Management of the Category II Fetal Heart Rate Tracing

Clin Obstet Gynecol. 2020 Sep;63(3):659-667. doi: 10.1097/GRF.0000000000000551.


Management of the category II fetal heart rate (FHR) tracing presents a common challenge in obstetrics. Up to 80% of women will have a category II FHR tracing at some point during labor. Here we propose a management algorithm to identify specific features of the FHR tracing that correlate with risk for fetal acidemia, target interventions to address FHR decelerations, and guide clinicians about when to proceed toward operative vaginal delivery or cesarean to achieve delivery before there is a high risk for significant fetal acidemia with potential for neurological injury or death.

Publication types

  • Review

MeSH terms

  • Acidosis* / complications
  • Acidosis* / diagnosis
  • Acidosis* / physiopathology
  • Algorithms
  • Arrhythmias, Cardiac* / etiology
  • Arrhythmias, Cardiac* / metabolism
  • Arrhythmias, Cardiac* / physiopathology
  • Arrhythmias, Cardiac* / therapy
  • Cardiotocography / methods*
  • Female
  • Fetal Diseases* / etiology
  • Fetal Diseases* / metabolism
  • Fetal Diseases* / physiopathology
  • Fetal Diseases* / therapy
  • Heart Rate, Fetal / physiology*
  • Humans
  • Labor, Obstetric / physiology
  • Pregnancy
  • Risk Adjustment / methods*