Intrapartum Care
Intrapartum content is the largest and most detail-driven area. Anchor every answer in cervical change, contraction adequacy, and the fetal heart tracing.
Labor progress
Active labor is generally defined as 6 cm or more with regular contractions. Active-phase arrest requires dilation of at least 6 cm, ruptured membranes, and no cervical change despite at least 4 hours of adequate contractions (or 6 hours of inadequate contractions).
Fetal monitoring
Use NICHD categories. Category I is a baseline of 110–160 with moderate variability, no late or variable decelerations, and accelerations present or absent. Category III is absent variability with recurrent late decelerations, recurrent variable decelerations, bradycardia, or a sinusoidal pattern. Everything else is Category II, and most tracings are Category II, so it is neither automatically reassuring nor automatically nonreassuring.
Interpret decelerations by shape and timing: early decelerations mirror contractions (head compression), variable decelerations are abrupt (cord compression), and late decelerations are gradual with the nadir after the contraction peak (uteroplacental insufficiency). A deceleration lasting 2 to 10 minutes is prolonged; 10 minutes or more is a baseline change.
Response
Intrauterine resuscitation includes stopping oxytocin, lateral repositioning, an IV fluid bolus, vaginal examination to rule out cord prolapse, and notification of the provider. Tachysystole is more than 5 contractions in 10 minutes averaged over 30 minutes.
Emergencies
Shoulder dystocia follows the HELPERR mnemonic. Cord prolapse requires elevation of the presenting part, knee-chest or Trendelenburg position, bladder filling, and emergent cesarean. Uterine rupture often presents as loss of station, sudden pain, and a Category III tracing.
Rule of thumb
A gradual deceleration that bottoms out after the contraction peak is late; one that keeps declining for 11 minutes is now a baseline change, not a deceleration.