractility were abandoned.
A three-tiered system for intrapartum EFM interpre-tation also was recommended (Box 1), with the nomen-clature  and  interpretation  described  elsewhere.  Thissecond  Practice  Bulletin  on  intrapartum  FHR  tracingsreviews the management of heart rate patterns based onthe three-tiered classification system (Figure 1).
完整版下载2010ACOG临床指南：产时胎儿心律监护的管理