Baseline
Variability
Decels
Category
Interventions
Grab Bag
100

110-160 bpm defined in increments of 5 bpm.

What is normal fetal heart baseline?

100

Determined in a 10-minute window excluding accelerations and decelerations.


What is baseline variability?

100

The onset, lowest point (nadir), and recovery of the deceleration occur at the same time as the onset, highest point, and recovery of the contraction

What is an early deceleration?

100

Fetal heart rate baseline 110-160 bpm

Moderate variability

Late or variables deceleration absent

Early deceleration absent or present

What is Category 1?

100

Continue to observe the patient

Document observations

Notify provider – “Routine” communication

What are the Nurse’s interventions for a Category I FHR strip?

100

Greater than 5 contractions in 10 minutes averaged over a 30-minute window. 

What is uterine tachysystole? 

200

Fetal heart rate less than 110 for greater than 10 minutes. 

What is Bradycardia?

200

Undetectable fetal heart rate range.

What is absent variability?

200

The decrease in fetal heart rate of greater than 15 bpm lasting greater than 15 seconds but less than 2 minutes from onset to return to baseline. 

What is a variable deceleration?

200

Minimal baseline variability with accelerations

Variable decelerations without slow return to baseline or overshoots

Single prolonged deceleration within 12 hours

What is Category II ?

200

Recognize and document Category ___ pattern

Institute intrauterine resuscitation

Request provider evaluation of fetal monitoring strip, communicate fetal/patient response

Document: observations, actions, and fetal/patient response

Anticipate the potential to transition to next Category

What is the Nurse’s role with a Category II FHR tracing?

200

The pressure exerted by uterine muscle cells and supportive tissues when they are at rest. 

What is uterine resting tone?

300

Fetal heart rate greater than 160 bpm for greater than 10 minutes.

What is Tachycardia?

300

Greater than undetectable but equal to or less than 5 bpm.

What is minimal variability?


300

Fetal heart rate with either gradual or abrupt decrease of greater than or equal to 15 bpm lasting greater than or equal to 2 minutes but less than 10 minutes from onset to return to baseline.

What is a prolonged deceleration?

300

Minimal baseline variability without accelerations lasting greater than 60 minutes

Absent baseline variability not accompanied by recurrent decelerations

Marked baseline variability

What is Category II?

300

Recognize and document Category ___ pattern

Institute intrauterine resuscitation as appropriate

Notify provider, communicate status

Document provider response




What is the Nurse’s role with this Category II FHR tracing?

300

A visually apparent, smooth, sine wave-like undulating pattern in fetal heart rate baseline with a cycle frequency of 3-5 cycle per minute that persists greater than 20 minutes. 

What is sinusoidal pattern?

400

Enhance Fetal Oxygenation trough:

Position Changes

Increasing Fluids

Applying Oxygen

What is intrauterine resuscitation?

400

Fetal heart fluctuation of 6-25 bpm. 

What is moderate variability?

400

The onset, lowest point (nadir), and recovery of the deceleration occurs after the onset, highest point, and recovery of the contraction with greater than 50 percent of contractions in any 20 minute segment. 

What is recurrent late decelerations? 

400

Tachycardia

Absent baseline fetal heart rate variability

Late recurrent decelerations

What is Category III?

400

Recognize and document Category ___ pattern

Institute intrauterine resuscitation

Require onsite assessment or intervention

Document provider response

Prepare for delivery

Activate team for emergency cesarean section

Prepare patient for delivery

Call for available OB/General surgeon

Document observations, actions, and fetal/patient response

What is the Nurse’s role with a Category III FHR tracing?

400

The sum of each contraction’s peak minus the resting tone in a 10 minute period.

What is montevideo units?

500

Speedy and Pokey nerve impulses. 

What are sympathetic and parasympathetic?

500

Fetal heart fluctuation of greater than 25 bpm.

What is marked variability?

500

When cord occlusion is released, the fetal heart rate goes above the baseline and then return to baseline over 40-60 seconds, hypoxemia is indicated.


What is an overshoot?


500

Institute intrauterine resuscitation

Prepare for delivery

Activate team for emergency c-section

Document provider response

What is the Nurse role in a Category III?

500

Implement Chain of Command protocol!

What is the nurse’s action if at any time the provider does not respond appropriately to any Category of FHR tracing?

500

•Standardized definitions to support processes and protocols

•Improved communication between the healthcare team

•Improved patient outcomes

What are NICHD Guidelines?