Periodic and episodic changes in FHT tracing

[wensshad]

We have a new educator for our Fetal monitoring. She has attended the AWHONN class for fetal monitoring and is trying to get us to change the way we chart. Does anyone know if you must chart that accerlerations and decelerations are periodic or episodic. She stresses that this is mandatory but has little to back up what she is saying. We have a 2nd person now going through the training who says that it is not necesary. If anyone has any good referance materials it would be very much appreciated.

[Halinja, BSN, RN]

We are using the new terminology, and periodic and episodic are things we know....but we don't chart them. We might tell the doc when calling, or we might not.

[babyktchr, BSN, RN]

As an AWHONN instructor, I do teach periodic and episodic changes, but in context of a systematic approach to evaluating a strip. What is the baseline, what is the variability, are there any periodic or episodic changes(accels or decels)? I do not advocate using the terms when charting, nor do I find that it is intended to be taught that way. (I could be wrong, do let me know). You may find these terms helpful when the decel does not fit a definition..therefore saying you are having "periodic" decels may be appropriate. Periodic accels (with contractions) is an important thing to chart, especially if persistent, because of it physiology (partial cord compression).

You can find NICHD nomenclature at the AWHONN website, in the FHM Principles and Practices text, or at the NCC website (they have a nomagram you can download).

[mombabyrn]

"FHR tracing eval must include a baseline rate, baseline variability, presence (or absence) of accelerations, periodic or episodic decelerations, and changes or trends over time"

This is straight out of Miller's Advanced Fetal Monitoring course.

So it sounds like there may be a bit of confusion about what to chart as periodic or episodic, but you are supposed to be noting this in regards to decels. Now exactly when and where you are supposed to chart these things seems (to me) to be up to the individual institutions. Assessment does not absolutely mean documentation every single time. Review the NICHD definitions. Personally I think it makes it so much easier now that we are all supposed to be speaking the same language and viewing the strip in the same manner now.