2. A heart rate that is faster or slower than this may indicate that there is an issue that needs further attention. Pregnancy outcomes in patients with autoimmune diseases and anti-Ro/SSA antibodies. Cardiac manifestations of neonatal lupus: A review of autoantibody associated congenital heart block and its impact in an adult population. A fetal arrhythmia may be diagnosed when a developing babys heart rate falls outside the normal range of 120 to 180 beats per minute (BPM). They resemble the letter U, V or W and may not bear a constant relationship to uterine contractions. Atrial tachycardia (AT) occurs when the hearts upper chambers, the atria, beat too quickly. Fetal arrhythmias are detected in around 2 percent of pregnancies. where do you file a complaint against a hospital; failure to pay full time and attention va code; bones angela and hodgins in jail; mirabella svadobny salon dubnica nad vahom 10. Sometimes treatment is needed during the first year or so of life, and for a small number of patients, beyond their first year. One benefit of EFM is to detect early fetal distress resulting from fetal hypoxia and metabolic acidosis. Reassuring patterns correlate well with a good fetal outcome, while nonreassuring patterns do not. Of these arrhythmias, 10% are considered potential sources of morbidity. The Centers for Disease Control and Prevention (CDC) report that around 1 percent of babies (40,000) are born with congenital heart defects each year in the United States. Non-conducted PACs result in bradycardia. Another 0.5% will develop supraventricular tachycardia. Fetal Arrhythmia/Dysrhythmia. Cardiol, A., (2018). The most important risk of EFM is its tendency to produce false-positive results. If the fetus does not appear to suffer, an abnormal fetal rhythm is most often closely monitored before birth. Furthermore, poor signal quality and suboptimal fetal position are often encountered, which limits the application of M-mode. Magnetocardiography records the magnetic field produced by the electrical activity of the fetal heart and uses signal averaging to generate waveforms that are very similar to those obtained by ECG. The baseline rate is interpreted as changed if the alteration persists for more than 15 minutes. coconut milk smells like sulfur what happened to tom from choccywoccydoodah midland women's soccer roster Nonreassuring variable decelerations associated with the loss of beat-to-beat variability correlate substantially with fetal acidosis4 and therefore represent an ominous pattern. Identify type of monitor usedexternal versus internal, first-generation versus second-generation. Management Options for Irregular Cardiac Rhythm. Note the green coloration of the right ventricle (RV) in fetus B (arrows), indicating right ventricular dysfunction. Our Commitment to Diversity, Equity and Inclusion (DEI), Congenital (present at birth) heart defects. Steroids can sometimes be used to slow the progression to complete heart block when antibodies are the cause, but the results are not conclusive. Fetal arrhythmia is an abnormal fetal heartbeat or rhythm. The M-mode cursor line intersects the right atrium (RA) and left ventricle (LV). You can learn more about how we ensure our content is accurate and current by reading our. Evaluation of fetal well-being using fetal scalp stimulation, pH measurement, or both, is recommended for use in patients with nonreassuring patterns.11,12 Evaluation for immediate delivery is recommended for patients with ominous patterns. Atrial contractions (A) are identified by the start of the A-wave in the mitral valve and ventricular contractions (V) by the aortic outflow. This pattern is sometimes called a saltatory pattern and is usually caused by acute hypoxia or mechanical compression of the umbilical cord. Limitations of this technology include its lack of availability in many centers and the need for a magnetically shielded room (10, 11). We avoid using tertiary references. 