Intrapartum fetal heart rate monitoring

In 2002, approximately 3.4 million fetuses (85% of approximately 4 million live births) in the United States were assessed with electronic fetal monitoring (EFM), making it the most common obstetric procedure (1). Despite its widespread use, there is controversy about the efficacy of EFM, interpretation of fetal heart rate (FHR) patterns, reproducibility of its interpretation, and management algorithms for abnormal or nonreassuring patterns. Moreover, there is evidence that the use of EFM increases the rate of cesarean and operative vaginal deliveries. The purpose of this document is to review nomenclature for FHR assessment, review the data on the efficacy of EFM, delineate the strengths and shortcomings of EFM, and describe the management of nonreassuring FHR patterns.