A nurse is assessing a fetal heart rate (FHR) tracing for a client who is in active labor.
The nurse notes that the baseline FHR is 150 bpm with absent variability and recurrent variable decelerations with slow return to baseline.
What category of FHR tracing does this represent?
A.
Category I.
B.
Category II.
C.
Category III.
D.
Category IV.
The Correct Answer and Explanation is:
The correct answer is C. Category III.
Explanation:
Fetal heart rate (FHR) tracings are classified into three categories based on the patterns observed, which help in determining the fetal well-being and guiding clinical interventions. The categories are:
- Category I: This is a normal FHR tracing and includes:
- Baseline FHR of 110-160 bpm.
- Moderate variability (6-25 bpm).
- No late or variable decelerations.
- Early decelerations may be present.
- Accelerations may be present or absent.
- Category II: This represents a pattern that is neither clearly normal nor abnormal and requires continued monitoring and evaluation. Characteristics might include:
- Baseline FHR of 110-160 bpm.
- Minimal variability (less than 5 bpm) or absent variability with recurrent accelerations or decelerations.
- Recurrent variable decelerations or occasional late decelerations.
- Category III: This is an abnormal FHR pattern that indicates an increased risk of fetal hypoxia or acidemia. It requires prompt evaluation and intervention. Characteristics of Category III include:
- Absent baseline variability with recurrent late decelerations, recurrent variable decelerations, or bradycardia.
- A baseline FHR of less than 110 bpm or greater than 160 bpm with absent variability.
- Sinusoidal pattern (a smooth, wave-like pattern with no variability).
In the scenario provided:
- The baseline FHR is 150 bpm, which is within the normal range of 110-160 bpm.
- There is absent variability, which means there is no fluctuation in the baseline FHR. This is concerning as variability is an important indicator of fetal oxygenation and neurological function.
- Recurrent variable decelerations with slow return to baseline are noted. Variable decelerations are abrupt decreases in FHR that can be associated with umbilical cord compression, and when recurrent and accompanied by absent variability, they can indicate possible fetal distress.
Given these findings, the FHR tracing falls into Category III due to the combination of absent variability and recurrent variable decelerations with slow return to baseline, indicating an increased risk of fetal hypoxia or acidemia. Immediate evaluation and possible intervention are necessary to address potential fetal distress.