II. Classification of FHT Variability

  1. Absent variability
  2. Minimal variability (5 or less bpm change)
  3. Moderate variability (6 to 25 bpm change)
  4. Marked variability (more than 25 bpm change)

III. Evaluation

  1. Continuous monitoring

IV. Interpretation

  1. Normally FHR varies 10-15 bpm from baseline
  2. Variability is related to fetal cerebral activity
  3. Evaluation based on one of two techniques
    1. Continuous Electronic Fetal Monitoring (CEFM)
    2. Structured Intermittent Auscultation (SIA)
      1. Count FHR in five second intervals over 60 seconds
      2. Examples (12 number sets)
        1. Good: 10,12,13,12,10,12,13,11,11,13,12,13
        2. Poor: 11,11,10,11,11,11,11,10,10,10,11,10

V. Efficacy: Loss of Variability

  1. Most accurate with internal scalp electrode
  2. Low sensitivity: 17%
  3. High Specificity
    1. Reassuring if normal variability
    2. Most specific for fetal asphyxia
    3. Negative Predictive Value >98%

VI. Causes of decreased FHT Variability

  1. Normal causes
    1. Fetal sleep cycle (usually lasts 20-40 minutes)
    2. Extreme prematurity
    3. Medications
      1. Narcotics
      2. Sedative-Hypnotic medications
      3. Barbiturates
      4. Phenothiazines
      5. Parasympatholytic medications
      6. General anesthesia
  2. Fetal Hypoxia or Metabolic Acidosis
    1. Especially concerning if other findings of distress
      1. Late Decelerations
      2. Variable Decelerations
    2. Associated with decreased APGAR Scores if uncorrected
  3. Other abnormal causes
    1. Fetal neurologic anomalies (Anencephaly)
    2. Chorioamnionitis
    3. Fetal Heart Block
    4. Fetal Tachycardia

VII. References

  1. Bailey (2000) ALSO, E:1-13
  2. Gabbe (2002) Obstetrics, p. 395
  3. Rylander (2001) Clin Fam Pract 3(2):287-305 [PubMed]

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