Intrapartum Care and Labor Management
Intrapartum Care and Labor Management
This domain tests labor diagnosis, fetal surveillance interpretation, induction and augmentation, dystocia, and emergency response. Items favor the correct next action and precise definitions.
Core rules
- Labor is regular contractions with cervical change. ACOG defines active-phase arrest at ≥6 cm with ruptured membranes and no cervical change for ≥4 hours of adequate contractions or ≥6 hours with inadequate contractions.
- Fetal heart rate categories: Category I = baseline 110-160, moderate variability, no late or variable decelerations. Category III = absent variability with recurrent late or variable decelerations, bradycardia, or sinusoidal pattern. Category II is everything else.
- Intrauterine resuscitation: reposition, IV fluid bolus, stop oxytocin, consider tocolysis, and treat hypotension. Routine maternal oxygen is not recommended without hypoxemia.
- Induction: assess Bishop score; options include misoprostol, dinoprostone, and transcervical Foley. Avoid misoprostol with prior cesarean outside protocol.
- Shoulder dystocia: McRoberts, suprapubic pressure, then internal maneuvers; document time and sequence.
- Postpartum hemorrhage: uterine atony is most common; quantify blood loss and escalate uterotonics.
Worked example
A term patient at 7 cm has recurrent late decelerations with moderate variability. This is Category II, not III. Start resuscitation: left lateral reposition, fluids, stop oxytocin, check blood pressure. If decelerations persist with absent variability or bradycardia, escalate to Category III and prepare for operative delivery. Reasoning: the category drives urgency, not the deceleration name alone.
Traps
Calling arrest before 6 cm; labeling moderate variability with late decelerations as Category III; giving oxygen routinely; using methergine in hypertension.