Decel Interventions

[hoping to be an rn, ADN]

What Are Some More Tricks Of The Trade With Prolonged Decels I Know The Fluid Bolus, Turn Off The Pit, O2, Changing Position, Knee Chest, Contacting The Docs But Anymore Tricks? Last Nite After A Pt Got An Epidural She Had A Big Old Decel I Shook Her Belly, Changed Position Checked Her And Still It Did Not Improve What Else Can I Do??? I Am A New Ob Nurse....i Want To Do Good And This Freaks Me Out...going Into Csections Freak Me Out Too Esp When Its An Emergency And I Am Being Rushed I Feel Like I Dont Do Good And Go Home And Dwell On The Situation I Am Really Afraid Of Even Calling The Dr's Do You Think I Am In The Wrong Area? I Am Just Sooooo Unsure Of Myself....

[klone, MSN, RN]

What do you mean when you say "it didn't improve"? Do you mean the baby's baseline rate never recovered from the decel, or the baby continued to have decels with contractions? How dilated was the mom and what station was baby at? Could it have been vagal stimulation causing the decel(s) (in which case I would not be particularly worried as long as the strip is reactive and baby recovers at the end of the UC)? What kind of decel was it - variable, early, late? That comes into play in determining the type of intervention. How deep was the decel?

Just curious - doesn't it take you a really long time to compose a post when you capitalize every word?

[hoping to be an rn, ADN]

Uh Not Really I Had The Cap Locks On And It Just Came Out That Way...no The Decel Would Recover But Not Back Up To Baseline As Well...and Yes...the Baby Did Have Good Variability But It Made Me Nervous....i Guess Cuz I Am So New.....

[at your cervix]

Not knowing anything about this situation but what you have just said, the one thing that you left out that I would wonder about is-what was mom's bp? It is very common to get a drop in BP right after the epidural and this can affect the FHR, usually if you get mom's bp up with fluid bolus and/or ephedrine, the FHR will come up too. I think you have listed most of the common interventions. Giving terbutaline can also help, even if the decel is not related to uterine hyperstim, but be careful cuz you don't want to give terb to a mom with a uterine ruputure or placental abruption.

[hoping to be an rn, ADN]

Oh I Love Your Screen Name...yeah, Her B/p Was Ok And Was About To Give Terb But She Was A/c And I Got The Fhr To Come Back Up A Little...it Just Made Me Nervous...i Am Trying Soooo Hard Which I Think Is Putting Too Much Pressure On Myself...when Do You Start Feeling A Lil Comfortable?

[at your cervix]

I always feel a little uncomfortable! Just kidding!! Keep in mind that otherwise healthy babies have about 10 min of residual, therefore, a 2 min decel is most likely not going to cause permanent damage. However, the question becomes this....when you are two min into it, how much longer is it going to stay down? How quick could you have the pt back for a c/s if you had to??? I usually start inteventions (postion change, fluid bolus etc) at about 1 min, if no improvement after 1-2 more min, I call MD and continue with other interventions as needed. It never fails that as soon as the MD walks in the FHR comes right back up and he will probably make some comment about calling him when everything is OK. But, don't let that bother you.

I always point out to the MD's that they are looking at the strip in hindsight, I was looking at in real time and it is a lot scarier that way!!!

[decartes]

I heard that putting the mother on all fours might help.

[babyktchr, BSN, RN]

All of the interventions that you mentioned are correct. Sometimes it takes longer for a kid to recover, depending on the insult. Very often after an epidural, there is a drop in BP that decreases placental perfusion. It takes a variety of interventions to sometimes get that correct itself. Sometimes it doesn't work...and off to the OR you go. Always react to your decel in a proactive way. Think first of your physiology, and what is going on at the time. Do a quick systematic differential diagnosis of what you see...what you have at hand. Keep your interventions going as long as it is needed, and at the same time getting some help, and the doc's attention.

Remember...variability is your key to your baby's oxygenation. If you had moderate LTV before the decel, then you have a baby with reserve. Keep your head about you and do what you need to do.

By the by, I don't know that shaking the belly is an approved intervention for decels.:uhoh21:

It does get better. The more you experience, the better it will be. But even seasoned veterans of OB will tell you there are times they wanted to lay in the fetal position and suck their thumbs. Good luck to you.

[MemphisOBRNC, BSN, RN]

Do any of you do amnioinfusion for variables? And what state do you practice in? (Just curious) All of our Docs will let us do them except for 1. We do them for thick mec., too.

[hoping to be an rn, ADN]

Yes We Do Them But I Did Not Have An Iupc In....

[mitchsmom]

I guess we don't do amnioinfusion... I've been at work since July (+ the month of April)... I haven't seen it done at all.

[klone, MSN, RN]

We do amnioinfusion, but not very often. Usually it's done for mec, rather than decels. I've only seen it twice in the year and a half I've worked in OB.