Fetal Distress

Fetal distress is a compromise of the fetus during the antepartum period (before labor) or intrapartum period (birth process). It is commonly used to describe fetal hypoxia (low oxygen levels in the fetus).

Fetal distress can be detected due to abnormal slowing of labor, the presence of meconium (dark green fecal material from the fetus) or other abnormal substances in the amniotic fluid, or via fetal monitoring with an electronic device showing a fetal scalp pH of less than 7.2

Signs and Symptoms of Fetal Distress:

• Fetal heart rate less than 120 or greater than 160 beats per minute
• Fetal hyperactivity
• Meconium-stained amniotic fluid
• Progressive decrease in baseline variability
• Late deceleration
• Severe variable decelerations

Nursing Interventions:

• Place patient in a lateral position, elevate legs
• Administer oxygen at 8-10 L/min via face mask
• Discontinue oxytocin (Pitocin) if infusing
• Monitor maternal and fetal status
• Prepare for emergency cesarean section

Supine Hypotensive Syndrome

Supine hypotensive syndrome occurs when the venous return to the heart is impaired by the weight of the uterus. It results in partial occlusion of the vena cava and descending aorta and in reduced cardiac return, cardiac otuput, and blood pressure

Signs and Symptoms:

• Hypotension
• Fetal distress
• Faintness, light-headedness, dizziness

Nursing Interventions:

• Place patient in a lateral recumbent position
• Monitor vital signs and fetal heart rate
• Treat for shock if other signs of shock are present

Amniotic Fluid Embolism

Amniotic fluid embolism is the condition in which the amniotic fluid is escaped into the maternal circulation. It is usually fatal to the mother because the debris containing amniotic fluid deposits in the pulmonary arterioles.

Signs and Symptoms:

• Respiratory distress and chest pain
• Seizures
• Cyanosis
• Heart failure and pulmonary edema
• Fetal bradycardia and distress

Nursing Interventions:

• Emergency action is performed to maintain life
• Administer oxygen at 8-10 L/min by face mask or resuscitation bag
• Position patient on side
• Prepare for intubation and mechanical ventilation
• Administer IV fluids, blood products, and coagulation therapy
• Monitor fetal status
• Prepare for emergency delivery
• Provide emotional support for patient, partner and family

Uterine Inversion

Uterine inversion is a condition that the uterus turns inside out completely or partly. It usually occurs during delivery or after delivery of placenta.

Signs and Symptoms of Uterine Inversion:

• Severe pain
• Hemorrhage
• Depression in the fundal area
• Interior of the uterus may be seen through the cervix or protruding the vagina

Nursing Interventions:

• Monitor for signs of hemorrhage and shock and treat shock
• Prepare patient to reposition the uterus to the correct position via the vagina or laparatomy if unsuccessful

Placenta Abruptio

Placenta abruptio is premature separation of placenta from the uterine wall after 20 weeks of gestation and before the fetus is delivered.

Signs and Symptoms:

• Painful vaginal bleeding (dark red)
• Uterine rigidity and tenderness
• Severe abdominal pain
• Signs of maternal shock
• Signs of fetal distress

Nursing Interventions:

• Monitor maternal vital signs and fetal heart rate
• Assess for excessive vaginal bleeding, abdominal pain, and increase in fundal height
• Bed rest, oxygen, IV fluids, and blood products as prescribed
• Monitor and report any uterine activity
• Prepare for the delivery of the fetus as quickly as possible
• Monitor for sings of disseminated intravascular coagulation in the postpartum period
• Administer Rh immune globulin if the mother is Rh-negative and has not been given the injection at 28 weeks of gestation

Placenta Previa

Placenta previa is a condition in which the placenta implanted improperly in the lower uterine segment near or over the internal cervical os.

Types of Placenta Previa:

1. Total: the internal os is covered entirely by the placenta when the cervix is dilated fully
2. Partial: the internal os is covered incompletely
3. Marginal: only an edge of the placenta extends to the internal os
4. Low-lying placenta: the placenta is implanted in the lower uterine segment but does not reach the internal os

Signs and Symptoms:

• Painless red vaginal bleeding occur in the last half of pregnancy
• Uterus is soft, relaxed, and non-tender
• Fundal height may be greater than expected for gestational age

Nursing Interventions:

• Interventions depend on the classification of the previa and gestational age of the fetus
• Monitor maternal vital signs, fetal heart rate, and fetal activity
• Prepare for ultrasound
• Avoid vaginal examination
• Bed rest in a left leteral position
• Monitor amount of bleeding (shock)
• Administer IV fluids, blood products, or tocolytic medication as prescribed
• Cesarean section may be performed if bleeding is heavy
• Administer Rh immune globulin if the mother is Rh-negative and has not been given the injection at 28 weeks of gestation

Rupture of Uterus

Rupture of uterus is a separation of the uterine tissue, complete or incomplete. It is a result of a tear in the wall of the uterus from the stress of labor.

Signs and Symptoms - Rupture of Uterus:

• Chest pain
• Abdominal pain or tenderness
• Contraction may stop or fail to progress
• Rigid abdomen
• Signs of maternal shock
• Absent fetal heart rate
• Fetus palpated outside the uterus (complete rupture)

Nursing Interventions - Rupture of Uterus:

• Monitor and treat signs of shock (oxygen, IV fluids, blood products)
• Prepare patient for cesarean section or hysterectomy
• Provide emotional support for both of patient and partner