Editing Maternal and Newborn Nursing (section)

=== Electronic fetal monitoring ===

Interpret in this order: '''baseline rate, variability, accelerations, decelerations, and uterine activity'''.

* '''Baseline''' 110 to 160 bpm. Above 160 for 10 minutes or more is '''tachycardia''' (maternal fever, infection, dehydration, medications, fetal hypoxia). Below 110 is '''bradycardia''' (cord compression or prolapse, rapid descent, maternal hypotension, abruption).
* '''Variability''' is the most important single indicator of fetal central nervous system oxygenation. Absent (undetectable), minimal (5 bpm or less), '''moderate (6 to 25 bpm, the reassuring finding)''', marked (more than 25 bpm). Fetal sleep cycles, narcotics, and magnesium reduce variability without necessarily meaning hypoxia.
* '''Accelerations''' are reassuring and essentially rule out fetal acidemia at that moment.
* '''Decelerations''':
** '''Early''' - gradual, mirror the contraction, nadir with the peak. Cause is '''head compression'''. Benign; no intervention.
** '''Variable''' - abrupt drop of 15 bpm or more for 15 seconds or more, variable in shape and timing. Cause is '''cord compression'''. Interventions: reposition, and consider amnioinfusion for repetitive variables.
** '''Late''' - gradual, begin after the contraction starts, nadir after the peak, return after the contraction ends. Cause is '''uteroplacental insufficiency'''. Always concerning.
** '''Prolonged''' - 15 bpm or more below baseline lasting 2 minutes to less than 10 minutes.
* Memory aid '''VEAL CHOP''': '''V'''ariable = '''C'''ord compression, '''E'''arly = '''H'''ead compression, '''A'''ccelerations = '''O'''K, '''L'''ate = '''P'''lacental insufficiency.
* '''Category I''' is normal (baseline 110 to 160, moderate variability, no late or variable decelerations, early decelerations and accelerations may be present or absent). '''Category III''' is abnormal and requires prompt intervention: '''absent variability with recurrent late decelerations, recurrent variable decelerations, or bradycardia; or a sinusoidal pattern'''. '''Category II''' is everything in between, is the most common category, and requires evaluation and continued surveillance.

'''Intrauterine resuscitation''' for a nonreassuring pattern: '''reposition the patient to a lateral position''' (usually the first and fastest action), '''stop oxytocin''', give an IV fluid bolus of isotonic solution, give oxygen by nonrebreather mask as indicated by facility protocol, perform a vaginal exam to rule out cord prolapse and assess rapid descent, correct maternal hypotension, and notify the provider. Consider terbutaline for tachysystole and amnioinfusion for recurrent variables.