low fhr baseline

[ldnurse7581]

I had a pt the other night who came in in labor, g2p1, and when she first came in (around 2230) the fhr baseline was running 110-120, with +accels, no decels. then, around 0200, the baseline was down to 100-105 and decreased variabilty and the pt was 250# w/hx of gastric bypass, so it was very hard to pick up ctx d/t large abdomen. but i called the md to make him aware of the decrease in baseline and also that her membranes ruptured and fluid was bloody. i asked if he could come in and put on an internal monitor and an iupc so we could tell if/when she was having decels,ctx,etc. but he said he "just took boards on this and he wasnt concerned". so then the charge nurse called him back about 20 minutes later (after what looked like a couple decels, but of course we couldnt tell, d/t not being able to trace ctx) and he told her the same thing. then he called back about 10 min later and said he would come in and put in an internal monitor. then while he was on his way, pt started bleeding. informed pt of probable c/s and reason (probable abruption, etc) then when md came in, he told her we'd have to do a c/s but then he checked her and she was complete and +2. baby was fine, but i just never thought a doctor wouldnt be concerned about a baseline that low! what do u think about this???

[SmilingBluEyes]

A low baseline by itself is not a major concern, as long as there is sufficient variability and baby has been healthy all along, absent of risk factors or maternal health problems that would indicate trouble.

Now, not knowing when decels are occuring is a problem, so you were right to request internal monitors be placed. On "fluffy" patients where there is a question of fetal wellbeing, these are a must, if you can get them in. I am glad, where I work, we are trained and certified to do these ourselves as RN's. No begging doctors to come out at 3:00 a.m. to do this for us. It saves us a lot of time, being able to do this ourselves, time we dont' want to lose interpreting and treating any problems that crop up.

I am glad the baby turned out ok. In my experience, it's not unusual for doctors not to "jump" at the first request for these things. You need to be very assertive if you feel a doctor should evaluate the situation. Make it clear you want his/her presence as soon as possible whenever the wellbeing of a mom or baby are in doubt--- to clear these things up and intervene where appropriate. Good luck to you!

[BETSRN]

Post dates babies will often have a low baseline. Was she given any medication that might also have lowered the baseline?

[ldnurse7581]

It was post epidural,which i would expect,but it stayed 100-105. but luckily the time that started to the time she delivered was only about an hour. but the charge nurse and i were still worried, esp w/the bloody srom. but thanks for the replies...

[BETSRN]

It was post epidural,which i would expect,but it stayed 100-105. but luckily the time that started to the time she delivered was only about an hour. but the charge nurse and i were still worried, esp w/the bloody srom. but thanks for the replies...

I daresay that if it was epidural related and she had not delivered so quickly, you probably would have seen the basline return to what it had been before.

[SmilingBluEyes]

I agree with Betsy.