Intrapartum Management If the fetus is mature, proceed with delivery. In the face of abnormal fetal testing in preterm patient, assuming mother’s health does not suggest imminent delivery, confirming gestational age & fetal maturity should be determined prior to proceeding. If the amniocentesis is not mature…. Intermediate fetal maturity Consider repeat testing (BPP or CST) Proceed with delivery if testing remains abnormal Immature fetal maturity CST, if not previously performed Hospitalize Continuous fetal heart monitoring Tocolytic IV therapy (MgSO4) to delay labor, PRN Consider antenatal steroids (e.g., betamethasone) Watch glucose level closely as it will increase INTRAPARTUM MANAGEMENT Induction of labor IF: 37 weeks’ gestation with Poor glucose control Macrosomia AND mature fetal lungs by amniocentesis Insulin-dependent GDM at 40 weeks’ gestation Glucose management Goal is to provide adequate glucose intake to meet energy requirements while maintaining maternal glucose control. To maintain euglycemia during labor & delivery Monitor blood glucose Q 1 hour Withhold morning sub-Q insulin Initiate and maintain D5W infusion at 100 mL/hour throughout labor Initiate and maintain regular insulin infusion throughout labor Adjust infusion to maintain maternal glucose at 80-120 mg/dL Some MDs may elect to provide insulin coverage by using a sliding scale instead of a continuous infusion If this is the case, the RN must be diligent in: Monitoring the woman’s blood glucose Reporting results to the MD Promptly administering ordered insulin An insulin pump may also be used If a continuous insulin infusion is not initiated or if a pump is used, start a separate 2nd maintenance IV line Labor Assessment Continuous fetal monitoring: Assess for fetal well-being Establish & maintain a labor pattern providing timely & appropriate progress Side-lying position: Maximizes placental perfusion Assess for normal 2nd stage length Anticipate & prepare for high-risk emergent delivery Vaginal or Operative Notify other staffs (e.g. Nursery, Postpartum) prior to delivery Arrange for additional staff at delivery 2nd Nurse Physician for infant Respiratory Therapist Potential for postpartum hemorrhage due to over distended uterus Check fundus frequently ….and delivery is accomplished
Posted on: Thu, 21 Aug 2014 22:54:35 +0000
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