Question

Emily, a 26-year-old G3P2, has been in labor for 5 hours and is 7 cm, 90% effaced and +2 station. She has external fetal monitoring in place, which reveals a baseline fetal heart rate of 120 bpm, minimal variability. Suddenly, as a contraction is beginning to subside, the fetal heart rate drops to a low of 80 bpm and has a slow return to the baseline 1 minute after the contraction has ended.

A. What is happening to Emily’s baby at this point in time? What does this mean?

B. What interventions do you need to implement/recommend at this point in time? (explain 2 interventions)

Answer 1

Expulsion of the fetus and the placenta is called delivery. There are three stages which occur during delivery.

Emily being a multipara ,is at first stage active phase of labour.Normal heart beat of fetus may be 140 beats per minute at this stage and there may 10-20 beats per minute variation . A increase in fetal heart rate more than 160 beats per minute or decrease rate less than 120 beats per min may be a evidence for fetal distress .Here in Emily's case  the fetal heart rate drops to a low of 80 bpm and has a slow return to the baseline 1 minute after the contraction has ended which is a strong evidence of fetal distress ( decreased oxygen supply to the fetus causing asphyxia ).

The interventions can be done are

• Provide oxygen to mother via tight fitting mask to decrease the fetal distress by increasing the available oxygen from the mother to the fetus
• Stop injection oxytocin drip if it is on flow to decrease the contractions which may be helping to reduce fetal distress
• Change maternal position to  lateral or knee-chest to keep mother relaxed to reduce fetal distress.