When is FHR too high?

Slobgob · Apr 20, 2005

Roughly the scenario is an induction, mom has an epidural and a temperature (don't know how high), baby has meconium and elevated FHR (180s) but good variability. If mom is getting antibiotics, is the elevated FHR really a concern and a legitimate reason for a c/section?

Knowing the exact temperature might make the difference...

180s might be a little high, but not that bad... the question is... how high does it rise with contractions or randomly...

Is the baby overcooked? What is the gestational age?

If the baby is almost there... it seems fine to me... but if things are going slow, i've seen C/S with similiar cases...

SmilingBluEyes · Apr 20, 2005

The combination of a "temperature" and high FHR is very concerning to me. Sounds like potential for chorio-amnionitis or infection of other sort. This is the problem with inductions----they do raise risks significantly. I would look at how LONG mom was ruptured and how many lady partsl checks she had. Also were internal monitors used? Was mom positive for Group B Strep infection? Lots of things to look at.

Nevertheless, the risk is INFECTION: I am sure the baby will be worked up for infection/sepsis, and maybe given antibiotics right after birth for several days.

RNLaborNurse4U · Apr 20, 2005

Knowing the exact temperature might make the difference...
180s might be a little high, but not that bad... the question is... how high does it rise with contractions or randomly...
Is the baby overcooked? What is the gestational age?
If the baby is almost there... it seems fine to me... but if things are going slow, i've seen C/S with similiar cases...

What about mom's WBC? GBS status? How long the fetal tachycardia has been occuring? Has the heartrate been steadily rising? Primip vs multip? Dilitation progress of labor? Have fluid boluses, oxygen, tylenol to mom been given to help reduce the tachycardia/maternal fever? Is mom's temp rising or staying stable? Is delivery imminent, or going to be delayed by a few hours or more? Lots of things to consider.

SmilingBluEyes · Apr 20, 2005

Short runs of "tachycardia" may actually be accelerations in heart rate, which are healthy. But the scenario changes when you see tachycardia PLUS increase in maternal temps. This is the problem.

healingheart · Apr 20, 2005

last week I had a pt who was a nurse and really wanted to deliver lady partslly. She had no risk factors, other than an epidural and AMA but baby's HR slowly but progressively went from 150s to 190s to 200s, even the ocassional 210. Midwife was very concerned after 2 hours of elevated FHR and waiting for the cervical lip to disappear. Doc came in and decided that pushing could take just as much time as a c-section and did not decrease the risk of infection so they had her push for 1.5 hours with MD and CNM helping the baby A LOT to come down and baby came out perfect, with no evidence of infection or distress. I was impressed!

BETSRN · Apr 23, 2005

The combination of a "temperature" and high FHR is very concerning to me. Sounds like potential for chorio-amnionitis or infection of other sort. This is the problem with inductions----they do raise risks significantly. I would look at how LONG mom was ruptured and how many lady partsl checks she had. Also were internal monitors used? Was mom positive for Group B Strep infection? Lots of things to look at.
Nevertheless, the risk is INFECTION: I am sure the baby will be worked up for infection/sepsis, and maybe given antibiotics right after birth for several days.

The fetal heart rate is always elevated when Mom has a temp, though not always as high as 180's. It would depend on the duration of the tachycardia and also the amount of variability (which tends to decrease as the baseline rises).

The good thing about a small hospital is that we do NOT work up lots of babies just because the mother has had a temp. There are lots of mitigating factors.

SmilingBluEyes · Apr 23, 2005

Betsy I, too, work in a small hospital and it seems prudent to our peds to work up babies for infection in the presence of maternal and newborn fever. By "work up" i mean, getting CBC's initially, and then abx prn.