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Part IV - SPECIAL ISSUES
John Patrick O'Grady, Tufts University, Massachusetts, Martin L. Gimovsky, Lucy A. Bayer-Zwirello, Kevin Giordano
Book:

Operative Obstetrics

Published online:

07 May 2010

Print publication:

04 August 2008, pp -
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Summary

This chapter focuses primarily on surveillance during the intrapartum period using electronic fetal heart rate (FHR) monitoring and ancillary techniques of fetal evaluation, including capillary blood sampling, pulse oximetry, and automated electrocardiographic (ECG) analysis of ST waveform changes in refining the evaluation of moderately abnormal FHR pattern. It is critical to the understanding of FHR patterns that in the presence of uterine contractions, any fetal hypoxia is reflected by the appearance of decelerations before a rise in the baseline rate or decrease in variability. In the evaluation of decelerations, recovery from a deceleration sequence means a return to the previously normal baseline rate and variability. There is universal agreement that the frequency of decelerations increases dramatically in the second stage of labor, probably because of the effects of frequent uterine contractions and maternal expulsive forces on the fetal head and the cord.