OB / NCLEX Practice
Maternal–Fetal Monitoring Lab
Read the fetal heart rate strip alongside uterine contractions, recognize accelerations or decelerations, and choose the best intervention. Generated drawings are schematic teaching examples, not actual patient recordings.
Fetal heart rate & contractions
Case 1Upper panel: FHR (bpm). Lower panel: uterine activity (relative units). Time runs left to right; vertical gray marks represent 1 minute.
Select the tracing interpretation and intervention. Answers remain hidden until grading.
Interpret the strip
Remember: fundus assessment after birth
After delivery, assess uterine tone and vaginal bleeding. A soft, boggy fundus can signal uterine atony: the uterus is failing to contract and compress the blood vessels at the placental site. Support the lower uterine segment and massage the fundus according to training and local protocol while escalating hemorrhage care. Reassess tone, blood loss, vital signs, and bladder distention. Routine massage of an already firm fundus is not recommended.
Fast reference
Baseline, variability, accelerations
Normal baseline is 110–160 bpm, averaged over 10 minutes in clinical practice. Variability: absent, minimal (≤5 bpm), moderate (6–25 bpm), marked (>25 bpm). Acceleration at ≥32 weeks: ≥15 bpm above baseline lasting ≥15 seconds but <2 minutes; before 32 weeks, ≥10 bpm for ≥10 seconds. This simulator compresses time and does not replace a full 10–20 minute analysis.
Early, late, variable, prolonged decelerations
Early: gradual fall mirrors contraction, often due to head compression. Late: gradual fall, nadir after contraction peak, may indicate impaired uteroplacental oxygen transfer. Variable: abrupt drop with variable timing, often associated with cord compression. Prolonged: fall ≥15 bpm lasting at least 2 but <10 minutes.
Category I, II, III
Category I: baseline 110–160, moderate variability, no late or variable decelerations; early decelerations and accelerations can occur. Category II: patterns not I or III; requires evaluation and surveillance. Category III: absent variability with recurrent late or variable decelerations or bradycardia, or sinusoidal pattern; urgent evaluation and action.
Why these interventions?
Position change can reduce vena cava compression or cord compression; reducing oxytocin addresses tachysystole; fluids may help maternal hypovolemia; treating maternal hypotension addresses perfusion. Amnioinfusion may be considered for recurrent variable decelerations under appropriate orders. Per ACOG's 2025 guidance, do not routinely give maternal oxygen for Category II or III solely to treat the tracing if maternal oxygenation is normal.
EDUCATIONAL USE ONLY. Never use synthetic tracing interpretation or this tool to make real-time clinical decisions. Verify intervention with your preceptor, orders, local protocols, and the full patient picture. References: ACOG 2025 fetal monitoring guidance; WHO/FIGO postpartum hemorrhage guidance.