📌 NCLEX Topic: Fetal Heart Rate (FHR) Decelerations
Definition:
Decelerations are temporary slowing of the fetal heart rate (FHR) during contractions. They are classified into early, variable, and late decelerations, each with different causes and clinical significance.
Types of Decelerations & Their Causes
| Type | Cause | Appearance on FHR Monitor | Nursing Interventions |
|---|---|---|---|
| Early Decelerations | Head compression (normal finding, often seen in labor) | Gradual decrease, mirrors contraction | No intervention needed, continue monitoring |
| Variable Decelerations | Umbilical cord compression (e.g., oligohydramnios, nuchal cord, cord prolapse) | Abrupt drop in FHR, variable shape (V, U, or W) | Reposition mother, administer oxygen, consider amnioinfusion |
| Late Decelerations | Uteroplacental insufficiency (e.g., preeclampsia, post-term pregnancy, maternal hypotension) | Gradual decrease, starts after peak of contraction | Emergency! Stop oxytocin, reposition, oxygen, IV fluids, prepare for delivery if persistent |
Nursing Interventions for Fetal Distress
🚨 If FHR decelerations are concerning (late or prolonged variable decelerations), follow this sequence:
- Stop oxytocin (Pitocin) – To reduce uterine contractions and improve placental perfusion.
- Reposition the mother – Move to side-lying position to relieve cord compression.
- Administer oxygen (8-10 L via face mask) – Increases fetal oxygenation.
- Increase IV fluids – Improves blood circulation to the placenta.
- Prepare for emergency delivery – If late decelerations persist despite interventions.
NCLEX Mnemonic for Decelerations
