Learning FHR interpretation

[JoyfulRN14, BSN, RN]

I just got a job transfer to L+D from working 5 years in a busy med-surg ICU. I'm doing some self study before starting, and currently working on a FHR monitoring module.

My question is about determining baseline. For example, in this strip, I feel like I could look at it 2 ways:

1. Baseline around 175 with decels

2. Baseline around 160 with accels.

I feel like it is more like my first thought, with minimal variability. But how do you know for sure? Is it because of the relationship with the contractions? Any advice would be helpful.

[NurseNora, BSN, RN]

I'd say 175 with decelerations. When you're not sure, it's safest to err on the safe side. Turn off or down the Pit since you have 5 contractions in about 8 min. Change position and give a fluid bolus; intrauterine resus citation never hurts (as long as you don't fluid overload her) Check her temp and fetal movement, why is the baseline so high? Most importantly, look at the previous strip. What has her baseline been in the half hour previously? It's difficult to identify baseline when contractions are so close. Sometimes you just have to admit that you're unable to determine the the baseline. But you'd better be doing something about it.

[klone, MSN, RN]

You need more than 5 minutes of strip in order to determine that baseline. I would say, based on only that strip, that it's an indeterminate baseline.

I would say that it *looks* like 175 with decels (because the greatest amount of consistency is in the 175 range) but again, based only on what's there, it could still go either way and I would want to see a longer strip.