Fetal Heart Rate Monitoring

A fetal heart rate tracing is a time-linked picture of fetal reserve. Read it in sequence: first confirm that the signal is fetal, then assess the baseline, variability, accelerations, decelerations, and uterine activity. Baseline rate tells you whether the fetal heart is generally fast, slow, or within the expected range. Variability reflects moment-to-moment autonomic activity and is the clearest bedside sign that the fetus has oxygen available to respond. Accelerations are reassuring; decelerations explain when and why that reserve is being challenged. The strip is not interpreted in isolation. A late deceleration may follow maternal hypotension or excessive uterine activity, while tachycardia may accompany fever or medication exposure. The experienced nurse looks at the tracing and the patient together: blood pressure, temperature, oxygenation, contraction frequency, oxytocin dose, and recent procedures can reveal a reversible cause. After identifying the pattern, classify it using the SOGC three-tier system and act without delaying escalation when the tracing is abnormal.