Decel Interventions

We also do amnioinfusions quite often for variables and for thick mec.

I think that you did everything fine. The best intervention I learned as a new nurse was if you are not comfortable with the situation, get some hlep. Get another RN in the room get the charge nurse, this will just make you feel more at ease with the situation if you have another person you trust with you. Even if they do nothing but stand in the room, it just made me feel more comfortable. I now hlep the new people and I will ask before I leave the room "are you OK with me going now?" If they say no then I will just hang out in the room, maybe talk to the family and pt and tell them what just happend and why we did what we did.

You will get it! It takes a lot of time and practice. One thing that helped me learn what to do in emergencies is go help with others emergencies, you won't feel so stressed because it is not your pt, you can ask the RN what she wants you to do, or if you know what to do then just start doing it. Attending others emergencies helped me learn A LOT! I got to see what other people did, and I didn't feel the great anxiety that goes along with these situations when it was not my pt.

hope this helps

I have done amnioinfusions for variables, usually with success.

ACOG recommends against routine amnioinfusion for mec. I won't do it and I haven't seen it done for a while. (Not that I agree with everything ACOG says, but this one I happen to.)

Becki

Our facility does amnioinfusions for variable decels and it works great for some patients. We also use them for thick meconium, although one of our docs was telling me the other day that studies have show they're not really helpful for meconium.

I have done amnioinfusions for variables, usually with success.

ACOG recommends against routine amnioinfusion for mec. I won't do it and I haven't seen it done for a while. (Not that I agree with everything ACOG says, but this one I happen to.)

Becki

Hello!

Not with Mec?

I think I did hear a doc mention that the other day

less of a risk of meconium aspiration if we "rinse it out" so why are we advised not to now?

Thank You

Amnioinfusion does not prevent meconium aspiration syndrome. ACOG Committee Opinion #346, October 2006

ABSTRACT: Amnioinfusion has been advocated as a technique to reduce the

incidence of meconium aspiration and to improve neonatal outcome.

However, a large proportion of women with meconium-stained amniotic fluid

have infants who have taken in meconium within the trachea or bronchioles

before meconium passage has been noted and before amnioinfusion can be

performed by the obstetrician; meconium passage may predate labor. Based

on current literature, routine prophylactic amnioinfusion for the dilution of

meconium-stained amniotic fluid is not recommended. Prophylactic use of

amnioinfusion for meconium-stained amniotic fluid should be done only in

the setting of additional clinical trials. However, amnioinfusion remains a

reasonable approach in the treatment of repetitive variable decelerations,

regardless of amniotic fluid meconium status.

This opinion quotes a large, multicenter trial (published in NEJM in fall 2005, I think) that found no difference in perinatal death, meconium aspiration, or cesarean section in the group that had amnioinfusion compared with the group that did not when controlled for the presence or absence of variables.

sometimes scalp stim will help, too. at least you can see how the baby responds. also, i wonder what the maternal bp is. that's a biggie

I have learned, really, we should not be doing scalp stims in the presence of repeated decels, or most particularly, during a deceleration. ( ever heard Michelle Murray say "Hey I am in distress why are you tickling my scalp???! help!!!"---as if quoting the fetus.)

You do attempt intrauterine resuscitation, e.g., IV fluid boluses, turning off pitocin, or giving brethine if needing to decrease uterine stimulation, O's by tight facial mask, repositioning, and possible amnion-infusion (as per protocol or dr order)----- but never, should we do scalp stim during decels. This will only stress an already-taxed fetus.

And I always call the doctors for repeated decelerations of any sort, unless they are the benign earlies.