What are the management steps for fetal heart tone (FHT) increases during uterine contractions?

Management of Fetal Heart Rate Increases During Contractions

Fetal heart rate increases (accelerations) during uterine contractions are reassuring and require only continued monitoring, as they indicate normal fetal well-being and absence of acidemia. 1

Understanding the Pattern

• Accelerations are a normal, reassuring finding that predict the absence of fetal acidemia and indicate fetal well-being 1
• This pattern falls under NICHD Category I (Normal), which is characterized by normal baseline FHR (110-160 bpm), moderate variability, and absence of concerning decelerations, with accelerations present or absent 1
• Category I tracings require no intervention beyond routine monitoring 1

Critical Distinction: What This Is NOT

It is essential to distinguish FHR accelerations (increases) from decelerations (decreases), as management differs dramatically:

Early Decelerations (Benign)

• These are symmetric decreases in FHR that mirror the uterine contraction, with the nadir occurring at the peak of the contraction 1
• They are nearly always benign and related to fetal head compression 1
• No intervention required beyond continued monitoring 1

Late Decelerations (Concerning)

• These are decreases in FHR with delayed onset after the contraction begins, with the nadir occurring after the peak of the contraction 1
• They indicate uteroplacental insufficiency and require immediate intervention 1, 2

Variable Decelerations

• These are abrupt decreases in FHR usually related to cord compression 1
• Generally benign unless atypical features are present 1

Appropriate Management for FHR Accelerations

• Continue current monitoring method (intermittent auscultation or continuous electronic fetal monitoring) 1
• No resuscitative measures are needed 1
• No need to discontinue oxytocin if being administered 2
• Document the reassuring pattern 1

Common Pitfall to Avoid

• Do not confuse accelerations with decelerations - the management is completely opposite. Accelerations require no intervention, while certain decelerations (particularly late decelerations with reduced variability) may require immediate resuscitative measures including discontinuing oxytocin, maternal repositioning, oxygen administration, and potentially expedited delivery 2, 3

When to Escalate Care

If the pattern changes from accelerations to concerning decelerations:

• Category III tracings (absent baseline variability with recurrent late or variable decelerations and/or bradycardia) require immediate intervention 2
• Stop oxytocin infusion immediately 2, 3
• Implement resuscitative measures: maternal repositioning to left lateral position, oxygen administration (6-10 L/min via face mask), IV fluid bolus, and vaginal examination 2
• Prepare for potential expedited delivery if the tracing does not improve 2