variable decels...Thoughts?

perfexion, ASN, RN · Sep 20, 2014

Variables are common in pretermers. I would still make note of it but I wouldn't be majorly concerned either.

BSNbeauty, BSN, RN · Sep 20, 2014

Thanks

NurseNora, BSN, RN · Sep 21, 2014

Especially with ruptured membranes. Decreased amniotic fluid volume makes it easier to compress the cord. Variable decelerations in this patient are not a surprise, but pre term babies will go downhill faster than term babies, so the monitoring is a good idea.

AvaRN22, MSN, RN · Sep 21, 2014

I worked on an antepartum floor where we had a number of longterm PPROM patients. If they made it past the 24 hour period of ROM, they did very well and stayed on our unit for months sometimes. The variable decels were almost the norm in these patients, d/t the decreased amniotic fluid which made it cord compression easier (as NurseNora mentioned in the post above). We would just reposition the patient to get the baby off their cord and monitor longer to ensure that the tracing was reassuring (i.e. 15x15 accels x2, moderate variability) one hour after the last deceleration. If more frequent, prolonged, or deeper decelerations occurred or absent or sustained minimal variability occurred (and pt previously had moderate variability), that would concern me and I would call the MD. Sometimes the MD would order an LR bolus to hydrate the patient and that fixed the problem.

Elvish, BSN, DNP, RN, NP · Sep 23, 2014

In 9 years of antepartum nursing, I've learned to not get too wigged out by the occasional variable. God only knows what those PPROM kids are doing with their cords in there. (TBH, I'm surprised more of them don't prolapse.) Every now and then with otherwise good variability and/or accels present would not be concerning. If they lasted 90 seconds as you described the story might change a little.. Pretermers don't have the reserves that full-termers do, so if they are repeated or prolonged they usually get transferred to L&D for continuous EFM.