A woman in active labour at 7 cm dilation has epidural analgesia. The CTG shows baseline FHR 135 bpm, reduced variability (3 bpm), and late decelerations following each contraction. The oxytocin infusion is running at 10 mU/min. The MOST appropriate immediate management is:

• A Increase oxytocin to achieve more regular contractions
• B Continue monitoring and reassess in 30 minutes
• C Administer terbutaline to reduce uterine activity only
• D Stop oxytocin, administer maternal oxygen, lateral position, IV fluid, and prepare for delivery ✓

Explanation

This is a Category II/III FHR pattern — reduced variability with recurrent late decelerations — indicating potential fetal hypoxia from uteroplacental insufficiency possibly exacerbated by oxytocin. Immediate intrauterine resuscitation includes: stopping oxytocin (removing potential cause of hyperstimulation), maternal left lateral positioning, IV fluid bolus, and supplemental oxygen. If there is no improvement or pattern worsens, delivery (operative vaginal or cesarean) is indicated. Increasing oxytocin would worsen the situation. Terbutaline alone is insufficient without stopping oxytocin.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.