What Does VEAL CHOP Stand For in Nursing?

What is VEAL CHOP in Nursing?

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

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

It is used in conjunction with fetal heart rate monitoring to help evaluate the status of the baby. It is simply one tool utilized by labor and delivery nurses and OBs. It can also be used during,

• Nonstress test
• Contraction stress test
• Biophysical profile (BPP)

There are countless things that can affect a baby’s heart rate during labor including,

• Pain medications/epidural
• Procedures
• Active labor ie. pushing
• Uterine contractions
• Dehydration
• Pain

What Does VEAL CHOP Stand For?

V = Variable Decelerations / C = COMPRESSION

Variable decelerations generally indicate that the baby’s blood supply is limited and interrupted for a specific period of time.  

During pregnancy, the fetus receives blood and oxygen through the umbilical cord via the placenta. During labor, the cord can become compressed for a variety of reasons and disrupts the blood flow to the baby. 

The decelerations are unpredictable and can impact heart rate, causing frequent drops but the heart rate may have periods that it is normal. 

Common causes include:

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

The first intervention for variable decelerations is to adjust the patient’s position to help relieve compression on the cord. Depending on the ultimate reason, repositioning will not help. For example, a knot in the umbilical cord will not be resolved by changing the position of the patient. 
Other interventions include,

• Administer oxygen therapy
• Stop Pitocin infusion

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E = Early Decelerations / H = Head Compression

Early decelerations are when the heart rate of the baby progressively slows before the contraction reaches its peak. This is commonly seen when the head of the baby is compressed. Typically, these decelerations are a normal variant and little to no intervention is needed. 

Other causes of early decelerations include, 

• Late stages of labor as the baby descends through the birth canal
• Due to uterine contractions

As a baby’s head progresses down through the birth canal the head may become compressed. Furthermore, during contractions, the uterus will squeeze the baby’s head to help move them. 

While most OBs will agree that early decelerations are okay, it is important to continue to monitor the baby through fetal heart rate monitoring. 

The H in VEAL CHOP stands for head compression. This is most directly related to early decelerations. It is a result of increased pressure on the baby’s head during labor which can result in a brain injury due to lack of oxygenation and blood flow.

Possible reasons for head compression are, 

• Uterine contractions
• Mother refusing to push during labor
• Lack of oxygen to the fetal brain 

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A = Accelerations / O = Okay

Fetal heart rate accelerations are temporary increases of 15 bpm or more lasting 15 seconds or more. These are OKAY and something a healthcare provider will want to see as labor progresses. These should occur and if they are not then the OB may help induce them. 

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)
• Instructing the mother to eat or drink
• Contraction of the uterus
• Compression of the umbilical vein

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L = Late Decelerations / P = Placental Insufficiency

Late decelerations occur when the fetal heart rate gradually decreases for 30 seconds or more after a contraction. 

This is one of the most concerning types of decelerations and requires immediate interventions. A late deceleration indicates placental insufficiency which can lead to a lack of oxygen and blood flow to the baby. 

Specific causes of late decelerations include, 

• Amniotic fluid infections
• Low maternal blood pressure
• Placenta previa or abruption
• Hyperactive uterine activity
• Result of epidural or spinal anesthesia

Interventions are similar to those for early decelerations. Nurses should immediately intervene with all late decelerations including, but not limited to, 

• Turning patient to side
• Bringing knees to chest

If late decelerations continue despite initial interventions, other measures include,

• Oxygen administration
• Stop Pitocin infusion
• IV hydration
• Immediate delivery of the baby via c-section

The P in VEAL CHOP stands for placental insufficiency. There are a variety of reasons for this including the aforementioned list but others may include, 

• Placental not growing correctly
• Irregularly formed
• Smoking
• Illicit drug use
• Diabetes
• Pre-eclampsia
• Blood clotting disorders

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How is VEAL CHOP Used? 

VEAL CHOP is used throughout labor and delivery and is commonly associated with the status of the baby. 

During labor, fetal heart rate monitoring is used to monitor the patient. Initially developed by Yale University in 1958, fetal heart rate monitoring is a less invasive tool used to understand the progress of labor and the well-being of the unborn baby. 

An average fetal heart rate is 110 to 160 beats per minute with variations of 5 to 25 beats per minute, according to Johns Hopkins.  

OB Nurses can use VEAL CHOP throughout their practice to help remember the different types of decelerations and if they are okay, bad, or need further evaluation. 

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VEAL CHOP Interventions

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

For example, if a patient is having variable declarations on the fetal heart rate monitoring, the nurse should immediately place the patient on their side, continue to monitor, and inform the OB. Ongoing variable declarations may require immediate delivery of the baby via c-section. Even though the nurse will not be able to perform this procedure independently, it is important to know and understand all of the possible interventions for each type of deceleration. 

*This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease.