In the recent past, routine obstetrical management of a newborn with meconium-stained amnionic fluid included intrapartum suctioning of the oropharynx and nasopharynx. In 2005, management guidelines were signiicantly modiied. Now, the American College of Obstetricians and Gynecologists (2017c) recommends that newborns with meconium-stained amnionic fluid, regardless of their vigor, should no longer routinely receive intrapartum suctioning. Suctioning is reserved for those with airway obstruction. hey also recommend that an appropriately credentialed team with full resuscitation skills be available (Chap. 32, p. 607).
TABLE 24-3. Some Resuscitative Measures for Category II or Category III Tracings
Tachysystole with category II or III tracing Discontinue oxytocin or prostaglandins; tocolytics: terbutaline, magnesium sulfate
Recurrent variable decelerations Reposition mother; amnioinfusion; with cord prolapse, manually elevate Prolonged decelerations or bradycardia the presenting part while preparing for immediate delivery aSimultaneous evaluation of the suspected cause(s) is also an important step in management of abnormal FHR tracings.
The combination of multiple interventions Simultaneously may be appropriate and potentially more effective than doing them individually or serially.
FHR = fetal heart rate.
Principal management options for variant fetal heart rate patterns consist of correcting any fetal insult, if possible. Suggestions are listed in Table 24-3. he woman is moved to a lateral position, and supplemental oxygen is provided by mask. Correcting maternal hypotension caused by regional analgesia and discontinuing oxytocin both serve to improve uteroplacental perfusion. Vaginal examination excludes a prolapsed cord or impending delivery. Simpson and James (2005) assessed the beneits of three maneuvers in 52 women with fetal oxygen saturation sensors already in place. They used intravenous hydration-500 to 1000 mL of lactated Ringer solution given over 20 minutes; lateral versus supine positioning; and administration of supplemental oxygen at lOiLl min using a nonrebreathing mask. Each of these maneuvers signiicantly raised fetal oxygen saturation levels.
Terbutaline sulfate given to relax the uterus can be a temporizing maneuver in the management of nonreassuring fetal heart rate patterns during labor. A single 250-�g intravenous or subcutaneous injection is used to inhibit uterine contractions and thereby improve fetal oxygenation. Cook and Spinnato (1994) described their 10-year experiences with terbutaline tocolysis in 368 pregnancies. Such resuscitation improved fetal scalp blood pH values, although all fetuses underwent cesarean delivery. hese investigators concluded that although the studies were small and rarely randomized, most reported favorable results with terbutaline tocolysis for nonreassuring patterns. Small intravenous doses of nitroglycerin-60 to 180 �g-also have been reported to be beneicial (Mercier, 1997). Bullens and associates (2015) concluded in their review that tocolysis was beneicial. Still, the American College of Obstetricians and Gynecologists (20i1i7b) cites that evidence is insuicient to recommend tocolysis for nonreassuring fetal heart rate patterns.