A primigravida at 41 weeks gestation is admitted for labor induction due to post-term pregnancy. The nurse is preparing to assist with amniocentesis to assess fetal lung maturity. Which nursing action is the highest priority to ensure patient safety during this procedure?

Pre-Procedure Safety Checklist

• Verify informed consent is signed and documented before the patient is prepped or sedated.
• Confirm patient identity, correct gestational age (41 weeks), and indication for amniocentesis using two identifiers.
• Assess for contraindications: active vaginal bleeding, oligohydramnios, or maternal coagulopathy.
• Perform a baseline 20-minute electronic fetal monitoring strip to confirm a reassuring fetal heart rate pattern and absence of contractions.
• Position the patient with a left lateral tilt using a wedge under the right hip to displace the uterus off the vena cava and prevent supine hypotension.
• Prepare ultrasound guidance equipment to determine placental location, fetal position, and a safe needle insertion pocket.

Intra-Procedure Monitoring Priorities

• Maintain continuous electronic fetal monitoring throughout the needle insertion and fluid aspiration. This is the highest priority nursing action to detect immediate fetal distress.
• Observe the fetal heart rate tracing for sudden bradycardia, variable decelerations, or loss of variability, which may indicate cord compression, placental abruption, or fetal vagal response.
• Monitor maternal vital signs every 5 minutes, noting any hypotension, tachycardia, or complaints of sharp abdominal pain.
• Assist the provider by labeling amniotic fluid samples correctly and transporting them immediately to the lab for L/S ratio or phosphatidylglycerol testing.
• Provide emotional support and coaching; instruct the patient to remain still and breathe slowly during needle insertion.

Post-Procedure Surveillance

• Continue fetal heart rate monitoring for at least 30 minutes after the procedure to confirm a return to baseline and rule out delayed decelerations.
• Monitor maternal vital signs and assess for vaginal bleeding, amniotic fluid leakage, or uterine tenderness every 15 minutes for the first hour.
• Administer Rh immune globulin (RhoGAM) if the patient is Rh-negative, as fetal-maternal hemorrhage is a risk.
• Document the procedure: time, provider, number of attempts, fluid characteristics, FHR response, and patient tolerance.
• Report any non-reassuring fetal status or maternal instability immediately to the provider and prepare for possible emergency cesarean delivery.