Category II Management Algorithm App


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The Category II Management App, a free web-based app offered exclusively by PeriGen, is based on published research and designed for US usage to help support the management of patients with FHR tracings in category II (present in over 80% of labors).

Only 4-8 clicks get you the suggested outcome and the app takes seconds to use.

  • Answer a few questions about the tracing and labor status
  • The application processes the data through the algorithm and presents its conclusion along with the publication’s original image.

This online app (not for download) can be used as often as needed on any computer or mobile device.

Any questions or feedback, email

A Message from Thomas Garite, MD
Chief Medical Officer:

“Category II fetal heart rate tracings are common and cover a wide spectrum ranging from relatively minor findings to more significant combinations that require very different clinical management. This app based on a researched algorthm represents a practical set of management guidelines for clinicians to consider as they care for women in labor. The algorithm was designed in accordance with a fundamental premise in patient safety circles – that standardization and simplification of critical care processes promote better outcomes. Please do read the full publication that describes a number of important concepts that clinicians must also include in their clinical reasoning. No simple algorithm can handle every unusual circumstances or rapid change in the tracing. We look forward to your feedback and hope it will be a useful tool for clinicians to access on their smart phones when managing patients whose tracings are in Category II.”

“We present an algorithm for the management of category II FHR patterns that reflects a synthesis of available evidence and current scientific thought. Use of this algorithm represents one way for the clinician to comply with the standard of care, and may enhance our overall ability to define the benefits of intrapartum FHR monitoring.”

Reference Publication:
Intrapartum management of category II fetal heart rate tracings: towards standardization of care. Clark SL, Nageotte MP, Garite TJ, Freeman RK, Miller DA, Simpson KR, Belfort MA, Dildy GA, Parer JT, Berkowitz RL, D’Alton M, Rouse DJ, Gilstrap LC, Vintzileos AM, van Dorsten JP, Boehm FH, Miller LA, Hankins GD. Am J Obstet Gynecol. 2013 Aug;209(2):89-97. doi: 10.1016/j.ajog.2013.04.030. Epub 2013 Apr 27


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:

  1. The Category II Management App algorithm follows NICHD definitions
  2. This algorithm should be viewed as a one next step in management recommendations
  3. The goal is to deliver the baby prior to any damage from asphyxia
  4. Non operative interventions may be appropriately used and an effect should be apparent within 30 min.
  5. Baseline variability and loss of accelerations will be reliably depressed before the pH has reached a level associated with damage
  6. FHR patterns cannot be interpreted in isolation – labor progress must be considered
  7. Some well-defined features of Category II are not included in the algorithm
  8. 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
  9. The algorithm does not address recurrent prolonged decelerations
  10. A given fetus may have experience more than one pathologic process concurrently
  11. The algorithm authorizes judgment between CS and operative vaginal delivery
  12. 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.
  13. A fetus with minimal/absent variability without decelerations presents a diagnostic and management dilemma
  14. The algorithm used by the Category II Management App represents a consensus of 18 authors
  15. The algorithm is supported by a substantial body of research
  16. Usage is for United States only.


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