NCC Certified Electronic Fetal Monitoring (C-EFM) Practice Exam

The most likely physical rationale for recurrent late decels after epidural is?

1. Uterine Hypertonicity

2. Maternal Sympathetic Blockade

3. Inadequate Blood Flow

4. Fetal Distress

The correct answer is: Maternal Sympathetic Blockade

The rationale for recurrent late decelerations following epidural anesthesia primarily relates to maternal sympathetic blockade. When an epidural is administered, it can block sympathetic nerve pathways alongside sensory and motor ones. This blockade can result in vasodilation and reduced vascular resistance, which can lead to hypotension in the mother. As the maternal blood pressure drops, there may be a decrease in uteroplacental perfusion, which can compromise oxygen supply to the fetus. This reduced blood flow can subsequently lead to fetal distress, manifesting as late decelerations in the fetal heart rate pattern. Late decelerations are characterized by a gradual decrease in the fetal heart rate that starts after the peak of a contraction and indicates that the fetus is not receiving enough oxygen during contractions. While uterine hypertonicity and inadequate blood flow are indeed concerns in labor management, they do not specifically account for the mechanism of recurrent late decelerations as closely as maternal sympathetic blockade does, especially in the context of administering epidurals. Fetal distress is a broader term that encompasses various potential issues affecting the fetus but does not pinpoint the specific physiological mechanism triggered by the epidural effect. Understanding how sympathetic blockade after an epidural affects the maternal hemodynamics and consequently the fetal condition is