Assessment of the concordance among 2-tier, 3-tier, and 5-tier fetal heart rate classification systems

Cynthia Gyamfi Bannerman*, William A. Grobman, Leah Antoniewicz, Maria Hutchinson, Sean Blackwell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Objective: In 2008, a National Institute of Child Health and Human Development/Society for Maternal-Fetal Medicine-sponsored workshop on electronic fetal monitoring recommended a new fetal heart tracing interpretation system. Comparison of this 3-tier system with other systems is lacking. Our purpose was to determine the relationships between fetal heart rate categories for the 3 existing systems. Methods: Three Maternal-Fetal Medicine specialists reviewed 120 fetal heart rates. All tracings were from term, singleton pregnancies with known umbilical artery pH. The fetal heart rates were classified by a 2-tier, 3-tier, and 5-tier system. Results: Each Maternal-Fetal Medicine examiner reviewed 120 fetal heart rate segments. When compared with the 2-tier system, 0%, 54%, and 100% tracings in categories 1, 2, and 3 were "nonreassuring. " There was strong concordance between category 1 and "green" as well as category 3 and "red" tracings. Conclusion: The 3-tier and 5-tier systems were similar in fetal heart rate interpretations for tracings that were either very normal or very abnormal. Whether one system is superior to the others in predicting fetal acidemia remains unknown.

Original languageEnglish (US)
Pages (from-to)288.e1-288.e4
JournalAmerican journal of obstetrics and gynecology
Issue number3
StatePublished - Sep 2011


  • 2-tier system
  • 3-tier system
  • 5-tier system
  • electronic fetal monitoring
  • fetal heart tracing

ASJC Scopus subject areas

  • Obstetrics and Gynecology


Dive into the research topics of 'Assessment of the concordance among 2-tier, 3-tier, and 5-tier fetal heart rate classification systems'. Together they form a unique fingerprint.

Cite this