Assessment of the concordance among 2-tier, 3-tier, and 5-tier fetal heart rate classification systems

Am J Obstet Gynecol. 2011 Sep;205(3):288.e1-4. doi: 10.1016/j.ajog.2011.06.065. Epub 2011 Jun 24.


Objective: In 2008, a National Institute of Child Health and Human Development/Society for Maternal-Fetal Medicine-sponsored workshop on electronic fetal monitoring recommended a new fetal heart tracing interpretation system. Comparison of this 3-tier system with other systems is lacking. Our purpose was to determine the relationships between fetal heart rate categories for the 3 existing systems.

Methods: Three Maternal-Fetal Medicine specialists reviewed 120 fetal heart rates. All tracings were from term, singleton pregnancies with known umbilical artery pH. The fetal heart rates were classified by a 2-tier, 3-tier, and 5-tier system.

Results: Each Maternal-Fetal Medicine examiner reviewed 120 fetal heart rate segments. When compared with the 2-tier system, 0%, 54%, and 100% tracings in categories 1, 2, and 3 were "nonreassuring." There was strong concordance between category 1 and "green" as well as category 3 and "red" tracings.

Conclusion: The 3-tier and 5-tier systems were similar in fetal heart rate interpretations for tracings that were either very normal or very abnormal. Whether one system is superior to the others in predicting fetal acidemia remains unknown.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiotocography / methods*
  • Female
  • Heart Rate, Fetal / physiology*
  • Humans
  • Labor, Obstetric
  • Male
  • National Institute of Child Health and Human Development (U.S.)
  • Pregnancy
  • Retrospective Studies
  • United States