Which of the following is noted on the external monitor tracing a contraction, when a nurse suspects umbilical cord compression while monitoring a mother in labour?

1. A

   Early decelerations

2. B

   Accelerations

3. C

   Variable decelerations

4. D

   Variability

Appeared in: DSSSB -28 August 2019 (Shift-2)

Explanation

• Variable decelerations are abrupt, sharp drops in the fetal heart rate (FHR) that are variable in timing, shape, and duration in relation to uterine contractions.
• They are the most common periodic FHR pattern seen during labor.
• The primary cause is umbilical cord compression, which reduces blood flow to the fetus.
• This compression triggers a vagal nerve response (via baroreceptors and chemoreceptors), leading to a sudden decrease in the FHR, often appearing as a 'V', 'U', or 'W' shape on the monitor.

Why Other Options Were Wrong

• Option A: Early decelerations are gradual, shallow decelerations that mirror the uterine contraction.
• Option B: Accelerations are temporary increases in the FHR above the baseline.
• Option D: Variability describes the normal beat-to-beat fluctuations in the baseline FHR, not a specific periodic change like a deceleration.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Interpretation of fetal heart rate (FHR) patterns and their underlying causes during labor helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Prompt recognition of variable decelerations is a critical nursing skill to prevent fetal hypoxia and acidosis.
• The nurse's first action is intrauterine resuscitation, which involves changing the mother's position to alleviate pressure on the cord.
• What if? If variable decelerations are accompanied by absent or minimal variability and are recurrent, it signifies a more severe fetal compromise. In this case, in addition to repositioning, the nurse must administer oxygen, increase IV fluids, discontinue oxytocin, and notify the provider immediately, as an operative delivery may be necessary.

How to Approach the Question

• Identify the keyword in the question: "umbilical cord compression."
• The question asks for the specific FHR pattern associated with this cause.
• Recall the common FHR patterns and their causes. The mnemonic VEAL CHOP is highly effective for this:
• V = Variable -> C = Cord Compression
• E = Early -> H = Head Compression
• A = Acceleration -> O = Okay

Concept Tested & Keywords

• Concept Tested: Interpretation of fetal heart rate (FHR) patterns and their underlying causes during labor.
• Stem keywords: external monitor, contraction, umbilical cord compression, labour
• Lead-in keywords: Which of the following
• Negative lead-in flag: false

Question ID

QKA63uC6_PLZufyM6IEkFW

Copy ID

Reference Book

E6 Obstetrics Williams p. 45-64

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 46-54