Fetal Monitoring  

Condition Causes Grade

Fetal tachycardia > 160 bpm
Fetal tachycardia can be Mild : > 5 bpm from baseline
caused by an infection of the
fetus or the mom, Mod.: 6- 25 bpm from baseline
dehydration, fever, fetal
hypoxemia, anemia, Severe:>25 bpm from baseline
prematurity, drugs to stop
labor such as terbutaline. Absent: no fluctuation in FHR
Drugs such as caffeine,
epinephrine or theophylline.
Illicit street drugs

Fetal Bradycardia Fetal bradycardia can be Mild : > 5 bpm from baseline
caused by maternal
hypotension, supine Mod.: 6- 25 bpm from baseline
hypotensive syndrome,
Severe:>25 bpm from baseline
fetal decompression . late
fetal hypoxia, cord Absent: no fluctuation in FHR
compression. Abruptio
placenta , vagal stimulation

Variability  
FHR drops from baseline then recovers, usually jagged and erricatically shaped. Can happen at 
anytime during contraction  
Nursing interventions : Leftside. IV bolus of fluids, O2 6l mask, Notify HCP 
Decreased or absent variability​: Non reassuring, acute tx and monitoring are indicated.
Wandering baselines with no variability could indicate
- Congenital defects
- Metabolic acidosis
The nurse should administer 02 and the baby needs to be delivered quickly as possible.

Accelerations:​ must be 15 BPM above the FHR baseline for 15 seconds (​ 15x15 window)

Decelerations ​: A decrease in FHR during uterine contraction ​“ U shape”​ mirrors contractions

Periodic changes ​: variations that occur during a contraction. “​ periodic changes= Period “cramps”
- Reassuring periodic changes : ​must be 15 BPM above the FHR baseline for 15 seconds (​ 15x15
window)

- Benign periodic changes:​ Early decelerations

Episodic changes:​ occur in association with medication administration or analgesia “​ non uterine”

Decreased or absent variability: ​medications, narcotics, mag sulfate ( preeclampsia, preterm),

terbutaline, fetal sleep ( normally 20 minute cycles), prematurity, fetal hypoxemia.
Documentation tip : document contractions and FHR q15m

 
Fetal decelerations  

Early decelerations : ​A decrease in FHR during uterine contraction “​ U shape”​ mirrors uterine
contractions​ . ​caused by uterine squeeze​ (​ reassuring “normal’’)
1. FHR slows as the contraction begins
​
2. Lowest point nadir​
​ coincides with the highest point ACME ​ of the contraction
( FHR should return to normal at this time)
3. Deceleration ends with the contraction ​

( gradually over 30 seconds or more​) ​

Late deceleration: ​occurs after the peak of contraction (ACME)
​ due to
uteroplacental insufficiency, pitocin, HTN, diabetes, placental abruption.
- Too many decelerations will indicate a need for C-section
- Prepare for fetal resuscitation

Variable decelerations​: may indicate cord compression. Occur at different times during a
contraction, resulting in fetal HTN that causes the aortic arch to slow the FHR. usually abrupt
and sudden.

Measures to clarify NON reassuirng FHR patterns

- Fetal stimulation
- Fetal scalp sampling
- Fetal scalp oxemetry