Cesarean delivery for nonreassuring fetal heart rate tracing

An understanding of cesarean delivery (CD) for nonreassuring fetal heart rate tracing (FHR) is important for several reasons. The rate of emergent CD is increasing [1] as new technology [2] is being introduced to decrease its occurrence. Although there are guidelines for interpretation of electronic FHR monitoring [3], there is no suggestion that the intraobserver and interobserver variability has decreased [4]. Although risk factors for CD for fetal distress are being understood [1], there is no evidence that the ability to identify these parturients has improved compliance with intrauterine resuscitation before undertaking the operation [5]. Lastly, despite the increasing reliance on electronic FHR to assess fetal well-being during labor, there is no evidence that the rate of pathologic acidosis, defined as umbilical arterial pH less than 7 [6], has been diminished among those who underwent emergent CD. This article describes the prevalence of CD for nonreassuring FHR and the risk factors, indicates what type of FHR abnormalities prompts CD, reiterates the intrauterine resuscitation the American College of Obstetricians and Gynecologists (ACOG) recommends before making the incision, attempts to explain why clinicians often do not comply with ACOG guidelines, and suggests steps clinicians should undertake to minimize legal liability.