Re: Fundal Pressure
From: Efrain Ramirez (eramirezt@coqui.net)
Wed Mar 1 11:14:41 2006
Have no policy - BTW how do you get out the baby in a C/S?
Ef
..>At Tue, 28 Feb 2006, Dr. Ainsworth wrote:
>
>I have always been taught that fundal pressure was contraindicated
>because of the risk of uterine rupture and shoulder impaction at the
>time of shoulder dystocia, i.e., I do not use it. When this policy came
>through our perinatal, I objected to it because of the above.
>Medical-legally, I don't feel it should be used. I have no problem with
>suprapubic pressure for stabilizing the head when rupturing membranes,
>applying the scalp electrode, assisting with rotation of the shoulders
>in a shoulder dystocia and use it in those circumstances. This policy
>came from "corporate headquarters" and one other OB wants to keep it as
>it is. Any comments would be appreciated.
>
>POLICY/PROCEDURE SUMMARY/INTENT (EXPECTED OUTCOME): 1) To describe the
>appropriate use and application of fundal pressure by the RN. Fundal
>pressure may be useful in the following clinical circumstances:
>a. To ease the fetal head against the cervix to prevent cord prolapse
>during artificial rupture of membranes (AROM).
>b. To stabilize the fetal head to facilitate placement of a scalp
>electrode.
>c. To expedite delivery when fetal heart tones (FHTs) are nonreassuring
>and fetal head is crowning.
>d. To assist with outlet forceps or vacuum delivery when the fetal head
>crowning and the mother’s pushing is ineffective.
>
>DEFINITION (S): 1) Fundal Pressure - The application of steady pressure
>on the fundus of the uterus.
>
>AFFECTED DEPARTMENTS/SERVICES (COLLABORATION): 1) Perinatal
>
>POLICY AND PROCEDURE: COMPLIANCE—KEY ELEMENTS
>
>I. POLICY
>
>A. Fundal pressure is to be performed by the RN upon the request of the
>physician in those situations where fundal pressure is appropriate and
>not contraindicated.
>B. Contraindications: Fundal pressure is contraindicated when there is
>a shoulder dystocia as it may lead to further impaction of the shoulder
>against the symphysis, or even catastrophic uterine rupture.
>C. Responsibility: Labor and Delivery Registered Nurses who can
>demonstrate knowledge of uterine anatomy and physiology and the forces
>of labor.
>
>II. PROCEDURE
>
>A. Apply gentle, steady pressure with one hand to the fundus at a
>30-degree to 45-degree angle to the maternal spine in the direction of
>the pelvis.
>B. If a higher elevation is needed to achieve proper positioning and to
>maintain proper body mechanics, stand on a footstool.
>C. Avoid perpendicular (direct downward) pressure on the maternal
>spine, which may cause direct vena caval compression and maternal
>hypotension. Pressure should not be applied in a longitudinal
>direction.
>
>III. DOCUMENTATION
>
>A. Who ordered the fundal pressure.
>B. Who applied the fundal pressure.
>C. In what manner was fundal pressure applied (e.g., number of hands,
>steady vs. intermittent pressure, amount of pressure).
>D. How long was fundal pressure applied.
>
>APPLICABLE STANDARDS OR REGULATORY REQUIREMENTS: None
>REFERENCES: 1) T. Benedetti, “Dystocia: Causes, Consequences, Correct
>Response,” Contemporary OB/GYN, Vol. 36, Special Issue, Medical
>Economics Publishing, Montvale, NJ, Oct. 15, 1991, pp. 37-48. 2) V.
>Kline-Kaye and D. Miller-Slade, “The Use of Fundal Pressure During
>Second Stage Labor,” Journal of Obstetric, Gynecologic, and Neonatal
>Nursing, Lippincott, Hagerstown, MD, Vol. 19:6, Nov./Dec. 1990, pp.
>511-517. 3) D.S. Penney and D.W. Perlis, “Shoulder Dystocia: When to
>Use Suprapubic or Fundal Pressure,” MCN, The American Journal of
>Maternal/Child Nursing, Vol. 7:1, 1992, pp. 34-36. 4) K.R. Simpson
>and P.A. Creehan, AWHONN’s Perinatal Nursing, Lippincott, Philadelphia,
>1996, Chapter 8, pp.160-166. 5) C. Rommal, “Risk Management Issues in
>the Perinatal Setting,” Journal of Perinatal & Neonatal Nursing, Vol.
>10:3, Aspen Publishers, Inc., Gaithersburg, MD, Nov./Dec. 1996, pp.
>13-14.
--
“ The greatest obstacle to knowledge is not ignorance,
it is the illusion of knowledge.” Daniel J. Boorstin - Historian
