FHR Basics
A fetal heart rate baseline has remained at 165 BPM for over 12 minutes. What is the clinical implication?
What is fetal tachycardia?
Fetal tachycardia is defined as a baseline FHR above 160 BPM lasting more than 10 minutes. It often indicates fetal distress due to maternal fever, infection (chorioamnionitis), dehydration, or stimulant drugs. Prompt assessment is needed to address the underlying cause.
A patient is having contractions every 3 minutes. After each contraction, the FHR dips and recovers slowly. What should the nurse suspect?
What is late deceleration?
Late decelerations occur after the peak of contractions and are due to uteroplacental insufficiency, indicating compromised oxygen delivery to the fetus. These are non-reassuring and require immediate nursing interventions.
A patient with ruptured membranes and 4 cm dilation is being monitored. What internal device could best monitor FHR?
What is fetal scalp electrode?
A fetal scalp electrode is placed directly on the presenting part to measure FHR accurately when external monitoring is unreliable. Conditions include ruptured membranes and dilation ≥2 cm.
The nurse sees late decelerations and absent variability. What should be the priority action?
What is reposition the mother and notify provider?
Changing maternal position improves uteroplacental blood flow and is a first-line intervention for non-reassuring patterns like late decelerations.
A tracing shows absent variability and repeated late decelerations. What FHR category does this indicate?
What is Category III?
Category III FHR includes absent variability with late or variable decelerations, bradycardia, or sinusoidal patterns. It suggests significant fetal hypoxia and requires immediate intervention.
A nurse notices a baseline FHR of 100 BPM for 12 minutes. What is this called?
What is fetal bradycardia?
Bradycardia (FHR <110 BPM for >10 min) may reflect fetal hypoxia, maternal hypotension, umbilical cord prolapse, or uterine rupture. It requires immediate evaluation and possible intervention depending on variability and associated decelerations.
A laboring patient’s FHR tracing shows abrupt drops and quick recoveries in FHR. What is the likely cause?
Variable deceleration
Indicates cord compression with a contraction; when the contraction is over the FHR returns to normal
A nurse applies a TOCO transducer and asks the patient to avoid moving. What is this device for?
What is monitoring uterine contractions externally?
Despite repositioning and oxygen, the FHR remains abnormal. What should the nurse prepare for?
What is possible emergency cesarean?
If intrauterine resuscitation fails to improve FHR and signs of fetal compromise persist, rapid delivery is necessary, often via cesarean section.
A patient has a Category I FHR strip. What action is needed?
What is continue monitoring?
Category I FHR (normal baseline, moderate variability, no decelerations) is reassuring and requires no interventions beyond routine monitoring.
A patient’s FHR tracing shows a jagged, erratic variability with no clear baseline. How should the nurse interpret this?
What is marked variability?
Marked variability (>25 BPM amplitude) may indicate fetal stress, hypoxia, or cord compression. Though sometimes benign, persistent marked variability can signal worsening fetal condition and requires close monitoring.
A deceleration lasts 3 minutes and FHR drops 30 BPM below baseline. What type is this?
What is prolonged deceleration?
Prolonged decelerations (>2 min, <10 min) may result from sustained cord compression, hypotension, or uterine rupture, and warrant urgent evaluation.
The provider asks for accurate measurement of uterine contraction strength. What should the nurse prepare to insert?
What is intrauterine pressure catheter?
The IUPC provides direct, accurate measurement of uterine pressure. It is used when precise contraction intensity is needed, often in dysfunctional labor.
A laboring patient’s IV fluids were stopped due to overload. Now FHR variability is minimal. What should the nurse consider?
What is fluid bolus to improve perfusion?
IV fluid boluses can correct maternal hypotension or dehydration, improving placental perfusion and fetal oxygenation.
A mother asks what accelerations mean. What’s the nurse’s best response?
What is they are a reassuring sign of fetal well-being?
A labor nurse observes reduced fluctuations in FHR baseline. What should the nurse document?
What is minimal variability?
Minimal variability (≤5 BPM) can occur due to fetal sleep, CNS depressants, or hypoxia. Evaluation includes reviewing maternal medications, gestational age, and presence of decelerations.
FHR tracing shows deceleration mirroring contractions. What is the clinical interpretation?
What is early deceleration due to head compression?
Early decelerations mirror contractions and result from fetal head compression stimulating the vagus nerve. They are generally benign and not associated with fetal distress.
Which method uses sound to stimulate fetal acceleration?
What is vibroacoustic stimulation?
This technique uses sound to stimulate fetal movement and accelerations, helping to assess fetal responsiveness and neurologic function.
The fetus shows repeated decelerations with every contraction. What can be administered to reduce uterine activity?
What is terbutaline?
Terbutaline is a beta-agonist that reduces uterine contractions, used in cases of tachysystole or hypertonic labor to improve fetal oxygenation.
FHR tracing shows moderate variability with occasional accelerations. How is this pattern classified?
What is Category I?
What is minimal variability defined as?
What is a fluctuation range of 5 BPM or less?
Minimal variability (≤5 BPM) can occur due to fetal sleep, CNS depressants, or hypoxia. Evaluation includes reviewing maternal medications, gestational age, and presence of decelerations.
What is the initial nursing action for late decelerations?
What is reposition the mother?
Changing maternal position improves uteroplacental blood flow and is a first-line intervention for non-reassuring patterns like late decelerations.
Which internal monitor measures uterine pressure?
What is the intrauterine pressure catheter?
The IUPC provides direct, accurate measurement of uterine pressure. It is used when precise contraction intensity is needed, often in dysfunctional labor.
What must be done before giving potassium IV?
What is confirming renal function? — Potassium affects cardiac function and must be excreted properly. Confirming renal function prevents hyperkalemia and related complications.
What does absent variability indicate?
What is possible fetal hypoxia or acidosis?
Absent variability may indicate disrupted autonomic regulation and is a serious sign when accompanied by other abnormal patterns.