Which sex has the highest suicide rate according to global statistics?

Choice A rationale

A fetal heart rate of 160 to 190 beats per minute is elevated and falls outside the normal physiological range. This sustained tachycardia can indicate fetal distress, such as hypoxia or infection, and warrants immediate investigation and potential intervention to ensure adequate oxygenation and fetal well-being.

Choice B rationale

A fetal heart rate of 110 to 160 beats per minute is considered the normal range for a healthy fetus. This range reflects proper autonomic nervous system regulation, adequate oxygenation, and overall fetal well-being, indicating a balanced interplay between sympathetic and parasympathetic influences on cardiac activity.

Choice C rationale

A fetal heart rate of 100 to 110 beats per minute is below the normal range, indicating mild bradycardia. While sometimes benign, persistent bradycardia can signal fetal compromise, such as umbilical cord compression or placental insufficiency, requiring close monitoring and further assessment.

Choice D rationale

A fetal heart rate of 80 to 100 beats per minute is significantly below the normal range, indicating severe bradycardia. This marked decrease in heart rate is a critical sign of significant fetal distress, often associated with severe hypoxia or acidosis, and necessitates immediate medical intervention.

The nurse should determine that the FHR pattern represents Early decelerations due to Fetal head compression during contractions.

Rationale for correct answers:

Early decelerations are a gradual decrease and return to baseline of the fetal heart rate (FHR) associated with uterine contractions. They mirror contractions, beginning and ending with the contraction. This pattern is physiologic and typically benign.

Fetal head compression during contractions causes a vagal response leading to early decelerations. At a station of +4 and full dilation, fetal descent is significant, making head compression the most likely cause.

Rationale for incorrect Response 1 Options:

Late decelerations occur after the peak of the contraction and are due to uteroplacental insufficiency. These are non-reassuring and do not mirror contractions, unlike what is noted in the case.

Variable decelerations are abrupt drops in FHR and vary in timing, shape, and duration. They are not mirror images and are often associated with cord compression, which is not supported by this case’s findings.

Prolonged decelerations last >2 minutes and <10 minutes. The decelerations in this case are transient (to 105 bpm) and resolve before the end of the contractions, ruling out prolonged patterns.

Rationale for incorrect Response 2 Options:

Umbilical cord compression leads to variable decelerations, which are abrupt and not aligned with contraction timing, unlike the current pattern.

Uteroplacental insufficiency results in late decelerations, which occur after the contraction ends. These are non-reassuring and not consistent with the current findings.

Maternal hypotension due to epidural could cause late decelerations from reduced placental perfusion. However, despite a BP drop at 0900 (100/52 mm Hg), the FHR deceleration pattern does not match.

Take home points:

• Early decelerations are benign and typically reflect fetal head compression during contractions.
• Differentiate early from late decelerations based on timing relative to contractions—early mirrors, late lags.
• Variable decelerations are abrupt and typically linked to umbilical cord compression, not head compression.
• Maternal hypotension from epidural requires close monitoring, but it leads to uteroplacental insufficiency and late decelerations, not early.