Intrapartum Care and Labor Management
Core concepts
Intrapartum care centers on the partograph, the stages of labor, and timely recognition of poor progress. Understand the first stage (latent and active phases), second stage (full dilatation to birth), and third stage (birth to placental delivery). Know normal parameters: cervical dilatation of about 1 cm/hour in active phase, descent of the presenting part, and fetal heart rate monitoring (intermittent auscultation every 15–30 minutes in first stage, every 5 minutes in second stage). Learn positions, ambulation, and support as labor-comfort measures, and the active management of the third stage of labor (AMTSL): uterotonic, controlled cord traction, and uterine massage. Recognize obstructed labor signs (bandl's ring, maternal exhaustion, fetal distress) and shoulder dystocia maneuvers (McRoberts, suprapubic pressure).
Traps
Questions confuse latent versus active phase thresholds and the action triggered by a partograph crossing the alert or action line. Another trap: assuming every slow labor needs cesarean - first assess power, passenger, and passage. Also watch fetal heart deceleration interpretation: early (head compression, benign), variable (cord compression), late (uteroplacental insufficiency, concerning).
Worked rule of thumb
On the partograph, a plot crossing the alert line calls for reassessment and transfer if needed; crossing the action line mandates definitive intervention. Use this as your decision anchor in progress questions.
Exam strategy
When a scenario describes fetal bradycardia with a prolapsed cord, the answer is call for help, elevate the presenting part, position the woman, and prepare for immediate delivery - not observation.