33.12) occur in fetuses with congenital cardiac malformations, especially left atrial isomerism (heterotaxy) (see Chapter 30) or congenitally corrected transposition of the great arteries (see Chapter 28). They are usually associated with fetal movement, vaginal examinations, uterine contractions, umbilical vein compression, fetal scalp stimulation or even external acoustic stimulation.15 The presence of accelerations is considered a reassuring sign of fetal well-being. Fetal arrhythmia is caused by abnormalities or interruptions in the hearts electrical system. To find out more about fetal arrhythmia and heart conditions that affect children, including finding support groups, a person can ask a primary physician or cardiologist for recommendations. Fetal arrhythmias may not always be caused by a structural heart defect, though. Chemoreceptors located in the aortic and carotid bodies respond to hypoxia, excess carbon dioxide and acidosis, producing tachycardia and hypertension.15 The FHR is under constant and minute adjustment in response to the constant changes in the fetal environment and external stimuli. In animal studies, administration of amiodarone to rabbits, rats, and mice during organogenesis resulted in embryo-fetal toxicity at doses less than the maximum recommended human maintenance . We also follow baby closely as well, to make sure their heart rhythm is slowed to a safe rate. The average fetal heart rate is between 110 and 160 beats per minute, and can vary five to 25 beats per minute. Strasburger JF, et al. The normal heart rate for a fetus is anywhere between 120 and 160 beats per minute. 3333 Burnet Avenue, Cincinnati, Ohio 45229-3026 | 1-513-636-4200 | 1-800-344-2462. That said, 2 to 3 percent of cases may lead to supraventricular tachycardia (SVT). The transducer uses Doppler ultrasound to detect fetal heart motion and is connected to an FHR monitor. Figure 33.3: Pulsed Doppler of left ventricular (LV) inflow (mitral valve) and outflow (aortic valve) in a fetus with normal sinus rhythm. Beta-adrenergic agonists used to inhibit labor, such as ritodrine (Yutopar) and terbutaline (Bricanyl), may cause a decrease in variability only if given at dosage levels sufficient to raise the fetal heart rate above 160 bpm.19 Uncomplicated loss of variability usually signifies no risk or a minimally increased risk of acidosis19,20 or low Apgar scores.21 Decreased FHR variability in combination with late or variable deceleration patterns indicates an increased risk of fetal preacidosis (pH 7.20 to 7.25) or acidosis (pH less than 7.20)19,20,22 and signifies that the infant will be depressed at birth.21 The combination of late or severe variable decelerations with loss of variability is particularly ominous.19 The occurrence of a late or worsening variable deceleration pattern in the presence of normal variability generally means that the fetal stress is either of a mild degree or of recent origin19; however, this pattern is considered nonreassuring. 33.6) (35). With a complete heart block, for example, doctors may treat it by giving you steroids or medications like hydroxychloroquine. Differentiating this type of bradycardia from AV heart block is critical given a divergent prognosis. Atrial (A) and ventricular (V) contractions are in triplets (double-sided arrows) with a longer pause between the triplet sequence. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. PACs are due to atrial ectopic beats (atrial ectopy), which occur most commonly in the late second trimester of pregnancy through term and are usually benign. Fetal arrhythmia is a term that refers to any abnormality in the heart rate of your baby. Bravo-Valenzuela NJ, et al. Stephenson, E. (2010, March 19). Fetal tachycardia, the most common of the rhythm defects, occurs in approximately one in 200 pregnancies. Most babies, however, can wait until they are a little older and stronger. Irregular fetal cardiac rhythm is the leading cause for referrals to fetal echocardiography centers for rhythm disturbances, and the vast majority of those are benign atrial ectopic beats. Heart block can also be associated with some congenital heart diseases including congenitally-corrected transposition of the great arteries and heterotaxy (abnormal arrangement of organs in the chest and abdomen). Ventricular tachycardia (VT) occurs when the hearts lower chambers, the ventricles, beat too rapidly and cannot pump enough blood around the body. Abnormal heart rhythms are diagnosed through ultrasound or fetal echocardiogram. When the fetal irregular beats are sustained until delivery, the authors recommend the performance of an ECG in the neonatal period. Other causes of fetal arrhythmia include: Some studies have linked caffeine and fetal arrhythmia. pediag > Blog > Uncategorized > how could a fetal arrhythmia affect fetal oxygenation? Retrieved August 15, 2014. Cardiovascular health: Insomnia linked to greater risk of heart attack. In some cases of severe bradycardia, medication alone is not effective and a pacemaker may need to be implanted. This is typically corrected with medication that you take and pass to your baby through the placenta. on georgia law on drug testing newborns 2019; whole health recovery . And transient arrhythmias those that come and go are more common than sustained arrhythmias, ones that are present always or