Problem: Intravenous fluid boluses, lateral positioning and oxygen administration are common techniques used by nurses during labor when the fetal heart rate pattern suggests fetal compromise. Little data exists concerning their efficacy in improving fetal oxygen status. Purpose: To evaluate the efficacy of these techniques in improving fetal oxygen status as measured by fetal oxygen saturation (FSpO2). A physiologic framework was used to guide the study. Methods: This prospective study evaluated three intrauterine resuscitation techniques in 56 healthy women during labor. Women were first randomized to a 500 mL or 1000 mL intravenous fluid bolus, and then one of six position sequences that included L lateral, R lateral and supine with the head of the bed elevated 30o. Finally, each received oxygen at 10 L/min via nonrebreather facemask for 15 minutes. Differences in FSpO2 were evaluated before, during, and after each intervention. Results: Both intravenous bolus amounts increased FSpO2 (500 mL: M=3.71, p=.03; 1000 mL: M=5.15, p=.001), however the effect was greater and longer lasting for the 1000 mL group (p=.003). FSpO2 was higher in a lateral position (Left M=48.28, Right M=47.68) than a supine position (M=Supine 37.48, p < .001). Oxygen at 10 L/min increased FSpO2 (M=8.73, p=.001).The effect persisted for >30 minutes after the oxygen was discontinued (p=.001). For fetuses with FSpO2 <40% before maternal oxygen administration, the increase was greater (M=11.38) and longer lasting as compared to those with FSpO2 >40% (M=7.56, p < .001). Conclusions: Intravenous fluid boluses, lateral positioning and oxygen administration at 10 L/min via nonrebreather facemask each are effective nursing interventions to increase FSpO2 during labor. Supported by a Grant from AWHONN sponsored by Philips Medical Systems.
Session #1206 - Childbearing
The 29th Annual MNRS Research Conference (April 1-4, 2005)