Early, late, and variable deceleration help!

[springchick1, ADN, RN]

I just want to make sure that I am understanding this:

Early Deceleration happens at the onset of the contraction and will return to baseline FHR by the end of the contraction.

Late Deceleration happens after the start of the contraction and returns to baseline after the contraction. This is always considered bad.

Variable Deceleration occurs suddenly and resolves abruptly and may or may not be associated with contractions. A slow return to baseline FHR is considered bad.

Is that correct or am I totally misunderstanding everything? Thanks for the help!

[Esme12, ASN, BSN, RN]

This is so not my strong suit........but this reference should help....Electronic Fetal Heart Monitoring

[springchick1, ADN, RN]

Thank you so much! It was very helpful:)

[jenndavis]

Thanks for the link. I'm going through family focus right now too, and this monitoring business can become confusing.

[SubSippi]

Have you heard of veal chop? Probably the most helpful pneumonic I learned in school....

V.ariable = C.ord compression

E.arly = H.ead compression

A.cceleration = O.kay

L.ate = P.lacental insufficiency

Veal chop!

[threelilies]

VEAL Chop is what I learned as well. And it all makes sense if you think about what's happening. An "early decel" is the uterus squeezing the fetal head, right, so that's always going to happen. The kid gets a little freaked out by the pressure but when the pressure goes away everything goes back to normal. "Late decel" is where the fetal heart rate drops after the peak of the contraction so it isn't uterine pressure causing it. In that case it's hypoxia from the pressure on the placenta. If the placenta is compromised, the fetus can't survive long, so that's bad.

"Variable decels" just mean that the fetal heart rate is dropping quickly at some point not necessarily related to the contractions. If it's not contractions, then it must be something pressing on the cord, right? If the cord is just pressed up against the fetus when it moves (or something similar) the heart rate will drop quickly, quickly return to baseline and all is well. If the cord is being compressed by prolapse or something that is not going to be relieved quickly, then the heart rate will drop fast but not return to baseline because the compression keeps happening. In that case we're back to hypoxia and bad outcomes. So Variable decelerations could be nothing to worry about or they could be very bad... it all depends on the situation.

Acceleration is almost always good. It means the kid is getting plenty of oxygen and is tolerating it's environment well.

Does this make sense?

[Saalbunch]

There is a great app that I use with my students to help understand EFM. It is called Fetal Heart Rate Monitoring and it is free through the apple app store. Great tool!

[springchick1, ADN, RN]

VEAL Chop is what I learned as well. And it all makes sense if you think about what's happening. An "early decel" is the uterus squeezing the fetal head, right, so that's always going to happen. The kid gets a little freaked out by the pressure but when the pressure goes away everything goes back to normal. "Late decel" is where the fetal heart rate drops after the peak of the contraction so it isn't uterine pressure causing it. In that case it's hypoxia from the pressure on the placenta. If the placenta is compromised, the fetus can't survive long, so that's bad.

"Variable decels" just mean that the fetal heart rate is dropping quickly at some point not necessarily related to the contractions. If it's not contractions, then it must be something pressing on the cord, right? If the cord is just pressed up against the fetus when it moves (or something similar) the heart rate will drop quickly, quickly return to baseline and all is well. If the cord is being compressed by prolapse or something that is not going to be relieved quickly, then the heart rate will drop fast but not return to baseline because the compression keeps happening. In that case we're back to hypoxia and bad outcomes. So Variable decelerations could be nothing to worry about or they could be very bad... it all depends on the situation.

Acceleration is almost always good. It means the kid is getting plenty of oxygen and is tolerating it's environment well.

Does this make sense?

Yes! Thank you so much! Labor and delivery has just REALLY confused me but this helps tremendously!

[BriManRN]

Have you heard of veal chop? Probably the most helpful pneumonic I learned in school....

V.ariable = C.ord compression

E.arly = H.ead compression

A.cceleration = O.kay

L.ate = P.lacental insufficiency

Veal chop!

This helped me soooo much when I was studying!

[bear14]

Veal Chop was a great reminder! I had forgotten some of that! Thanks!