Important considerations when using
the PeriGen Category II Management App
In the parent publication, the authors discuss important issues to consider when using the algorithm. We strongly encourage everyone to read the original article in full. For you convenience brief outlines are listed here:
- The algorithm follows NICHD definitions
- This algorithm should be viewed as a one next step in management recommendations
- The goal is to deliver the baby prior to any damage from asphyxia
- Non operative interventions may be appropriately used and an effect should be apparent within 30 min.
- Baseline variability and loss of accelerations will be reliably depressed before the pH has reached a level associated with damage
- FHR patterns cannot be interpreted in isolation – labor progress must be considered
- Some well-defined features of Category II are not included in the algorithm
- Sentinel events can occur without warning. Clinical situations exist where Category II may be harbingers of sentinel events and more prompt action may be appropriate, such as Vaginal bleeding and TOLAC
- The algorithm does not address recurrent prolonged decelerations
- A given fetus may have experience more than one pathologic process concurrently
- The algorithm authorizes judgment between CS and operative vaginal delivery
- We caution against delay in delivery for a deteriorating FHR pattern because criteria indicating probable severe metabolic acidemia have not yet been met- minimal and absent variability are treated the same way.
- A fetus with minimal/absent variability without decelerations presents a diagnostic and management dilemma
- The algorithm represents a consensus of 18 authors
- The algorithm is supported by a substantial body of research
- Usage is for United States only.