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Discussion

OB for NICU Nurses :)

Ok, so I'm throwing my brain back to nursing school, but apparently some things have faded. Can someone give me a quick review? I know that late decels are generally a bad thing in regards to fetal well-being. But what is the difference between early decels, variable decels, and late decels in regards to what you see on the monitor and what it indicates about fetal well-being? Thanks!

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    • Featured Replies

    early decels = fetal head compression, on the monitor they appear as mirror images to the contraction. They indicate fetal descent.

    variable decels = cord compression, on the monitor they can occur at any point during the contraction, usually appear V or U shaped, and may include little accelerations at the beginning and end of the deceleration (aka "shoulders"). Their significance will depend on how deep and frequently they are occuring.

    late decels = uteroplacental insufficiency, on the monitor these will begin as the contraction is subsiding and will not recover until the contraction is over. They are always non-reassuring.

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    early decels = fetal head compression, on the monitor they appear as mirror images to the contraction. They indicate fetal descent.

    variable decels = cord compression, on the monitor they can occur at any point during the contraction, usually appear V or U shaped, and may include little accelerations at the beginning and end of the deceleration (aka "shoulders"). Their significance will depend on how deep and frequently they are occuring.

    late decels = uteroplacental insufficiency, on the monitor these will begin as the contraction is subsiding and will not recover until the contraction is over. They are always non-reassuring.

    :yeah:Bravo!

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    Very well done. I will only add that decels are symptoms of what is going on.....ie. head compression, cord compression, utero-placental insufficiency. Your variability is really what you want to keep an eye on, because that is telling you what your oxygenation status is. How many times have you seen deep variables or early decels and have a baby come out with apgars of 9/9 and a cord pH of 7.45. Late decels tell you that your placenta isn't doing what it is supposed to be, but can be a reaction of a temporary process (decreased BP after epidural, lying in a flat position etc). When you correct these issues, the decel resolves. It isnt' so much that it is not reassuring as it is telling you you need to fix something, especially if your late decel is occuring with mod variability. If a late is combined with decreased or absent variability, your baby is telling you that it has compromised oxygenation and needs to have a birthday sooner rather than later. The key is really not reacting to one decel, but looking at the big picture and being proactive in keeping your baby well oxygenated.

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    Easy way to remember

    V E A L C H O P

    Variable Compression

    Early Head

    Accel Ok

    Late Placental

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    • Experts

    The only thing I will add to all that is to consider gestation.

    For a baby under 32 weeks the standard for an accel is lower (10 bpm in a 10 sec span) than for 32+ weeks (15 x 15). Unless, of course, said under-32-weeker has already proven themselves to 15 x15; in that case, you hold them to the higher standard.

    Also, with a preterm fetus, variable decels are considered normal. Obviously, you want to look at the entire tracing, not a single event, in order to get the best picture of what's going on in utero.

    I'm sure as a NICU nurse you already know that a good strip doesn't guarantee a good baby, nor does a 'nonreassuring' strip equal a bad baby after delivery. :)

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    I feel your pain. I've had to read up on my ob drugs recently, as well.

    Honestly, my best plan has been making friends with the ob nurses. Volunteering to come catch babies when they get busy has scored me some points.

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