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VEAL CHOP: Understanding Fetal Heart Rate Decelerations

Amanda Guarniere

Close-up of Hands Holding Baby Feet

Fetal heart rate monitoring is crucial during labor and delivery to ensure the health of both mother and baby. VEAL CHOP is a tool that nursing professionals use to help identify variations in fetal heart rate patterns.

This mnemonic device, which stands for Variable decelerations, Early decelerations, Accelerations, and Late decelerations, helps to identify the cause of each fetal heart rate change. This article will delve deeper into VEAL CHOP in nursing, how fetal heart rates are monitored, and the importance of timely intervention.


  • There are two methods for monitoring fetal heart rates.
  • Fetal oxygenation refers to transferring oxygen and nutrients from the mother’s blood to the fetus via the umbilical vein.
  • Interventions for VEAL CHOP are directly related to the type of declaration.

Table of Contents

What Does VEAL CHOP Mean in Nursing?

The nursing mnemonic device VEAL CHOP is most commonly used in labor and delivery to help identify variations in fetal heart rate patterns during birth. It is an abbreviation for

Variable decelerations-> Cord compression 

Early deceleration -> Head compression

Accelerations -> OK

Late decelerations -> Placental insufficiency

It is used with fetal heart rate monitoring to help determine the baby’s condition. It is only one of the tools used by labor and delivery nurses and OBs. It can also be used while

  • Nonstress examination
  • Stress test for contraction
  • Biophysical profile (BPP)

How are Fetal Heart Rates Monitored?

Did you know that during pregnancy, healthcare providers monitor fetal heart rates to ensure the health of both mom and baby?

There are two methods for monitoring fetal heart rates: auscultation with a stethoscope and an electronic fetal monitor. During routine office visits, your provider may listen to your baby’s heartbeat with a stethoscope. However, an electronic fetal monitor may be used instead in high-risk pregnancies or the hospital. 

Fetal electronic monitors can be internal or external.

  • Internal monitoring involves inserting an electrode into the uterus and placing it on the fetus’s scalp, along with a catheter to measure contractions. Only after the amniotic sac has ruptured can this method be used.
  • The external method utilizes two transducers secured to the abdomen with elastic belts. One transducer measures fetal heart rate, while the other measures uterine contractions. This non-invasive method is frequently used to monitor fetal heart rates during labor.

The fetal heart rate and maternal contractions will be tracked and displayed on the monitor for healthcare providers to review, regardless of the method used. Monitoring fetal heart rates is essential to prenatal care because it can help detect potential complications early on, so you can be confident that your healthcare team is looking after you and your baby.

Understanding VEAL CHOP

The acronym VEAL CHOP is used to remember fetal heart rate pattern changes in which the letters in VEAL correspond to accelerations or decelerations. The letters in CHOP help you remember the cause of each FHR change. V stands for variable, and C stands for cord compression. E stands for early, and H stands for head compression. L for late goes to P for placental insufficiency, while A for acceleration goes to O for okay.

V: Variable Decelerations

Because variable deceleration is unpredictable and causes frequent drops in fetal heart rate, it is more severe than late deceleration. Variable deceleration happens when the baby’s umbilical cord is temporarily tightened. The majority of pregnancy labors experience variable deceleration.

The infant relies on a continuous blood supply via the umbilical cord to obtain oxygen and other vital nutrients. If the fetus’s blood supply is limited, variable decelerations may occur. This type of pattern can be harmful to the infant.

Causes of Variable Deceleration

Here are some possible explanations for variable decelerations:

  1. Compression of the intrauterine umbilical cord caused by:
    • The mother’s and fetus’s positions
    • True knot or umbilical cord?
    • Tachysystole of the uterus
    • Pushing efforts during the second stage of labor
    • Oligohydramnios, or a lack of amniotic fluid
    • Ties in the nuchal cord or other cords
  1. Fetal acidemia has increased
  2. The umbilical cord prolapse
  3. The uterus has ruptured.

Management of Variable Deceleration 

  1. Adjusting maternal posture to relieve pressure on the umbilical cord and minimizing fetal head compression are two nursing interventions for variable decelerations.
  2. Administering an IV bolus may boost the volume of blood and its circulation, as well as the fetal heart rate.
  3. Examine the cervix for signs of a prolapsed cord or a shift in labor progress.
  4. Monitor FHR regularly to assess the current situation and detect any changes in FHR patterns.
  5. If necessary, provide oxygen.
  6. Keep a record of your observations and report them to your doctor.
  7. Prepare for the possibility of cesarean birth. Take into account the previous interventions.

E: Early Decelerations

“Early deceleration” refers to the proportional decreases and subsequent restoration of the normal fetal heart due to uterine contractions. The heart rate gradually slows down in this condition. Before the contraction reaches its maximum, there are early decelerations. Early deceleration may occur if the baby’s head is compressed.

