Labour, Delivery, and Intrapartum Care
Core concepts
Intrapartum care questions test your command of the partogram, the diagnosis of labour, and the recognition of abnormal progress. Understand the stages of labour, the cardinal movements of delivery, and the definitions of prolonged latent phase, protraction and arrest disorders. Know the indications, technique and complications of induction (prostaglandins, balloon, amniotomy, oxytocin), and the interpretation of cardiotocography using a structured system (baseline rate, variability, accelerations, decelerations, and overall category).
Instrumental delivery requires explicit prerequisites: fully dilated cervix, engaged head at the correct station, known position, adequate analgesia, empty bladder, and a willingness to abandon the attempt. Shoulder dystocia is a drill: call for help, McRoberts, suprapubic pressure, then internal manoeuvres, with documentation of the sequence and the neonatal examination.
Traps
- Treating a category II trace as normal; category II requires interpretation and action, not reassurance.
- Diagnosing arrest of labour before an adequate trial of oxytocin and without confirming cervical dilatation.
- Forgetting that a prolonged deceleration with a non-reassuring baseline demands expedited delivery, not observation.
- Missing that failure to progress in the second stage may reflect malposition (occiput posterior) rather than inertia.
Worked rule of thumb
When asked about a non-reassuring fetal heart trace, use the ABC of intrapartum rescue: Address maternal (hypotension, hypoxia, haemorrhage, uterine hyperstimulation), Begin intrauterine resuscitation (left lateral, IV fluids, oxygen if hypoxic, tocolysis for hyperstimulation), and Choose delivery if the trace does not recover. Document the time of decision to delivery.
Exam technique
State the diagnosis, the stage of labour, the immediate action, and the definitive management. Examiners look for whether you would escalate safely.