ACOG Clinical Practice Guideline No. 10:Intrapartum Fetal Heart Rate Monitoring: Interpretation and Management.

PURPOSE The purpose of this document is to provide an evidence-based framework for the evaluation and management of intrapartum fetal heart rate (FHR) patterns. TARGET POPULATION Pregnant individuals in the first or second stage of labor. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of three maternal-fetal medicine subspecialists and one specialist in obstetrics and gynecology appointed by the American College of Obstetricians & Gynecologists' (ACOG) Committee on Clinical Practice Guidelines-Obstetrics. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes an overview of intrapartum FHR monitoring nomenclature and classification systems and provides recommendations for evaluation and management of intrapartum FHR tracings. Recommendations are classified by strength and evidence quality.