Intrapartum Care and Labour Management
What this domain tests
Intrapartum Care and Labour Management tests whether you can recognise normal progress, record it objectively on a partograph or Labour Care Guide, interpret fetal surveillance, and conduct a safe second and third stage.
Core rules
- Stages. First stage: latent (0–5 cm, variable length - delay is not diagnosed here) then active (5 cm to full dilatation). Second stage: full dilatation to birth; prolonged if over 2 hours in a nullipara or 1 hour in a multipara, extended by an hour with epidural analgesia. Third stage: birth to placental delivery.
- Progress. Plot dilatation, descent, contractions, maternal pulse, BP, temperature and urine. The alert line runs at 1 cm/hour from 4 cm; the action line sits 4 hours to its right. Crossing the alert line triggers reassessment, not immediate caesarean.
- Fetal surveillance. Intermittent auscultation every 15–30 minutes in the first stage and every 5 minutes in the second for low-risk labour; continuous CTG when risk factors exist. Classify decelerations as early, variable, late or prolonged.
- Third stage. Active management: oxytocin 10 IU IM within 1 minute, controlled cord traction with counter-traction, uterine massage, then inspection for completeness and quantified blood loss.
- Comfort. Upright and mobile positions, oral fluids in low-risk labour, and continuous support all reduce intervention.
- Newborn transition. Delayed cord clamping for 1–3 minutes and immediate skin-to-skin.
Worked example
A nullipara is 5 cm at 08:00 and 6 cm at 12:00 - the plot has crossed the alert line. Review the whole picture: contractions 2 in 10, membranes intact, pulse 88, normal CTG, full bladder. Empty the bladder, encourage mobilisation, offer amniotomy and reassess in 2 hours. Augment with oxytocin only if slow progress persists and there is no obstruction.
Traps that cost marks
Labelling the latent phase as failure to progress; reading early decelerations as hypoxia (they reflect head compression); starting oxytocin without checking contractions and fetal status; pulling the cord before signs of separation; estimating blood loss by eye alone.