This is to be expected when the baby descends into the delivery canal in the later stages of labor. If the baby is preterm or transverse, it can also occur during premature labor. As a result of contractions, the uterus squeezes the baby’s head. Early decelerations are generally not harmful.

Causes of Early Deceleration 

  1. The fetus’s head compression is one of the causes, rather than fetal hypoxia.
  2. When the baby descends through the birth canal, early deceleration may occur.
  3. Because of uterine contractions, the heart rate slows, resulting in early decelerations.

Management of Early Deceleration 

  1. Cardiotocography; electronic fetal monitoring technology (CTG). Cardiotocography (CTG) is an electronic fetal monitoring tool that allows the clinician to observe early decelerations or other FHR disparities in the fetus.
  2. Changing one’s body position is one early deceleration intervention. Allow the patient to lie down in the left lateral, knee-chest, or correct lateral posture to relieve compression on the big vein (or vena cava). This method, along with the uterus and placenta, increases the flow of deoxygenated blood to the heart and the rest of the body.
  3. Because they are not caused by low fetal oxygenation or metabolic acidosis, early decelerations do not necessitate immediate medical attention. However, it is critical to monitor FHR tracings throughout labor to detect any abnormalities that may be concerning due to changes in the fetus’ acid-base state.

A: Accelerations

Doctors will look for signs of acceleration during labor. Temporary increases in heart rate of at least 15 beats per minute that last at least 15 seconds are referred to as accelerations. Accelerations are natural and beneficial.

Accelerations alert the doctor that the infant is getting enough oxygen, which is critical. The majority of fetuses spontaneously accelerate at various stages of labor and delivery.

If the doctor is concerned about the baby’s health and does not notice any accelerations, they may try to generate them. They may try a variety of approaches to generate fetal heart rate accelerations. Here are a few examples:

  • Gently rocking the mother’s abdomen.
  • Creating a brief burst of sound (vibroacoustic stimulation)
  • Providing food or fluids to the mother
  • Contraction of the uterus
  • Inserting a finger through the baby’s cervix
  • Compression of the umbilical vein

If these methods cause fetal heart rate accelerations, the baby is healthy.

L: Late Decelerations

Late decelerations do not begin until a contraction has peaked or the uterine spasm has ended. They are smooth, brief drops in heart rate that mimic the contraction pattern. Late decelerations are not always a cause for concern as long as the baby’s heart rate also exhibits accelerations (known as variability) and a quick return to the normal heart rate range.

Late decelerations sometimes indicate the infant is not getting enough oxygen. Late decelerations with a rapid heartbeat (tachycardia) and minor fluctuation show that the contractions may harm the baby due to oxygen depletion.

If the baby is in danger due to late decelerations and other signs, the doctor may decide to perform an immediate cesarean surgery.

Causes of Late Deceleration

  1. Uteroplacental insufficiency (depleted oxygen for the fetus)
  2. Maternal blood pressure is low.
  3. Consequences of epidural or spinal anaesthesia
  4. Uterine hyperactivity
  5. Infection of the amniotic fluid, which could occur as a result of prolonged labor
  6. Placenta previa, also known as abruption.

Management of Late Deceleration 

  1. Keep a record of your findings and present them to your doctor.
  2. Maintain the maternal position on the left.
  3. Examine the progress of the labor.
  4. Begin planning for an emergency cesarean birth.
  5. Explain the treatment plan to the woman and her husband.
  6. Use a face mask to deliver 7-10 L/min of oxygen.
  7. Examine the mother’s blood pressure and pulse rate.
  8. Increase the IV fluids.
  9. Assist the doctor in collecting fetal blood.

C: Cord Compression

Compression is a common cause of umbilical cord issues. Compression occurs when pressure partially or entirely prevents blood circulation through the umbilical cord. Fetuses can survive for short periods when the umbilical cord is compressed, but if the baby’s blood circulation is not restored, the newborn may suffer catastrophic birth complications. This is dangerous because babies require nutrition and oxygen to develop correctly.

Reduced activity from the baby is thus a sign of umbilical cord compression, as measured by a reduction in movement or an irregular heartbeat detected by fetal heart monitoring.

Causes of Cord Compression 

The following are some of the most common causes of umbilical cord compression:

  1. Nuchal cords. A nuchal cord is a clinical term for when an umbilical cord wraps around the baby’s neck multiple times within the womb.
  2. True knots. The true knot is the medical term for when the umbilical cord twists into a rope-like knot. This condition can develop simply due to the baby’s activity within the mother’s womb.
  3. Umbilical cord prolapse. A prolapse occurs when the umbilical cord moves down the delivery canal ahead of or alongside the infant. The umbilical cord should ideally accompany the baby down the delivery canal. If the cord moves ahead of or beside the infant, it can cause fetal hypoxia, Hypoxic-Ischemic Encephalopathy, and other birth complications.

