During the second stage of labor, a sustained deceleration to 70 bpm lasting 5 minutes occurs with a 4/5 fetal head palpable abdominally and complete cervical dilatation. Maternal pushing efforts are effective. Which is the MOST appropriate immediate intervention?

• A Intrauterine resuscitation: left lateral position, oxygen, IV fluids, stop oxytocin ✓
• B Emergency cesarean section
• C Operative vaginal delivery with vacuum or forceps
• D Fetal scalp blood sampling for pH

Explanation

A prolonged deceleration to 70 bpm for 5 minutes constitutes a non-reassuring CTG. The first response should always be intrauterine resuscitation: left lateral decubitus (relieves aortocaval compression), supplemental oxygen, IV hydration, and cessation of oxytocin. With 4/5 head palpable abdominally (station still high), operative vaginal delivery would be inappropriate (station not adequate). If intrauterine resuscitation fails to restore fetal heart rate after 3 minutes and head is not low enough for operative vaginal delivery, cesarean section would follow. Fetal scalp sampling would further delay action.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.