January 23, 2010

"Nonreassuring" Vocabulary

The word "nonreassuring" is a curious phenomenon of OB/GYN.  Nowhere else is this particular word used in a professional context... which is embarrassing that the word is cited in literature when it doesn't exist.


Reassuring is defined thusly:

tr.v. re·as·sured, re·as·sur·ing, re·as·sures

1. To restore confidence to.

2. To assure again.

3. To reinsure.

The implication is that "nonreassuring" means the opposite -- worrisome, vexing.  Of course, to a pregnant mother about to deliver, that's some of the scariest news to hear about her unborn child!


In an effort to further obscure the assessment in Fetal Heart Tone monitoring, in April of 2008 the "National Institute of Child Health and Human Development Workshop Report on Electronic Fetal Monitoring" issued a new statement to categorize it in a "Three-Tier Fetal Heart Rate System:

Category I
Category I fetal heart rate (FHR) tracings include all of the following:
• Baseline rate: 110–160 beats per minute (bpm)
• Baseline FHR variability: moderate
• Late or variable decelerations: absent
• Early decelerations: present or absent
• Accelerations: present or absent

Category II
Category II FHR tracings include all FHR tracings not categorized as Category I or Category III. Category II
tracings may represent an appreciable fraction of those encountered in clinical care. Examples of Category II
FHR tracings include any of the following:
Baseline rate
• Bradycardia not accompanied by absent baseline variability
• Tachycardia
Baseline FHR variability
• Minimal baseline variability
• Absent baseline variability not accompanied by recurrent decelerations
• Marked baseline variability
• Absence of induced accelerations after fetal stimulation
Periodic or episodic decelerations
• Recurrent variable decelerations accompanied by minimal or moderate baseline variability
• Prolonged deceleration 2 minutes but 10 minutes
• Recurrent late decelerations with moderate baseline variability
• Variable decelerations with other characteristics, such as slow return to baseline, “overshoots,”
or “shoulders”

Category III
Category III FHR tracings include either:
• Absent baseline FHR variability and any of the following:
- Recurrent late decelerations
- Recurrent variable decelerations
- Bradycardia
• Sinusoidal pattern

Basically, Category I is "reassuring", Category III is "Nonreassuring" (ugh) and Category II is somewhere in between.


Personally, I don't like it when the assessment of a patient needs to be translated for the patient's benefit -- why is there a deliberate effort to make something difficult to understand even harder to explain to patients?!?  We don't need to tell someone what they already know, but in a completely different language.


It's doubtful, but in the future it could be categorized as "good," "hmm" and "uh oh."


DR C BRaVADO: mnemonic for Fetal Heart Monitoring

Define Risk (low/high)
Contractions (freq)
Baseline Rate (110-160)
Variability (10-15bpm)
Accelerations (2, >20 over 20s)
Decelerations (early/variable/late)
Overall assessment (reassuring vs "nonreassuring" ugh!)



Advanced Life Support in Obstetrics (ALSO)

AAFP website

AAFP Mnemonics brochure

National Institute of Child Health and Human Development Workshop Report on Electronic Fetal Monitoring

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