Which of these can interrupt umbilical blood flow leading to prolonged decels?

Cord compression or prolapse is the correct answer because it directly affects the umbilical cord, which serves as the conduit for oxygen and nutrients from the placenta to the fetus. When the cord is compressed, either due to an abnormal fetal position, tightness of the umbilical cord itself, or its prolapse into the birth canal, it can lead to a reduction in blood flow. This interruption of blood flow manifests as prolonged decelerations in the fetal heart rate, indicating the fetus is experiencing stress likely due to diminished perfusion and oxygenation.

In contrast, other options may contribute to fetal distress but do not specifically disrupt umbilical blood flow in the same direct manner. Fetal acidemia involves a buildup of acid in the fetus's blood due to hypoxia rather than a direct obstruction of blood flow. Maternal hypertension can impact uteroplacental blood flow but may not lead to immediate, mechanical interruptions of umbilical circulation like cord compression. Intrauterine growth restriction suggests poor fetal growth often due to placental insufficiency but does not inherently mean that there is an active interruption of blood flow such as that which occurs with cord compression.