A Guide to VEAL CHOP: Nursing Mnemonics

Fetal heart rate monitoring is an important tool used during labor and delivery. It allows us to gauge how effectively a baby is receiving oxygen, and can be used to inform decisions about possible interventions. The VEAL CHOP nursing mnemonic can help you recall how to interpret different fetal heartbeat patterns. 

What Is the VEAL CHOP Nursing Mnemonic?

“VEAL CHOP” is a mnemonic device, or a memory technique, nurses use to identify variations in fetal heart rate patterns during birth. It can also be used for fetal heart beat changes during the earlier stages of pregnancy, such as during nonstress tests. Medical professionals have been using electronic fetal heart rate monitoring since it was first developed at Yale University in 1958. Most commonly, external heart rate monitoring is performed via ultrasound, though it’s also possible for doctors to track the fetus’s heart rate internally using a thin wire fixed to the baby’s scalp through the cervix. 

According to Johns Hopkins Medicine, a fetal heart rate ranges between 110 and 160 beats per minute (bpm), with variations of up to 5 to 25 bpm. Should sudden increases (accelerations) or decreases (decelerations) occur, it could indicate insufficient oxygen or another issue requiring intervention. With that in mind, the American College of Obstetricians and Gynecologists notes that fetal heart rate monitoring also helps to prevent unnecessary treatments. 

The VEAL CHOP nursing mnemonic indicates different heart rate changes and the causes behind them. In this mnemonic device, the first letter of the first word corresponds with the first letter of the second word, and so forth. Here’s a breakdown of what each letter stands for:

• Variable decelerations → Cord compression
• Early deceleration → Head compression
• Accelerations → OK 
• Late decelerations → Placental insufficiency

Below is a closer look into fetal heart rate changes and their potential causes.

Variable Decelerations

Variable decelerations could indicate that the fetus’s blood supply is limited. Because the fetus receives blood supply through the umbilical cord to receive oxygen, this suggests the cord is compressed. The decelerations are unpredictable and can impact heart rate, causing frequent drops. Some possible causes include:

• The mother and fetus’s positioning
• True knot in the umbilical cord
• Nuchal cord entanglements
• Insufficient amniotic fluid
• Rupture of the uterus
• Umbilical cord prolapse

Adjusting the mother’s position to alleviate umbilical cord compression may be the first step in managing variable decelerations. From there, steps to address the issue could include examining the cervix to check for cord issues, administering an IV to increase blood volume, administering oxygen, or preparation for cesarean birth.

Early Decelerations

With early decelerations, the heart rate slows progressively before the contraction reaches its peak. This typically occurs when the baby’s head is compressed. Although common in the later stages of labor as the baby’s head descends through the birth canal, the issue can also develop with preterm or transverse babies during premature labor. The uterus also squeezes the fetus’s head during normal contractions. As such, early decelerations typically aren’t harmful.

Changing the mother’s position to increase the flow of oxygen may reduce compression and alleviate early deceleration. For instance, having the mother lie down on their left side with their knees into their chest can reduce pressure on the vena cava (the large vein carrying blood from the heart) to provide sufficient blood to the uterus. Ongoing fetal heart rate monitoring is also advised. 

Accelerations

Fetal heart rate accelerations are temporary increases of 15 bpm or more lasting 15 seconds or more. These changes are natural and healthy, indicating that the fetus is getting sufficient oxygen. Spontaneous accelerations should occur during birth, but doctors may try to trigger them if none occur naturally. The following interventions may be used:

• Placing a finger on the baby’s head through the cervix
• Gently rocking the mother’s abdomen
• Providing vibroacoustic stimulation (a short burst of sound)

Late Decelerations

Late decelerations occur when the fetal heart rate gradually decreases for 30 seconds or more after a contraction. This change is the most concerning of all as it suggests placental insufficiency, which could lead to serious issues such as shortage of oxygen for the baby. As with early decelerations, one immediate intervention may be turning the patient on their side and having them bring their knees to their chest to increase blood flow. If the issue persists, interventions such as an oxygen mask, intravenous hydration, and cesarean birth may be needed. 

The VEAL CHOP Nursing Mnemonic in Practice

A baby’s heart rate experiences ongoing changes throughout labor and delivery in response to the fetal environment and stimuli. While many of these variations are normal, acting quickly when abnormalities occur is critical to promoting safe outcomes for a mother and her baby. The VEAL CHOP nursing mnemonic can help you remember when to act if the fetal heart rate rapidly changes. 

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