A patient undergoes an amniotomy. Shortly afterward, the nurse detects large variable decelerations in the fetal heart rate on the external monitor. These findings signify:

• A. Umbilical cord prolapse
• B. Early decelerations
• C. Late decelerations
• D. Prolonged decelerations

Answer: (A)

Variable decelerations are abrupt drops in fetal heart rate that reflect intermittent umbilical cord compression. When they occur shortly after an amniotomy, the concern is that a loop of cord may have prolapsed into the birth canal ahead of the presenting part. A prolapsed cord can be squeezed with contractions, causing sudden, sharp, irregular decreases in fetal heart rate—often more pronounced and variable in shape than other decelerations. This is an obstetric emergency because it can rapidly reduce fetal oxygen delivery unless promptly managed.

In practice, treat this as a cord prolapse until proven otherwise: ensure the presenting part is not obstructing the cord, reposition the mother (often with the hips elevated and knees to chest or in a Trendelenburg position) to relieve cord compression, stop any oxytocin if being infused, and prepare for urgent delivery. Distinguishing features of other decelerations: early decelerations accompany contractions and mirror them (head compression, generally benign); late decelerations occur after the contraction peak (uteroplacental insufficiency); prolonged decelerations last longer than two minutes and indicate sustained hypoxia.