A scoring system for nonstressed antepartum fetal heart rate monitoring.

A scoring system developed to assess nonstressed antepartum fetal heart rate records has been evaluated. The system scores from 0 to 2 for each of five factors, i.e., baseline rate, amplitude and frequency of fluctuation, decelerations, and accelerations. A total of 1,367 nonstress tests in 284 patients were retrospectively reviewed. Three groups of patients were delineated with respect to the fetal heart rate scores. When the group with the highest score of 8 to 10 and a perinatal mortality rate (PNM) rate of 4.7/1,000 was compared with the groups having intermediate (5 to 7) and low (less than or equal to 4) scores, there was a highly significant increase in PNM to 69.8/1,000 (p less than 0.01) and 433/1,000 (p less than 0.001), respectively. A significant increase in low Apgar scores at 1 and 5 minutes, in fetal acidosis (low umbilical arterial pH), and in duration of intensive care nursery stay was also seen as the fetal heart rate score progressively deteriorated from the 8 to 10 group to the less than or equal to 4 group. We conclude that this scoring system clearly delineates normal from prepathologic and pathologic changes in fetal heart rate and can be used as warning of impending fetal death.