Late decel?

[jennf83]

Hello

We had a patient the other day that me and another nurse thought was having late decels. They started out looking like subtle lates and then a few minutes later looked like obvious lates. We questioned the seasoned nurse and she said that since they had good variability that they werent really lates and you didnt have to chart them, that just try changing positions to see if it "fixes them". I always thought a late was a late, no matter if it had good variability or not, but just with minimal to no variability its worse. Any thoughts on this??

[Stacy in North Texas]

A late is a late and a sign of distress, even if it has good variability. You are right that the lack of variability only makes it even worse. The fact that she said you don't have to chart them is disturbing and wrong. The usual interventions should be done and the doctor notified and everything charted.

[babyktchr, BSN, RN]

A late decel is telling you something. Variability tells you something also. The decel is telling you that there is some perfusion issue with the placenta and it warrants investigating, for example a mom that is lying flat, a decreased BP after epidural etc. Turning the mom and fixing the BP would correct the situation, maximizing placental perfusion and oxygenation. Having moderate variability along with your decels is telling you that you still have adequate oxygenation of your baby, despite the decels. While this is reassuring, you still have to do something about the decels AND chart what you are doing AND seeing. It is absolutely incorrect not to chart this. Lates associated with minimal or absent variability are more ominous and is telling you two things...your baby is not oxygenated well AND you have perfusion issues with your placenta. You need to correct this or have a birthday.

[zahryia, LPN]

A late decel is telling you something. Variability tells you something also. The decel is telling you that there is some perfusion issue with the placenta and it warrants investigating, for example a mom that is lying flat, a decreased BP after epidural etc. Turning the mom and fixing the BP would correct the situation, maximizing placental perfusion and oxygenation. Having moderate variability along with your decels is telling you that you still have adequate oxygenation of your baby, despite the decels. While this is reassuring, you still have to do something about the decels AND chart what you are doing AND seeing. It is absolutely incorrect not to chart this. Lates associated with minimal or absent variability are more ominous and is telling you two things...your baby is not oxygenated well AND you have perfusion issues with your placenta. You need to correct this or have a birthday.

If it's subtle late (

[babyktchr, BSN, RN]

That would depend on your BIG PICTURE.....variability and such. If it is just one, and there is a reason ( mom just got epidural, mom is lying flat etc) then it never hurts to change positions. Would I put on oxygen for one decel...no. But again, what is the big picture. What is my baby telling me, what is my mommy telling me. What could be the differential? Start with the basics and then move upward to the big guns. Again, its all about what has happened over time. Those subtle lates are pesky. So much has changed as far as what is ominous or not. If I have subtle late with moderate variability, I may just check BP and turn and see if that doesn't correct it....if it continues then increase fluids and notify provider. If it is a min/abs variability thing going on, you have to act more expeditiously because your baby is already telling you it is having issues with oxygenation. Remember, accels and moderate variability (or mod variability alone) rule out metabolic acidemia, so even if you have lates (subtle or not), you may not be looking at compromise, but a short term placental issue (BP, position, fluid status). Take steps to correct and go from there. Hope that answers your question.

[redbeads]

You have some great responses, so I won't add to that. I am curious to know what the outcome was...did the lates continue and worsen, did they stop, what was the cord pH on baby (if one was done)?