FETAL HEART TONES

CONDITION CAUSE GRADE

Fetal Tachycardia ❖ Infection ❖ Mild : > 5 BPM from baseline

❖ Dehydration ❖ Moderate: 6-25 BPM from baseline
❖ Fever ❖ Severe: < 25 BPM from baseline
❖ Fetal hypoxemia ❖ Absent : No fluctuation in fetal heart rate
❖ Anemia
❖ Prematurity
❖ Terbutaline
❖ Caffeine
❖ Epinephrine
❖ Theophylline
❖ illicit drugs

Fetal bradycardia ❖ Maternal hypotension ❖ Mild : > 5 BPM from baseline

❖ Supine hypotensive syndrome ❖ Moderate: 6-25 BPM from baseline
❖ Fetal decompression ❖ Severe: < 25 BPM from baseline
❖ Late fetal hypoxia ❖ Absent : No fluctuation in fetal heart rate
❖ Cord compression
❖ Abruptio placenta
❖ Vagal stimulation

Accelerations & Decelerations

Variability Accelerations: must be 15 BPM above the FHR baseline for 15
seconds 15x15 window
FHR drops from baseline then recovers, usually jagged and Decelerations : A decrease in FHR during uterine contraction ”
erratically shaped. Can happen at anytime during contraction mirrors contractions usually a U shape
Periodic changes : variations that occur during a contraction.
Nursing interventions : Left Side. IV bolus of fluids, O2 6l mask, ❖ Reassuring periodic changes : must be 15 BPM
Notify HCP above the FHR baseline for 15 seconds ( 15x15 window)
❖ Benign periodic changes: Early decelerations
A great way to remember this is L.I.O.N
Decreased or absent variability: Non reassuring, acute treatment Episodic changes: occur in association with medication
and monitoring are indicated. administration or analgesia
Decreased or absent variability: medications, narcotics, mag
Wandering baselines with no variability could indicate
sulfate ( preeclampsia, preterm), terbutaline, fetal sleep (
❖ Congenital defects normally 20 minute cycles), prematurity, fetal hypoxemia.
❖ Metabolic acidosis

Fetal decelerations
The nurse should administer 02 and the baby needs to be
delivered as quickly as possible.

Memory trick
V: variable deceleration
E:early deceleration
A: acceleration
Late deceleration
Early decelerations : A decrease in FHR during uterine contraction mirrors
uterine contractions . caused by uterine squeeze
❖ FHR slows as the contraction begins
C: cord compression ❖ Lowest point coincides with the highest point ACME of the
H: head compression contraction
O: ok ❖ Deceleration ends with the contraction
Placental insufficiency Late deceleration: occurs after the peak of contraction 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 NONreassuring FHR patterns
❖ Fetal stimulation
❖ Fetal scalp sampling
❖ Fetal scalp oximetry