A 32-year-old G2P1 at 41 weeks undergoes induction of labour with oxytocin. After 4 hours of adequate contractions (Montevideo units >200), cervical dilation progresses from 6 cm to 7 cm with the vertex remaining at station 0. Fetal heart rate shows recurrent variable decelerations with moderate variability. What is the most appropriate next step?
- A Continue oxytocin and reassess after 2 hours
- B Perform amniotomy if membranes are intact ✓
- C Administer tocolytics for fetal distress
- D Proceed to emergency cesarean section
Correct answer: B. Perform amniotomy if membranes are intact
Explanation
A protracted active phase with adequate contractions and moderate variability (reassuring) warrants amniotomy to accelerate labour. Amniotomy at 6 cm or more in the active phase can shorten labour duration. Variable decelerations with moderate variability do not indicate immediate operative delivery.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.