Category II Management Algorithm

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Disclaimer
My patient is in category II
When Category II patterns exist, the FHR algorithm should be applied every 30 minutes.

Adapted from

Intrapartum management of category II fetal heart rate tracings: towards standardization of care.

Clark SL, Nageotte MP, Garite TJ, Freeman RK, Miller DA, Simpson KR, Belfort MA, Dildy GA, Parer JT, Berkowitz RL, D'Alton M, Rouse DJ, Gilstrap LC, Vintzileos AM, van Dorsten JP, Boehm FH, Miller LA, Hankins GD. Am J Obstet Gynecol. 2013 Aug;209(2):89-97.

ncbi.nlm.nih.gov/pubmed/23628263

Labor Status

Phase:

Yes
Latent
Active

Active Phase

Stage:

Yes
First
Second

Normal progress?

Yes
Yes
No

Tracing Status

Moderate variability or accelerations?

Yes
Yes
No

Recurrent significant decelerations?

Yes
No or <30 min
Yes, 30-59 min
Yes ≥60 min

Has the lack of moderate variability or accelerations persisted for more than 1hr?

Yes
No
Yes

Outcome

 

Algorithm may be overridden at any time if, after evaluation of patient, physician believes it is in the best interest of the fetus to intervene sooner.

Show me the algorithm pathway

 

 

© 2014, PeriGen, Inc.

Variability:

Variability refers to predominant baseline FHR pattern (marked, moderate, minimal, absent) during a 30-minute evaluation period, as defined by NICHD.

Recurrent:

Decelerations with more than 50% contractions.

Significant decelerations:

Persisted:

Refers to low variability and lasting greater than 1 hour

Disclaimer

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