DIP Episode 338 - Fetal Heart Rate Tracings Made Easy

Okay, welcome. My name is Divine. This is episode 338 of the Divine Intervention Podcasts. And into this podcast I'm going to be talking about an important topic, although it's going to be a short podcast on Fido Heart Rate Tracins. On Fido Heart Rate Tracins. And I'm going to really discuss this as a series of 10 different principles. And as I say, if anyone is studying for the USM list of juicy keys, step three exams, and you're taking it within the next few days, I do have an MBME Test-Teach and Strategy's course. Taking place next Monday from 2 to 4.30 p.m. Pacific Standard Time. And then I have a comprehensive step-to-seek-steep-third review course. Taking place next week Tuesday, Thursday from each unknown, Pacific Time and from 1 to 5 Pacific Time. During that course we'll be reviewing internal medicine, PEEDS, surgery, OBGYN, psych, neuro, bio-stats, ethics, communications, professionalism, multi-system processes, and disorders, pharmacology as necessary to the step-to-seek-steep-third exams. Again, I've had many people take these courses and they've done extremely well on their exams. I've had people get as high as the 270's on the exams after taking the course. Let's jump right into the FITO heart rate. If you're interested in the courses, just shoot me an email through the website. The very first thing to keep in mind is that a FITO heart rate is between 110 to 160. A normal FITO heart rate will be between 110 to 160 on an MBME exam.

Now, obviously, the FITO heart rate is more than 160. That's going to be FITO tagging cardio. If the FITO heart rate is less than 110, that's going to be FITO brain cardio. So what are some things that classically will cause FITO tagging cardio on MBME exams? It's going to be things like maternal fever. If form is February, metabolic rate is going to go up. If a metabolic rate is up, and the Bibi's metabolic rate is going to go up as well, so the FITO's will have tagging cardio. If the Bibi is anemic, because if you think about it, there's this equation for oxygen delivery to the body. The equation is oxygen delivery is equal to cardiac output multiplied by the oxygen content of the blood. So when the oxygen content of the blood is low because the Bibi's anemic, to balance out oxygen delivery, the cardiac output has to go up. As oxygen delivery goes down, cardiac, as oxygen blood oxygen content goes down, cardiac output has to go up to compensate. Also, if mommy is hypotensive, again, whenever there is hypotension, many times the FITOS is going to respond with a tacky cardio. Because if the FITOS is not getting enough blood, and the FITOS will have to increase its heart rate, so that the blood makes more rounds through the FITO body. And also if the FITOS is hypoxic again, whenever there is hypoxia that decreases the oxygen content of blood, that's going to cause a compensatory increase in cardiac output.

And FITO body cardio, I mean, what are some things that cause FITO body cardio? If mommy is on a beta blocker, so they can give you a question about a woman that has hypertension. So she has preeclampsia, remember hypertension, preeclampsia. The homework with those things is your blood pressure is going to be elevated as mom. If you're taking a little bit of low, remember a little bit of low, is one of those anti-hypertensives that are syphilipregnancy. That can cause a FITO body cardio. Another with the can also test FITO body cardio is in the context of being a child of a mom that has lupus. Remember, some women that have lupus, the produce anti-roll and anti-agg antibodies, and those things can cross the placenta and damage the conducting system in the FITOS. That'll cause a complete heart block, that'll cause a third degree heart block. Obviously, in those circumstances, that can cause a FITO body cardio. Now let's go ahead and jump into some stuff with these actual fetal heart rate tracins. The first thing is, whenever you see a sine wave, fetal heart rate tracin, you want to think about severe fetal and eamy. When you see a sine wave fetal heart rate tracin, what do you think of a severe fetal and eamy? The fourth thing I'll talk about is what is an acceleration? Many people hear this term, asl, d cell. What in the world do these things mean?

