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Compression of the fetal head
12%
3/24
Compression of the umbilical cord
21%
5/24
Normal fetal heart rate tracing
4%
1/24
Sleeping fetus
Uteroplacental insufficiency
50%
12/24
Select Answer to see Preferred Response
The electronic fetal heart rate tracing in Figure A shows late decelerations, which are due to uteroplacental insufficiency. Early, variable, and late decelerations are the 3 primary categories of declerations that can be seen on electronic fetal heart monitoring. Late decelerations are concerning and present on monitoring with a completed contraction followed by a decrease in fetal heart rate. Late decelerations occur due to uteroplacental insufficiency. They are a concerning finding that require close monitoring as they may be a foreboding finding that could prompt emergent delivery or C-section. Management involves close monitoring and immediate delivery if there is any sign of fetal compromise. Figure/Illustration A depicts a late deceleration with contractions (red arrows) occurring followed temporally by a decrease in fetal heart rate (blue arrows). Incorrect Answers: Answer 1: Compression of the fetal head can cause early decelerations which are the result of a vagal response to fetal head compression. Answer 2: Compression of the umbilical cord can cause variable decelerations which are characterized by abrupt departure and return to the baseline of fetal heart rate and are often unrelated to the timing of contractions. Answer 3: Normal fetal heart rate tracing would present with normal variability and possible accelerations in response to contractions. Answer 4: Sleeping fetus may show minimal variability on fetal heart rate tracing which can be concerning. Vibroacoustic stimulation will wake up the fetus and lead to a normalization of this finding. Bullet Summary: Late decelerations occur secondary to uteroplacental insufficiency.
5.0
(6)
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