Question

Renee is a 22-year-old G2 P0 at 42 weeks of gestation in active spontaneous labor. Her pregnancy has been complicated by mild hypertension, but no medications were needed. She is 4 cm/100/0 station, vertex position. Her membranes have just ruptured, and there is thick meconium staining. She is comfortable and using epidural anesthesia.

1. What risk factors are present that may impact the way this fetus tolerates labor?

2. The fetal heart rate shows a rate of 140, moderate variability, no accelerations, and decelerations to 120 beginning after the peak of most contractions and recovering to baseline 30 seconds after the contraction ends. Contractions are every 4 minutes. How should the nurse describe this pattern?

3. What should the nurse do at this point?

4. Renee is now 8/100/0. She is in the left lateral position with oxygen at 8 liters/minute. The fetal heart rate is 145. There is moderate variability. Accelerations are not present. There are decelerations in the fetal heart rate beginning at the onset of a contraction, descending to 120 with recovery by the end of a contraction. The contractions are every 3 minutes now. How would the nurse describe the fetal heart rate pattern now?

5. Renee is now completely dilated and +1 station. She has been instructed to push with every contraction. The fetal heart rate is now 164. There is absent variability and decelerations to 120 are occurring with maternal pushing, which do not resolve until 30 seconds after the contraction. The contractions are every 1½ minute. How should the nurse describe this pattern?

6. What should the nurse do in this situation?