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Difficulty: MediumAnte/Intra/Postpartum and Newborn Care

A nurse is evaluating the continuous electronic fetal heart rate (FHR) tracing of a client in active labor. Which of the following FHR patterns indicate potential fetal compromise and require the nurse to initiate corrective interventions? Select all that apply.

  1. Recurrent late decelerations occurring with the majority of uterine contractionsAnswer
  2. B
    Early decelerations that mirror the onset, peak, and recovery of contractions
  3. A prolonged deceleration dropping below baseline for 4 minutesAnswer
  4. D
    Spontaneous fetal heart rate accelerations rising 15 beats per minute above baseline
  5. A sustained baseline fetal heart rate of 175 beats per minute for 20 minutesAnswer
  6. F
    Moderate baseline variability with fluctuations of 12 beats per minute

Answer

The correct selections are the options describing recurrent late decelerations, a prolonged deceleration, and a sustained fetal tachycardia of 175 beats per minute.
The correct options represent nonreassuring fetal heart rate patterns. Recurrent late decelerations indicate uteroplacental insufficiency. A prolonged deceleration (a decrease lasting more than 2 minutes but less than 10 minutes) represents a significant disruption in oxygen transfer. Fetal tachycardia (a baseline greater than 160 beats per minute lasting 10 minutes or longer) can be an early indicator of fetal hypoxemia, maternal infection (such as chorioamnionitis), or dehydration. All three of these abnormal patterns indicate potential fetal compromise and require immediate intrauterine resuscitation, such as maternal repositioning, intravenous fluid bolus, administration of supplemental oxygen, or discontinuation of oxytocin.

Step-by-Step Solution

1
Identify the core objective of the question.
The goal is to differentiate between normal (reassuring) and abnormal (nonreassuring) fetal heart rate patterns that demand nursing intervention.
Safe intrapartum care requires the nurse to promptly recognize and treat signs of fetal hypoxia.
2
Evaluate the reassuring FHR patterns among the choices.
Early decelerations, spontaneous accelerations, and moderate baseline variability are identified as normal findings.
These findings are physiological indicators of a well-oxygenated fetus with an intact central nervous system and do not warrant corrective interventions.
3
Identify the nonreassuring FHR patterns among the choices.
Late decelerations, prolonged decelerations, and fetal tachycardia are identified as nonreassuring findings.
These patterns are associated with compromised fetal oxygen supply (uteroplacental insufficiency, hypoxemia) or maternal/fetal distress (infection, dehydration) and necessitate immediate intrauterine resuscitation measures.

Key Concept

Interpretation of Intrapartum Fetal Heart Rate (FHR) Patterns
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Topics

Ante/Intra/Postpartum and Newborn Care

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