Chart — Maternal-Newborn
Fetal Heart Rate Pattern Comparison
A side-by-side comparison of all major fetal heart rate patterns — accelerations, early decelerations, variable decelerations, and late decelerations — with description, mechanism, NICHD category, and nursing response.
Educational use only. FHR interpretation requires AWHONN/NCC training and clinical judgment. Always notify the provider immediately for Category II or III patterns. Follow institutional EFM and AWHONN guidelines. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
FHR Pattern Comparison
| Pattern | Description | Cause | Category | Nursing Response |
|---|---|---|---|---|
| Accelerations | Abrupt increase ≥15 bpm above baseline; duration ≥15 sec <2 min (≥32 weeks) | Fetal movement, intact autonomic nervous system, fetal well-being | I | Document as reassuring; no intervention required; 2 accels in 20 min = reactive NST |
| Early Decelerations | Gradual decrease (onset to nadir >30 sec); mirrors contraction shape; nadir coincides with contraction peak | Fetal head compression — vagal response during contraction | I | Document; routine monitoring; no intervention needed; indicates fetal descent |
| Variable Decelerations | Abrupt decrease (onset to nadir <30 sec) ≥15 bpm below baseline; ≥15 sec, <2 min; vary in shape and timing | Umbilical cord compression — most common deceleration type in labor | II(III if severe) | Position change (left lateral, knee-chest); IV fluid bolus; O2 10 L/min NRB; notify provider if persistent or severe |
| Late Decelerations | Gradual decrease (onset to nadir >30 sec); nadir and return occur AFTER contraction; symmetric mirror offset | Uteroplacental insufficiency — decreased O₂ delivery to fetus during contractions | II(III if absent variability) | STOP: Stop oxytocin; Turn left lateral; O2 10 L/min NRB; Provider notify STAT; IV fluid; prepare for urgent delivery |
| Prolonged Decelerations | Decrease ≥15 bpm below baseline lasting ≥2 min but <10 min | Cord prolapse, maternal hypotension, uterine hyperstimulation, placental abruption | II–III | Emergency response; notify provider immediately; reposition, O2, IV fluids; assess for cord prolapse |
Baseline Variability Quick Reference
| Variability | Amplitude | Significance | Action |
|---|---|---|---|
| Absent | Undetectable | Significant CNS depression or severe hypoxia | Category III with late/variable decels; urgent evaluation |
| Minimal | 1–5 bpm | Sleep, opioids, MgSO4, or early compromise | Evaluate context; fetal stimulation test; notify if persistent |
| Moderate | 6–25 bpm | Normal — most reassuring FHR finding | Document; routine monitoring |
| Marked | >25 bpm | Cause unclear; may indicate cord compression | Evaluate; notify provider if concern |
NCLEX Pearls
- Early decelerations = head compression = benign; no intervention needed
- Variable decelerations = cord compression; first action is position change (left lateral or knee-chest)
- Late decelerations = uteroplacental insufficiency; first action is stop oxytocin
- Moderate variability (6–25 bpm) is the most reassuring single FHR finding
- Absent variability + recurrent late or variable decelerations = Category III = urgent delivery
- Accelerations = reactive fetus; two in 20 minutes = reactive NST
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with NICHD / AWHONN EFM Standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →