Re: Fundal Pressure
From: Efrain Ramirez (eramirezt@coqui.net)
Wed Mar 1 17:41:20 2006
Same here
Ef
>At Wed, 1 Mar 2006, D. Ashley Hill wrote:
>
>I use fundal pressure at cesarean, because the "dystocia" keeping the
>baby from delivering is the width of the incision, not the bony pubis.
>It's a different mechanism of delivery. Thanks,
>
>Ashley
>
>At Wed, 1 Mar 2006, Efrain Ramirez wrote:
>>
>>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
>>
>--
>D. Ashley Hill, MD
>Associate Director
>Department of Obstetrics and Gynecology
>Florida Hospital Family Practice Residency
> and Loch Haven Ob/Gyn Group
>Orlando, Florida
>
--
“ The greatest obstacle to knowledge is not ignorance,
it is the illusion of knowledge.” Daniel J. Boorstin - Historian
