Assigned topics

Heparin Therapy
Rendering Nursing Care during
Intrauterine Fetal Demise

Types of decelerations
PRESENTED BY: Quindala, See, Tano

Clinical Instructor: Dr. Rosemarie Sistosa



HEPARIN THERAPY

Heparin is an anticoagulant drug. This means that is slows down blood clotting or “thins” the

blood. There are various types of heparin – the type we usually use is a Low Molecular Weight

Heparin (LMWH) such as Enoxaparin (also known as Clexane) or Dalteparin.

Venous thrombosis is a condition in which a blood clot (thrombus) forms in a vein (venous

thrombosis). Most commonly, venous thrombosis occurs in the “deep veins” in the legs, thighs
or pelvis and this is called a deep vein thrombosis or a DVT. A DVT can limit blood flow

through the vein, causing swelling and pain, but there is a risk that it can break off and travel

through the blood stream. This is called an embolus. If the embolus lodges in the lung this is

known as a pulmonary embolus (PE). A PE may cause breathing problems, chest pain and

coughing up blood but a large PE can cause collapse and may be life threatening. However,

the risk of developing a pulmonary embolus, once a DVT has been diagnosed and treated, is

extremely small.

Warfarin can be used after week 12 but a woman will then be returned to heparin therapy during
the last month of pregnancy so the fetus will not develop a coagulation disorder at birth (heparin
does not cross the placenta and enter the fetus).
During pregnancy and the immediate period after birth, the risk of venous thrombosis is
increased. Your risk of developing a thrombosis will be assessed in pregnancy and after the birth
of your baby.
The three most common reasons for women starting heparin during pregnancy or after the birth
are:
A clot arising during this or a previous pregnancy.
An increased risk of a clot forming during pregnancy or after birth, e.g. after some caesarean
births or if you are immobile for a period of time.
Already on long-term anticoagulation, e.g. recurrent thrombosis.

Subclinical bleeding from the anticoagulant in the mother can cause placental dislodgement.
Observe a woman who is taking an anticoagulant for signs of petechiae and signs of premature
separation of the placenta during pregnancy and labor.
Is Low Molecular Weight Heparin
Heparin

safe for my unborn baby?

and women who have given

For pregnant women

birth, heparin is the anticoagulant of choice and is

recommended by the Royal College of

Obstetricians and Gynecologists. It does not cross

the placenta, and therefore is considered to be

safe.

Is it safe to breast feed?

There is no evidence that the heparin, including the one that we

use (Enoxaparin), passes into breast milk due to the nature of

the drug. If a very small amount passed into breast milk it is

broken down by stomach acids therefore any absorption by a

breast-fed baby is negligible. No adverse effects on any babies

have been reported. Therefore, it is considered that heparin is

safe for you to have whilst you are breastfeeding.

 RENDERING NURSING CARE

DURING INTRAUTERINE FETAL

DEMISE
● Allot a private room if a patient wants it, with regular contact by

care providers. Encourage feelings unlimited visiting by family and

friends.
● Support free flow of emotional expression.
● Include a partner in planning care. Grant opportunity for partners

to be seen individually. Reinforce discussion of concerns.

● Discover the magnitude of the loss for both members of the

couple. Regards how strongly the couple desired this pregnancy.

● Consider the dynamic characteristics of each person's experience

through the phases of grief; inform the patient/couple that delays or

relapses in grief are normal.

Consider the individual nature of movement through the stages of grief;

tell patient/couple that delays in the grief process or relapses of grief

are normal.
Assess patient’s/couple’s information and understanding of events

surrounding the death of the fetus/infant. Provide more accurate

information and correct misconceptions based on couple’s readiness

and ability to listen effectively.

Recognize stage of grief being displayed, e.g., denial, anger,

bargaining, depression, acceptance. Use therapeutic communication

skills (e.g., Active-listening, acknowledgment), respecting patient’s

desire/request not to talk.

Regard communication patterns among members of the couple and

support systems.
● Reinforce family’s expression of feelings and listen (remaining calm

or commenting as appropriate). Observe body language. Promote a

relaxed atmosphere.

● Recognize what has happened as often as necessary, reinforcing the

reality of the situation and encouraging discussion by the patient.

● Render physical care (e.g., bath, back rub, nourishment) as needed.

Allow patients to engage at a level of ability.

● Talk about anticipated physical and emotional responses to loss.

Evaluate coping skills. Consider religious beliefs and ethnic

background.


TYPES OF
DECELERATION
Decelerations are temporary decreases in the fetal heart rate

(FHR) during labor. Hon and Quilligan first described three types

of decelerations (early, variable, and late) in 1967 based on the

shape and timing of decelerations relative to uterine contractions.

Intrapartum FHR monitoring allows for the identification of

changes associated with fetal distress that allows for early

intervention.

Early Deceleration

Early decelerations are normal periodic

In this way, it serves as a mirror image of

decreases in FHR resulting from pressure on

the contraction. The rate rarely falls below

the fetal head during contractions.

100 bpm, and it returns quickly to between

Parasympathetic stimulation in response to

120 and 160 beats at the end of the

vagal nerve compression brings about a

contraction.
slowing of FHR. Early decelerations normally occur late in

labor, when the head has descended fairly

Early deceleration follows the pattern of the

low. As such, they are viewed as a normal

contraction, beginning when the contraction

pattern. However, if they occur early in

begins and ending when the contraction ends.

labor, before the head has fully descended,

However, the waveform of the FHR change is

the head compression causing the

the inverse of the contraction waveform, with

waveform change could be the result of

the lowest point of the deceleration occurring

cephalopelvic disproportion and is a cause

with the peak of the contraction. to investigate.

Late Deceleration
Late deceleration is defined as a visually apparent,

gradual decrease in the fetal heart rate typically following

the uterine contraction. The gradual decrease is defined

as, from onset to nadir taking 30 seconds or more. A late

deceleration typically follows a uterine contraction

meaning, the onset, nadir and the return of the

deceleration will follow the onset, peak, and the return of

a uterine contraction.

 Typically, late decelerations are shallow, with slow onset and gradual return to

normal baseline. The usual cause of the late deceleration is uteroplacental

insufficiency.
Causes of “late decelerations” or the drop in heart rate with uterine contraction

are known to be: uteroplacental insuffiency ( not enough oxygen to the baby),

amniotic fluid infection which can occur due to excessively long labor is

permitted after the water has been broken, low maternal blood pressure,

complications of spinal or epidural anesthesia, uterine hyperactivity (often

caused by the excessive use of Oxytocin) and large babies ( which are arguably

even candidates for a vaginal delivery)and placenta previa or abruption in which

the placenta has become displaced from the uterine wall, damaged and not

effectively giving the baby the oxygen it requires.

Variable Deceleration
Variable decelerations are irregular, often jagged dips in the fetal

heart rate that look more dramatic than late decelerations. Variable

decelerations happen when the baby’s umbilical cord is temporarily

compressed. This happens during most labors. The baby depends on

steady blood flow through the umbilical cord to receive oxygen and

other important nutrients. It can be a sign that the baby’s blood flow is

reduced if variable decelerations happen over and over. Such a

pattern can be harmful to the baby.

Variable decelerations are caused by compression of the umbilical cord. Pressure on the

cord initially occludes the umbilical vein, which results in an acceleration (the shoulder of

the deceleration) and indicates a healthy response.

 THANK YOU
FOR LISTENING!