All tables are from Parer and Ikeda, AJOG 2007
TABLE 5: Risk categories for fetal acidemia related to FHR variability, baseline rate and presence of recurrent decelerations
MODERATE (NORMAL) VARIABLILTY
No | Early | Mild VD | Mod VD | Sev VD | Mild LD | Mod LD | Sev LD | Mild PD | Mod PD | Sev PD | |
Tachy | B | B | B | Y | O | Y | Y | O | Y | Y | O |
Normal | G | G | G | B | Y | B | Y | Y | Y | Y | O |
Mild Brd | Y | Y | Y | Y | O | Y | Y | O | Y | Y | O |
Mod Brd | Y | Y | O | O | O | O | |||||
Sev Brd | O | O | O | O | O |
MINIMAL VARIABILITY
No | Early | Mild VD | Mod VD | Sev VD | Mild LD | Mod LD | Sev LD | Mild PD | Mod PD | Sev PD | |
Tachy | B | Y | Y | O | O | O | O | R | O | O | R |
Normal | B | B | Y | O | O | O | O | R | O | O | R |
Mild Brd | O | O | R | R | R | R | R | R | R | R | R |
Mod Brd | O | O | R | R | R | R | |||||
Sev Brd | R | R | R | R | R |
ABSENT VARIABILITY
No | Early | Mild VD | Mod VD | Sev VD | Mild LD | Mod LD | Sev LD | Mild PD | Mod PD | Sev PD | |
Tachy | R | R | R | R | R | R | R | R | R | R | R |
Normal | O | R | R | R | R | R | R | R | R | R | R |
Mild Brd | R | R | R | R | R | R | R | R | R | R | R |
Mod Brd | R | R | R | R | R | R | |||||
Sev Brd | R | R | R | R | R |
Sinusoidal | R |
Marked Variability | Y |
VD = variable deceleration
LD = late deceleration
PD = prolonged deceleration
Brd = bradycardia
Tachy = tachycardia
G= green; B=blue; Y=yellow; O=orange; R=Red
Table 4: Proposed management of the color-coded categories (will vary depending on institution).
Conservative techniques | Operating Room | Obstetrician | Anesthestist | Newborn Resuscitator | Location of Patient | |
Green | No | - | - | - | - | - |
Blue | Yes | Available | Informed | |||
Yellow | Yes | Available | At bedside | Informed | Informed | |
Orange | Yes | Immediately Available | At bedside | Present | Immediately Available | OR |
Red | Yes | Open | At bedside | Present | Present | OR |
Table 2: Risk of acidemia, evolution to a more serious pattern, recommended action
Risk of acidemia | Risk of evolution | Action | |
Green | 0 | Very low | None |
Blue | 0 | Low | CT and begin preparation |
Yellow | 0 | Moderate | CT and increased surveillance |
Orange | Borderline/acceptaby low | High | CT and prep for urgent delivery |
Red | Unacceptaby high | Not a consideration | Deliver |
CT = conservative techniques:
Position change
Hyperoxia
Correct hypotension
Adequate intravascular volume
Correct excessive contractions (e.g. decrease oxytocin)
Avoid constant pushing
Tocolysis
Amnioinfusion to correct amniotic fluid deficit