Maternity Nursing: Intrapartum Q 25
When examining the fetal monitor strip after the rupture of the membranes in a laboring client, the nurse notes variable decelerations in the fetal heart rate. The nurse should:
A. Stop the oxytocin infusion
B. Change the client’s position
C. Prepare for immediate delivery
D. Take the client’s blood pressure
Correct Answer: B. Change the client’s position.
Variable decelerations usually are seen as a result of cord compression; a change of position will relieve pressure on the cord. Variable decelerations can be seen resulting from the fetal movement if the fetus is premature. In the term fetus, variable decelerations result from vagus nerve-mediated parasympathetic effects on the heart. There are several theories regarding the pathway that leads to this vagal stimulation.
Option A: If a patient is having uterine tachysystole, reducing the number of contractions by decreasing oxytocin or administration of a beta-agonist may be appropriate.
Option C: Ultimately, if the fetal heart tracing is persistently abnormal, facilitating delivery is indicated. In the term, laboring patient, an operative vaginal delivery may be considered. If the patient is remote from delivery, it may indicate the need for cesarean delivery. In a patient with preterm prelabor rupture of membranes, induction or augmentation of labor may be the next step if the fetus is in the vertex presentation. Alternatively, cesarean delivery may be indicated if the fetus is in the breech presentation.
Option D: Fetal heart rate tracings reflect the response of the fetal central nervous system to intrauterine hypoxia. Variable decelerations are under vagal mediation through baroreceptors or chemoreceptors. Possibly, direct cord compression leads to fetal hypertension, which in turn leads to baroreceptor response and subsequent vagal-mediated heart rate decrease. Alternatively, hypoxemia resulting from decreased uteroplacental perfusion triggers chemoreceptors, which in turn lead to a cascade of physiologic responses that ultimately result in vagal-mediated heart rate decrease.