Management of Cord Compression

  1. Umbilical cord compression is commonly treated with amnioinfusion. Amnioinfusion is a procedure in which a room-temperature saline solution is infused into the uterus during childbirth to relieve the pressure that could cause the umbilical cord to become compressed.
  2. Improve blood circulation through the umbilical cord by increasing the mother’s oxygen levels.
  3. If the infant shows signs of discomfort or if the baby’s heart rate abruptly shows some signs of brief fluctuations in the heart rhythm, a C-section may be required to preserve the baby’s health.
  4. Changing positions: Changing the mother’s position (from the right to the left side) may help relieve compression and increase blood circulation to the baby.

H: Head Compression

When a baby’s head is subjected to increased pressure during labor and delivery, it can result in brain injury. This condition can occur without visible external head trauma, oxygen insufficiency, or birth asphyxia.

Causes of Head Compression 

The following are some of the possible causes of head compression:

  1. During uterine contractions, particularly when severe and leading up to birth.
  2. A lack of oxygen to the fetal brain is the most common cause of head compression during pregnancy or labor.
  3. Obstinate maternal pushing during labor.

Management of Head Compression

  1. Change the mother’s posture.
  2. Assure that the mother is properly hydrated.
  3. Make sure the mother gets enough oxygen.
  4. Educate the mother on proper maternal pushing technique during labor.

O: Oxygenated/OK

The transfer of oxygen and nutrients from the mother’s blood to the fetus via the umbilical vein is known as fetal oxygenation. This improved blood flows into the baby’s organs via the umbilical cord. It then passes through a shunt known as the ductus venosus. In addition, some blood can be sent to the liver due to adequate oxygenation.

Signs of Normal Fetal Oxygenation 

  1. Heart rates are normal. Babies who develop normally in the womb have stable and robust heartbeats.
  2. Bleeding has been reduced.
  3. A sufficient amount of amniotic fluid.
  4. The fetal movement has increased.
  5. Maternal cramping has been reduced.

P: Placental Insufficiency

The placenta does not always work properly. As a result, the baby will not get enough oxygen and nutrition. If the mother has placental insufficiency, the baby may not grow normally or have difficulties during labor. The condition can be harmful to both the mother and the child. When the placenta pulls away from the uterine wall, it has been linked to pre-eclampsia and spontaneous abortion.

It can also inhibit the baby’s normal development in the womb, a condition known as intrauterine growth restriction (IUGR). As a result, there could be severe complications for the infant, such as a lack of oxygen during birth, preterm labor, hypoglycemia, insufficient calcium in the blood, an excess of red blood cells, and, in rare cases, miscarriage.

Causes of Placental Insufficiency

  1. When the placenta fails to grow properly or is destroyed, this results in placental insufficiency.
  2. When a mother is carrying twins or more, the placenta may not grow sufficiently. It may take an irregular shape or fail to connect correctly to the uterine wall.
  3. Diabetes, pre-eclampsia, and blood clotting disorders are all risk factors.
  4. The lifestyle that we lead has the potential to harm the placenta.
  5. Smoking
  6. Using illegal drugs while pregnant may result in placental insufficiency.

Management of Placental Insufficiency 

  1. The baby’s growth will be closely monitored if the healthcare professional suspects placental insufficiency. The mother will be asked to keep track of the baby’s movements and to notify the medical team if anything changes.
  2. The stage of the pregnancy will determine the treatment. If the mother is less than 37 weeks pregnant, the doctor may advise her to keep the baby in the womb as long as possible while under observation.
  3. If the mother is already full term or there are signs that the baby is in distress, the doctor may induce labor or perform a cesarean section.

Importance of Timely Intervention

Interventions for VEAL CHOP are directly related to the type of declaration. Some will require minor position changes, whereas others may result in the baby being delivered immediately. It is critical that nurses understand the interventions for each type of deceleration because some can be done immediately and without a doctor’s order.

For example, if a patient has variable declarations on fetal heart rate monitoring, the nurse should immediately turn the patient to their side, continue to monitor, and notify the OB. Ongoing variable declarations may necessitate the baby’s immediate delivery via c-section. Even though the nurse will not be able to perform this procedure independently, she must be aware of and comprehend all the possible interventions for each deceleration type.

FAQs About VEAL CHOP in Nursing

Can VEAL CHOP be used in other healthcare settings?

The mnemonic VEAL CHOP is commonly used in obstetrics to help healthcare providers remember the potential causes of fetal heart rate changes during labor. The principles underlying VEAL CHOP, on the other hand, can be applied in different healthcare settings.

Why is VEAL CHOP important in nursing?

VEAL CHOP is essential in nursing because it provides a quick and easy-to-remember framework for interpreting fetal heart rate patterns during labor, which can help nurses identify potential fetal distress and take appropriate interventions.


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