more often than not. Zaidi, A., & Ro, P. (n.d.). Most fetal arrhythmias are benign. The good news is that many cases of heart rhythm issues that are treated early have positive outcomes. Texas Childrens Fetal Center has a long and successful history of treating babies with abnormal heart rhythms and other fetal heart conditions. Learn more here. 5. This can be performed during the newborn period if necessary. The prenatal diagnosis of cardiac rhythm abnormalities has been made possible with advancements in ultrasound imaging. Instead, they may be caused by things like inflammation or electrolyte imbalances. Finally, the recovery phase is due to the relief of the compression and the sharp return to the baseline, which may be followed by another healthy brief acceleration or shoulder (Figure 8). Detailed analysis of the type of arrhythmia in utero is possible using M-mode and Doppler echocardiography. This arrhythmia happens when the fetus has extra heartbeats, or ectopic beats, that originate in the atria (PACs) or the ventricles (PVCs). Doctors will perform an electrocardiogram (EKG) if they hear an irregular heartbeat after birth. Fetal bradycardia is defined by a sustained fetal heart rate of less than 100 beats/min. Fetal cardiac arrhythmias: Current evidence. The FHR recordings may be interpreted as reassuring, nonreassuring or ominous, according to the pattern of the tracing. how could a fetal arrhythmia affect fetal oxygenation? 33.11) (13, 16). how could a fetal arrhythmia affect fetal oxygenation? If your doctor suspects fetal arrythmia, you need to consult a fetal cardiologist immediately. The effect of continuous EFM monitoring on malpractice liability has not been well established. 4. These usually resolve without treatment and cause no harm to the fetus. PDF Causes and consequences of fetal acidosis - ADC Fetal & Neonatal Edition how could a fetal arrhythmia affect fetal oxygenation? The anxious parents Guide to Pregnancy (p. 108). Some arrhythmias may indicate a structural abnormality of the heart, in which case your healthcare provider will run further tests and take any appropriate action necessary. (2015). However, based on the information that doctors do have, it appears that most arrhythmias are not life-threatening to you or your baby and will resolve themselves. All Rights Reserved. Bradycardia in the range of 100 to 120 bpm with normal variability is not associated with fetal acidosis. Fetal arrhythmias: diagnosis and treatment - PubMed When the ventricular rate is faster than 180 bpm or slower than 100 bpm, such fetal arrhythmia is classified as fetal tachycardia or fetal bradycardia, respectively. MaterniT21 Plus: DNA-Based Down syndrome test, Pediatric Imaging / Interventional Radiology, Neonatology and Neonatal Intensive Care Unit, Pediatric and Pediatric Surgical Specialties, Pediatric and Perinatal Pathology/Genetics, Congenital High Airway Obstruction Syndrome (CHAOS), Hypoplastic Left and Right Heart Syndrome, General Research at the Fetal Treatment Center, Fetal Intervention For Severe Congenital Diaphragmatic Hernia, Randomized Trial for Stage 1 Twin-To-Twin Transfusion Syndrome, Research Publications at the Fetal Treatment Center, Licensure, Accreditations and Memberships. Fetal echos can be performed as early as 12 weeks into pregnancy but are more reliable after the 17- to 18-week mark. Normal atrial contractions (A) are seen followed by normal ventricular contractions (V). Doctors will perform an electrocardiogram (EKG) if they hear an irregular heartbeat after birth. Some may refer to PAC as a skipped beat.. Figure 33.12: M-mode recording of a fetus with complete heart block. It is a structural difference present from birth. Fetal arrhythmias may not always be caused by a structural heart defect, though. A heart-healthy lifestyle can help prevent heart damage that can trigger certain heart arrhythmias. SVT complicates approximately 1 in 1,000 pregnancies and may lead to hydrops or heart failure. In the remaining 60%, no structural fetal anomaly is found and heart block is almost always caused by a connective tissue disease (immune mediated) of the mother. Figure 33.10: M-mode recording (A) and pulsed Doppler of the umbilical artery (B) in a fetus with bigeminy. Accelerations are transient increases in the FHR (Figure 1). Autoimmune congenital heart block: A review of biomarkers and management of pregnancy. A doctor may also order further tests, such as: Sometimes, doctors cannot tell what is causing an arrhythmia. