Intrapartum Care and Labor Management
Core concepts
Labor management rests on stages of labor, fetal heart rate interpretation, and dystocia management. Know the updated definitions: active-phase arrest is no cervical change for at least 6 hours with ruptured membranes and adequate contractions (or 6 hours with inadequate contractions despite oxytocin). Fetal heart rate patterns require categorization: Category I (baseline 110–160, moderate variability, no late or variable decelerations), Category III (absent variability with recurrent decelerations, sinusoidal, or bradycardia), and Category II (everything else). Understand tachysystole, intrauterine resuscitation measures (position change, oxygen, IV fluids, stop oxytocin, tocolysis), and operative vaginal delivery criteria (complete dilation, engaged station, known position, adequate pelvis).
Traps
Questions conflate early decelerations (head compression, benign) with late decelerations (uteroplacental insufficiency). Also watch for the trap of treating Category II patterns as automatically operative - most require observation and intrauterine resuscitation. Another common error is misapplying the 6-hour arrest rule without confirming membrane status and contraction adequacy.
Rule of thumb
For any abnormal fetal heart rate tracing, run the intrauterine resuscitation sequence first, then reassess; escalate to delivery for Category III or unresolved Category II with fetal compromise.