### Description

Changes in the fetal heart rate patterns seen during fetal monitoring can be used to predict the Apgar score following delivery.

Features:

(1) baseline heart rate

(2) periodic changes

 Heart Rate Points >= 200 beats/minute 3 180 - 199 beats/minute 2 160 - 179 beats per minute 1 101 - 159 beats per minute 0 80 - 100 beats per minute 1 70 - 79 beats per minute 2

where:

• The points in the original tables are negative values, not positive. However, the final point total will be subtracted from the maximum Apgar score of 10.

• Hon and Quilligan give a normal fetal heart rate as 120 - 160 beats per minute (page 783).

• No points are assigned in the tables for bradycardia < 70 beats per minute. In the implementation I assigned 3 points for this.

If the heart rate is:

(1) >= 160 beats per minute, AND

(2) the baseline is smooth

 Periodic Change Finding Points cord compression frequent (with >= 80% of uterine contractions) 1 increasing 2 < 80% of uterine contractions 0 uterine-placental insufficiency present 2 increasing 3 absent 0

If

(1) cord compression is present, AND

(2) the heart rate is < 70 beats per minute

If

(1) uterine placental insufficiency is present, AND

(2) the fetal heart rate is < 100 beats/minute

then add 1 point for each episode.

If

(1) uterine placental insufficiency is present, AND

(2) the fetal heart rate is < 70 beats/minute

then add 1 point for each minute.

where:

• The original tables are somewhat ambiguous for assigning points to the periodic changes. I have used what I have interpreted the tables to mean.

• Cord compression pattern = periodic decelerations in the fetal heart rate of variable shape, which show no consistent relationship to the onset of uterine contractions (variable decelerations).

• Uterine-placental insufficiency = periodic symmetrical decelerations in fetal heart rate beginning characteristically well after the onset of uterine contractions (late decelerations).

points for fetal heart rate changes =

= (points for heart rate) + (points for smooth baseline) + (points for cord compression) + (points for uterine-placental insufficiency) + (points for additional periodic changes)

predicted Apgar score =

= MAX(0,10 - (points for fetal heart rate changes))