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), The Great Vessels: Axial, Oblique, and Sagittal Views, Fetal Cardiac Examination in Early Gestation, Anomalies of Systemic and Pulmonary Venous Connections, Cardiac Chambers: The Four-Chamber and Short-Axis Views, Optimization of the Two-Dimensional Grayscale Image in Fetal Cardiac Examination, A Practical Guide to Fetal Echocardiography 3e. The FHR is under constant variation from the baseline (Figure 1). Thus, it has the characteristic mirror image of the contraction (Figure 5). When this happens more persistently, its called sustained tachycardia, which occurs more than 50 percent of the time. Though your baby will need to be on medication to regulate the heartbeat for the first few months of life, most rhythm abnormalities have excellent outcomes. Srinivasan S, et al. In PACs, extra heartbeats can come from the top of the heart, separate from the sinus node. Read about the causes of swollen feet during pregnancy and the treatments and home remedies. This pregnancy-friendly spin on traditional chili is packed with the nutrients your body needs when you're expecting. Less than 2 percent of fetal heartbeat irregularities represent true cardiac arrhythmias. how could a fetal arrhythmia affect fetal oxygenation? Although these decelerations are not associated with fetal distress and thus are reassuring, they must be carefully differentiated from the other, nonreassuring decelerations. Long QT syndrome is suggested in the presence of family history or when intermittent runs of ventricular tachycardia with 2:1 AV block are noted in this setting (18, 19). Since variable and inconsistent interpretation of fetal heart rate tracings may affect management, a systematic approach to interpreting the patterns is important. compte fortnite switch gratuit; luke ducharme actor older; regence claims address; excel android video; property guys stephenville, nl; ucf college of medicine acceptance rate 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. Stretch marks are easier to prevent than erase. how could a fetal arrhythmia affect fetal oxygenation? Figure 33.8: A: Tissue Doppler measurement of atrial (A) and ventricular (V) heart rate in a fetus with complete heart block. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Srinivasan, S. & Strasburger, J., Overview of Fetal Arrhythmias. These medications are given to pregnant mothers and pass to the fetus through the placenta. The most common types you may encounter include the following: Premature contractions are the most common type of arrhythmia thats found in the second and third trimesters of pregnancy. Fetal arrhythmia: Diagnosis, causes, treatment, and more Post comments: direct characterization of clarisse fahrenheit 451 direct characterization of clarisse fahrenheit 451 Figure 33.2: Color Doppler M-mode recording of normal sinus rhythm in a fetus. Fetal Arrhythmias | Obgyn Key A healthy fetus has a heartbeat of 120 to 160 beats per minute, beating at a regular rhythm. Heart arrhythmia - Symptoms and causes - Mayo Clinic BosqueReal desde 162 m 2 Precios desde $7.7 MDP. With SVT, the heart beats too fast, either because of an abnormal connection between the top and bottom of the heart, or many extra heartbeats coming from the top of the heart. It can be overwhelming researching them on your own ask your doctor to explain your babys to you so you understand whats going on and what part of the heart is affected. Many fetal arrhythmias resolve on their own and dont require treatment. Fetal cardiac arrhythmia detection and in utero therapy. It is recommended that mothers deliver in a hospital that has immediate access to a specialized neonatal intensive care unit (NICU), with a pediatric cardiologist and other specialists present. Determine whether accelerations or decelerations from the baseline occur. A scalp pH of less than 7.20 is considered abnormal and generally is an indication for intervention, immediate delivery, or both.12 A pH less than 7.20 should also be assumed in the absence of an acceleration following fetal scalp stimulation when fetal scalp pH sampling is not available. Sustained arrhythmias may be associated with heart failure, however, manifesting as nonimmune hydrops fetalis. Fetal arrhythmia and anxiety in pregnant women have also been linked. Hunter LE, et al. Each case of fetal arrhythmia is different, and not all fetal arrhythmias require treatment. Last medically reviewed on October 29, 2021. This frittata is high in protein and rich in essential nutrients your body needs to support a growing baby. The normal FHR range is between 120 and 160 beats per minute (bpm). The presence of a saltatory pattern, especially when paired with decelerations, should warn the physician to look for and try to correct possible causes of