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Difficulty: Very hardAnte/Intra/Postpartum and Newborn Care

A gravid client at 3939 weeks gestation with chronic hypertension is admitted for labor induction. The client has a continuous epidural infusion and an intravenous oxytocin infusion at 12 mU/min12\text{ mU/min}. An intrauterine pressure catheter and a fetal scalp electrode are in place. The nurse evaluates the tracing and observes a baseline fetal heart rate of 165 bpm165\text{ bpm} with minimal variability. Over the past 2020 minutes, uniform decelerations begin exactly at the peak of each uterine contraction and return to the baseline approximately 3030 seconds after the contraction ends. Uterine contractions occur every 22 minutes, lasting 9090 seconds, with a resting tone of 25 mmHg25\text{ mmHg}. Which actions should the nurse prioritize? Select all that apply.

  1. Discontinue the intravenous oxytocin infusion immediately.Answer
  2. Assist the client into a right or left lateral decubitus position.Answer
  3. Administer oxygen at 10 L/min10\text{ L/min} via a non-rebreather face mask.Answer
  4. D
    Prepare the client for an amnioinfusion to alleviate umbilical cord compression.
  5. E
    Delegate the patient care technician to monitor the fetal tracing while the nurse notifies the provider.
  6. F
    Elevate the head of the bed to a high Fowler's position to improve maternal diaphragmatic excursion.

Answer

The priority actions are to discontinue the oxytocin infusion, assist the client into a lateral decubitus position, and administer oxygen via a non-rebreather mask.
The client is experiencing uterine tachysystole (inadequate resting time between contractions) compounded by chronic hypertension, leading to uteroplacental insufficiency. This is evidenced by the fetal tachycardia, minimal variability, and late decelerations. Immediate intrauterine resuscitation is required to restore oxygenation to the fetus. The priority interventions are to stop the oxytocin to relax the uterus, place the client in a lateral position to optimize cardiac output and placental perfusion, and administer high-flow oxygen to increase maternal oxygen saturation available for fetal transfer.

Step-by-Step Solution

1
Analyze the continuous electronic fetal monitor tracing and maternal contraction pattern.
Identified fetal tachycardia (165 bpm165\text{ bpm}), minimal variability, late decelerations, and uterine tachysystole (contractions every 2 minutes2\text{ minutes} lasting 90 seconds90\text{ seconds} with an elevated resting tone).
Accurate interpretation of the fetal-maternal dyad status is required to identify uteroplacental insufficiency.
2
Determine the physiological cause of the abnormal fetal heart rate pattern.
The late decelerations and minimal variability indicate fetal hypoxia driven by inadequate uterine relaxation between contractions (tachysystole), limiting placental blood flow.
Linking the contraction pattern to the fetal response guides the targeted interventions.
3
Select priority interventions for intrauterine resuscitation.
Selected stopping oxytocin, lateral positioning, and high-flow oxygen administration.
These actions directly address the root causes by halting the uterotonic agent, relieving aortocaval compression, and increasing maternal circulating oxygen.

Key Concept

Intrauterine Resuscitation for Uteroplacental Insufficiency
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Topics

Ante/Intra/Postpartum and Newborn Care

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