Fetal Monitoring, Stages of Labor, and Key MEDS

Definition: Fetal heart rate below 110 bpm.
Significance: This pattern is considered concerning, as it may indicate fetal distress or compromised blood flow.
Action: LION protocol
- L: Left side positioning to enhance uteroplacental blood flow.
- I: Administer IV fluids to support hydration and circulation.
- O: Administer oxygen to improve fetal oxygenation.
- N: Notify healthcare provider immediately.
If Pitocin is being administered, consider: Stop Pitocin to alleviate potential overstimulation of contractions.

Definition: Fetal heart rate above 160 bpm.
Significance: Typically not a cause for immediate concern; may indicate maternal fever or fetal activity.
Action: Document the findings and check maternal temperature to rule out fever.

Definition: Fetal heart rate fails to fluctuate within a normal range.
Significance: Indicates either fetal hypoxia or depression of the central nervous system; may suggest distress.
Action: Implement LION protocol as immediate intervention.

Definition: Fetal heart rate shows considerable fluctuations, indicating healthy fetal movement and reassurance.
Significance: Indicates good fetal well-being; generally acceptable unless persistently high without cause.
Action: Document findings; ongoing monitoring is essential.

Definition: Fetal heart rate slows down near the end of contractions, often returning to base after the contraction ends.
Significance: Indicates uteroplacental insufficiency and may signal a risk to fetal well-being.
Action: Implement LION protocol promptly to address potential fetal distress.

Definition: Brief fetal heart rate drops at the beginning of contractions, with a mirror effect to the contraction pattern.
Significance: Normal physiological response due to head compression; not concerning unless other issues present.
Action: Document findings, and continue to monitor the fetal heart rate for stability.

Definition: Sudden drops in fetal heart rate that can happen any time, often related to umbilical cord compression.
Significance: Considered the most concerning pattern, may predict acute fetal hypoxia; needs immediate attention.
Action: Implement Push position (such as knee-chest) to relieve pressure on the umbilical cord.

Good patterns: High Fetal Heart Rate, High Baseline Variability, Early Decelerations indicating well-being.
Bad patterns: Low Fetal Heart Rate, Low Baseline Variability, Late Decelerations, Variable Decelerations indicating potential distress.
Mnemonic for bad patterns: Any that start with ‘L’ (Low Fetal Heart Rate, Low Baseline Variability, Late Decelerations) need the LION protocol. Variable Decelerations are separately defined as very bad and needing special attention.

Deliver head.
Suction the mouth with a bulb syringe.
Suction the nose gently using the bulb syringe.
Check for nuchal cord (cord around the neck) by feeling around the head and neck.
Deliver shoulders and body by guiding them downward after the head emerges.
ID band before leaving delivery area for proper identification of the newborn.

Ensure the placenta and membranes are complete to prevent postpartum hemorrhage.
Check for three blood vessels in the umbilical cord (two arteries and one vein).

Vital signs - look for signs of shock (blood pressure down, heart rate up).
Fundus - massage if boggy or catheterize if displaced.
Assess perineal pads - over-saturation signifies excessive bleeding (saturated if >100%).
Roll patient over - check for bleeding underneath.

Common assessment practice every 4 to 8 hours after delivery.
Mnemonic: BUBBLE-HEEAD
B: Breasts - Inspect for engorgement or cracks.
U: Uterine fundus - should be firm and midline.
L: Lochia - notable discharge stages: Rubra (Red, 1-4 days postpartum), Serosa (Pink, 4-10 days postpartum), and Alba (White, up to 6 weeks postpartum).
E: Episiotomy - inspect for healing or signs of infection.
H: Hemoglobin/Hematocrit - assess for postpartum anemia.
E: Extremity check for thrombophlebitis (Best practice: Measure bilateral calf circumference).
A: Affect - assess mood and emotional condition.
D: Discomforts - inquire about pain or discomfort.

Postpartum fundal height reflects the number of days postpartum (e.g., 4 days means fundus is four fingerbreadths below the belly button).

All variations are typically normal except for certain conditions.
Important conditions to distinguish:
Caput Succedaneum: Crosses sutures, symmetrical swelling of the head.
Cephalohematoma: Does not cross sutures, asymmetrical swelling due to bleeding.
Jaundice: Know the difference between physiological (normal postnatal transition) and pathological (need intervention) jaundice.

Tocolytics (Stop labor):
- Terbutaline: Monitor for maternal tachycardia and hypokalemia.
- Mag Sulfate: Causes decreased heart rate, blood pressure, reflexes, respiratory rate, and level of consciousness (must monitor respiratory and reflexes closely).
Oxytoxics (Stimulate labor):
- Pitocin: Monitor for uterine hyperstimulation (frequency >5 contractions in 10 minutes).
- Methergine: Causes high blood pressure; contraindicated in patients with hypertension.
Fetal Lung Maturing Drugs:
- Beta Methasone: Given to mother before baby is born to enhance fetal lung maturity.
- Cervanta: Given transtrachially to the neonate after birth to aid respiratory function.

Heparin: Quick action, given IV/SQ; antidote is protamine sulfate; monitored by PTT (partial thromboplastin time).
Coumadin: Long-term use, given orally; antidote is vitamin K; monitored by PT/INR (prothrombin time/international normalized ratio).

K-wasting diuretics end in “x” (e.g., Lasix) and may lead to hypokalemia.
K-sparing diuretics include Spironolactone, etc., which retain potassium and prevent hypokalemia.

Common medications: Baclofen and Flexeril.
Key side effects: Fatigue and muscle weakness; avoid alcohol, driving, and operating heavy machinery.