The Cat 2 FHT Conundrum

In 2009, the ACOG released practice bulletin 106 which introduced the 3- tier fetal heart rate classification system. This was followed up in November 2010 with its sister practice bulletin, number 116, “Management of Intrapartum Fetal Heart Rate Tracings”. Yet now, 13 years later, management of the category II tracing remains a conundrum. How long can you watch/observe a category II tracing? Can category II tracings predict fetal acidemia? And what is a step-by-step, evidence-based algorithm for category II management? In this episode, we will cover all of these questions, and summarize a new systematic review/meta-analysis from the AJOG (October 2023) focused on this very condition.