A woman being induced with high-dose oxytocin develops more than 5 contractions in 10 minutes with recurrent late decelerations and reduced variability. Which is the MOST appropriate immediate sequence of actions?

• A Perform amniotomy and apply a fetal scalp electrode
• B Increase oxytocin to overcome decelerations and prepare for instrumental delivery
• C Immediate cesarean section without any intrauterine resuscitation
• D Stop oxytocin, give terbutaline 0.25 mg subcutaneously, left lateral position, intravenous fluid bolus ✓

Explanation

Tachysystole with an abnormal fetal heart rate tracing requires stopping the oxytocin infusion first, then intrauterine resuscitation: uterine relaxation with terbutaline 0.25 mg subcutaneous, maternal repositioning to the left lateral, and an isotonic fluid bolus. Cesarean is reserved only if resuscitation fails. Increasing oxytocin would worsen hyperstimulation, and amniotomy does not address the cause.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.