From the Guidelines
The management algorithm during fetal delivery involves a systematic approach to ensure safe birth outcomes, prioritizing continuous fetal monitoring, regular cervical examinations, and adequate pain management, as well as preparation for potential complications. The approach to delivery should be individualized, taking into account the patient's medical and obstetric history, as well as any fetal conditions that may impact the delivery process 1. Key considerations include:
- Continuous fetal monitoring to assess well-being through heart rate patterns
- Regular cervical examinations every 2-4 hours to track dilation progress
- Adequate pain management, including epidural analgesia or intravenous opioids
- Augmentation with oxytocin if labor progress stalls
- Directed pushing during the second stage, with position changes to facilitate descent
- Active management with oxytocin immediately after delivery to prevent postpartum hemorrhage
- Preparation for potential complications, including having emergency medications and equipment for neonatal resuscitation readily available 1. It is essential to balance the risk of prematurity against the risk of stillbirth, particularly in pregnancies with fetal growth restriction, and to consider the presence of maternal hypertensive disease, which can significantly impact pregnancy outcomes 1. Ultimately, the goal of the management algorithm is to optimize outcomes by ensuring timely interventions while maintaining physiologic birth processes when possible.
From the Research
Management Algorithm During Fetal Delivery
The management algorithm during fetal delivery involves several key steps and considerations.
- Monitoring the condition of the fetus during delivery is crucial, with methods including cardiotocography to monitor the fetus's heart rate and variability in relation to the mother's contractions 2.
- ST analysis of fetal ECG can depict the oxygenation of fetal cardiac muscle during delivery, while analysis of blood gases and lactate determination are also used in assessing the condition of the fetus 2.
- In cases of suspected preeclampsia or new-onset hypertension, blood and urine tests should be carried out, including dipstick test for proteinuria 3.
- The management of preeclampsia, the appropriate timing of delivery, the optimal method of anesthesia, and the mode of delivery are also critical considerations 3, 4.
- Electronic fetal monitoring (EFM) is a key tool in assessing fetal well-being during labor, although its interpretation and intervention can be variable 5.
- The use of a fetal monitor safety nurse role has been proposed as a potential solution to minimize risk of adverse events during labor related to accurate assessment of EFM data and timely interventions 6.
Key Considerations
- The development and implementation of consistent international protocols can help improve maternal and neonatal outcomes 3.
- Safe staffing measures and budgetary support are required to make the fetal monitor safety nurse role operationally feasible and safe 6.
- Guidelines for the diagnosis and management of gestational hypertension and preeclampsia are essential for healthcare providers 3, 4.