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Biomedical subjects

Kathleen Rice Simpson

Publications and source records attributed to Kathleen Rice Simpson.

At least 19 recordsLinked to original sources
PubMed2005

Efficacy of intrauterine resuscitation techniques in improving fetal oxygen status during labor.

OBJECTIVE: To evaluate the efficacy of 3 common intrauterine resuscitation techniques used during labor. METHODS: Intrauterine resuscitation techniques were prospectively evaluated in healthy women during labor. Forty-two women were randomized to either a 500-mL or 1,000-mL intravenous (IV) fluid bolus over 20 minutes. Fifty-one women were randomized to 1 of 6 position sequences including supine with the head elevated 30 degrees , left lateral and right lateral for 15 minutes each in succession. Forty-nine women received 10 L/min of oxygen (O(2)) via nonrebreather face mask for 15 minutes. Differences in fetal oxygen saturation (FSpO(2)) were evaluated before, during, and after each intervention. RESULTS: An IV fluid bolus of 1,000 mL had a greater effect on FSpO(2) than an IV fluid bolus of 500 mL (500 mL: mean increase 3.7; 1,000 mL: mean increase 5.2; P = .05). Fetal oxygen saturation was higher in a lateral position (left mean 48.3%, right mean 47.7%) than in a supine position (mean supine 37.5%, P = .03). Oxygen administration increased FSpO(2) (mean increase 8.7, P = .03). The effect persisted for more than 30 minutes after the O(2) was discontinued (P = .03). For fetuses with FSpO(2) less than 40% before maternal O(2) administration, the increase was greater (mean increase 11.4) than for those with FSpO(2) of 40% or greater (mean increase 7.6, P = .03). CONCLUSION: An intravenous fluid bolus of 1,000 mL, lateral positioning, and O(2) administration at 10 L/min via nonrebreather face mask are effective in increasing FSpO(2) during labor.

Female↗
PubMed2004

Fetal assessment in the adult intensive care unit.

Ideally the clinical management of a critically ill pregnant woman is based on a collaborative approach with members of the ICU and perinatal team each contributing their expertise to promote the best out-come for the mother and baby. The interdisciplinary team also should include anesthesia providers and neonatal specialists. The physical space (ICU or labor and delivery unit) is less important than the quality and coordination of the care and treatment. The responsibility for fetal assessment when the woman is critically ill should rest with those who have this expertise. Working together provides the best opportunity for optimal outcomes.

Critical Illness↗
PubMedDate not supplied

Critical illness during pregnancy: considerations for evaluation and treatment of the fetus as the second patient.

When a critically ill woman is pregnant, clinical interventions for the mother can have a profound effect on fetal status. It is essential that the fetus be considered as the second patient when developing the plan of care. The most practical solution for providing comprehensive care to pregnant women in the intensive care unit (ICU) is a collaborative approach involving members of the ICU and the perinatal team, each contributing their unique knowledge and skills to the care of the mother and her unborn baby. The purpose of this article is to describe a collaborative approach to caring for a pregnant woman in the ICU along with a brief overview of fetal assessment for ICU care providers so they can become familiar with terms and methods used in assessing fetal status and common interventions that promote fetal well-being.

Abbreviations as Topic↗
PubMedDate not supplied

Common areas of litigation related to care during labor and birth: recommendations to promote patient safety and decrease risk exposure.

Reducing the risk of liability exposure and avoiding preventable injuries to mothers and infants during labor and birth can be relatively easy when all members of the perinatal care team (nurses, nurse-midwives, and physicians) agree to follow two basic tenets of clinical practice: use applicable evidence and/or published standards and guidelines as the foundation for care and whenever a clinical choice is presented, choose patient safety rather than production. Adhering to these two principles could theoretically eliminate the need for extensive and overly detailed policy and procedure manuals. Most clinicians feel the need to have some written guidelines for practice. A summary of the most common foci of professional perinatal liability claims together with the most current applicable evidence and published standards and guidelines from professional associations and regulatory agencies is provided. The purpose is to provide a framework for reviewing existing institutional protocols and/or developing future policies and guidelines that decrease professional liability exposure and minimize the risk of iatrogenic injury to mothers and infants.

Delivery, Obstetric↗
PubMedDate not supplied

Failure to rescue: implications for evaluating quality of care during labor and birth.

