Intrauterine Resuscitation
Key Points
- Intrauterine resuscitation targets reversible causes of reduced fetal oxygen transfer during labor.
- Typical triggers include late decelerations, prolonged decelerations, and minimal or absent variability.
- Response must be rapid, stepwise, and continuously reassessed for improvement or escalation.
Pathophysiology
Intrauterine resuscitation is used when fetal heart rate patterns suggest inadequate oxygen delivery from maternal circulation through placenta and umbilical cord to the fetus. The intervention goal is to quickly improve perfusion and gas exchange before compromise progresses to metabolic acidemia.
Most interventions act on maternal hemodynamics, uterine workload, or mechanical compression factors. By decreasing contraction burden, improving maternal circulation, and optimizing fetal-placental blood flow, nursing care can reverse many nonreassuring patterns when the cause is still reversible.
Classification
- Perfusion-focused interventions: Maternal lateral repositioning and IV fluid bolus for hypotension-related compromise.
- Uterine-load interventions: Discontinue oxytocin and consider terbutaline for tachysystole or elevated resting tone.
- Oxygenation interventions: Administer oxygen when maternal saturation is low and fetal compromise persists.
- Escalation interventions: Immediate provider notification and expedited birth planning when no recovery occurs.
Nursing Assessment
NCLEX Focus
Priority questions ask which nonreassuring patterns warrant immediate intrauterine resuscitation and which intervention should occur first.
- Identify trigger patterns: late decelerations, prolonged decelerations, and worsening variability.
- Correlate tracing changes with uterine activity, oxytocin exposure, and maternal blood pressure/oxygen status.
- Reassess tracing response after each intervention step to determine recovery trajectory.
- Recognize nonresponse early and escalate without delay.
Nursing Interventions
- Stop oxytocin infusion to reduce contraction-related oxygen-transfer interruption.
- Reposition to left or right lateral position to improve uteroplacental blood flow.
- Initiate IV fluid bolus when hypotension or reduced perfusion is suspected.
- Administer oxygen at 10 L/min via non-rebreather only when maternal oxygenation is low.
- Administer terbutaline when ordered for tachysystole or increased resting tone.
Escalation Threshold
Persistent nonreassuring patterns despite resuscitation indicate ongoing fetal compromise and require urgent provider-directed delivery planning.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| uterotonics | Oxytocin context | Discontinue promptly when contraction excess contributes to fetal compromise. |
| tocolytics | Terbutaline context | Use for tachysystole/elevated tone to restore fetal recovery intervals. |
Clinical Judgment Application
Clinical Scenario
A laboring patient receiving oxytocin develops recurrent late decelerations and minimal variability.
Recognize Cues: Nonreassuring periodic changes with decreased variability on continuous monitoring. Analyze Cues: Fetal oxygen transfer is likely compromised, possibly worsened by contraction burden. Prioritize Hypotheses: Most urgent issue is preventable progression to fetal acidemia. Generate Solutions: Stop oxytocin, lateral repositioning, fluid bolus, assess oxygenation, and consider tocolysis. Take Action: Execute intrauterine resuscitation sequence and notify provider with response updates. Evaluate Outcomes: Improvement in variability/deceleration profile confirms effective reversal; nonresponse requires expedited birth plan.
Related Concepts
- fhr-and-uc-intervention-framework - Organizes tracing-based nursing response by category and cause.
- fetal-heart-rate-and-contraction-patterns - Defines pattern terminology that triggers resuscitation.
- physiological-influences-on-fetal-heart-rate-patterns - Etiologic analysis guides intervention selection.
- external-and-internal-fetal-monitoring - Reliable data is required to confirm intervention effectiveness.
- oxytocin-therapy - Uterotonic management is a common modifiable factor in intrapartum compromise.
Self-Check
- Which fetal heart patterns most strongly indicate the need for immediate intrauterine resuscitation?
- Why is oxytocin discontinuation often the first intervention in tachysystole-associated compromise?
- Which findings indicate failure of intrauterine resuscitation and need for expedited birth?