To identify physician and nursing interventions for category II fetal heart rate (FHR) tracings to facilitate decision making regarding intrapartum management. When considering individual patient needs, alternative independent clinical assessments and judgments may be necessary. A clinical guideline reflects the state of current clinical knowledge, as published in literature, regarding the effectiveness and appropriateness of practices or procedures. The goal of a guideline is to describe a recommended course of action for a specific condition, procedure or patient population. A hospital may create a policy stating that the clinical guideline is to be followed. A hospital may also modify guidelines in accordance with its understanding of the science of medicine or its own determination of the best interest of its patients. Guidelines are periodically revised in accordance with new knowledge and recommendations that emerge as a result of continued research. Category II FHR tracings are indeterminate. Category II FHR tracings are not predictive of abnormal fetal acid–base status, yet presently there is not adequate evidence to classify these as Category I or Category III. Category II FHR tracings require evaluation and continued surveillance and reevaluation, considering the entire associated clinical circumstances. In some circumstances, either ancillary tests to ensure fetal well-being or intrauterine resuscitative measures may be used with Category II tracings. Category III FHR tracings are abnormal. Category III tracings are associated with abnormal fetal acid–base status at the time of observation. Category III FHR tracings require prompt evaluation. Depending on the clinical situation, efforts to expeditiously resolve the abnormal FHR pattern may include but are not limited to provision of maternal oxygen, change in maternal position, discontinuation of labor stimulation, treatment of maternal hypotension, and treatment of tachysystole with FHR changes. If a Category III tracing does not resolve with these measures, delivery should be undertaken. Course updated in RISE.
show less
