LABOR AND DELIVERY

FETAL MONITORING INTERPRETATION

Student Name: Allie Jones

Type of deceleration Cause Treatment

Early deceleration As the fetal head is No nursing interventions are needed as the
compressed an altered head is most likely just being compressed
A transient decrease in fetal cerebral blood flow during the beginning of the contraction
heart rate, dipping in decreasing the HR (vaso causing a decrease in HR; report this
conjunction with & vagal reflex); contractions finding to MD and continue to observe the
mirroring uterine then cause the fetal head to FHR.
contraction; the shape will be subjected to stimuli of the
be that of a U on the EFM vagus nerve.
tracing – just like a
contraction.

Variable deceleration Initially due to vaginal If the variable decelerations occur prior to
stimulation resulting in the second stage of labor, the treatment can
Variable decelerations compression of the umbilical include saline amnioinfusion. The nurse
which fluctuate in intensity, cord, but repetitive variable will also want to alleviate cord
duration and relation to decelerations may be due to compression by having the woman get into
uterine contraction; they significant fetal hypoxia a lateral, knee-chest or supine position to
appear V or U shaped. and/or acidosis. release the cord. With recurrent
decelerations during the second stage,
pushing should be modified to fetal
response, and possibly only every other, or
every third contraction to increase blood
flow to fetal and allow it to recover
between contractions.

Late deceleration Uteroplacental insufficiency Nursing interventions should include

is a compromise of the blood placing the patient on her side, providing
Repetitive, persistent, flow to the fetus. This causes 02 by NRB mask, discontinuation of
smooth, symmetric decrease the amount of oxygen Oxytocin and correction of any
in HR occurring at or after received by the fetus to be hypotension. If the decelerations are
the peak of uterine inadequate, and the stress of associated with uterine tachysystole, the
contraction; decelerations labor may not be able to be MD may order Terbutaline SC, beta-
are down to 90 bpm. A endured. sympathomimetics IV, or magnesium
return to baseline only sulfate IV. If decelerations continue despite
occurs after the end of the all treatment efforts, emergency delivery
contraction, and recovery may be necessary.
can be slow.

Variability: Fetal HR variability is fluctuations, and normal irregular changes seen as an

irregular HR seen on the fetal heart tracing, instead of a smooth line; the baseline rate should
vary between 10 – 15 beats over one minute. The variation in beats causes a jagged tracing, but
is positive due to its indication of maturity of the fetal neurologic system, and the additional
suggestion of fetal reserve. Variability is the most important indicator of an adequately
oxygenated fetus.
Types of variability:

• Absent: less than 2 bpm; this is a possible indication of fetal hypoxia especially if it is
associated with late or severe variable decelerations.
• Minimal: less than 5 bpm; a normal variant may possibly be related to sleep cycles, drugs
or prematurity. It is uncommon, but possible, for it to be related to hypoxia.

• Moderate: highly correlated with the absence of significant metabolic acidosis, and is an
indication that the fetus is maintaining tolerance to the changes in blood flow occurring
during labor; fluctuation in the FHR baseline of as little as 6 bpm to as much as 25 bpm.
• Marked: is the presence of more than 25 bpm of fluctuation in the FHR, usually seen
only in intrapartum.