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Fetal anemia
0%
0/39
Fetal head compression
36%
14/39
Intraamniotic infection
3%
1/39
Placental abruption
8%
3/39
Umbilical cord compression
54%
21/39
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This patient’s fetal heart rate tracing demonstrates variable decelerations, which typically occur due to umbilical cord compression. Variable decelerations commonly present after the rupture of membranes or decreased amniotic fluid volume that leads to umbilical cord compression. As the umbilical cord is compressed, the umbilical vessels are compressed, causing an increase in fetal vascular resistance and blood pressure which leads to a rapid decrease in fetal heart rate. The abrupt decrease in fetal heart rate seen with variable decelerations usually lasts < 30 seconds from onset to nadir and rapidly returns to baseline when the umbilical cord is decompressed. First-line management includes maternal repositioning (if compression is minor) and amnioinfusion, in which a saline solution is introduced into the uterus to decompress the umbilical cord. Figure A/Illustration A is a fetal heart tracing demonstrating variable decelerations. Note the abrupt decrease in fetal heart rate (< 30 seconds from onset to nadir), rapid return to baseline, and correlation with contractions. Incorrect Answers: Answer 1: Fetal anemia usually presents with a sinusoidal fetal heart rate tracing with no variability. This patient’s tracing has moderate variability and no sinusoidal wave pattern. Answer 2: Fetal head compression typically results in early decelerations on fetal heart monitoring, which correlate with contractions and tend to have a slower time from onset to nadir (> 30 seconds) rather than an abrupt decrease in fetal heart rate seen with variable decelerations. Answer 3: Intraamnotic infection results in fetal tachycardia on fetal heart rate monitoring (> 180/min) and is commonly caused by maternal infection (chorioamnionitis). This patient is afebrile with no signs of infection and has a normal fetal heart rate on monitoring. Answer 4: Placental abruption leads to late decelerations on fetal heart rate monitoring. Late decelerations have a slower time from onset to nadir (> 30 seconds) and are delayed with contractions, unlike the abrupt decrease and return to baseline in fetal heart rate that correlates with contractions as seen on this patient’s tracing. Bullet Summary: Variable decelerations typically occur due to umbilical cord compression.
2.7
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