Rythme cardiaque fœtal pendant le travail : définitions et interprétation

Continuous fetal heart rate monitoring is widely used during labor even in low risk pregnancies. Consensus is necessary to define and interpret accurately the different FHR patterns. The normal FHR tracing include baseline rate between 110-160 beats per minute (bpm), moderate variability (6-25 bpm), presence of accelerations and no decelerations. Uterine activity is monitored simultaneously: contractions frequency, duration, amplitude and relaxation time must be also normal. Abnormal baseline heart rate during 10 minutes or more is termed tachycardia above 160 bpm (except for FIGO above 150) and bradycardia below 110 bpm. Variability is minimal below 6 bpm and absent when non visible. Decelerations are classified as early, variable, late, and prolonged. Early and late decelerations have an onset gradual decrease of FHR, in contrast variable decelerations have an abrupt onset. Early deceleration is coincident in timing with uterine contraction. Variable deceleration is variable in onset, duration and timing, and may be described as typical or non reassuring. Late deceleration is associated with uterine contraction; the onset, nadir, and recovery occur after onset, peak and end of the contraction. Prolonged deceleration is lasting more than two but less 10 minutes, with almost onset abrupt and no repetition. Electronic fetal monitoring is a method to detect risk of fetal asphyxia; analysis and interpretation of FHR patterns are difficult with a high false positive rate, increasing operative deliveries. The patterns who are predictive of severe fetal acidosis include recurrent late or variable or prolonged decelerations or bradycardia, with absent FHR variability, and sudden severe bradycardia. The other FHR patterns are not conclusive and defined as non reassuring; obstetrical risk factors must be considered and other method (like scalp sampling for pH) utilised to evaluate fetal state.