Case of the mistaken stat C/S or my mistake?

[epiphany]

We wheeled in a pt for c-stat, and I think it might have been a mistake. I hope I didn't do anything stupid. Please let me know what you think:

Pt was 30 y.o. G1P0 wks, came in for mild contractions. Hx of drug use. FHR was 140-150, average LTV, no accels, no decels, but one that just goes along the track horizontally. Not the prettiest tracing, but nothing that is non-reassuring. Pt keeps sitting up intermmitently to make a phone call, and I would get her HR on the tracing- her pulse was around 75. I felt there was nothing to worry about.

Resident comes in to speak to her. She sits up and the resident is suddenly alerted to the "decel". I said that's the mother HR. She listens for a few seconds, and suddenly announces that it NOT the mother HR, and calls for a stat c/s. We wheeled her in there, and sure enough when put on the monitor, the baby's baseline is back to 140-150, no accels, no decels. They go ahead with the surgery anyway.

I know what I should have done. I should have taken her pulse to prove my point. But I didn't probably because I kinda panicked and got worried that I might have been wrong.

In reviewing the tracing, and the incidents leading up the surgery, I am pretty sure I am right, but now, there's no way to know for sure without taking the mother's pulse. My question is, can a decel tracing look like a sudden jump from a horizontal baseline to a horizontal 70's and then back to baseline again? Her movement may have caused the decel, but it just doesn't look like the behavior of a decompensating baby. The decompensating is always a progression, right? It always looks like a dip, whether it's a slow dip or a sudden dip, right? This baby showed no signs of stress for the last two hours that she came in. I was just so sure...

[ladylabor]

I have made it a habit in my practice to record mother's heart rate with pulse oximeter always. It is an annoyance for most mothers but i would rather trace mom and baby at the same time and not mistake the fht's for mht's. This is actually the only way to cya when that "decel" appears.

[SC RN, RN]

Out of habit, I always put a pulse ox on the mom to get her heart rate whenever I have even the slightest doubt about who's heart rate I am tracing. Takes only a sec and clear up quite a bit of wondering.

On another note, a "flat" heartrate is not reassuring. Even though you are seeing nothing negative (decels, dips, etc) you are still seeing nothing positive ... therefore it is a nonreassuring FHR. I always compare a tracing to what we would expect to see on a NST ... and if it doesn't pass the NST, then something needs to be looked at closer.

Don't ever second guess what you did, though, because it's done now and can't be taken back. Learn from it and you'll be a better nurse. Period. :heartbeat

[RNnL&D]

My question is, can a decel tracing look like a sudden jump from a horizontal baseline to a horizontal 70's and then back to baseline again?

No, not usually. You are right, it generally looks like a progressive dip. Anytime the monitor loses contact, the FHR should be confirmed against mother's pulse, to be sure. You said the resident listened. Like stood there and listened to the monitor or actually adjusted Mom's position and the EFM, then listened? IMO, before deciding on a stat CS, FHT should be confirmed, bt you're right, there's no way of knowing w/o checking maternal pulse.

Don't beat yourself up about it, just make it a point from now on to compare the two. Then you won't worry yourself unnecessarily.