Question

Kathy is a 23-year-old G2P0 at 42 weeks of gestation in active spontaneous labor. Her pregnancy has been complicated by mild hypertension, but no medications were needed. She is 4 cm/100/0 station, vertex position. Her membranes have just ruptured, and there is thick meconium staining. She is comfortable and utilizing epidural anesthesia.

1.   What risk factors are present that may impact the way the fetus tolerates labor?

2.   The fetal heart rate shows a rate of 140, moderate variability, no accelerations, and decelerations to 120 beginning after the peak of most contractions and recovering to baseline 30 seconds after the contraction ends. Contractions are every 4 minutes.
How should the nurse describe this pattern using? What are the nursing interventions if any?

3.   Kathy is now 8/100/0. She is in the left lateral position with oxygen at 8 liters/minute. The fetal heart rate is 145. There is moderate variability. Accelerations are not present. There are decelerations in the fetal heart rate beginning at the onset of a contraction, descending to 120 with recovery by the end of a contraction. The contractions are every 3 minutes now. How should the nurse describe the fetal heart rate pattern now? What are the nursing interventions?

4.   Kathy is now completely dilated and +1 station. She has been instructed to push with every contraction. The fetal heart rate is now 164. There is absent variability, and decelerations to 120 are occurring with maternal pushing that do not resolve until 30 seconds after the contraction. The contractions are every 1.5 minutes. How should the nurse describe this pattern? What are the nursing interventions?

Answer 1

1)Risk factors :

• Post dated pregnancy
• Mild hypertension
• Premature rupture of membranes
• Thick meconium stained liquor

2)Late decelerations with preservation of variability

Nursing interventions :

• Inform the gynecologist
• Make the patient to lie in left lateral position
• Oxygen inhalation
• Hydration with IV fluids and correct hypotension if present
• Scalp PH monitoring

3)Early decelerations : Mostly due to head compression during labour

Nursing intervetions :

• No specific treatment
• Continue electronic fetal heart rate monitoring

4)Late decelerations with absent variability

Nursing interventions :

• Immediately inform the concerned gynecologist and prepare her for emergency or expeditious delivery of the baby