A nurse is assessing a client who is in labor and has meconium-stained amniotic fluid.

The nurse observes variable decelerations on the EFM tracing, which are decelerations that have an abrupt onset and vary in shape, duration, and degree of fall below the baseline FHR.

What is the most appropriate nursing intervention for this situation?

Prepare for an amnioinfusion to dilute the meconium and relieve cord compression.

An amnioinfusion is a procedure in which sterile fluid is infused into the uterus through a catheter to increase the volume of amniotic fluid and reduce the risk of fetal distress caused by meconium aspiration or cord compression.

Variable decelerations are a sign of cord compression and can be alleviated by an amnioinfusion.

Choice A is wrong because repositioning the client may not be enough to improve placental blood flow and prevent fetal hypoxia.

Choice B is wrong because administering oxygen to the client may not be sufficient to increase fetal oxygenation if the cord is compressed.

Choice D is wrong because an emergency cesarean delivery may not be necessary if an amnioinfusion can resolve the variable decelerations and improve fetal well-being.

Accelerations.According to the National Institute of Child Health and Human Development (NICHD) terminology, accelerations are defined as transient increases in the FHR of at least 15 bpm above the baseline for at least 15 seconds.Accelerations are a reassuring sign of fetal well-being and oxygenation.

Early decelerations are decreases in the FHR that coincide with the onset and end of a uterine contraction.They are caused by fetal head compression and are usually benign.

Late decelerations are decreases in the FHR that begin after the peak of a uterine contraction and do not return to baseline until after the contraction ends.They are caused by uteroplacental insufficiency and are a sign of fetal hypoxia.

Variable decelerations are abrupt decreases in the FHR that vary in timing.