Page 79 - 33Elctronic Book (3) Normal Labor

5. Variable deceleration:

variable decelerations are irregular, often jagged dips in the fetal heart rate that look more
dramatic than late decelerations.
Causes:

- Intermittent compression of umbilical cord by fetal head.
- Oligo hydrominos.
- Cord between fetus and mother's uterus or pelvic without obvious prolapse.
Management:

- Change maternal position to decrease cord compressive (turn sides to side or knee chest
position).

- Give O2 at 8 – 10 L/min by tight face mask.
- Improve circulating volume.
- Amnion per fusions.
- Monitor for change fetal heart pattern dis continue oxytocin if it being administered.

- Perform vaginal examination to assess for prolapsed cord

6. Prolonged deceleration:

there are isolated deceleration which last longer than 60 – 90 seconds.
Causes:
- Tetanic uterine contractions.

- Placental abruption.
- Umbilical cord prolapse.
- Maternal hypoxia.

Management: - Notify physician or mid wife of first occurrence.
- Check for cord prolapse.
- Examine the cervix.
- Check progress of dilation and descent.

- Correct maternal hypotension increase intravenous fluids.
- Continuous observation until delivery be prepared for emergency delivery.

7-Sinusoidal pattern:
it indicates fetal anemia as in case of ruptured vasa praevia, feto maternal haemorrhage,
twin-to-twin transfusion syndrome, and Rh-immunization.

Causes:
- Acute intra partum asphyxia.
- Fetal maternal hemorrhage.

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