Late Decelerations and uteroplacental insufficiency

[Cattnipp]

I hope to get some feedback....I am in my OB rotation now. According to our instructor, the priority nursing action with Late Decelerations of FHR is increase IV fluids. We are also taking ATI exams and ATI says to turn mother to lateral side with late decelerations. Any thoughts? Thank you!

[BacktotheBeach, ADN, BSN, RN]

I just finished OB in nursing school and we were taught position change is the first thing you do with late decels.

[~Mi Vida Loca~RN, ASN, RN]

We were taught to change positions first also.

[anonymousstudent]

We were taught to move mom to her left side.

[anonymousstudent]

OK, I just ran across a question addressing this while I was studying today.

From Saunder's NCLEX book, 5th edition, pg. 307:

251. A nurse in the labor room is caring for a client in the active stage of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. The appropriate nursing action is:

1. Administer oxygen via face mask

2. Place the mother in the supine position

3. Increase the rate of oxytocin (Pitocin) intravenous infusion

4. Document the findings and continue to monitor fetal patterns

In this case the answer is #1! Here's the rationale:

pg. 309: Late decelerations are due to uteroplacental insufficiency and occur because of decreased blood flow and oxygen to the fetus during the uterine contractions. Hypoxemia results; oxygen at 8-10 L/min via face mask is necessary.

The repositioning would certainly increase oxygen flow to the fetus, but it seems like the priority action would be to give oxygen. Perhaps the stage of labor is a consideration as well.

[tntrn, ASN, RN]

I am thinking that you ask the mom to turn to her left side, while you, the nurse is increasing the iv flow with one hand and reaching for the oxygen mask with the other.

[~Mi Vida Loca~RN, ASN, RN]

OK, I just ran across a question addressing this while I was studying today.

From Saunder's NCLEX book, 5th edition, pg. 307:

251. A nurse in the labor room is caring for a client in the active stage of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. The appropriate nursing action is:

1. Administer oxygen via face mask

2. Place the mother in the supine position

3. Increase the rate of oxytocin (Pitocin) intravenous infusion

4. Document the findings and continue to monitor fetal patterns

In this case the answer is #1! Here's the rationale:

pg. 309: Late decelerations are due to uteroplacental insufficiency and occur because of decreased blood flow and oxygen to the fetus during the uterine contractions. Hypoxemia results; oxygen at 8-10 L/min via face mask is necessary.

The repositioning would certainly increase oxygen flow to the fetus, but it seems like the priority action would be to give oxygen. Perhaps the stage of labor is a consideration as well.

With these options then yes the answer would be the O2, the only positional option was supine which you wouldn't do, pitocin would be stopped not increased and you wouldn't just document, late decels are bad.

I would be curious to see the answer if turning mom to left side was an option. Pretty sure I came across a similar question in the Kaplan book and turning mom to left side was the answer.

While you would do many situations in this scenario I would imagine turning on left side would be first with O2 happening right after. That's what they did for me in real life and the way we learned it in school.

[JROregon, ASN, BSN, RN]

The priority is getting O2 to the baby and either repositioning the mom (left lateral being the best position) or giving oxygen to mom is going to be the answer. You will likely see only one of those answers on the test and not have to choose between both.

[Bob_N_VA]

Straight from my notes:

Fetal Distress"Big Five" You Must Know THESE!!!

1. LLR position

2. O2 @ 8-10 LPM

3. Increase IV Fluid ­

4. Pit off

5. Call MD

You switch to the LLR first because it is the quickest and easiest intervention to take and do that while you get her oxygen going. Then you keep going down the list.

[anonymousstudent]

The priority is getting O2 to the baby and either repositioning the mom (left lateral being the best position) or giving oxygen to mom is going to be the answer. You will likely see only one of those answers on the test and not have to choose between both.

This is good to know. I'm glad they likely won't throw them together.

[klone, MSN, RN]

Yes, position first because it's the fastest intervention to do (and often the mom or a family member can do it on their own without your physical help, which frees you up to grab the mask and turn up the IV).

Although in real-life nursing, for one late decel we wouldn't panic. We would probably just reposition her and see if that improves the strip. Keep in mind, also, that RL is also acceptable, if she's already in LL when she has a late. Basically "change position to improve placental blood flow and the FHR".

[melmarie23, MSN, RN]

change positions first and then increase fluids.