Center crafts guide to fetal heart rate patterns. (Confronts Lack of Data in this Area).

KAUAI, HAWAII -- Clinicians at one medical center have developed fetal management guidelines based on heart rate patterns in an effort to reduce fetal acidemia while avoiding unnecessary operative interventions.

Thirty years after the introduction of feral heart rate monitoring, physicians lack evidence-based guidelines or even consensus on how fetal heart rate patterns should guide management, stymied by a lack of research data. "It's fine to talk about evidence-based medicine, but when good evidence is unavailable, the obstetrician still has to do something based on the best evidence available," Dr. Julian T. Parer said at a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law.

A team of physicians, nurses, midwives, and others at the University of California, San Francisco, reviewed the medical literature and tapped expert opinion to define 22 fetal heart rate patterns that led to 88 algorithms for management. The algorithms--developed specifically for use at UCSF--will be put through validation resting in prospective, randomized trials.

"We think this is the way to go," said Dr. Parer, director of perinatal medicine and genetics and professor of ob.gyn. at the university.

A 1997 consensus committee convened by the National Institute of Child Health and Human Development essentially agreed on the definitions of a normal fetal heart rate tracing and--at the other end of the spectrum--several patterns that predict current or impending fetal asphyxia so severe that it puts the fetus at risk of damage or death.

In between those extremes, management remained controversial, and the consensus committee proposed that smaller groups take a stab at creating recommendations that could be tested.

The UCSF guidelines draw on "very shaky" evidence in the literature--virtually ...