A 28-year-old G1P0 woman at 35 weeks gestation is in the obstetrical (OB) triage area with spontaneous rupture of membranes. The fetal hea rate baseline is 150 bpm with normal variability. There are accelerations seen, and numerous late decelerations noted. In an effo to improve oxygenation to the fetus, which of the following maneuvers would most likely help in this circumstance
The supine position causes uterine compression on the vena cava, which decreases the venous return of blood to the hea, leading to supine hypotension. One impoant maneuver when encountering fetal hea rate abnormalities is a positional change, such as the lateral decubitus position. Oxytocin and epidural anesthesia both can decrease oxygen delivery to the placental bed. Oxytocin may hyperstimulate the uterus and cause frequent contractions; this then results in frequent vasoconstriction of the uterine vessels which decreases the amount of blood arriving to the placenta and fetus over time. Thus, stopping the oxytocin may help improve oxygenation. An epidural can cause hypotension in the mother which may then lead to fetal bradycardia by also decreasing the amount of blood profusing the fetus per given time. Morphine sulfate can cause respiratory depression in the fetus, so it would not be a method of choice for increasing delivery of oxygen to the fetus.
Supine position
Epidural anesthesia
Stop the oxytocin
Morphine sulfate
Anatomy of the female genital tract