In a 24-year-old primigravida at 39 weeks gestation in the latent phase with a 2 cm dilated cervix and cardiotocography showing a baseline of 140 beats per minute, moderate variability and recurrent early decelerations, what is the most appropriate management?

Management of Early Decelerations in Latent Labor

Continue routine monitoring (Option B) is the appropriate management for this patient, as early decelerations with moderate variability represent a Category I (normal) fetal heart rate pattern that requires no intervention. 1

Rationale for Routine Monitoring

Early decelerations are benign and physiologic. The cardiotocography findings in this case—baseline of 140 bpm, moderate variability, and recurrent early decelerations—represent a completely reassuring fetal heart rate pattern that does not indicate fetal compromise. 1

Key Distinguishing Features Present

• Early decelerations mirror uterine contractions with perfect timing synchronization, reflecting normal fetal head compression during contractions rather than hypoxia. 1

• The presence of moderate variability is crucial—this indicates intact fetal autonomic nervous system function and excludes fetal acidosis or compromise. 1

• The American College of Obstetricians and Gynecologists classifies early decelerations as Category I (normal) when occurring with moderate variability and normal baseline, which is exactly what this patient demonstrates. 1

Why Other Options Are Inappropriate

Oxygen Therapy (Option A) Is Not Indicated

• Oxygen therapy is reserved for concerning patterns such as late decelerations or Category II/III tracings, not for benign early decelerations. 1, 2

• Early decelerations result from a vagal reflex triggered by fetal head compression and have no association with fetal acidosis or hypoxia. 1

Cesarean Section (Option C) Is Not Indicated

• Cesarean delivery is recommended only for Category III (abnormal) tracings or persistent Category II patterns that fail to respond to resuscitative measures. 2, 3

• This patient has a Category I (normal) tracing that requires no intervention beyond routine monitoring. 1

• At 2 cm dilation in latent labor with a reassuring tracing, there is absolutely no indication for operative delivery. 1

Common Pitfall to Avoid

Do not confuse early decelerations with late decelerations. Late decelerations have delayed timing with the nadir occurring after the peak of the contraction, indicating uteroplacental insufficiency and requiring immediate intervention. 1, 2 Early decelerations have perfect temporal alignment with contractions and are completely benign. 1