A reliable indicator of fetal oxygenation is fetal

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AWHONN and NICHD definitions state that fetal accelerations are a strong indicator of adequate fetal oxygenation and neurologic integrity. Accelerations reflect intact sympathetic and parasympathetic balance and adequate oxygen reserve.

Simpson & Creehan emphasize accelerations as “the most reliable sign of fetal well-being,” because they require intact autonomic function, sufficient pH, and adequate oxygenation. Menihan also identifies accelerations as the most reassuring feature on a fetal heart tracing.

Fetal movement is helpful but not directly reflective of oxygenation, as movements can decline for non-hypoxic reasons (sleep cycles, maternal sedation). Regular sleep–wake cycles are normal developmental neurologic patterns and not oxygenation markers.

Creasy & Resnik reinforce that “presence of accelerations reliably indicates absence of metabolic acidemia.”