Immediate Cesarean Section is Required
This patient requires immediate cesarean delivery due to the presence of type 2 (late) decelerations on CTG, which indicate uteroplacental insufficiency and fetal hypoxemia requiring urgent intervention to prevent fetal acidemia and adverse neonatal outcomes. 1
Understanding the Clinical Emergency
Late decelerations represent uteroplacental insufficiency with delayed onset after contraction begins, indicating fetal hypoxemia and potential acidosis, particularly concerning in a primigravida at 6 cm dilation with irregular contractions. 1
The presence of late decelerations significantly increases the risk of adverse neonatal outcomes and requires urgent intervention to prevent progression to fetal acidemia. 1
Late decelerations are characterized by the nadir occurring after the peak of the contraction and are associated with fetal acidosis when accompanied by loss of variability. 1
Why Other Options Are Contraindicated
Observation (Option A) is Dangerous
Observation is absolutely contraindicated as late decelerations indicate active fetal compromise requiring immediate intervention, not continued monitoring. 1
Late decelerations represent established fetal compromise, not an equivocal tracing that can be observed. 1
Amniotomy (Option B) Will Worsen the Situation
Amniotomy is contraindicated in the presence of late decelerations as it could worsen uteroplacental insufficiency by removing the cushioning effect of amniotic fluid. 1
Amniotomy is only appropriate for variable decelerations (suggesting cord compression), not late decelerations (indicating uteroplacental insufficiency). 2
Oxytocin (Option D) is Harmful
Oxytocin is absolutely contraindicated as it increases uterine contractility, which further compromises uteroplacental blood flow and worsens fetal hypoxemia. 1
If oxytocin were already being administered, it should be discontinued immediately. 1
Immediate Actions While Preparing for Cesarean Section
Intrauterine Resuscitation Measures
Discontinue oxytocin immediately if it is being administered, as it increases uterine contractility and further compromises uteroplacental blood flow. 1
Establish or increase IV fluid administration with physiologic electrolyte solutions to optimize maternal blood volume and uterine perfusion. 1
Perform a vaginal examination to assess for cord prolapse or rapid cervical change. 1
Check maternal vital signs to identify maternal hypotension or other contributing factors. 1
Administer oxygen to the mother and position on the left side to maximize uteroplacental perfusion. 1
Assessment of Fetal Heart Rate Variability
If absent baseline variability accompanies the late decelerations, this represents a Category III tracing requiring immediate expeditious delivery. 1
If moderate variability is present, this represents a Category II tracing requiring increased surveillance frequency and preparation for expedited delivery if abnormalities persist or worsen. 1
Critical Pitfalls to Avoid
Do not attempt fetal scalp stimulation or acoustic stimulation as a substitute for delivery when late decelerations are present—these are temporizing measures for equivocal tracings, not established fetal compromise. 1
Do not confuse late decelerations with variable decelerations—variable decelerations suggest cord compression and may respond to amniotomy, while late decelerations indicate uteroplacental insufficiency requiring delivery. 2
Do not delay delivery to achieve full dilation—at 6 cm with late decelerations, the fetus is already compromised and further labor progression risks worsening acidemia. 1