Decel Dina — Fetal Heart Rate Decelerations & Intrapartum Monitoring
VEAL CHOP: Variable=Cord, Early=Head, Accel=Okay, Late=Placenta
Dina is 6 cm dilated and progressing well when the monitor begins tracing a pattern the nurse has seen before, but not like this. The shape of each dip tells a different story about her baby.
Dina is in active labor with continuous fetal monitoring, and the strip is the story. Early decelerations mirror contractions and are benign, from fetal head compression. Variable decelerations are abrupt and unpredictable, from cord compression, and need repositioning. Late decelerations start after the contraction peaks and reflect uteroplacental insufficiency — an urgent, non-reassuring pattern requiring immediate intervention. The mnemonic VEAL CHOP links pattern to cause to nursing action.
Read Decel Dina's full story →The story arc
The setup
Dina's membranes rupture and contractions strengthen; continuous external fetal monitoring is applied per protocol.
The turn
The strip shows gradual dips that mirror each contraction, returning to baseline as the contraction ends.
The crisis
After a strong contraction, the fetal heart rate drops abruptly and stays low, and this time it starts well after the contraction has peaked and returns to baseline late.
The save
The nurse repositions Dina to her left side, applies oxygen, increases IV fluids, discontinues oxytocin, and notifies the provider immediately.
NCLEX study section — Fetal Heart Rate Decelerations & Intrapartum Monitoring
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Maternal & Newborn
Take this chapter into practice questions on the same topic.