Physiology of Intrauterine Resuscitation (Nursing)

00:01 So thinking about our response, we've talked about some decelerations, what are we going to do about it? Do we need to respond? In some cases yes, and we have about four option in terms of managing the situation that's going to help improve the fetal heart rate.

00:17 So each one of these interventions sort of falls into one of these categories.

00:21 We have tocolysis and toco, that term might sound familiar referring to the monitor that we have of the uterus, lysis meaning to kill, so it will stop the contraction.

00:32 So some of what we're going to do in terms of intervention is actually going to stop the contraction, and that's going to increase blood flow and make it easier for oxygenation to happen.

00:42 Some of our interventions may be centered around fluid, so we may actually increase IV fluid in order to increase blood viscosity or to bring up the blood pressure which will increase the flow through the placenta and increase oxygenation.

01:00 The next thing we might do is change the position of the patient, so thinking about the pregnant patient, what is the most optimal position for increasing cardiac output and oxygenation? You got it, left lateral.

01:17 So we might reposition the patient on one side or the other in order to increase the blood flow.

01:23 Maybe the client has ended up flat on their back for some reason and we have compression of the vena cava and that's why the blood pressure is low and that's why the heart rate is not as responsive.

01:35 So it may be just a simple case of changing the position.

01:37 Now left-lateral is the best position in terms of cardiac output.

01:41 But everybody and everybody doesn't read the manual so sometimes the right side is actually better or sometimes being on all fours is better, or sometimes just sitting straight up is better.

01:53 Either way, the goal is to reposition the patient to potentially increase the oxygenation.

01:59 The last way we may change the fetal heart rate is to just administer oxygen all together.

02:05 So, what we want to think about is which oxygen mask we should use? So when you think about all the options, do you remember the oxygen mask that has the plastic bag at the bottom? That's called non-rebreather oxygen mask, and that's going to deliver the highest concentration of oxygen, and in this situation, we've got to get oxygen from the patient all the way to the fetus, so we want the highest oxygen possible.

02:30 So the nasal cannula, not going to get it.

02:33 The mask without the plastic bag at the bottom, is going to be really drying, we're not going to use that either.

02:40 So we want to use the non-rebreather mask and we're going to turn it up to 10 liters a minute.

02:46 That's really high, in fact, if you try to put 10 liters a minute on the nasal cannula, it would come off the face, it would just be so strong.

02:56 So we're not going to do that.

02:57 non-rebreather mask and we're going to turn it up to at least 10 liters of oxygen, somewhere between 8–10 is fine.

03:04 So those are going to be our options for using intrauterine resuscitation so kinda like CPR, this is intrauterine resuscitation in order to help improve the heart rate or to get rid of some of those decelerations.