A 32-year-old woman, G2P1, at 39 weeks gestation is in active labour. Cervical examination shows 6 cm dilatation, 80% effacement, and the fetal head at 0 station. Electronic fetal monitoring shows a baseline heart rate of 145 bpm with repetitive late decelerations and minimal variability. The most appropriate immediate management is:
- A Administer intravenous oxytocin to expedite delivery
- B Reposition to left lateral decubitus, administer oxygen, and prepare for immediate delivery ✓
- C Perform amnioinfusion and continue expectant management
- D Deliver by mid-cavity forceps immediately
Correct answer: B. Reposition to left lateral decubitus, administer oxygen, and prepare for immediate delivery
Explanation
Repetitive late decelerations with minimal variability constitute a Category III fetal heart rate pattern, indicating non-reassuring fetal status with possible uteroplacental insufficiency. The initial resuscitative steps are maternal repositioning (left lateral), supplemental oxygen, stopping oxytocin if running, IV fluid bolus, and preparation for expedited delivery. Oxytocin would worsen uteroplacental perfusion.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.