The first thing is that an acceleration is where the fetal heart rate goes up by more than 15 bits per minute for at least 15 seconds. I'll say that again. An acceleration happens when the fetal heart rate goes up by more than 15 bits per minute for at least 15 seconds. And the thing is, you keep hearing about non-stress tests. What does it mean for a non-stress test to be reactive? Basically, for a non-stress test to be reactive, you need to have two accelerations, at least two accelerations in a 20 minute time period. So now the fifth thing I'll talk about is what is a deceleration? Well, a deceleration is basically where you have a more than 15 bit per minute decrease in the fetal heart rate for a sustained time period. So if you have a decrease in the fetal heart rate by more than 15 bits per minute for a sustained time period, that's a deceleration. The exact timing of that is not very clear, at least if from, you know, it's just something that you should be able to gestalt on in-beam exams. The fetal heart rate has dropped for more than like 30 seconds for more than 15 bit per minute. Then you should imagine that fetus having a deceleration. So many of us know the Ville Chopnomonic. I think that's probably the 16th I should talk about here. It's an amonic that talks about the Ville, the V-E-A-L, the V stands for V-Bode cells, the A stands for early decels, the A stands for A cells, and then the L stands for lead decels.

Then we know the chop, the chop CHOP, the C stands for court compression. So V-Bode cells are caused by a Biblical court compression, early decels are caused by head compression, A cells are good. That's why it's an O corresponding to that. Then lead decels are caused by utero plus cento in sufficiency. The key thing I just want to mention before I go into mechanisms here is that all these things are associated with utero in contractions. These are things you see on the fetal heart rate in response to mom's utero contracting. I think that's a particularly important thing that I need to emphasize here. Let's then go ahead and talk about some of these things. The first thing I will talk about is a V-Bode cell. One thing I think that will help you here is the contraction of the uterus looks like you're building a mountain. It's almost like an upside down V. These decelerations for the fetus are a regular V. You'll see me talk about the top of the maternal V, the bottom of the fetal V. Mom thinks of mom, I mean mom is like a mountain. I'm upside down V. Then the fetal heart rates as being like a down sloping V. What is a V-Bode cell? The big thing with a V-Bode cell is that we know that it's caused by head compression. What's the mechanism? The thing is when you compress the umbilical cord. The umbilical cord contains fetal blood vessels. When you compress those things it's almost like an increasing systemic vascular resistance.

When you increase systemic vascular resistance, the fetal bar or receptors kind of say, why is my blood pressure so high from this increased SVR? They're going to get a parasympathetic discharge in response. That parasympathetic discharge that comes in response is going to lower the fetal heart rate. Again, it's umbilical cord compression that causes a variable decel. The big thing about a variable decel is again, if you're looking at the big thing you need to look at is the fetal heart rate. Again, since it's a decel, the fetal heart rate will be down sloping. The big thing I want to say is from the peak to the trough. The trough is like the lowest part for the fetal V. That time period should be less than 30 seconds. That's like a very big important thing I think I want to emphasize here. That time period has to be less than 30 seconds. It's very abrupt. The fetal heart rate just goes down very quickly and comes up. That down sloping part of the V should take less than 30 seconds. That fetal heart rate tracing. That tells you that I'm dealing with a variable deceleration. The way to fix a variable deceleration, your very first step in management on MBM exams, is that you need to pretty much go ahead and have mom go to the left lateral decubidose position. Mom has to go to the left lateral decubidose position. Because by doing that, Dowling courage, profusion of the fetus.

But if that does not work, then your next step on MBM exams is to strongly consider getting an amnuy infusion. It's to strongly consider getting an amnuy infusion. When you get an amnuy infusion, because if you think about it, the thing that's causing this problem is that the fetus is pretty much banging into his own like a combilical cord. If you can do an amnuy infusion and you give more fluid, put more, basically more like thick amnetic fluid inside the uterus. The baby is going to stop banging into that thing. Because it's almost like you're providing a cushion between the baby and the uterus. So that's between the baby and the ombalical cord. That's something to keep in mind. That's how you manage a variable decel on MBM exams. That's how you manage a variable decel on MBM exams. Now the next thing I'll talk about here is that I want to talk about an early decel. Maybe one final thing I should mention here is that for variable decels, one thing sometimes if you don't see like this, turn on to the left lateral, the cubitose position, which is the first line measure for fixing it or amnuy infusion as an answer. One other answer you may see that will be correct is to turn down the oxytocin infusion. The mom just stops squishing the baby that much because the more the mom squishes the baby, the more the ombalical cords are compressed. So that's one. Now the eighth thing I'll talk about is early decels. Early decels, we know they are right from head compression.

