Later that night, the patient delivered a girl—Apgar scores, 8/9.
Value of a checklist
Long used in the aviation industry, checklists are thought to help practitioners remember what interventions are available when it’s necessary to respond to evolving, and potentially risky, situations. Checklists also help to build a joint vision of management options among providers on a clinical team.
I’ve provided a checklist for you on page 8 that lists the interventions available for responding to a Cat-II tracing—so that you don’t find yourself staring at it….
In utero resuscitation for Category-II and Category-III FHR tracings
| Make a check mark alongside the interventions that you plan to execute. Recheck the fetal heart rate pattern 15 to 20 minutes after each intervention. | |
|---|---|
 | Change maternal position—preferably, to a lateral position |
| Fluid bolus: Administer 500–1,000 mL lactated Ringer’s solution IV over 20 min |
| Maternal oxygen: Administer 10 L/min of O2 by nonrebreather face mask for at least 15 min |
| Decrease or stop infusion of oxytocin |
| Discontinue cervical ripening agent |
| Consider amnio-infusion if recurrent deep, variable decelerations are present (For transcervical amnio-infusion, place an intrauterine pressure catheter and administer 1) a bolus of 250–1,000 mL of lactated Ringer’s solution at 10 to 15 mL/min and then 2) continuous infusion at 100–200 mL/h by infusion pump or gravity.) |
| If clinically appropriate, consider 1) a cervical check to assess the progress of labor and 2) fetal scalp stimulation to assess for FHR acceleration (Digital scalp stimulation is performed by vigorously rubbing the fetal scalp for 15 sec using an examining finger. Following stimulation, acceleration in the FHR >15 beats/min above baseline, lasting longer than 15 sec, is associated with a low prevalence of fetal acidemia.) |
| Consider vibro-acoustic stimulation as an alternative method of fetal stimulation that does not require vaginal examination (Apply a vibro-acoustic stimulator to the abdominal wall for 5 sec to assess fetal status. After the stimulus, acceleration in the fetal heart >15 beats/min above baseline, lasting longer than 15 sec, is associated with a low prevalence of fetal acidemia.) |
| If the mother is relatively hypotensive, which may occur in association with an epidural anesthetic, consider ephedrine, in a 5-mg IV bolus (Note: Ephedrine may increase FHR.) |
| Consider administering terbutaline, 0.25 mg subcutaneously, if tachysystole is present |
| Consider placing a fetal scalp electrode if the FHR tracing is of suboptimal quality |
Copyright © 2011 Quadrant HealthCom, Inc. Clinicians may copy and use this checklist without permission of the publisher to provide care. All other copying and uses require explicit permission from the publisher.
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