Accurate FHR assessment may help in determining the status of the fetus and indicate management steps for a particular condition.  In order to accurately assess a FHR pattern, a description of the pattern should include qualitative and quantitative information in the following five areas:

1. Baseline rate
2. Baseline FHR variability
3. Presence of Accelerations
4. Periodic or episodic decelerations
5. Changes or trends of FHR patterns over time

These areas include fetal heart rate patterns with specific definitions and descriptions.  These definitions and descriptions are the terminology used by the National Institute of Child Health and Human Development and have been adopted by the American College of Obstetrics and Gynecology (ACOG) and the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN).

Fetal tracing are classified into the following patterns:

1. Baseline 
2. Baseline Variability 
3. Acceleration 
4. Bradycardia 
5. Early Deceleration 
6. Late Deceleration 
7. Tachycardia 
8. Variable Deceleration 
9. Prolonged Deceleration 

To appriopriately interpret a fetal monitoring tracing, the systematic approach below should be followed:

1. Evaluate the recording: is it continuous and adequate for interpretation?
2. Identify the type of monitor used - external versus internal: second generation versus first generation.
3. Identify the baseline fetal heart rate and presence of variability.
4. Determine the presence of accelerations or decelerations from baseline.
5. Identify changes or trends  in FHR patterns over time 

In addition to monitoring fetal heart rate patterns, information about the effects of labor on the fetus can also be learned by observing the pattern of uterine contractions.  Uterine contraction patterns can provide information about the progress of labor.  Also, because uterine contractions can affect placental exchange, evaluation of contraction patterns may provide clues as to the potential effects of the contraction rate and force on the fetus.

For information on uterine contraction patterns please click on the link below:

Uterine Contractions

Demonstrated below is a picture from a typical EFM display and a sample EFM strip. Click on the image to enlarge.

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