Intrapartum Management and Interventions
Core concepts
Intrapartum management focuses on supporting fetal oxygenation while labor progresses. Intrauterine resuscitation includes maternal repositioning (often left lateral), intravenous fluids, oxygen per protocol, reducing uterine activity, and considering amnioinfusion for recurrent variable decelerations. Oxytocin management requires careful titration and monitoring of contraction pattern.
Operative and instrumental delivery decisions depend on fetal status, station, and maternal factors. Shoulder dystocia and postpartum hemorrhage require team response. Communication and documentation are part of management, not an afterthought.
Traps
Questions often test the order of resuscitation steps and the difference between treating the fetal heart rate and treating the cause. Another trap is continuing oxytocin during a non-reassuring pattern. Also know that oxygen is not a universal fix and should follow protocol.
Rule of thumb
When the fetal heart rate is non-reassuring, first stop or reduce uterine stimulation, reposition the mother, and give fluids; then reassess.
Worked example
During oxytocin infusion, the fetal heart rate shows recurrent variable decelerations. Stop oxytocin, reposition, and consider amnioinfusion if decelerations persist. Reassess the tracing before restarting oxytocin at a lower rate.