CARDIOTOCOMETER

Measures baby’s heart rate & the pressure of the uterus

Baseline Fetal Heart Rate

Bradycardia
Tachycardia
Normal FHR: 110-160 bpm
Must not include accelerations/decelerations
Normally rounded to the nearest 5
Uterine contractions: 3-5 per 10 mins, at least 30 secs each, ≥200 MVU

Fetal Bradycardia Fetal Tachycardia

<110 bpm >160 bpm
Normal Fetal sleep (*not in labor because baby won’t be Fetal movement/stimulation
asleep during contractions- imagine may
nagcocontract sayo)
Maternal Factors Supine positioning (hypotension -> baby’s head Stress/ anxiety (Mom’s HR goes up ->
is sitting on top of the IVC -> reduction of Inc blood flow to baby -> baby’s HR
blood flow to the heart -> reduced CO -> goes up)
reduced BP) Fever/infection (Common cause of
Hpoglycemia tachycardia)
Thyrotoxicosis
Anemia
Hypoxia
Maternal-fetal interface Poor uterine perfusion Chorioamnionitis (Often accompanied
Umbilical cord prolapse by fever & infection)
Abruptio placenta
Fetal factors Arrythmia Arrythmia
Vagal stimulation Anemia/Acute blood loss (Baby has
reduced volume -> needs to
compensate by increasing BP, so there
will be inc HR
Medications Opioids Anticholinergics (Benadryl)
Anesthesia Sympathomimetics
Magnesium sulphate Illicit drugs (cocaine)
Beta blockers

Variability
Fluctuation of the baseline in amplitude & frequency of ≥2 cycles/min
Absent variability: undetectable variability, just a SMOOTH LINE, NON-REASSURING
Low variability: change of ≤5 bpm
 More of the parasympathetic NS kicking in -> *bradycardia: CNS depressants (alcohol), baby sleeping,
CNS anomalies: anencephaly, hydrocephaly
Moderate variability: change of 6-25 bpm, REASSURING
Marked variability: change of >25 bpm; can be associated with fetal hypoxia
Low, moderate, high

Accelerations in FHR (15 by 15!)

Periodic increases in FHR of 15bpm, sustained for at least 15 secs, but no more than 2 mins
If more thsn 2 mins, change in baseline
Coincides with fetal movements/stimulation
Always reassuring
Periodic accelerations: Coincides with uterine contractions
Episodic accelerations: Accelerations outside uterine contractions
Decelerations in FHR
Drop in FHR of >15 bpm with onset to nadir of >30 secs per duration
Early deceleration
 Inconsequential
 Decelerations coincide with contractions
 Associated with head compression (Uterus compresses the head -> Vagal stimulation: Innervates the SA
& AV nodes -> Reduced HR)
 Mirror images of the uterine contractions

Variable
 Non-reassuring when SEVERE
 Decelerations variable in relation to contractions
 Abrupt changes in FHR
 More jagged, more irregular
 Variable decelerations are associated with cord compression (Mild or moderate decels) or acidosis (Severe
decels)

From onset to nadir, less than 10 seconds; Very abrupt & significant drop; No apparent association with contractions,
even though they are caused by contractions
Severe variable decelerations; Look how far down it’s going -> All the way down to 50 bpm, & the baseline is about
120

Late
 Very gradual/ non-abrupt drop in FHR
 From onset to nadir is much more than 30 secs
 Very long & very shallow, no real significant drop in FHR
 Starts & ends after the contraction
 Utero-placental insufficiency or borderline O2 supply to the fetus
 ALWAYS NON-REASSURING

When the uterus is contracting, it reduces the BF to placenta

Baseline is 135 dropping to 115