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Retired NBME Step 2 CK Free 120 Answers
wutuwantbruv
I was a bit confused by this one because umbilical cord prolapse is normally associated with variable decelerations. Uteroplacental insufficiency is associated with late decelerations. Also, I am not even sure I would call this a late deceleration (since it never returns). There is a similar FHT on UWorld in which the there was fetal anemia due to vasa previa causing a step-down pattern on the tracing. My thought process was that since it looking similar to the UWorld one it must have something to do with the umbilical cord but this is probably a flawed thought process. Any other thoughts as to this question?
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shaz464
Exactly my thinking... I was also thinking late deceleration being UPI.
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cbreland
The artificial ROM then FHR tracings result with a tracing that I didn't recognize. FHR sitting at 75ish, made me think that something was acutely wrong with the cord (figured that ROM could bring the cord downwards as well)
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submitted by โbwdc(697)
Tracing shows late decels: the bad kind, a response to poor blood flow to the fetus during contractions. One cause, particularly common after AROM, is umbilical cord prolapse, where the fetal head compresses the umbilical cord, limiting blood flow as itโs squeezed inferiorly by the contracting uterus. Vertex station doesnโt actually matter as once previously thought, but a nondilated cervix (less than 6 cm) is a risk factor.