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✨ Featured Lessons · Lesson 6 of 8 · 60 sec

Late Decels: Four Moves in Sixty Seconds

📉 The fetal heart rate dips late and recovers late. The placenta is failing. You have four moves and about one minute to make them.

💡 Key idea

Late means placenta. Side, stop oxytocin, fluids, notify; oxygen only if she is hypoxic.

🧠 Why it matters

VEAL CHOP: Variable is Cord, Early is Head, Accelerations are Okay, Late is Placenta. For late decelerations: turn the client to her SIDE, STOP the oxytocin, give an IV FLUID bolus, and NOTIFY the provider. Give OXYGEN only if she is hypoxic or per protocol; ACOG no longer recommends routine maternal oxygen. For variable decelerations, reposition first and check for a prolapsed cord. For a prolapsed cord, lift the presenting part off the cord with a gloved hand and call for an emergency delivery.

🏥 In the real world

🔄 The pattern on the monitor is subtle and the room is calm. The nurse who knows VEAL CHOP sees the dips bottoming out after each contraction's peak and starts the four moves before anyone else notices. Two minutes later the strip looks reassuring again. Nobody will ever know how close it was, which is the point.

📌 Takeaways

  • Variable cord, early head, accelerations okay, late placenta
  • Lates: side, oxytocin off, fluids, notify; oxygen only if hypoxic
  • Prolapsed cord: lift the presenting part and call for delivery

✅ Test yourself

Which fetal heart rate pattern indicates uteroplacental insufficiency?
  1. Accelerations
  2. Early decelerations
  3. Variable decelerations
  4. Late decelerations

Answer: D · Late decelerations

Late decelerations reflect a placenta that cannot deliver enough oxygen during contractions.

A client receiving oxytocin has recurrent late decelerations. Which action is correct?
  1. Increase the oxytocin to speed delivery
  2. Stop the oxytocin and reposition her
  3. Prepare for a vaginal exam only
  4. Continue to monitor for 30 minutes

Answer: B · Stop the oxytocin and reposition her

Intrauterine resuscitation starts immediately: stop the oxytocin, reposition to side-lying, open the fluids, notify the provider, and give oxygen if she is hypoxic or per protocol.

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