Progressivity of Variable Deceleration to Late Deceleration – A Case Report and It’s Implication

Alfonsus Zeus Suryawan, Aditya Rifandi Zaenudin, Febia Erfiandi, Budi Handono


Abstract


Introduction: Cardiotocography (CTG) records changes in fetal heart rate and their temporal relationship with uterine contractions. This case report specifically highlights the progression of variable deceleration to late deceleration, its implication, and importance of variable deceleration.
Case Report: A 42-year-old G4P2A1 patient at 37–38 weeks of gestation presented to our emergency unit with severe preeclampsia (170/110 mmHg) and irregular heart rate (120 – 70 – 110 bpm). We performed CTG and showed baseline 120–130, with no variability and accompanied by deceleration. The first 2 deceleration occur without the same timing as contraction, and the two later occur after contraction. We performed C-section on the patient and healthy female baby.
Discussion: This case provides us with a rather unique pattern of CTG where we could see a slight progression from variable deceleration to late deceleration. Deceleration itself represents a reflex response of the fetus to reduce myocardial workload in response to stress; therefore, it can be secondary to cord compression or other causes. As this condition continues, the fetus deceleration progresses to late deceleration, presenting with a more dire condition and severe acidemic condition.
Conclusion: Most of the time variable deceleration are classified as “cord compression” decelerations, while most cases of fetal acidemia in labor are due to reduction in uteroplacental perfusion not the compression of cord. Therefore, variable deceleration is an important sign of fetal acidemia, and when such if itis present, we should take the initiative for termination of pregnancy to prevent bad outcomes of the fetus.

Progresivitas Deselerasi Variabel ke Deselerasi Lambat–Laporan Kasus dan Implikasinya

Abstrak
Pendahuluan:Kardiotokografi merekam perubahan detak jantung janin dan hubungannya dengan kontraksi uterus. Laporan kasus ini hendak menunjukkan perubahan dari deselerasi variabel ke deselerasi lambat serta implikasi dan pentingnya deselerasi variabel.
Laporan Kasus: Seorang wanita 42 tahun G4P2A1 gravida 37-38 minggu datang ke IGD dengan preeklamsia berat (170/110 mmHg) dan denyut jantung janin yang irreguler (120 – 70 – 110 x/menit). Setelah dilakukan kardiotokografi didapatkan baseline 120-130, tanpa ada akselerasi dan diikuti deselerasi. Dua deselerasi yang muncul pertama timbul tanpa ada hubungan dengan kontraksi uterus dan dua kontraksi berikut nya terjadi setelah kontraksi. Pasien kemudian dilakukan seksio sesarea dan lahir bayi perempuan sehat.
Diskusi: Kasus ini memberikan gambaran kardiotokografi unik dengan adanya progresivitas dari deselerasi variabel ke deselerasi lambat. Deselerasi sendiri merupakan respon fetus terhadap stress dengan menurunkan beban kerja myocardium janin. Hal ini terjadi akibat hipoksia pada janin yang terjadi akibat kompresi tali pusat dan atau penyebab lain. Bila kondisi ini berlanjut menjadi deselerasi lambat maka kondisi fetus akan semakin memburuk dan masuk kedalam asidemia berat.
Kesimpulan: Sering kali dalam melihat deselerasi variabel, kita menklasifikasikannya sebagai deselerasi yang disebabkan penekanan tali pusat/cord-compression yang bila dilakukan resusitasi dapat membaik. Akan tetapi mayoritas kasus dari asidemia fetus pada persalinan terjadi akibat penurunan aliran uteroplasental bukan dari kompresi tali pusat. Oleh karena itu deselerasi variabel justru merupakan tanda penting dalam menilai asidemia fetus dan bila ada dalam pemeriksaan karditokografi harus diambil langkah cepat untuk terminasi kehamilan guna mencegah luaran janin yang buruk.

Kata kunci : kardiotokografi; deselerasi variabel; asidemia fetus


Keywords


CTG; variable deceleration; fetal acidemia

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References


Alfirevic Z, Devane D, Gyte GM, Cuthbert A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. 2017;2(2):Cd006066.

Manning FA. The fetal biophysical profile score: current status. Obstet Gynecol Clin North Am. 1990;17(1):147-62.

James LS, Morishima HO, Daniel SS, Bowe ET, Cohen H, Niemann WH. Mechanism of late deceleration of the fetal heart rate. American Journal of Obstetrics and Gynecology. 1972;113(5):578-82.

Hibbard B. Assessment of fetal condition during labour. Hibbard BM, editor Principles of Obstetrics, 1st edition. London; UK: Butterworth & Co.; 1988. p. 472-89.

Gyllencreutz E, Varli IH, Lindqvist PG, Holzmann M. Variable deceleration features and intrapartum fetal acidemia – The role of deceleration area. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2021;267:192-7.

Brosens I, Pijnenborg R, Vercruysse L, Romero R. The "Great Obstetrical Syndromes" are associated with disorders of deep placentation. Am J Obstet Gynecol. 2011;204(3):193-201.

Yang JM, Wang KG. Relationship between acute fetal distress and maternal-placental-fetal circulations in severe preeclampsia. Acta Obstet Gynecol Scand. 1995;74(6):419-24.

Pereira S, Chandraharan E. Recognition of chronic hypoxia and pre-existing foetal injury on the cardiotocograph (CTG): Urgent need to think beyond the guidelines. Porto Biomedical Journal. 2017;2(4):124-9.

Sholapurkar S. Myths at the core of Intrapartum Cardiotocography Interpretation -Risks of false Ideology, Prospect theory and way forward. Clinical Obstetrics, Gynecology and Reproductive Medicine. 2019.

Ayres-de-Campos D, Spong CY, Chandraharan E. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. Int J Gynaecol Obstet. 2015;131(1):13-24.




DOI: http://dx.doi.org/10.24198/obgynia.v7i1.640

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