Failure to rescue is an indicator that has been used to measure quality of care for surgical patients by evaluating the number of patients who die after developing postoperative complications. There are 2 key components of failure to rescue: (a) careful surveillance and timely identification of complications and (b) taking action by quickly initiating appropriate interventions and activating a team response. This concept has not been explored as a potential method to evaluate quality of intrapartum care. In obstetrics, complications leading to death are relatively rare because mothers and infants are generally healthy. Thus, there are not large numbers of maternal or infant deaths in individual hospitals or healthcare systems that allow the types of statistical analyses that have been previously used to measure failure to rescue rates. With modifications in the measurement process for failure to rescue in this population, there are direct implications for perinatal patient safety and lessons to be learned. A new use of the failure to rescue concept in a population not previously considered is proposed.

Female↗
PubMedDate not supplied

Obstetric "conveniences": elective induction of labor, cesarean birth on demand, and other potentially unnecessary interventions.

Common obstetric interventions are often for "convenience" rather than for clinical indications. Before proceeding, it should be clear who is the beneficiary of the convenience. The primary healthcare provider must make sure that women and their partners have a full understanding of what is known about the associated risks, benefits, and alternative approaches of the proposed intervention. Thorough and accurate information allows women to choose what is best for them and their infant on the basis of the individual clinical situation. Ideally, this discussion takes place during the prenatal period when there is ample opportunity to ask questions, reflect on the potential implications, and confer with partners and family members. A review of common obstetric interventions is provided. While these interventions often are medically indicated for the well-being of mothers and infants, the evidence supporting their benefits when used electively is controversial.

Attitude to Health↗
PubMedDate not supplied

Obstetrical accidents involving intravenous magnesium sulfate: recommendations to promote patient safety.

Magnesium sulfate is commonly used in obstetrical practice both as seizure prophylaxis in women with preeclampsia, as well as to inhibit preterm labor contractions. However, despite (and perhaps because of) years of use and provider familiarity, the administration of magnesium sulfate occasionally results in accidental overdose and patient harm. Fortunately, in most instances when potentially fatal amounts of magnesium sulfate are given, the error is recognized before permanent adverse outcomes occur. Nevertheless, a significant and sometimes unappreciated risk of harm to mothers and babies continues to exist. Intravenous magnesium sulfate treatment has become routine practice in obstetrics, but this does not lessen the vigilance required for safe care for mothers and babies. Implementation of the recommendations provided in this article will promote patient safety and decrease the likelihood of an accidental overdose, as well as increase the chances of identifying an error before a significant adverse outcome occurs.

Adult↗
PubMedDate not supplied

Monitoring the preterm fetus during labor.

The purpose of this article is to discuss special challenges in monitoring the preterm fetus during labor, review implications of preterm fetal heart rate (FHR) patterns, and highlight appropriate nursing interventions that contribute to the best outcomes for mothers and babies. With the current incidence of preterm birth, monitoring the preterm fetus during labor is a common perinatal nursing responsibility. Most of the published research on this topic was conducted in the 1980s; there has been little attention to FHR monitoring during preterm labor in recent studies. There has been much more accumulated evidence about antepartum testing techniques involving electronic fetal monitoring (EFM) for the preterm fetus in contrast to FHR patterns during labor. Thus, this is an area of opportunity for nursing research. The perinatal nurse has a key role in promoting positive outcomes when caring for women during preterm labor. The condition of the fetus during labor and birth has a significant impact on the likelihood of survival and the odds of developing serious complications of prematurity.

Cardiotocography↗
PubMedDate not supplied

The context & clinical evidence for common nursing practices during labor.

The purpose of this article is to review the context and current evidence for common nursing care practices during labor and birth. Although many nursing interventions during labor and birth are based on physician orders, there are a number of care processes that are mainly within the realm of nursing practice. In many cases, particularly in community hospitals, routine physician orders for intrapartum care provide wide latitude for nurses in how they ultimately carry out those orders. An important consideration of common nursing practices during labor is the context or practice model in which those practices occur. Nursing practice is not the same in all clinical environments. Intrapartum nursing practice consists of an assortment of different roles depending on the circumstances, hospital setting, and context in which it takes place. A variety of intrapartum nursing practice models have evolved as a result and in response to the range of sizes, locations, and provider practice styles found in hospitals providing obstetric services. A summary of intrapartum nursing models is presented. The evidence is reviewed for the three most common clinical practices for which nurses have primary responsibility in most settings and that comprise the majority of their time in caring for women during labor: (1) maternal-fetal assessment, (2) management of oxytocin infusions, and (3) second-stage care. Evidence exists for these nursing interventions that can be used to promote maternal-fetal well-being, minimize risk, and enhance patient safety.

Clinical Nursing Research↗