Charting Accelerations

jrring1019 · May 20, 2008

Yes, I chart those accels as accels present. Accels , even with contractions are a sign of fetal well being.

Elvish, BSN, DNP, RN, NP · May 20, 2008

What jrring said - if accels are present, they are present regardless of what the uterus is doing.

babyktchr, BSN, RN · May 20, 2008

Although accels do represent fetal well being, be careful when your accels coincide with your contractions. (recurrently). This could be a sign of umbilical vein compression which in turn stimulates baro and chemo receptors which increases heart rate to compensate for the changes in pressure and oxygenation. If you see this consistently, you may just want to turn your patient, and most times they resolve. Its cord compression without vein AND artery compression. Its the "shoulder" before a variable, without the variable component.

nurse79 · May 21, 2008

Thanks for your input..i just wanted to make sure that I was charting correctly. Just to make sure, how long do you wait to call ad doc if your baby does not have any 15x15 accels (NO MEDS on board) but has moderate varibility (no decels?)... just wondering

thanks!

Elvish, BSN, DNP, RN, NP · May 21, 2008

Thanks for your input..i just wanted to make sure that I was charting correctly. Just to make sure, how long do you wait to call ad doc if your baby does not have any 15x15 accels (NO MEDS on board) but has moderate varibility (no decels?)... just wondering

I think it would vary depending on the situation. Fullterm fetuses can have up to 90-min sleep periods where their strips might not be as reactive as we'd like. Sometimes meds that we wouldn't normally associate with variability - bethamethasone, f.ex. - can cause a difference, so keep that in mind. If baby is less than 32 weeks, they don't have to have a 15x15 accel (I'm sure this is not news to you, am just using the example).

Anyway, long story short, 90 minutes is the most I've seen them let a fullterm (or close to term 34-35ish weeks) baby go without an accel and them not worry. Depends on the doc too.

I am hoping someone more coherent than I comes along....it's almost 0100 and I should be asleep by now! :bugeyes:

babyktchr, BSN, RN · May 21, 2008

Moderate variability without accels....baby is still not acidemic and has reserves left, but in the cascade, you lose your baby movements, then your accels, then your variability. Ask your patient if she has felt the baby lately, turn her, hydrate her and see what happens....perhaps acoustic stim or something to elicit an accel. If all of your interventions fail, I, personally would be chatting with the provider.

Some things to ask also....what is your uterus doing? Are they on Pit. Is there a hyperstim thing going on? IUGR baby? H&H of mom (is she anemic)?

I am sorry, I rant on here. :twocents:

eandgsma · May 21, 2008

Babyktchr,

Can you tell me what would be seen on the strip with an IUGR baby? A podmate of mine had one the other day and it was pretty flat most of the night, still had mod variability but no qualifying accels.

- N

babyktchr, BSN, RN · May 22, 2008

IUGR babies generally have decreased placental perfusion(sometimes up to 50%) and from the get go have decreased oxygen reserves. Any stressor to this baby will deplete what there is rather rapidly. These babies are very fragile, and should be handled delicately, especially when we are inducing. Now, I know that most times these moms are brought in BECAUSE they have an IUGR baby, but blowing the kid out with pit really does no one any good. A gentle induction is more prudent, lest you get a dish rag upon delivery. The baby you describe has moderate variability, which is telling you that it has SOME reserve left, but really needs careful assessment and intervention to keep it a happy baby. Maximizing that placental perfusion is key (fluids, position). Also, with these moms...look at that H&H. Is mom anemic and could that be aiding in oxygen transport issues with this kiddo?

Not every IUGR baby presents this way, believe me. I have seen great strips on "IUGR" kids. You just have to manage them well during labor to get a great kid after delivery.