A woman in labor is found to have a fetal heart rate of 180 bpm with variable decelerations. What is the most appropriate initial management step?
- (a) Immediate cesarean section
- (b) Administer oxygen to the mother
- (c) Change maternal position and provide hydration ✓
- (d) Prepare for fetal scalp monitoring
This finding indicates potential fetal distress, which requires careful evaluation and management.
Understanding Fetal Heart Rate Patterns
- Normal Fetal Heart Rate: The normal range for fetal heart rate is typically between 110 to 160 bpm. An FHR of 180 bpm is considered tachycardic and may suggest fetal hypoxia or other issues.
- Variable Decelerations: These are abrupt decreases in the fetal heart rate that can occur due to umbilical cord compression. They are often transient but can indicate that the fetus is experiencing some level of stress.
Initial Management Steps
When faced with abnormal fetal heart rate patterns, the initial management should focus on addressing potential causes and improving fetal oxygenation:
- Maternal Positioning: Changing the maternal position can relieve pressure on the umbilical cord, potentially alleviating variable decelerations. Positions such as left lateral or knee-chest can be particularly effective.
- Hydration: Providing intravenous fluids can help improve uteroplacental perfusion and enhance blood flow to the fetus.
- Oxygen Administration: While administering oxygen to the mother may be beneficial in cases of suspected hypoxia, it is not typically the first step unless there are signs of maternal hypoxia or significant distress.
- Monitoring: Preparing for fetal scalp monitoring may be necessary if there is ongoing concern about fetal well-being, but this would generally follow initial interventions aimed at stabilizing the situation.
- Immediate Cesarean Section: This is usually reserved for situations where there is clear evidence of severe fetal distress or when non-reassuring patterns persist despite initial interventions.
Given these considerations, the most appropriate initial management step in this case would be to change maternal position and provide hydration, as these actions directly address potential causes of variable decelerations and tachycardia without immediate invasive measures.
Thus, the answer to the question is:
(c) Change maternal position and provide hydration
