Calling the OB for decels..

SmilingBluEyes · Apr 18, 2007

a LATE IS A LATE.

if anyone is in doubt, that person needs a refresher in FHM classes.

Susgu · Apr 19, 2007

[our docs won't call them late unless they are truely "u" shaped and occur with at least 50% of the ucs (by the new guidelines). if they don't meet that criteria then they are considered variables, and therefore pretty insignificant in their eyes.

what are your thoughts?

my thoughts are that a late is a late is a late! chart it whether there is only one or if they are with every contraction.

i also checked online to see if i could find references with a good definition for late decelerations.

according to american family physician: interpretation of the electronic fetal heart rate during labor (1999):

a late deceleration is a symmetric fall in the fetal heart rate, beginning at or after the peak of the uterine contraction and returning to baseline only after the contraction has ended . the descent and return are gradual and smooth. regardless of the depth of the deceleration, all late decelerations are considered potentially ominous. a pattern of persistent late decelerations is nonreassuring, and further evaluation of the fetal ph is indicated. persistent late decelerations associated with decreased beat-to-beat variability is an ominous pattern. www.aafp.org

fetal heart monitoring principles & practices states that:

late decelerations are quantified by their relationship to the peak of the contraction. the nadir commonly decreases by not more than 10-20 bpm and rarely 30-40 bpm (freeman, garite, & nageotte, 2003). www.awhonn.org

i hope this is helpful!

nurse79 · Apr 19, 2007

THANK YOU! yes i have never heard that one defining critria for lates was whether they were repetitive or not! anyways, i too chart even an isolated late occurence as isolated.

weesyanne · Apr 19, 2007

NIH defines lates as being gradual in onset and that the nadir occurs more than 30 seconds from the beginning of the deceleration. Variables are quick and the nadir occurs less than 30 seconds from its onset. Even if a decel occurs after the peak of a contraction, it isn't defined as a late unless the nadir occurs more than 30 seconds from its onset. I know that isn't official wording or anything, I don't have time at this moment to actually look up the exact wording, since I have to go to work shortly.

Our hospital uses the NIH definition as our criteria in naming what a particular fetal heart rate pattern is. If a baby looks beautiful before and after a decel, I would be hesitant to call it a late for that reason. Most of the time with lates, I see a non-reactive strip that is not reassuring. I don't labor patients on antepartum. I will call if I see anything funky. If a physician doesn't want me to call them, then they shouldn't order continuous fetal monitoring, the way I look at it. :trout:

NPinWCH · Apr 20, 2007

NICHD definition of Late Decel:

Visually apparent gradual decrease (onset to nadir is ≥ 30 sec.) of FHR below baseline. Return to baseline with a uterine contraction. Nadir of deceleration occurs after the peak of the contraction. Generally, the recovery of the deceleration occur after same time as the onset, peak, and recovery of the contraction.

NICHD defintion of Variable decel:

Visually apparent abrupt decrease (onset to nadir is

So using those, as our docs do, any decel that drops to it's lowest level (at least 25 bpm) in under 30 seconds, but lasts at least 15 seconds is a variable, regardless of WHERE it occurs in relation to the UC. Any decel that takes 30 seconds or more to reach it's lowest level, occurs after the UC and lasts about as long as the UC is a late.

Our docs fine tooth comb those decels and if they don't meet ALL of the definition for late...then they ain't lates. I don't fully agree with all the NICHD guidelines, BUT that's what they go by and they have that big organization backing them up.

On the other hand, every study ever done on continuous fetal monitoring shows that they don't improve outcomes only increase the C/S rate. We've all been taught "treat the pt, not the monitor" but in these situations all we have is the monitor...so what do you do???????

Elvish, BSN, DNP, RN, NP · Apr 20, 2007

On the other hand, every study ever done on continuous fetal monitoring shows that they don't improve outcomes only increase the C/S rate. We've all been taught "treat the pt, not the monitor" but in these situations all we have is the monitor...so what do you do???????

Throw the stinkin' monitor out the window!!! (yeah right....)

SmilingBluEyes · Apr 21, 2007

Sad thing is, fetal heart monitoring increases have not improved outcomes in any significant manner. It's a legal nightmare.

newyorknursey · Apr 21, 2007

remember your licence is on the line, and the baby's life- doctors who want to chew someone out are going to do it no matter what eventually. NEVER let that fear make your decision. That said, I would let my charge nurse know first when i see a late, and remember everyone will read a strip differently- if your gut says call, then call- no matter what anyone says, because you will be the fall guy if it comes to that- not the charge nurse or the doc that you never informed- it's your opinion of the strip that matters most because they are your patients.

Belinda-wales, RN · Apr 28, 2007

For what it is worth - here are my thoughts - every situation is different you have to look at the whole clinical picture for example we had a primip who was in early labour who had one three min decel with slow recovery to base line did interventions trace recovered - but I asked the nurse to inform the doc so he is kept in the communication loop so if things turn more worring he already has a clear picture and there are no surprises to blam on the nurse. I have a lot of respect for Ob nurses what they have to but up with off some of the docs but i never let them affect my care after all the nurse is the acvocate for that patient if you feel you need to call then call- the Doc wll get over it!