Ambulatory Fetal Heart Rate and Rhythm Monitoring for Pregnancies at Risk for Fetal Arrhythmias: Perspectives from the Fetal Heart Society.

Fetal arrhythmias, including tachycardias, bradycardias and irregular rhythms, may require close surveillance and management to prevent fetal heart failure, premature delivery and stillbirth. With early detection and appropriate management of pathological fetal rhythms, 90-95% of fetuses with even high-risk arrhythmias are live-born and can be delivered at term gestation. Fetal heart rate monitoring (FHRM) is a feasible method for ambulatory detection of new-onset or recurrent arrhythmias. When indications for FHRM are met, prescribed monitoring, guided and supported by the healthcare team, can empower pregnant individuals in the management of their pregnancies. Despite several studies showing utility of ambulatory FHRM, fetal cardiologists and perinatologists face challenges in successfully implementing FHRM programs. Under the auspices of the Fetal Heart Society, the Fetal Cardiology Program Leaders Committee formed a writing group to develop a consensus-based ambulatory FHRM process to be used as a guide for providers caring for pregnancies complicated by or at risk of manifesting fetal arrhythmias.