FHT question, where is the variable on this strip?

[violet_violet]

Is there just one variable on this strip? I'd say very subtle one from between the time frame 10:19 to 10:20, is that so? Other than that, I don't see any other variable. (You can scroll the strip, left to right....see scroll on the bottom of this strip image)

[Elvish, BSN, DNP, RN, NP]

If you are calling a variable 15x15, then I'd agree with you the only one I see is where you saw it as well. However, depending on the gestation if you are using the 10x10 criteria, then a case could be made for another (also subtle) one at 10:35. That one also (kind of) looks like an early....not a clear call IMO.

[violet_violet]

Thanks, I do see that other subtle variable at 10:35. At this point, what would your interventions be??

[babyktchr, BSN, RN]

I don't know that I would document any variables on this strip. Need to know gestation here because you have some 10x10 accels but no 15x15 to call reactive for >32 week baby. Variability is mod in places and giving credit to the 10x10 accels, you don't have acidemia. You certainly could be turning this mom and hydrating her to see what happens. In this instance (this portion of strip) the one iffy variable I would not concern myself over, me personally. Would certainly have to see how this plays out...

[HeartsOpenWide, RN]

There is no variable here, not by variable definition. Also, notice the strip says category 1; there are no variables with Cat1

Must have ALL criteria:

- baseline rate 110-160 bpm

- baseline FHR variability: moderate

- late or variable decels: absent

- early decels: present or absent

- accelerations: present or absent

Details:

- category I tracings are normal, they are strongly predictive of normal fetal acid-base status (or, in other words, absence of fetal metabolic acidemia) at the time of observation

- category I FHR tracings can be followed in a routine manner, and no specific action is required.

- presence of accels (spontaneous or stimulated) reliably predicts absence of fetal metabolic acidemia; the absence of accels, however, does not reliably predict fetal acidemia

- moderate FHR variability reliably predicts absence of fetal acidemia.

[MKPRN]

There are no variables in this strip. IMO there is not a greater than 15bpm decrease to classify this as a deceleration.

NICHD defines a variable deceleration is as an apparent abrupt decrease in FHR below the baseline, with the time from the onset of the deceleration to the nadir of the deceleration as less than 30 seconds. The decrease is measured from the most recently determined portion of the baseline. Variable decelerations may or may not be associated with uterine contractions. The decrease from baseline is 15 beats per minute or higher and lasts less than 2 minutes from onset to return to baseline. When variable decelerations occur in conjunction with uterine contractions, their onset, depth, and duration may vary with each successive uterine contraction.

[MKPRN]

After looking again, the 10:20 spot may technically be a variable by definition. The baseline looks to be 145 and at 10:20 the FHR drops to 125-130. I would not even treat this, it is a category 1 tracing, continue regular monitoring.

[HeartsOpenWide, RN]

When you hear hooves, don't assume zebras. It's part of the variability....regardless, most are in agreement that they wouldn't even do anything with this strip. Even if it was a variable, I still wouldn't do anything. A single isolated variable isn't much do get excited about in labor. If they were reoccurring, or more than mild, ect, then I'd react.

[HeartsOpenWide, RN]

It's a Lambda pattern

[violet_violet]

I do see the lambda pattern....Majority of the responses say variable.... hmm?

[Fyreflie]

I quite honestly don't think it even matters--there is nothing repetitive or ominous and it's barely countable!