A G2P1 at 39 weeks undergoing induction develops six contractions in 10 minutes with a fetal heart rate showing repetitive late decelerations. The oxytocin infusion is running at 20 mIU/min. What is the FIRST step in management?

• A Administer intravenous terbutaline 0.25 mg
• B Perform amniotomy to augment labor progress
• C Proceed immediately to cesarean delivery
• D Discontinue the oxytocin infusion and institute intrauterine resuscitation measures ✓

Explanation

Tachysystole with an abnormal fetal heart pattern during oxytocin induction is managed first by stopping the oxytocin, turning the mother to the left lateral position, giving intravenous fluid bolus and oxygen if needed. Uterine activity often settles once oxytocin is withdrawn, restoring placental perfusion. Terbutaline is reserved for persistent tachysystole despite stopping the drug, and cesarean is indicated only if the tracing deteriorates to category III or resuscitation fails.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.