Use of three-tier classification system during intrapartum electronic fetal heart rate monitoring

Abstract

Abstract Evaluation of the fetal heart rate (FHR) for obtaining essential information is required for fetal risk assessment during labor and birth and it is helpful for the detection of potential harmful effects on fetal systems and for allowing timely and effective interventions to prevent perinatal/neonatal morbidity or mortality. Electronic FHR monitoring (EFM) is the most widely used method of intrapartum surveillance of fetal well-being. The most apparent problem with the use of EFM in maternity wards is the wide variability with which obstetricians interpret and respond to its findings in labor ward settings. There are many FHR patterns that lie between the completely reassuring patterns and those considered ominous. ACOG's Practice Bulletin 116 recommends the use of the three-tier classification system for FHR tracings. Category 1 FHR tracings are considered normal and no specific action is required. Category 2 tracings are considered indeterminate. This category requires evaluation and surveillance and possibly other tests to ensure fetal well-being. Category 3 tracings are considered abnormal and require prompt evaluation. Key words: Electronic fetal monitoring, fetal heart rate, intrapartum Ozet Dogum eylemi ve dogum sirasinda fetal risk durumu hakkinda degerli bilgiler elde etmek icin fetal kalp hizinin (FKH) degerlendirmesi gerekir ve bu degerlendirme fetal sistemler uzerine olasi zararli etkilerin saptanmasina ve perinatal/neotanatal morbidite ve mortalitenin onlenmesi icin zamaninda ve etkin onlemlerin alinmasinda yardimci olur. Elektronik fetal kalp hizi monitorizasyonu (EFM), intrapartum fetal iyilik halinin izlenmesinde en sik kullanilan yontemdir. Dogumhanelerde EFM kullanimi ile iliskili en belirgin sorun, dogum hekimlerinin dogumhane kosullarinda EFM bulgularini degerlendirmesinin ve bunlara karsi yaptiklari girisimlerin cok farkli olabilmesidir. Cok sayida FKH paterni tamamen saglikli olanlarla tehlikeli olanlarin arasinda bulunur. ACOG Pratik Bulteni 116 FKH traseleri icin uc asamali siniflama sistemini onermektedir. Kategori 1 FKH traseleri normal kabul edilir ve ozellikli bir onlem gerekmez. Kategori 2 traseleri arada kabul edilir. Bu kategori degerlendirme ve izleme gerektirir ve fetal iyilik halini gosteren diger testlere ihtiyac olabilir. Kategori 3 traseleri anormal kabul edilir ve hemen degerlendirme gerektirir. Anahtar sozcukler: Elektronik fetal monitorizasyon, fetal kalp hizi, intrapartum