Tuesday, January 24, 2017

Electronic Fetal Heart Rate monitoring interpretation (VEAL CHOP mnemonic)


So do you guys know about the VEAL CHOP mnemonic?

Variable decelerations - Cord compression
Early decelerations - Head compression
Accelerations - Oxygenation
Late decelerations - Placental insufficiency

Well, it has one kind of periodic FHR change pattern missing. That's the sinusoidal pattern associated with fetal anemia!

For those who don't know, let's run through them quickly :)

Accelerations are transient increases in the FHR. They are usually associated with fetal movement, vaginal examinations, uterine contractions, umbilical vein compression, fetal scalp stimulation or even external acoustic stimulation. The presence of accelerations is considered a reassuring sign of fetal well-being. e presence of at least two accelerations, each lasting for 15 or more seconds above baseline and peaking at 15 or more bpm, in a 20-minute period is considered a reactive NST.

Early decelerations are caused by fetal head compression during uterine contraction, resulting in vagal stimulation and slowing of the heart rate. These decelerations are not associated with fetal distress and thus are reassuring

Late decelerations are associated with uteroplacental insufficiency and are provoked by uterine contractions. Any decrease in uterine blood flow or placental dysfunction can cause late decelerations. A late deceleration is a symmetric fall in the fetal heart rate, beginning at or after the peak of the uterine contraction and returning to baseline only after the contraction has ended. The descent and return are gradual and smooth. A pattern of persistent late decelerations is nonreassuring, and further evaluation of the fetal pH is indicated.

Variable decelerations are shown by an acute fall in the FHR with a rapid downslope and a variable recovery phase. Variable decelerations are caused by compression of the umbilical cord. A persistent variable deceleration pattern, if not corrected, may lead to acidosis and fetal distress and therefore is nonreassuring.

Sinusoidal pattern is rare but ominous and is associated with high rates of fetal morbidity and mortality. It is a regular, smooth, undulating form typical of a sine wave that occurs with a frequency of two to five cycles per minute and an amplitude range of five to 15 bpm. It is also characterized by a stable baseline heart rate of 120 to 160 bpm and absent beat-to-beat variability. It indicates severe fetal anemia, as occurs in cases of Rh disease or severe hypoxia. It can also be due to rupture of fetal vessels.

That's all

Source: Interpretation of the Electronic Fetal Heart Rate During Labor 


  1. Variable is utero placental insufficiency and early is head compression

  2. My mistake. Thanks. mnemonic helps me now

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