Summary of Dr. Chapa’s Clinical Pearls

Episode: New Intrapartum FHT Guidance: Oct 2025 CPG 10

Date: September 21, 2025
Host: Dr. Chapa

Episode Overview

This episode covers the imminent release of ACOG’s new Clinical Practice Guidance (CPG) Number 10, set for October 2025, which focuses on intrapartum fetal heart rate (FHR) monitoring. Dr. Chapa breaks down what’s new (and not so new) in this guideline, with a practical, evidence-based review for clinicians. The core of the episode revolves around three main points in the new guidance: the role of intermittent fetal monitoring, updated recommendations on maternal oxygen administration, and the official stance on artificial intelligence (AI) for FHR interpretation in labor.

Key Discussion Points & Insights

The Ubiquity and Limitations of Fetal Heart Rate Monitoring

• Continuous fetal heart monitoring is deeply embedded in labor management, despite not reducing rates of neonatal death or long-term neurological issues.
• Some benefit exists for continuous monitoring (notably, in reducing immediate neonatal seizures), but data show increased rates of operative deliveries (both vaginal and cesarean) without decreasing mortality.
• “We are stuck with continuous electronic fetal monitoring.” (04:30)
• Despite discussions about multi-tier systems, the three-category system (I, II, III) remains the standard.

[07:30] Overview: What’s in CPG 10?

Quote: “In October of 2025, so in about two weeks, ACOG is releasing its new clinical practice guidance on intrapartum fetal heart rate monitoring, interpretation and management.”
— Dr. Chapa (07:30)

ACOG’s CPG 10 doesn’t fundamentally change core definitions, but it gives official direction on:

1. When intermittent monitoring is appropriate
2. The role (or lack thereof) of maternal oxygen for rescue
3. Current evidence on AI in fetal tracing interpretation

1. [13:00] Intermittent Auscultation: When and for Whom?

• Intermittent auscultation is acceptable—but only in low-risk patients (no oxytocin, no prior cesarean/TOLAC).
  • Quote: “Intermittent auscultation may be used during labor for patients at low risk of fetal acidemia who are not receiving oxytocin.” (14:58)
• Continuous monitoring is recommended for TOLAC (trial of labor after cesarean) per previous ACOG guidance (PB 205, Feb 2019) and for patients on oxytocin.
• Recommended intervals:
  • Active first stage: Every 15–30 minutes
  • Second stage: Every 5–15 minutes
  • Use a handheld Doppler during the contraction and for at least 30 seconds after.
  • Caveat: Optimal frequency is not rigid; guidance is based on consensus from ACNM and AWHONN.
• Document recordings for accountability and clarity.
• “Most providers are comfortable with continuous […] but in the appropriately selected low risk patient, which means not on Pitocin and not a TOLAC, then intermittent auscultation can be performed with those time guidances.” (24:13)

2. [28:00] Maternal Oxygen as a Rescue Measure: JUST SAY NO

Quote: “ACOG recommends against— that means don’t do it— routine maternal oxygen administration for category 2 or 3 fetal heart rate tracing in the absence of maternal hypoxia.” (28:50)

• Supplemental oxygen has been widely used as a ‘rescue’ measure for non-reassuring FHR strips, but new guidance makes it clear: Don’t do it unless the mother is hypoxic or obtunded.
  • Risks: For preterm infants, excess oxygen can generate free radicals, possibly causing harm (e.g., to the germinal matrix).
  • Evidence: No improvements found in pH, Apgar, or NICU admissions when oxygen is used without maternal hypoxia.
  • Correction strategies: Reduce contraction frequency (if tachysystole), IV fluids, maternal repositioning—not oxygen.
• “The idea of, well, it can't hurt and it could possibly help is wrong on both counts.” (29:15)

3. [34:15] Artificial Intelligence in FHR Interpretation

Quote: “The ACOG recommends against primary reliance on computerized approaches for the interpretation and management of the fetal heart rate in labor.” (35:12)

• AI is promising in medicine (notably in image-based tasks like mammography), but for FHR interpretation, it’s not yet ready to guide clinical management.
  • Systematic reviews/meta-analyses (>55,000 patients): No improvement in neonatal outcomes with AI use for intrapartum FHR interpretation.
  • Current recommendation: Use AI as an educational/research tool, not as the primary basis for management.
  • Vendor warning: No professional endorsements yet for any commercial AI FHR interpretation products.
• “Maybe use this as an ancillary […] but it should not be relied on as the primary interpretive tool.” (36:10)
• “At this time there are no clinical trials that support the notion that computer based fetal heart rate interpretation improves neonatal outcome.” (36:51)

Note: STAN (ST segment analysis) also not endorsed

• Early hope, but not recommended due to lack of reproducible benefit: “We recommend against its use because it’s just not reproducible and doesn’t really change any outcome.” (38:10)

[11:35–13:00] Notable Clinical Stories: “Three Saves”

Dr. Chapa shares three acute cases emphasizing the importance of rapid and accurate FHR interpretation:

• Case 1: 29-weeker with severe preeclampsia; classic Category III tracing—OR in 20 minutes, baby saved (cord gas pH 6.9).
  • “20 minutes more at the house, this child could have died. That was a save.” (12:24)
• Case 2: Abruptio placentae (teenager, primigravida); rapid identification, delivery in 25 minutes, Apgar 1 at 1 min, 8 at 8 min.
• Case 3: Anticipated shoulder dystocia avoided by identifying macrosomia (4.5 kg) in diabetic mother—planned cesarean, uncomplicated delivery.

Takeaway: Knowing and promptly responding to FHR categories is literally lifesaving.

“Not today, Satan. Not today. Those are three saves.” (13:12)

[42:10] Memorable Quotes & Moments

• “What has been will be again. What has been done will be done again. There is nothing new under the sun. Is there anything of which one can say, look, this is something new? It was here already long ago.” (06:45, quoting Ecclesiastes)
• “Even though continuous monitoring has issues, it allows for easier interpretation, it allows for a better record.” (22:49)

[41:00] Episode Wrap-Up

Key Takeaways:

• Intermittent auscultation is okay, in select, low-risk cases without oxytocin or TOLAC, at recommended intervals.
• Do not use maternal O2 for FHR rescue in the absence of hypoxia.
• AI/computerized tools for FHR are not ready or endorsed for primary clinical decision-making.

Dr. Chapa closes with gratitude for his team’s hard work and a preview of continued in-depth, no-spin reviews of new women’s health publications.

For Listeners

For deeply practical, up-to-date, and always entertaining clinical guidance on women’s health, keep tuning in to “Dr. Chapa’s Clinical Pearls”!