The thing is whenever you compress the head of the fetus, that's going to increase intracranial pressures. Whenever intracranial pressures are increased, cushions reflex is activated. Remember cushions reflex generally involves a Brady Cardia. When you compress the head of the fetus, you activate cushions reflex. You're going to get a big, big old tone and that's going to cause a reflex of Brady Cardia. Now the big thing I would say in terms of identifying an early decel is that the lowest point of the fetal heart retressing coincides with the highest point of mom's uterine contractions. So the baby, the lowest part of that baby is V coincides with the highest part of the maternal upside down V. When you see stuff like that, you know that you're dealing with an early deceleration. And again, the downsloping part of the fetal V should take more than 30 seconds. For a variable decel, it's very abrupt. That downsloping part of the fetal V takes less than 30 seconds. But for an early decel, the downsloping part of the fetal V takes more than 30 seconds. And for early decels, you don't have to do anything. That's just a regular physiologic thing. E cells, again, are a normal thing. So I guess let's talk about the last thing here, which are the lead decels. So lead decels, the big thing to keep in mind with lead decels is that you have a gradual decrease. And return to baseline of the fetal heart rate.

So it may be like, oh, the find how to differentiate a lead decel from an early decel. The thing is, remember I said that for an early decel, the lowest part of the fetal V coincides with the highest part of the maternal inverted V. For a lead decel, the lowest part of the fetal V comes after, okay? The lowest part of the fetal V comes after the highest point of the maternal inverted V. If you see that, you know you're dealing with a lead decel. And again, that period from the beginning of the fetal heart rate going down to the lowest point on the fetal heart rate, that time period, right? Again, like the first part of the V for the fetals, that time period should be more than 30 seconds. So remember, for variable decels, the first part of the fetal V, right, from the top to the very trough, is less than 30 seconds. But for early and for lead decels, it's going to be more than 30 seconds, right? So that's very, very important, right? And again, remember lead decels, they're a sign of utero placenta in sufficiency. Basically, there's not enough blood flowing through the placenta, right? Again, many times the first thing you need to do, your first line management for a lead decel, is to proceed to the left lateral, the cubitose position. But if you notice that that's not because if you go to the left lateral, the cubitose position, mom will stop compressing the inferior veneceva. And that's going to increase preload for mom's heart.

And that will obviously increase cardiac output to the fetus through the placenta vessels, right? But if you notice that these lead decels are repetitive, they don't seem to be resolving. Then you may have to intervene and deliver the baby very, very quickly, okay? You may have to intervene and go ahead and deliver the baby very quickly. You may have to do like a C-sectional or something like that, especially again, if they're recurrent lead decels. So I think with that, I'm going to go ahead and stop. Again, I do offer one or one tutoring for many of the USML exams, step one, step two, CK, step three, preclinical medical exams, third-year shelf exams. I do have a You Tube channel, Divine Intervention, USML, podcast and videos. If you subscribe to that, you'll see my videos there. And also, I have these podcasts along the podcast apps. I also have like a new podcast website called Divine Intervention Life Lessons.com, where you know, I have Bible-based teaching, just talk about a life lesson for usually like 10 minutes or less. And many people have found to be really helpful. And I also help with eRAS applications like personal statements, rec letters, mock interviews, editing the eRAS application itself. So if you interested in any of those, just shoot me an email through the website. And I'll be more than happy to help you. So thank you for joining me today. I'll see you next time. Have a wonderful day. God bless you. Thank you.

110 to 160 beats per minute (bpm).

An increase in FHR by more than 15 bpm for at least 15 seconds.

By having at least two accelerations within a 20-minute period.

Umbilical cord compression (Variable Deceleration).

Uteroplacental insufficiency (insufficient blood flow through the placenta).

It suggests an abrupt compression event, typically related to umbilical cord compression.

Repositioning the mother into the left lateral decubitus position.

Late deceleration (signaling uteroplacental insufficiency).

Increased intracranial pressure due to head compression, activating the cranial nerves and causing a reflex bradycardia.

Maternal fever, anemia (low $\text{O}_2$ content), hypotension, or hypoxia.

Anti-Ro and anti-La antibodies.

Repositioning the mother into the left lateral decubitus position.

Late deceleration (signaling uteroplacental insufficiency).

Increased intracranial pressure due to head compression, activating the cranial nerves and causing a reflex bradycardia.

Maternal fever, anemia (low $\text{O}_2$ content), hypotension, or hypoxia.

Anti-Ro and anti-La antibodies.