16.6: Intrauterine Resuscitation
By the end of this section, you will be able to:
- Recognize fetal heart patterns requiring intrauterine resuscitation
- Perform appropriate intrauterine resuscitation interventions based on the interpretation of the fetal heart rate pattern
Nursing interventions for nonreassuring fetal monitor tracings depend upon the cause of the tracing. For tracings associated with fetal hypoxia , the nurse must intervene to restore oxygenation to the fetus. Specific interventions aimed at increasing oxygen to the placenta and to the umbilical cord to reverse fetal hypoxia is called intrauterine resuscitation .
FHR Patterns Requiring Intrauterine Resuscitation
FHR patterns indicative of decreased oxygen transfer to the fetus can respond to intrauterine resuscitation. These FHR patterns include the following:
- Late decelerations caused by uteroplacental insufficiency . Intrauterine resuscitation should increase blood flow to the placenta and fetus resolving late decelerations.
- Prolonged decelerations caused by a disruption in oxygen transport to the fetus. Resuscitation is aimed at restoring the oxygen transport to the fetus.
- Absent and minimal variability can also respond to intrauterine resuscitation.
Intrauterine Resuscitation Nursing Interventions
Steps of intrauterine resuscitation are aimed at restoring blood flow and oxygenation. As described previously, FHR patterns that indicate an interruption in fetal oxygenation should respond to intrauterine resuscitation. The steps involved in intrauterine resuscitation are as follows:
- Discontinuing oxytocin to allow for reoxygenation of the fetus by decreasing contractions
- Rotating the laboring person to the left or right lateral position to relieve supine hypotension or hypertension when lying or sitting up in the labor bed
- Initiating IV fluid bolus to correct hypotension by increasing hydration to increase perfusion (Valencia et al., 2022)
- Administering oxygen at 10 L/min via a non-rebreather mask to the pregnant or laboring person whose oxygen saturation is low
- Administering terbutaline to resolve elevated uterine resting tone or tachysystole
The nurse can call for assistance to perform these steps as quickly as possible and to notify the health-care provider.