new terminology for fetal monitoring

CEG · Dec 18, 2009

Well, as I would understand it, you are going to look at the entire period of what you are charting on. So if it is q15 then you are charting for that entire 15 minute period. If it is Q30 then you are charting what you see during that 30 minutes.

In my mind, there's no way you could have both minimal and moderate variability when you are looking at a strip. If the variability is 0-5 beats per minute the entire time it is minimal. If it is up to 25 in some places then it is moderate. It isn't a measurement of snapshots of the time period- otherwise there would also be parts with no accels, etc. Just my .02 as i am certainly not an expert.

OB Nurse Andrea · Dec 18, 2009

I also would not want to pretend to be an expert, and I am aware of the fact that the terms for fetal monitoring have changed and a lot in the last so many years (while I am a new enough grad that I learned the "new" way, a lot of my preceptors and mentors were still coaching me with old techniques.

Just as CEG was saying, I would look at the whole time period that you were evaluating. If the baby demonstrates moderate variablility even some of the time, moderate would be the best choice. In the same manner, if the baseline fluctuates a bit during the time period you would chart the average baseline. It's about the whole picture. :-)

tewdles, RN · Dec 18, 2009

You simply need to describe it in your documentation as you did for us. Painting the picture is the important part...the terminology is secondary. When I was in OB it was ok to describe the variability as, well, variable-min/mod. Of course, I am older than moses and things change...

elanddeenrs · Dec 19, 2009

Just took AWHONN Advanced FM class. Instructor says it's OK to chart minimal and moderate if you have both.

CEG · Dec 19, 2009

Just took AWHONN Advanced FM class. Instructor says it's OK to chart minimal and moderate if you have both.

I'm curious how they explained that (it's been awhile since I had a class). If you are looking at a 15 minute strip and you have variability that is moderate in some places and minimal in others, how is it not moderate? It seems if I chart it as minimal then I have to be taking some action or considering it to be category II FHT. In reality any strip is going to have periods where the variability is going to be minimal when overall the strip looks great. Thanks for any input.

zahryia, LPN · Dec 19, 2009

I'm curious how they explained that (it's been awhile since I had a class). If you are looking at a 15 minute strip and you have variability that is moderate in some places and minimal in others, how is it not moderate? It seems if I chart it as minimal then I have to be taking some action or considering it to be category II FHT. In reality any strip is going to have periods where the variability is going to be minimal when overall the strip looks great. Thanks for any input.

I'm not sure you're understanding the OP's question. For example, if you have a 30 minute strip where there is 18 minutes of consecutive minimal variabilty and there is suddenly 12 minutes of moderate variabilty, how would you document the 30 minute strip?

Do you use the predominate pattern? minimal

Do you use the most reassuring pattern? moderate

Do you use both patterns? minimal and moderate

babyktchr, BSN, RN · Dec 19, 2009

You can certainly document both minimal and moderate variability but the predominate variability is probably the best to chart. As for minimal variability putting you into a category II....you would have to look at the big picture there. Minimal variability with accels would not be category II, nor would one 15 minute or 30 minute period of minimal variability dictate a category II situation. What you would need to do is figure out WHY you have this variability....are there factors associated with it that could be causing it. THe key to interpretation of EFM is looking at the big picture and not just the snapshot.