CATEGORY III: ABNORMAL

TRACINGS

A   20-year-old primigravida    at  39  weeks’  gestation   is  in  active  labor   at  7   cm

of  cervical    dilation.   The EFM strip   shows   a   baseline    heart   rate    of  175

beats/min,  and variability is  absent, but repetitive  late    decelerations   are seen

after   each    contraction.    No  accelerations   are noted.

Recognize that most abnormal tracings are not caused by fetal hypoxia. Ask
whether the tracing has biologic plausibility.

Specific interventions if immediate delivery Is indicated:

Examine the EFM strip   carefully   looking for baseline    heart   rate,   degree  of

variability,    and presence    of  periodic    changes (accelerations, decelerations).

Confirm abnormal    findings    using   criteria    discussed   above   (category   II  or

III).

Identify    nonhypoxic  causes  present that    could   explain the abnormal    findings.

Initiate    the intrauterine    resuscitation   measures    described   previously  to

enhance placental   perfusion   and fetal   oxygenation.

Observe for normalization   of  the EFM tracing.

Prepare for delivery    promptly    if  resuscitation   measures    do  not normalize   EFM

tracing.

In  stage   1   of  labor,  the only    option  is  emergency   cesarean    section.

In  stage   2   of  labor,  an  operative   vaginal delivery    (e.g.,  vacuum  extractor