Discussion Topics in Response to ACOG Clinical Practice Guideline (Number 10)

Summary

The American College of Obstetricians and Gynecologists (ACOG) recently released updated clinical practice guidelines titled “Intrapartum Fetal Heart Rate Monitoring: Interpretation and Management.” These recommendations emphasize the need for standardized interpretation and timely intervention. The following callouts highlight key discussion points and demonstrate how PeriGen solutions align with ACOG’s guidance.

Bias / Equity

ACOG: “Among those with unplanned cesarean deliveries, more Black and Hispanic patients are diagnosed with nonreassuring FHR as the indication for cesarean. This disparity underscores the urgent need for standardized EFM interpretation and management strategies that are applied consistently regardless of race, ethnicity, socioeconomic status, or other demographic characteristics.”

PeriGen: PeriWatch Vigilance^® helps clinicians reduce bias and promote equitable care through objective, standardized FHR interpretation.

Electronic Fetal Monitoring

ACOG: “…Intrapartum EFM, compared with no EFM, was associated with lower early neonatal mortality and morbidity and, therefore, lower infant mortality…”

PeriGen: As part of a recent quality improvement project at Community Health Systems. PeriWatch Vigilance contributed to a 12% decrease in unexpected complications in full-term babies over a two-year period.

Three-Tier vs. Five-Tier

ACOG: “Limitations of the three-tier system include the broad range of FHR patterns in category II that limit the specificity of this category and its ability to predict acidemia, as well as the modest interobserver reliability…”

ACOG: “In a single-center case-control study comparing the three-tier and five-tier classification systems, 79% of fetal acidemia was correctly characterized by the presence of an orange or red tracing using the five-tier system compared with only 12% with a category III tracing in the three-tier system. However, the sample size was small, with only 24 cases of acidemia, and there were concerns regarding the cumbersome nature of five complex categories. In another study, there was strong concordance at the extremes of ‘very normal’ and ‘very abnormal’ FHR tracings between the three-tier and five-tier classification systems, suggesting that the five-tier system may be an acceptable alternative for EFM classification.”

PeriGen: ACOG acknowledges that the 5-tier system provides more effective clinical guidance for category II tracings. PeriWatch Vigilance brings that system to life by automating and color-coding each tier to support easy implementation and adoption.

Trends Over Time

ACOG: “No matter which individual classification system is used, it is crucial that both nurses and obstetric clinicians at a given institution use the same classification system and terminology. Further, although classification systems can be helpful for prompt communication about FHR tracings, they may lose the nuance of individual FHR tracing characteristics such as baseline heart rate, variability, and decelerations and the changes in these elements over time or in response to specific clinical events. Regardless of the classification system used, it is important to note that categorization of the FHR tracing evaluates the fetus at that point in time; tracing patterns can and will change. An FHR tracing may move back and forth between the categories depending on the clinical situation and management strategies used.”

PeriGen: An isolated segment of a fetal heart rate tracing doesn’t tell the whole story. PeriWatch Vigilance helps clinicians see the full picture through 4- and 12-hour trend views, making it easier to identify meaningful changes that might be missed in standard monitoring displays.

ACOG: “Because a comprehensive assessment of the patient’s clinical picture is paramount, clinicians must consider labor progress (normal vs protracted or arrested) and proximity to delivery when determining next steps in management of a persistently category II FHR tracing. In a patient whose labor is progressing through the active phase, resuscitation interventions that do not stall or halt progress should be exhausted before those interventions that may interfere with labor progress toward a successful delivery. The comprehensive assessment is similarly essential in identifying a pattern of fetal status over time, to determine whether ongoing resuscitative efforts are likely to become effective or whether the patient is making adequate progress toward vaginal delivery to justify the persistence of the category II tracing despite resuscitative efforts.”

PeriGen: ACOG notes that a comprehensive assessment is essential for determining a care plan. PeriWatch Vigilance aligns with this guidance by monitoring the evolution of the FHR tracing alongside the patient’s labor progress using a modern multifactor labor curve inside the single-patient view. When combined with the clinical picture, this data supports more informed decision-making.

Reliance on AI

ACOG: Recommends against primary reliance on computerized approaches for interpretation and management.

PeriGen: At PeriGen, we believe AI is meant to complement clinical expertise, not replace it. As an AI-driven safety net, PeriWatch Vigilance is designed to promote situational awareness and highlight potentially concerning trends so that clinicians can focus their attention and expertise where it’s needed most.

Lack of Clinical Trials

ACOG: “There are no clinical trials that support the notion that computer-based FHR interpretation improves neonatal outcomes, nor are there case-control or cohort studies that have AI approaches that appear to improve the prediction of FHR monitoring for fetal hypoxia or acidemia.”

PeriGen: PeriWatch Vigilance delivers far more than static FHR interpretation — it trends data in near-real time and transforms those insights into actionable awareness for clinicians. This continuous trending capability is what sets Vigilance apart. While there are currently no clinical trials demonstrating that computer-based FHR interpretation improves neonatal outcomes, we’re actively collaborating with our partners to change that. Advancing this research is central to our mission to protect moms and babies, and we’re excited about the role PeriWatch Vigilance can play in shaping the future of safer care.

About PeriWatch Vigilance

PeriWatch Vigilance is an automated maternal-fetal early warning system for obstetrics that automates the process of identifying patients who may be at risk for adverse outcomes during labor and delivery. Designed to enhance clinical efficiency, standardize care, and facilitate timely intervention, Vigilance is the only AI-based EFM analysis tool commercially available in the United States.

For more information on Vigilance, contact us to talk to an expert today.