help with fetal monitoring

[mommy2BCD]

Hello everyone,

This past week was my first week in L&D and so far ILOVE it!! I am excited to get to the point where I understand things more. I came from an ICU background so I have a lot to learn. I will be attending a fetal monitoring class in December but in the mean time I need some help. My preceptor has explained fetal monitoring a little to me, but I need more. Can you tell me about decels, accels, variability, etc.?? I am kind of lost. I also have NO idea how to do a SVE and have done some research here on that as well. I feel like SVEs are so hard. I have no idea what I am feeling except for baby's head. I know everything comes with time so I am trying not to be too hard on myself. There is so much to learn.

[short1978]

I also loved my Labor and Delivery rotation and was blessed enough to get to do my senior practicum there as well.

Anyway...here is a way that helped me w/ decels

VEAL CHOP

V: Variable C: Cord Compression

E: Early H: Head Compression

A: Accelerations O: Okay

L: Late P: Placental Insufficiency

Just remember:

Earlys are okay and no intervention taken, natural for head to be compression DURING contractions. The compression will mirror the contraction.

Lates, bad

Variables, not good. They resemble letter U, V, W on the strip

Accellerations need to be 15 x 15 for a full term preg...15 bpm higher for 15 seconds in duration

[short1978]

As far as exams go....ask if the facility has any teaching material. The hospital I did my senior practicum had a "lady parts in a box" according to them. Basically you stick you hand in and ck dilation. They also had individual squishy cervix at different dilations to practice with. And a Leopold Maneuver stomach...so you could feel the baby inside and get a feel for which position baby was in.

Just ask though bc they are likely to have such items, especially if they take Interns/new grads bc they have to have a way to help them learn.

Hope that helps

[snazzy-jazzy, BSN, RN]

Baseline is determined by the mean FHR, find an area that contains no accels or decels and take it over a 5 to 10 minute period. Preterm will have a baseline near the upper end of norm while full term is usually at the lower end.

Variability are the minor fluctuations in the baseline HR. Assessed by estimating the diference in BPM between the highest peak and lowest peak in one segment of the trace. Should be between 5 and 25 bpm. Its reduced if 3 to 5 bpm. Once again choose a part of the trace that has no contractions or decelerations.

A sinusoidal patter is associated with foetal compromise. Its like a smooth undulating pattern, it looks even on a trace and kind of spooky. The fluctuations in the variability are caused by the autonomic NS.

Accelerations are 15bpm or more above the baseline and last for 15 seconds at least. these are present with foetal movements or contractions, and are reasuring showing the baby is responding to stimuli. Should see 2 or more in a 20 minute period... Unless baby is asleep. Move mum around and give cold water, juice etc to wake baby up or wait 40 minutes.

Decels can be early, variable, prolonged or late. Not good but early is ok as they usually appear at the onset of a contraction and return to the baseline at the end of it.

I just studied all of this for my exam and have some more stuff, like what is normal, non reasuring and abnormal if your interested. I'm doing a dual degree and this was part of my midwifery section. I'm back to nursing next year but loved the midwife part of it. Have to wait a year before I return there.

[nurseinnh]

Accellerations need to be 15 x 15 for a full term preg...15 bpm higher for 15 seconds in duration

Is it 15 seconds from when it leaves baseline to when it returns, or does the accel need to stay 15 beats above BL for 15 sec?

[babyktchr, BSN, RN]

The accel has to PEAK at 15 secs above the baseline, it does not have to stay up there for 15 secs. It would resemble a triangle if you can picture it in your mind. Granted there are some accels that do stay up there for 15 seconds or more, but for purposes of being "reactive" it only has to peak at 15 above above baseline. You would measure the duration at the baseline....where it started to accel and when the accel ended.

AWHONN has an online basic monitoring course (I don't know if that is the one you are already taking)..and their textbook is one of the better ones out there. Get a hold of that and start reading. It will prepare you well.

[Elvish, BSN, DNP, RN, NP]

The only caveat that I would add is that with someone below 32 weeks, you do not have to expect a 15 x 15 accel. 10 bpm above baseline x 10 sec is enough. But once they get to 15 x 15 you have to hold them to that, regardless of GA.