early decels during latent phase-advice needed

Specialties Ob/Gyn

Published

Advice needed. I had a pt being induce for high blood pressures. no mag ordered. during sve there was arom clear fluid about 1 hour later pt had thick mec and amnioinfusion was started pt had early decels with every contraction all night after that position changes o2 didn't really make a huge difference. pt was about 3cm physician was aware of strip my question is is there anything else i could have done about this situation.

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Are you sure they were early?? If they were, then it was probably CPD and you can't change that. How was LTV, accels?

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Specializes in Perinatal, Education.

I hate this situation and have dealt with it more than I would like--why is it always on night shift? Were they true earlies or variables? Did it turn out to be a nuchal cord? I hate those nuchal cord strips. How long do you wait to intervene? How did the rest of the strip look?

That is my least favorite part of EFM. I wish we knew how long these babies can take that kind of thing before they crumple. I hate having to watch them go through that. I'm sorry I wasn't much help, but you are not alone.

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Specializes in Nurse Manager, Labor and Delivery.

I wish we had the capability to see the strips we talk about. Ok...if they were early....then we are talking head compression...and at 3cms...either the baby is too fat to fit, or malpresented (acynclitic or direct OP). When early's appear that soon in labor, then you also could think about breech presentation and it being cord squish if it is between the baby's legs or something. In either case, head compression is head compression....can't do much about it. If the baby had good LTV and accels, then really you have ruled out hypoxia at least for the moment. You of course have to keep an eye on the labor progression and if the baby descends.

Just make sure that you document what you did and what you told the MD and what he said back to you. Always cover yer butt. When documenting, make sure you write somewhere the depth of the decel and how long it lasted. Documentation is key.

You didn't give and outcome. I am wondering breech because of the thick mec presenting after an initial clear AROM. Let us know if you can what happened.

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Check out Perinatal Trace where you can join a discussion of EFM tracings.

http://www.perinataltrace.com/board/index.php

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I wish we had the capability to see the strips we talk about. Ok...if they were early....then we are talking head compression...and at 3cms...either the baby is too fat to fit, or malpresented (acynclitic or direct OP). When early's appear that soon in labor, then you also could think about breech presentation and it being cord squish if it is between the baby's legs or something. In either case, head compression is head compression....can't do much about it. If the baby had good LTV and accels, then really you have ruled out hypoxia at least for the moment. You of course have to keep an eye on the labor progression and if the baby descends.

Just make sure that you document what you did and what you told the MD and what he said back to you. Always cover yer butt. When documenting, make sure you write somewhere the depth of the decel and how long it lasted. Documentation is key.

You didn't give and outcome. I am wondering breech because of the thick mec presenting after an initial clear AROM. Let us know if you can what happened.

this is well-stated. And I agree with this post.

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Specializes in home & public health, med-surg, hospice.
Check out Perinatal Trace where you can join a discussion of EFM tracings.

http://www.perinataltrace.com/board/index.php

Mindy,

I am lovin' this site/resource! :)

Just e-mailed it to my instructor in hopes she'll share it w/ my 100 (+) fellow students. We have a test coming up next week which will include FHR monitor strips and many are really struggling.

Again, thanks a lot!

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Hi, just wanted to add that I agree with what has been posted thus far. I too have seen this type of strip far too often (twice this week so far- ugh!) and unfortunately both babies ended up with c/s. Those cord strips are the worst. I literally stayed at my pt's side for a full four hours, flipping her back and forth, repositioning, bolusing and basically having mini heart attacks with each UC a few days ago. It was a relief when they called a code actually. Turned out there was a tight nuchal cord and baby had 9-9 apgars so go figure. But those strips are hard to watch for sure. Another nurse had a pt. like the one you're describing on my last shift and they crash sectioned her after attempting an amnioinfusion (I didn't see that mentioned, but it was sort of a "last resort" before cutting her) to see if they could float the cord, etc.

Anyway, I feel your stress in those types of situations. You're not alone, trust me! Good luck!!!

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Thanks for your replies unfortunately I was off for a couple of days after that happened and I was unable to find anything out but I had another pt getting decels with her contractions I was at her bedside for most of the time I tried every position after a while a just stood in her room because nothing was working and all i could do is keep on repositioning. Amnioinfusion had been infusing.

And after 5 hours of repositining a baby boy was born NSVD nuchal cord wrap around the neck once apgars 9 and 9.

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