Intrapartum care: labour assessment, monitoring, birth and immediate newborn care
This domain tests labour assessment, fetal monitoring, birth and immediate newborn care. Scenarios usually ask what you would do next and why, so link findings to action and escalation.
Assessment and monitoring
- Distinguish latent from active first stage and use a partogram, acting on action lines.
- Intermittent auscultation for low-risk labour: every 15 minutes in the first stage and every 5 minutes in the second stage.
- Use CTG when risk factors are present; interpret baseline, variability, accelerations and decelerations, then escalate.
- Vaginal examination only when the information will change management.
- Third stage: active management reduces postpartum haemorrhage; assess tone and blood loss.
- Document time of birth, condition, Apgar and cord gases if indicated.
Emergencies
- Shoulder dystocia: McRoberts, suprapubic pressure, internal manoeuvres, call for help.
- Cord prolapse: elevate the presenting part, knee-chest or Trendelenburg, call and transfer.
- Fetal compromise: left lateral, IV fluids, stop oxytocin, consider tocolysis, expedite birth.
- Slow progress requires review, not simply more time.
Immediate newborn care
- Dry, stimulate and assess tone and breathing; delayed cord clamping 1–3 minutes for well babies; skin-to-skin; vitamin K.
Worked example
In the second stage, recurrent late decelerations appear. The answer is not "continue observing": start intrauterine resuscitation and escalate for expedited birth, documenting times and responses.
Traps
Documenting "CTG normal" without parameters; failing to call for help; delaying cord clamping in an unwell baby.