A woman induced with high-dose oxytocin develops contractions lasting 90 seconds occurring every 1.5 minutes, and the CTG shows recurrent late decelerations with reduced variability. The cervix is 4 cm dilated. What is the FIRST step in management?

• A Immediate cesarean section
• B Perform immediate amniotomy to speed labor
• C Increase the oxytocin dose to overcome the decelerations
• D Stop the oxytocin infusion and give a left lateral tilt with intravenous fluid bolus ✓

Explanation

Uterine tachysystole with an abnormal fetal heart rate pattern requires immediate discontinuation of the uterotonic, maternal repositioning, and an intravenous fluid bolus. Subcutaneous terbutaline is added only if hyperstimulation persists after these measures. Cesarean is reserved for cases that do not recover, and increasing oxytocin would worsen the hypoxic stress.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.