Which of the following best describes Category II fetal tracing?

• A. Indeterminate
• B. Normal
• C. Abnormal with distress
• D. Not interpretable

Answer: (A)

Category II fetal tracing is an indeterminate pattern that sits between reassuring (normal) and clearly ominous (abnormal with distress). It doesn’t meet all the criteria for a normal tracing, but it also isn’t in a clearly distressed category. You’ll see patterns that are not clearly reassuring—for example, variability that is present but uneven, occasional decelerations that don’t fit the criteria for Category III, or a baseline heart rate that is largely normal yet with some ambiguous features. Because it’s not clearly normal or clearly abnormal, the student should understand that this tracing requires continued observation and possibly additional testing or interventions to clarify fetal status. Management focuses on ongoing monitoring, addressing reversible factors such as fetal position, maternal hypotension, or oxygenation, and considering further assessments (like nonstress testing, vibroacoustic stimulation, or fetal scalp sampling when appropriate) if concerns persist or worsen. If the tracing evolves to clearly abnormal features—such as recurrent late decelerations, repetitive severe variable decelerations, or a significant decrease in variability with distress signs—that would move into a Category III pattern requiring urgent action. Not interpretable would be used only when the tracing cannot be read at all due to artifacts, not when it is ambiguous but still interpretable.