NYMC Faculty Publications
Fetal Heart Rate Tracing Category II: A Broad Category in Need of Stratification
Author Type(s)
Faculty
DOI
10.1542/neo.22-2-e88
Journal Title
NeoReviews
First Page
88
Last Page
94
Document Type
Article
Publication Date
2-2021
Department
Obstetrics and Gynecology
Keywords
Cardiotocography, Cesarean Section, Female, Fetus, Heart Rate, Fetal, Humans, Infant, Newborn, Labor, Obstetric, Pregnancy
Disciplines
Medicine and Health Sciences
Abstract
Fetal heart rate (FHR) tracings are classified into 3 categories per the National Institute of Child Health and Human Development guidelines. There exists broad consensus on the recognition and management of categories I and III. However, a category II FHR tracing is considered "indeterminate" and cannot be classified as either reassuring or non-reassuring. Absence of variability and high frequency and increased depth of decelerations are the key determining factors that make a category II tracing non-reassuring and are associated with fetal metabolic acidosis. Periodic category II tracing is present in the majority of normal laboring patients. In the setting of a category II tracing, an initial attempt should be made for in utero resuscitation of the fetus. If the tracing fails to improve over a period of 1 to 2 hours, or the fetal tracing gradually deteriorates, a decision should be made for operative vaginal or cesarean delivery. Category II tracing management algorithms can aid in decision-making in this uncertain clinical scenario. Team training and simulation may improve team performance and have a positive impact on neonatal outcomes.
Recommended Citation
Shilkrut, A. G., Hsu, R. C., & Fuks, A. M. (2021). Fetal Heart Rate Tracing Category II: A Broad Category in Need of Stratification. NeoReviews, 22 (2), 88-94. https://doi.org/10.1542/neo.22-2-e88