acute hypoxia and to be alert for signs that the hypoxia is progressing to acidosis.21 Although it is a nonreassuring pattern, the saltatory pattern is usually not an indication for immediate delivery.19. The M-mode cursor line intersects the right ventricle (RV), the interventricular septum (S), and the left ventricle (LV). Fetal arrhythmia refers to an abnormal fetal heartbeat or rhythm. This pattern is most often seen during the second stage of labor. A scalp pH less than 7.25 but greater than 7.20 is considered suspicious or borderline. Sometimes the cause may even be unknown. What is the latest research on the form of cancer Jimmy Carter has? Without treatment, these conditions may lead to a buildup of fluid in your babys body/tissues (hydrops fetalis), preterm delivery, or even death. Identify baseline fetal heart rate and presence of variability, both long-term and beat-to-beat (short-term). Arrhythmia most often refers to an irregular heartbeat, while dysrhythmia represents all types of abnormal heartbeats: the heartbeat can be too fast (tachycardia) or too slow (bradycardia). In rare cases, it may be related to a congenital heart defect. You can learn more about how we ensure our content is accurate and current by reading our. Decrease in oxygen in the BLOOD Hypoxia Decrease oxygen in the TISSUES Acidemia Increase hydrogens ions in the BLOOD Acidosis Increase hydrogen ions in the TISSUES Oxygen content Oxygen that is disoved in the blood Oxygen affinity Oxygen that is held and released from the hemoglobin molecule Oxygen delivery Oxygen delivered to the tissues live music port clinton ohio; colleges that allow freshmen to live off campus Fetal Arrhythmia/Dysrhythmia A healthy fetus has a heartbeat of 120 to 160 beats per minute, beating at a regular rhythm. PVCs are less common than PACs. Atrial contractions (A) are identified by the retrograde A-wave in the SVC and ventricular contractions (V) by the aortic flow. Reduced blood flow to the fetus can affect how much oxygen they receive. how could a fetal arrhythmia affect fetal oxygenation? The fetal membranes must be ruptured, and the cervix must be at least partially dilated before the electrode may be placed on the fetal scalp. At Texas Childrens Fetal Center, we have treated fetal arrhythmias for decades, and have strategies to manage the various types. A pattern of persistent late decelerations is nonreassuring, and further evaluation of the fetal pH is indicated.16 Persistent late decelerations associated with decreased beat-to-beat variability is an ominous pattern19 (Figure 7). Introduction. It is also characterized by a stable baseline heart rate of 120 to 160 bpm and absent beat-to-beat variability. Is the ketogenic diet right for autoimmune conditions? According to an article in the Indian Pacing and Electrophysiology Journal, the normal fetal heart rate ranges between 110 and 160 beats per minute (bpm). Your health care providers first step will be to monitor the heart rate and well-being of your baby. german bakery long island. Figure 33.12: M-mode recording of a fetus with complete heart block. Prematurity, maternal anxiety . Almost any stressful situation in the fetus evokes the baroreceptor reflex, which elicits selective peripheral vasoconstriction and hypertension with a resultant bradycardia. If doctors can make an accurate diagnosis of fetal arrhythmia, they can select the best treatments for a baby before and after its birth. In some cases, however, we will monitor your baby and advise mom to reduce caffeine and stress. In cases where a first-degree relative (mom, dad, or sibling) has a heart defect, theres a three-fold increase in the risk that a baby may have a heart defect as well. Fetal arrhythmia. If the heart beats too fast, contractions are shallow and not enough blood is pumped with each heartbeat. Progressive vagal dominance occurs as the fetus approaches term and, after birth, results in a gradual decrease in the baseline FHR. 33.10) or trigeminy (Fig. The M-mode cursor is often placed to intersect an atrium and a ventricle so that the relationship of atrial-to-ventricular contractions is recorded (Fig. This chapter reviews placental oxygen transfer and supply to the fetus. Some studies have stated that maternal oxygen supplementation can alleviate abnormal patterns of fetal heart rate (FHR) but does not improve fetal acid-base status . Irregular fetal cardiac rhythm is the leading cause for referrals to fetal echocardiography centers for rhythm disturbances, and the vast majority of those are benign atrial ectopic beats. If SVT goes away in the fetus or in the first year of life, it may return again around