A 30-year-old woman at 40 weeks is in active labour with good contractions. CTG shows variable decelerations with slow recovery. Cervix is 6 cm, head at -1 station. Fetal scalp blood pH is 7.18. The appropriate management is:

• A Repeat scalp pH in 30 minutes
• B Intrauterine resuscitation and reassess
• C Continue monitoring and allow progress to full dilation
• D Emergency caesarean section ✓

Explanation

A fetal scalp pH of 7.18 indicates fetal acidosis (normal ≥7.25; borderline 7.21–7.24; abnormal ≤7.20). Combined with pathological CTG changes (variable decelerations with slow recovery), pH <7.20 mandates immediate delivery. At 6 cm dilation with head at -1 station, vaginal delivery is not imminent; emergency caesarean section is the correct response. Repeating the pH is appropriate only for pH 7.20–7.24.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.