The nursing intervention to relieve fetal distress due to maternal supine hypotension is:
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The intrapartum management of fetal distress is a challenge to obstetricians, compounded by difficulties in interpreting the fetal heart rate (FHR) pattern and confusion regarding the definition of asphyxia. The terms fetal distress and fetal asphyxia are often erroneously used interchangeably. In fact, in the past, asphyxia was presumed to be the cause of low Apgar scores in neonates, an assumption that has been challenged by both the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. Asphyxia refers to acidosis resulting from progressive hypoxia in utero. FHR monitoring can detect hypoxic episodes well before the development of asphyxia. Because FHR monitoring is sensitive and detects hypoxia early in the evolution to acidosis, low Apgar scores and poor perinatal outcome are not the inevitable results. The American College of Obstetricians and Gynecologists recently introduced the phrase nonreassuring fetal heart rate as opposed to fetal distress. Show 3
Electronic FHR monitoring was introduced in an attempt to reduce or eliminate the potentially disastrous consequences of fetal asphyxia. Enthusiasm for this new technology established the role of continuous FHR monitoring in labor before studies demonstrated its accuracy. Initial retrospective, uncontrolled studies evaluated more than 135,000 patients and showed a more than threefold improvement in the intrapartum fetal death rate for the electronically monitored group versus intermittent auscultation. 19
Clinical management of fetal distress.
Most subsequent randomized controlled trials have failed to demonstrate an improvement in the intrapartum fetal death rate by using continuous electronic FHR monitoring , , , , 44
Controlled trial of fetal intensive care.
, ; however, in these studies, electronic FHR monitoring was compared with frequent auscultation with one-on-one nursing, a standard that is difficult to maintain. Moreover, abnormal FHR patterns in the auscultation group were usually backed up by electronic fetal monitoring. A more recent randomized trial of continuous electronic monitoring versus intermittent auscultation demonstrated a significant improvement in perinatal mortality in the continuously monitored group. 51
A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation.
The past 3 decades have shown no change in the 2 per 1000 incidence of cerebral palsy, suggesting that FHR monitoring has not affected this problem; however, the dramatically improved survival rate of extremely premature infants may be increasing the incidence of cerebral palsy. Improved neonatal care may also improve the survival rate of asphyxiated infants. In fact, a report from 1982 suggests that a decrease in deaths from asphyxia is the only change in neonatal mortality in the preceding 20 years. Any of these factors may potentially obscure any effect that FHR monitoring has had on the incidence of cerebral palsy. Electronic FHR monitoring has other benefits over auscultation that are not always considered. These include an ability to understand the mechanism of developing hypoxia by pattern recognition, the ability to assess the fetal response to hypoxia by evaluating reactivity or variability, and the ability to monitor uterine contractions and FHR. In most obstetric settings, electronic FHR monitoring provides a clear advantage and therefore remains the modality of choice for most obstetric units. FHR monitoring has several disadvantages, however. The two most important are increased cesarean sections (CSs) associated with overreaction to, or misinterpretation of, FHR patterns and a large increase in medicolegal malpractice litigation. Whether the establishment of continuous FHR monitoring alone has unnecessarily increased the incidence of CS without significantly affecting perinatal outcome is difficult to evaluate. Changing obstetric practices have also contributed to this increase, with fewer vaginal breech deliveries and abandonment of midforceps deliveries; however, randomized studies also consistently show this increase in CS rate in electronically monitored patients. , , , , 44
Controlled trial of fetal intensive care.
, 51
A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation.
The ideal goals of fetal assessment in labor should be first to detect and reverse hypoxia before it progresses. Second, failing the ability to reverse hypoxia, monitoring should allow physicians to detect hypoxia and determine when it leads to metabolic acidosis. This allows for intervention by operative delivery before fetal death or damage occurs. Electronic FHR monitoring is helpful in detecting hypoxia, but determining the precise point when metabolic acidosis occurs is difficult at best. The frequency of metabolic acidosis in labor is generally approximately 1%. Allowing latitude for slightly early intervention and a modest degree of overinterpretation, generally CS rates for nonreassuring FHR patterns should be in the range of 3% to 4% at most. The second major problem is lawsuits. Brain-damaged and brain-dead infants can lead to some of the largest monetary judgments and settlements. Thus, these cases are particularly appealing to plaintiff's attorneys. Because electronic FHR monitoring is so difficult to interpret, often several “experts” provide several different interpretations. In addition, this modality has created an unrealistic expectation of perfect outcome. Couple these factors with the knowledge that most congenital neurologic damage is not associated with intrapartum asphyxia, and we have created a setting in which such malpractice cases thrive. Despite these disadvantages, we should not take a nihilistic view toward this important modality because the goal of protecting the fetus during this potentially dangerous intrapartum period should and does supersede all other considerations. A thorough understanding of abnormal FHR patterns not only allows physicians to direct resuscitative efforts and prevent hypoxic damage but also prevents unnecessary interventions. The following discussion addresses various FHR patterns, their causes, and treatment strategies. To read this article in full you will need to make a payment Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access One-time access price info
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Article InfoFootnotesAddress reprint requests to Stephanie Penning, DO, Department of OB/GYN, UCI Medical Center Bldg. 25, 101 The City Drive, Orange, CA 92868 IdentificationDOI: https://doi.org/10.1016/S0889-8545(05)70073-5 Copyright© 1999 W. B. Saunders Company. Published by Elsevier Inc. All rights reserved. ScienceDirectAccess this article on ScienceDirectRelated ArticlesHow does a nurse instruct the patient to lay to relieve fetal distress due to maternal supine hypotension?Turn the mother onto her side to correct any supine hypotension (a low blood pressure which some pregnant women can develop in late pregnancy when they lie flat on their back).
How do you manage fetal distress?How is fetal distress treated?. Changing your position. ... . Giving you oxygen through a mask.. Giving fluids through your IV line.. Giving you medicine to slow or stop contractions.. Amnioinfusion (a procedure that places fluid in your amniotic sac to relieve umbilical cord compression).. |
