Recurrent variables...

Specialties Ob/Gyn

Published

How would you manage a pt with recurrent variables with an anterior lip that cannot be reduced....unable to put in amnioinfusion due to dialation obviously and station at 0?

How long would you all allow the recurrent variables to take place before calling MD to eva ptl? And you've done maternal position change and recurrent variables are not resolved. This is not her first baby.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

How deep are the variables? Do they return to baseline immediately after the end of the UC? Is there variability and accels?

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Yes, moderate variability with recurrent variables dipping into the 90s for 30 to 50 seconds before returning to baseline. Variables are shape U, W and V. Category 2 tracing. Obviously cord compression. How long would you let this go on? What would be some interventions?

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Specializes in Orthopedics/Med-Surg, LDRP.

I had a pt like this recently. Iupc put in, pit turned off O2 applied, pt turned in L lateral position with a knee up to try to help the baby descend. Mom was very slow to go from 2-4 cm dil. This went on for hours, at least 5-6. Iv fluid bolus. She I sat her up in a modified indian style, bottom of the bed down. Sht turned a corner and was 6 then 8 and then complete. Once the baby was past 0 station, the variables let up and were more like earlies. Baby delivered fine, nuchal x 1, mild terminal mec, 8,9 apgars. I thought she was going to be sectioned but she made change and the baby had good variability.

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Specializes in Nurse Manager, Labor and Delivery.

What is the baseline here? Deeper variables would give me more concern than little ones at this point. I would also take into account what is going on at the time. Is the patient pushing? Is the head coming down?

You have moderate variability, so you have oxygen reserves still (no acidemia). Support the kiddo with fluids and O2 (makes us all feel better) and see what happens. As long as the head was coming down, I think that I would let the provider know what you are seeing and to stay available and ride it out.

If you weren't seeing the head move or had less than moderate variability, OR if the variables deepened and started having a slower return to baseline, I would think it prudent to have an eval to see if the kid is going to come out that way. May be the cord is tight and keeping the kid from descending.

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If she's a multip with just a lip and at 0 I would get her sitting up if baby tolerates (ie doesn't get any worse) and try my damnedest to get that lip gone so she can push and have a baby. Inform your provider, especially if you are calling the FHR abnormal for recurrent complicated variables. The fastest way to resolve the problem is to deliver, right?

My comfort level and calling the doc depends on the depth and length more than anything. 90 Bpm for 30 seconds from a baseline of 120? Probably would just call and say "hey, just so you know, this is happening." 90 bpm for 50 seconds from 155? Then I would call and ask them to come lay eyes on it.

Also depending on the facility and provider, her MD could try to hold the lip back with a push and see if it stays gone. Most of the docs I've worked with would do that without hesitation for a multip and if the cervix is soft and stretchy it usually works. I've even done it at the docs request before but I would always wait for their guidance and discuss how to do it properly or you can make it swell and make things worse.

Does she have an epidural? Have you tried hands and knees, leaning forward etc? I love my upright positions, even with an epidural, and I find we tend to stay away from them for some reason. Everyone I work with now thinks their blocks will drop but I've rarely had that happen and it really helps to keep things going. Last night I had a primip with a couple of recurrent long 6-7 minute decels and they resolved in high fowlers so we kept her there. Couldn't turn the oxytocin back on but she was 8 cm when I left this morning!!!

But quite honestly I would just get rid of that lip and then have a baby :)

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I had a pt like this recently. Iupc put in, pit turned off O2 applied, pt turned in L lateral position with a knee up to try to help the baby descend. Mom was very slow to go from 2-4 cm dil. This went on for hours, at least 5-6. Iv fluid bolus. She I sat her up in a modified indian style, bottom of the bed down. Sht turned a corner and was 6 then 8 and then complete. Once the baby was past 0 station, the variables let up and were more like earlies. Baby delivered fine, nuchal x 1, mild terminal mec, 8,9 apgars. I thought she was going to be sectioned but she made change and the baby had good variability.

NJ, my baby was born and was very similiar as yours. I just never like moments like this because it makes me nervous and makes me wonder how I am doing and if I am doing enough.

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Specializes in Public Health, L&D, NICU.

I would report the variables to the MD (after repositioning, fluid bolus, maybe some O2) just to cover my butt, but most of our docs don't really worry about variables unless they are deep and wide with decreased variablity. You know you have a cord somewhere, but what can you do? If the baby has good variablity and they aren't too deep and wide, it's going to be aggravating to watch but all will probably be well.

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