Intrapartum Care: Labor Assessment and Fetal Surveillance
Core concepts
Intrapartum questions test your ability to interpret labor progress and fetal status together. Know the stages of labor, the meaning of effacement, dilation, station, and fetal position, and the expected patterns of descent. Understand the difference between true and false labor, and the signs of normal versus abnormal progress (arrest of dilation, arrest of descent, protracted labor).
Fetal surveillance is heavily tested. Learn category I, II, and III fetal heart rate patterns. Category I is baseline 110-160 with moderate variability and no late or variable decelerations. Category III includes absent variability with recurrent late or variable decelerations, bradycardia, or a sinusoidal pattern. Category II is everything else and requires continued evaluation and intrauterine resuscitation as indicated. Understand interventions: repositioning, oxygen per policy, IV fluid bolus, stopping oxytocin, and notifying the provider.
Traps in questions
A frequent trap is a deceleration that looks reassuring but is actually late (onset after contraction peak, gradual) versus early (mirrors contraction, benign). Another is choosing an intervention before assessing maternal position, blood pressure, and uterine activity. Questions may describe a Category II strip and ask for the best next action: usually continued surveillance with appropriate repositioning, not immediate cesarean.
Rule of thumb
For any nonreassuring fetal heart rate pattern, first do intrauterine resuscitation: change maternal position, give IV fluids, stop oxytocin if running, and assess for hypotension or tachysystole. Then reassess.
Worked example: A laboring patient has a baseline of 140, moderate variability, and decelerations that begin after the contraction peak and return slowly. These are late decelerations, suggesting uteroplacental insufficiency. Action: reposition, IV bolus, stop oxytocin, notify provider, continue close monitoring.