Nursing Student needs help with Fetal Monitoring Question.

  1. We are doing our Maternal-Newborn rotation this semester, I am so excited cause this is where I want to work. Since I am so interested in this field of Nursing I want to know everything that there is to know. I have been studying fetal monitoring strips and Know that Variable Decelerations are caused by Umbical Cord compression. Today in class we were talking about Prolapsed Cord and the Teacher kept saying that this would show as a Late deceleration. I understood late decels to mean Uteroplacental Insufficiency. Our book said that Prolapsed cord would show Variables, When I questioned my teacher in reference to this, she stuck with her explanation that it would show as late decels. Help, I thought I had it all figured out, but Now she has totally confused me. I understood that a Late decel is a gradual deceleration of the fetal heart beat, whereas a Variable is a Rapid Deceleration. Please Help.

    PS. If any of you could recommend any good web sights in reference to OB Nursing, I would be greatly appreactive.
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  2. 9 Comments

  3. by   SmilingBluEyes
    Decelerations happen. The TYPE depends on when and how severe and if they recover. OK...EARLY decels happen right before or during, the contraction. The END BEFORE THE CONTRACTION DOES. These often signal head compression and fetal decent. Provided the heartrate returns to baseline and there is good variability, these are NOT NON-REASSURING.

    Variable decels, dip and almost seem to "mirror" the nadir of a contraction. They occur during the contraction and often get lowest at the nadir, or peak of the contraction then they rise. Again these can mean different things. Often variable decels are due to cord compression or nuchal cord (around fetal neck)..and provided they recover to baseline and good variability exist, I dont' freak out, but I DO WATCH THEM CAREFULLY. Variables should also not "overshoot" the baseline, eg, end and then see hte heart rate JUMP UP much higher. You may see "shoulders" around each variable. This is reassuring as long as the baseline and beat to beat variablity remain normal.

    LATE decels start during or after the contraction....they END AFTER THE CONTRACTION. These are often quite ominous. These can be due to so many physiological conditions, but suffice it to say, if they are repeated, a nurse will be calling the dr/midwife to report these and watching them VERY CAREFULLY.

    Persistent deep variable and late decels are NOT reassuring and if a patient is on pitocin, it is shut off. The patient is placed on left lateral position and oxygen by mask at about 8-12 L is applied. Sometimes, an IV fluid bolus is adminstered to "cushion" the fetus, especially if her water is broken or she may be dehydrated. To explain each and every reason decels occur is much too much to get into here. I hope this helps explain a bit more. Any more questions, pls PM ME! Good luck in clinical and in school!
  4. by   shay
    The times when I have seen a cord prolapse 'happen' on the monitor, first I saw a HUGE, DEEP variable decel, then the FHR just crashed.

    That's been my experience, anyway. {{shrug}}
  5. by   fergus51
    FH monitoring is not an exact science anyways. You can't really say "A prolapsed cord will always cause _____". FHR monitor interpretation differs from nurse to nurse and doc to doc anyways.
  6. by   SmilingBluEyes
    agree w/fergus and shay. < NO SET RULES> but a cord prolapse always looks BAD on the monitor in the experiences I have seen and heard of (I have not seen too many thank God) But it looks....real bad. anytime you see a NON REASSURING tracing , the wise thing is to intervene and check it out!

    It is absolutely true, prolapsed cords do not always present the same way.....and sometimes what you are seeing on the monitor is something else...like a true KNOT in the cord, or an occult placental abruption....many things can cause a bad tracing...sometimes, you don't know WHY when the baby comes that it looked so bad "inside".....when they score high apgars and go on to do well in recovery. it happens. my guess, is sometimes, it is only the baby telling you he/she does not want to be IN THERE ANY MORE. somehow, the intrauterine environment has gotten hostile.

    ....but hey that is another thread. This is WAY too complicated to cover here.
  7. by   Nurse2BinNC
    [QUOTE]Originally posted by shay
    [B]The times when I have seen a cord prolapse 'happen' on the monitor, first I saw a HUGE, DEEP variable decel, then the FHR just crashed.

    Shay that is what may book says and what my clinical instructor says(who is studying to be a nurse/Midwife)


    Thanks Shay, Debbie and fergus, I know it is not an exact science, but as a student and for test purposes, it is really confusing when the instructors keeps changing her account of things. That is why I decided to come and ask the experts that work with it everyday.
  8. by   SmilingBluEyes
    I hear you Tammy. the frustration factor can be HUGE in nursing school. hang in there....we are here for you.
  9. by   HardDaysNight
    The few times that I've had a prolapsed cord, the FHR dipped rapidly (like a variable), then just stayed down. But, I've had that same thing happen, and it be something else. Like everyone else mentioned, its just going to depend on the situation. Good luck to you!
  10. by   mother/babyRN
    In my experience, when you hear the ominous "doot doot" of a failing fetal heart and actually see it on the monitor, you usually don't waste any time trying to figure out what sort of deceleration it is- you rush in, intervene quickly (as with iv fluids, position changes and oxygen), get the fh to recover at least somewhat, do a vaginal exam if it is warranted and glean your info from all of that interventive stuff. You can feel a prolapsed cord, often, and in that case, leave your hand inside the woman in order to lift the cord from the infant head, and you remain in that position until and during the mad rush to the or for the stat c/s. Unless you are in the beginning or midpoint of a labor where there are few dilatation changes but many decelerations, you probably aren't going to diagnose the strip until afterwards...Just keep in mind that nothing is written in stone. You can have a cord prolapse with out a late decel. And remember, a cord prolapse would, in effect, cause a uteroplacental insufficiency...Learn the basics and don't worry. It is important to know, but the experience you develop by actually participating, listening and examining strips will get you where you need to be...If you can, attend a fetal monitoring course or ceu program. They always have neat examples to talk about and show....Expect the unexpected....Always.....Good luck!
  11. by   ADN 2002
    Just wanted to share my story...

    I'm a GN working in my first job on an OB floor. My first day in L&D was this past Monday and we were monitoring this woman that was 4cm and doing nicely. All of a sudden the FHR crashed: no prolapsed cord, nothing we could see from the outside that would indicate such a response from the fetus. We did all the usual interventions for this (she was on pit, we of course stopped that, turned her and put her on oxygen) but the baby continued to be in the 50's. We did a stat c/s and the apgars were 9 and 9. Cord wasn't around the neck, placenta looked normal, so did the uterus.

    Kinda scary for the 1st day in L&D (hasn't chased me away though, L&D is still what I want to do).


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