Fetal strip question

[KRVRN, BSN, RN]

Okay, I work in a NICU and we will monitor the fetal strips of the women up in L/D to get an idea of what we might get, what's going on, etc. Well, our Advanced Practice RN was closely watching a strip which had what she called a sinusoidal rhythm (sp?). She tried to explain what it was, but couldn't really tell me the phsyiology behind it, just that it was bad. She knew, she was just too distracted watching this strip to give a long involved description. It looked very strange to me, just a regular, wavy line with occasional DEEP late decels.

She was very on edge, even got prepped for an emergent UV insertion and parked the code cart outside the pt's room because she was expecting to have to code the baby. The baby had had that rhythm for over an hour and the OB wanted to deliver lady partsl and so they just kept increasing the pit! And did I mention it was a 33 weeker?

So, my question: what's the physiology behind a sinusoidal rhythm?

[canoehead, BSN, RN]

It indicates severe anemia, and can also be caused by some drugs administered during labor. I don't know the physiology behind it.

She had probably checked that it was not just a drug they had given, it had probably been consistent for this baby, and the deep decels indicate more problems. If the baby had a decreased variability as well that strip was very ominous.

Maybe someone else knows more.

[KRVRN, BSN, RN]

It started very soon after artificially rupturing the bag. Mom also had a suspected partial abruption and a filamentous cord. I think that's what it was called...I guess the cord was attached at the placenta's edge rather than center? That sound right?. There WAS decreased variability and frequent late decels dipping below 60 with slow recovery at times, all starting shortly after AROM.

So...anemia, abruption...makes sense.

[canoehead, BSN, RN]

Do you know what the outcome was for the baby?

[KRVRN, BSN, RN]

Baby came out pale, floppy, ill-perfused and retracting. She was intubated and brought to NICU. Never coded. Received either 1 or 2 NS boluses. Vent was weaned down and she was pink, perfused, extubated and satting 100% on room air within 6 hours.

And mom HAD had an abruption.

Lucky, huh? :-)

[Q.]

My understanding of sinusoidal patterns was that of distress and a major hypoxic insult to the baby. The pattern results because the fetus has no reserve left to even have a cardiac response, such as a decel. I would have to look in my fetal heart rate book, which, is at home.

I will write down the definition they give and get back to you.

[Jolie, BSN]

I'm glad that all ended well. We had a patient (an RN at our hospital) whose filamentous cord ruptured during early labor. The baby bled out immediately and died. The OB was on his way in to admit his patient when she started to hemorrhage, and the heart rate was gone when he arrived about 15 minutes later. It was so tragic.

I wonder why the doctor in KRVRN's case was so intent on a lady partsl delivery, given that the patient had a suspected abruption and an ominous fetal heart tracing. Again, glad to hear that the baby is doing OK!

[KRVRN, BSN, RN]

We were all a little uncomfortable with the doctor's decision to wait out for a lady partsl delivery. I don't know her reasoning for waiting.

What is a little disturbing is that the parents didn't know the full danger of the situation. I think they might have been told that the baby was in some distress and that they needed to hurry up the labor, and that's why they were increasing the pit. I didn't go up to the delivery, but we sent up 2 RN's and 2 RT's and took along an already-prepared UVC setup. There were also 4 L/D RN's in the room and the crash cart was outside the door. I'm told that the dad seemed to know something was up but the mom didn't realize. This was thir 2nd baby so I'm sure they knew that there aren't usually THAT many people and equipment present.

So lucky.

[kennedyj]

I remember a patient we had who had a fetal strip without any long or short term variability (completely flat) with a FSE. We were all a little on edge. After about 30 min she was sectioned. The baby came out screaming and looking great. Weirdest thing.

[mother/babyRN, RN]

Major hypoxic insult is the etiology usually, and if you see it NOT connected to drugs lke stado, which can induce a pseudosinusodal rhythm, it is a ominous ryhthm, so take a deep breath, put on the running shoes and prepare for a resus....( HATE true sinusoidal rhythms as much as and probably more than I HATE prolapsed cords...)

[Angel Baby]

Amen, mother/babyRN. A true sinusoidal rhythm should never be managed conservatively. Have we put so much emphasis on lady partsl delivery that infant morbidity/mortality is overlooked?????

[obtnt]

First of all make sure the strip is internal monitoring! The TRUE sinusoidal rhythm is rare and when it rares it's ugly strip--beware! 99% of the time there is blood loss in there!