The nurse is reviewing several fetal heart rate (FHR) tracings for laboring clients at term gestation. Based on the FHR tracings, which client requires priority assessment by the nurse?

Question

Quizplus · Accepted Answer

Uterine contractions during labor cause cervical dilation and effacement and promote fetal descent. During each contraction, compression of spiral arterioles (uterine vessels) normally decreases circulation in intervillous spaces, reducing placental blood flow. During resting intervals, reperfusion is restored between contractions to allow for fetal oxygenation. A healthy fetus easily tolerates this process. Uterine tachysystole occurs when contractions are too frequent (>5 in 10 minutes). It is sometimes associated with abnormal fetal heart rate (FHR) patterns because too-frequent contractions may cause inadequate reperfusion of the uterus and placenta due to shortened resting intervals between contractions. Unresolved uterine tachysystole may result in serious complications (eg, inadequate fetal oxygenation, placental abruption, uterine rupture) and warrants priority assessment and intervention by the nurse (eg, discontinuation of oxytocin, intrauterine resuscitation measures, tocolytics) (Option C). (Option A) Despite showing minimal variability, this FHR tracing does not require priority intervention over uterine tachysystole because accelerations indicate adequate fetal oxygenation at this time. Early decelerations indicate fetal head compression; they are not associated with poor outcomes, so the contraction pattern is not concerning. (Options B and D) FHR tracings with a normal frequency of contractions and FHR pattern (ie, category I) do not require priority assessment. Educational objective: Uterine tachysystole occurs when contractions are too frequent (>5 in 10 minutes), which may cause inadequate fetal oxygenation, placental abruption, or uterine rupture. This contraction pattern warrants priority assessment and intervention by the nurse to prevent maternal and fetal harm.

The Nurse Is Reviewing Several Fetal Heart Rate (FHR) Tracings