puberty. This system determines how fast the heart beats. Fetal arrhythmia: Prenatal diagnosis and perinatal management. Get the latest on vaccine information, in-person appointments, video visits and more. advanced FHM Flashcards | Quizlet Sometimes the cause may even. Electronic fetal heart rate monitoring (EFM) was first introduced at Yale University in 1958.1 Since then, continuous EFM has been widely used in the detection of fetal compromise and the assessment of the influence of the intrauterine environment on fetal welfare. A premature atrial contraction is an extra beat in the hearts upper chambers. how could a fetal arrhythmia affect fetal oxygenation? Of all tachyarrhythmias, atrial flutter and SVT heart rate between 220 and 300 beats per minute are the most common types you may see. Variability should be normal after 32 weeks.17 Fetal hypoxia, congenital heart anomalies and fetal tachycardia also cause decreased variability. Non-conducted PACs are the most common type of fetal arrhythmias. DiLeo, G. (2002). While most fetal arrhythmias are benign, certain cases may require medical intervention. For more information or to schedule an appointment, call Texas Children's Fetal Center at 832-822-2229 or 1-877-FetalRx (338-2579) toll-free. These can include tachycardia-an increased heart rate-or bradycardia, which is a slowed heartbeat. Other maternal conditions such as acidosis and hypovolemia associated with diabetic ketoacidosis may lead to a decrease in uterine blood flow, late decelerations and decreased baseline variability.23. This test lets your doctor see your unborn childs heart. Arrhythmias are discovered in about 1% of fetuses. Fetal Arrhythmia - American Pregnancy Association Another type of arrythmia we treat quite often is supraventricular tachycardia, or SVT. If your doctor detects an arrhythmia, keep up with your prenatal appointments and any specialist appointments or additional testing, like fetal echocardiograms. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. On very rare occasions, premature beats originate from the ventricle rather than the atrium and are thus termed premature ventricular contractions (PVCs). In these cases, heart block is related to a structural issue, not a signaling problem, and cannot be treated with steroids. Unfortunately, precise information about the frequency of false-positive results is lacking, and this lack is due in large part to the absence of accepted definitions of fetal distress.7 Meta-analysis of all published randomized trials has shown that EFM is associated with increased rates of surgical intervention resulting in increased costs.8 These results show that 38 extra cesarean deliveries and 30 extra forceps operations are performed per 1,000 births with continuous EFM versus intermittent auscultation. If your doctor suspects your baby has an arrhythmia, you may be sent for more detailed imaging called a fetal echocardiogram. Centers for Disease Control and Prevention (CDC), ncbi.nlm.nih.gov/pmc/articles/PMC5963229/, ncbi.nlm.nih.gov/pmc/articles/PMC3558034/, ncbi.nlm.nih.gov/pmc/articles/PMC3275696/, frontiersin.org/articles/10.3389/fped.2020.607515/full, ahajournals.org/doi/full/10.1161/01.cir.0000437597.44550.5d, heart.org/en/health-topics/congenital-heart-defects/symptoms--diagnosis-of-congenital-heart-defects/fetal-echocardiogram-test, ahajournals.org/doi/10.1161/JAHA.113.000064, ncbi.nlm.nih.gov/pmc/articles/PMC4481419/, ncbi.nlm.nih.gov/pmc/articles/PMC4580692/, obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1447-0756.2009.01080.x, ahajournals.org/doi/full/10.1161/circulationaha.109.857987, ncbi.nlm.nih.gov/pmc/articles/PMC3678114/, obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.2819, ncbi.nlm.nih.gov/pmc/articles/PMC3326657/. Impact of prenatal risk factors on congenital heart disease in the current era. Capone C, et al. Cesarean section may be necessary for obstetrical reasons, however. Long QT syndrome is a genetic abnormality of the sodium and potassium channels regulating cardiac repolarization. Arrhythmia most often refers to an irregular heartbeat, while dysrhythmia represents all types of abnormal heartbeats: the heartbeat can be too fast (tachycardia) or too slow (bradycardia). A very fast heart rate may be caused by abnormal firing of the nerves that are responsible for the heartbeat. If the heartbeat is very fast, such as in SVT, treatment may be necessary. These highlights do not include all the information needed to use Differentiating between a reassuring and nonreassuring fetal heart rate pattern is the essence of accurate interpretation, which is essential to guide appropriate triage decisions.