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American Academy of Pediatrics
Index of Suspicion in the Nursery

Strip of the Month: Pseudosinusoidal Pattern in Labor

Kafui A. Demasio
NeoReviews August 2019, 20 (8) e475-e481; DOI: https://doi.org/10.1542/neo.20-8-e475
Kafui A. Demasio
*Department of Obstetrics and Gynecology, and Women’s Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
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Electronic Fetal Monitoring Case Review Series

Electronic fetal monitoring (EFM) is a popular technology used to establish fetal well-being. Despite its widespread use, the terminology used to describe patterns seen on the monitor has not been consistent until recently. In 1997, the National Institute of Child Health and Human Development (NICHD) Research Planning Workshop published guidelines for interpretation of fetal tracings. This publication was the culmination of 2 years of work by a panel of experts in the field of fetal monitoring and was endorsed in 2005 by both the American College of Obstetricians and Gynecologists (ACOG) and the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). In 2008, ACOG, NICHD, and the Society for Maternal-Fetal Medicine reviewed and updated the definitions for fetal heart rate (FHR) patterns, interpretation, and research recommendations. Following is a summary of the terminology definitions and assumptions found in the 2008 NICHD workshop report. Normal arterial umbilical cord gas values and indications of acidosis are defined in Table 1.

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Table.

Arterial Umbilical Cord Gas Values

Assumptions from the NICHD Workshop

  • Definitions are developed for visual interpretation, assuming that both the FHR and uterine activity recordings are of adequate quality

  • Definitions apply to tracings generated by internal or external monitoring devices

  • Periodic patterns are differentiated based on waveform, abrupt or gradual (eg, late decelerations have a gradual onset and variable decelerations have an abrupt onset)

  • Long- and short-term variability are evaluated visually as a unit

  • Gestational age of the fetus is considered when evaluating patterns

  • Components of FHR do not occur alone and generally evolve over time

Definitions

Baseline FHR

  • Approximate mean FHR rounded to increments of 5 beats/min in a 10-minute segment of tracing, excluding accelerations and decelerations, periods of marked variability, and segments of baseline that differ by >25 beats/min

  • In the 10-minute segment, the minimum baseline duration must be at least 2 minutes (not necessarily contiguous) …

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NeoReviews
Vol. 20, Issue 8
1 Aug 2019
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Strip of the Month: Pseudosinusoidal Pattern in Labor
Kafui A. Demasio
NeoReviews Aug 2019, 20 (8) e475-e481; DOI: 10.1542/neo.20-8-e475

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Strip of the Month: Pseudosinusoidal Pattern in Labor
Kafui A. Demasio
NeoReviews Aug 2019, 20 (8) e475-e481; DOI: 10.1542/neo.20-8-e475
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More in this TOC Section

  • Case 1: A Rare Presentation of Abdominal Distention in a Preterm Newborn
  • Case 3: What's That Smell? The Significance of Infant Body Odors in the Evaluation of Metabolic Acidosis
  • Case 2: Intergluteal Sulcus Flattening in a Newborn
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