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!

[melmarie23, MSN, 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.

ditto what ~MiVidaLocaRN~ said. Don't read into the question. Look only at the options given. Out of the four listed, the only one that makes sense is option 1. You know that with 2, remaining supine (i.e. flat on back) can cause vena cava syndrome. 3. You would NEVER increase pit with late decels. If anything you would stop it. 4. is a reasonable answer, HOWEVER you must intervene first, then document. So that leaves option 1 as the best answer.

[hapham3693, BSN]

Why do we need to increase the IV fluid?