Variable decelerations can occur at any time during uterine contractions and are caused by compression of the umbilical cord.
The umbilical cord can be wrapped around the fetal neck, chest, arm, or leg. When the cord is between the fetus and maternal pelvis, it can lead to compression. Also, a short cord, knot in the cord, or a prolapsed cord can lead to variable decelerations.
Variable decelerations commonly occur during the transition phase of labor as the fetus descends into the birth canal, which causes stretching of the umbilical cord and some compression.
It is important to provide oxygen by nonrebreather face mask to the mother to alleviate the shortage of oxygen exchanging across the placental to the fetus due to umbilical cord compression.
Depending on where the cord is being compressed, it is helpful to move the laboring mother side to side or to place her in knee chest position for prolapsed cord.
Whenever there is a nonreassuring fetal heart rate and pattern, it is important to discontinue oxytocin (Pitocin), because it will stop the simulation of the uterus and slow down the contractions.
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