Cord prolapse: The Daily PANCE Blueprint
A 25-year-old woman in her first pregnancy presents to the labor and delivery unit at 38 weeks gestation. She reports feeling decreased fetal movements since the morning. Continuous fetal heart rate monitoring is initiated due to her concern. In occult umbilical cord prolapse, the umbilical cord is often compressed by a shoulder or the head. A fetal heart rate pattern that suggests cord compression and progression to hypoxemia may be the only clue. Which of the following characterizes that heart rate pattern?
A. Sinusoidal pattern
B. Variable decelerations
C. Sustained bradycardia
D. Early decelerations
E. Accelerations
Answer and topic summary
The answer is B. Variable decelerations
Variable decelerations are abrupt decreases in fetal heart rate below the baseline, with rapid descent and return to baseline. These are associated with umbilical cord compression, making them particularly relevant in cases of occult cord prolapse. The decelerations vary in timing and duration relative to contractions, reflecting the episodic and transient nature of cord compression.
Explanation for Incorrect Answers:
- A. Sinusoidal pattern: This pattern is smooth and undulating, resembling a sine wave, and is associated with fetal anemia and chronic hypoxia, not acute events like cord compression.
- C. Sustained bradycardia: This indicates a prolonged fetal heart rate below 110 bpm and suggests a more serious, enduring hypoxemic state rather than intermittent cord compression.
- D. Early decelerations: These are generally benign and mirror contractions, reflecting head compression during labor rather than umbilical issues.
- E. Accelerations: These are brief increases in fetal heart rate above the baseline and are considered signs of fetal well-being, indicating healthy fetal autonomic function.
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