| November 2006 · Vol. 18, No. 11 OBSTETRIC EMERGENCIES
Management of prolonged decelerations
Some are benign, some are pathologic but reversible, and others are the most feared complications in obstetrics
|
Fast Track
Fetal bradycardias and prolonged decelerations are 2 distinct entities; the first usually does not
warrant immediate intervention
Amnioinfusion for cord compression reduces variable FHR decelerations and the need for
cesarean section
Fetal scalp stimulation to assess fetal status should be done during periods of FHR baseline
|
|
Gary
A.
Dildy
III,
MDClinical Professor, Department of Obstetrics and Gynecology, Louisiana State University, Health Sciences Center, New Orleans
Director of Site Analysis, HCA Perinatal Quality Assurance, Nashville, Tenn
Staff Perinatologist, Maternal-Fetal Medicine, St. Mark’s Hospital, Salt Lake City, Utah
A prolonged deceleration may signal danger—or reflect a perfectly normal fetal response to maternal pelvic examination. Because of the wide range of possibilities, this fetal heart rate pattern justifies close attention. For example, repetitive prolonged decelerations may indicate cord compression from oligohydramnios. Even more troubling, a prolonged deceleration may occur for the first time during the evolution of a profound catastrophe, such as amniotic fluid embolism or uterine rupture during vaginal birth after cesarean delivery (VBAC). In some circumstances, a prolonged deceleration may be the terminus of a progression of nonreassuring fetal heart rate (FHR) changes, and becomes the immediate precursor to fetal death (TABLE 1).1
When FHR patterns exhibit these aberrations, we rightly worry about fetal well-being and the possible need for operative intervention. Unfortunately, the degree of fetal compromise is difficult to predict and depends on preexisting fetal condition, physiologic reserve, degree and duration of the insult, and other variables.
|
