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Wednesday, August 17, 2011

Fetal Heart Rate: when is a c-section indicated for tachy cardia

I was asked a question that I thought I'd post here.

"Can you tell me what a foetal heartrate of over 190bpm with little to no variation means?

No-one at the time told me exactly what this means, and so I wonder was the C/S really necessary and would everything have been ok if I had birthed vaginally."

That kind of depends on what else was going on. This is one of those more hazzy areas in fhr interrpretation. I'm going to quote to you mostly from monitoring textbook so you can see what is being taught.

The most common cause of an increased heart rate is a fever in mom, not necessarily a problem with the baby. It is also caused by some medications or dehydration. It is not believed to be an indication of the babies status as long as there are no decelerations(decreases in the babies heart rate).

It does tax the babies oxygen reserves though, so I could see a doctor wanting to do a c-section do avoid this. It is also seen after a baby has been having some problems.

If there is no variability along with it, it is hard to determine if it is due to complications or not. It could be more serious if it has the decelerations I talked about or has no variability.

Minimal variability is seen during sleep cycles, or from some medication use. Sleep cycles can last up to 75 min.

Tracings that show minimal or absent variability may also be due to other underlining neurological problems with the baby.

It is also common to see minimal variability with tachycarida. The best indicator that a baby is not doing well(though it is still not very good), is when there is absent variability with decelerations or bradycardia(low heart rate <110).

In your case I would hope that other measures where taken to make sure the baby was healthy. This would include decreasing your temperature if you had one, make sure you were hydrated, and looking over your medication history. I would also look at the previous heart rate tracings for what is called accelerations(an increase in the heart rate for a breif time). This is a great indicator that the baby is doing well. I would also make sure you were feeling the baby move. Waiting for awhile to make sure that the baby is not just sleeping would also be good. You could drink juices or something sugary to wake them up a bit.

Basically this is a hard judgement call by the doctor. Some would be more tolerant of the this situation than others. But tachycardia and minimal variability are not an indication in of themselves for a c-section. They are in the maybe section, which, quite honestly, many fetal heart rate tracings are.


Fetal Heart Monitoring Principles and Practices. Published by AWHONN as a part of the Fetal Heart Rate Monitoring Program.


Melanie said...

This was my question and I thank Rachel not only for answering but for turning my question into another blog post.

Some more background about my experience. I was 40 weeks, not in labour and not fully engaged. This was to be a planned home birth and I only went in to hospital for CTG as the heart rate had been high since the night before.

I was well. I did not have a temperature, I was not dehydrated, and I had not taken any medication. I did not feel as though anything was wrong as I felt good, and I felt the baby was ok. The baby was also moving normally as he had done for the last few weeks. There was nothing that I could feel in me that indicated a problem.

I have PTSD from how the hospital treated me and how I feel I was sacrificed by those caring for me. I was the most unimportant person in that room, yet it was my body, my baby and my life that was being affected. And even though I asked, a few times, for an U/S it was denied. I asked to be induced, this was also denied. The only thing the hospital wanted to was cut me open.

There has always been some part of me that felt the surgery was unnecessary. I have tried telling myself that it was, but I have never really believed it and this post has reaffirmed that belief.

Rachel said...

I'm not sure, but it could be that the hospital was worried about the minimal variability. Sometimes that can indicate an oxygenation problem, especially if it had been for such a long time. A baby's heart rate is expected to fluctuate a little bit. But this is sort of one of those grey areas too.

I'm sorry to hear that you were treated badly...that's one thing that is not grey. Hospital staff should always treat women with respect and allow them to make their own decisions. Hopefully you can find some healing.

Rachel said...

I wanted to discuss this a little bit further after talking to a midwife that I know. I think both of us agreed in this case, that there was some cause for concern in this fetal heart rate tracing. Tachycardia is a tough one to nail down, but there was also minimal variability which usually is not a good sign, but not always.

The conclusion we came to...maybe a c-section was needed, maybe not. Which was pretty much what I was thinking. What is hard though, is that you felt abused, and that is something that for sure is wrong.

Melanie said...

My belief that the C/S was unnecessary stems from the point in time I was at the hospital, because I felt that everything was ok. A few hours or days later and I may have felt differently. I'll never get the chance to know.

The way I was treated was despicable. There was no respect for who I was as a person and a lot of my trauma stems from how they made me feel while they did what they did, not necessarily what they did.

Because fetal heart rate tracings are so inexact in their interpretation I no longer trust them to tell me anything about the health of the baby. So I've decided for this pregnancy, I won't be listening.

Rachel said...

I think you have a very valid point...our way of knowing whether or not the baby is doing ok(the fhr) is not very reliable. That's why you'll find so much variation in practice. I also tend to listen to a mom feels about the health of her baby, because I think can help us sometimes.

Thanks for sharing your story, Melanie, this is actually a really good topic to discuss.

Birth is a Journey: Does it have to be life changing?

  • One woman might have to climb on an overfilled boat, risking her life and nearly dying as she escapes over the ocean to come to this land. This experience could certainly be life altering. It may very well color the rest of her life, positively or negatively. (I overcame this amazing struggle and here I am triumphant! OR Holy crap, that was SO hard I don’t know if I can go on! By the way, neither response is “right”. No one would judge the woman with the 2nd response.)
  • One woman may buy an airplane ticket, sit on a comfortable 747 and fly to America with a nice smooth flight and landing. She is happy to be in America. Those welcoming her are glad she is here safe and sound. She may only travel by plane 2-4 times in her life, so it is pretty memorable. But the journey itself probably wouldn’t be life changing; it would simply be a journey.
  • One woman may learn to fly an ultra-light plane to lead a flock of geese into America teaching them to migrate. This experience could certainly be empowering and life altering.