A 29-year-old woman at 39 weeks gestation presents in active labour. The fetal heart rate shows late decelerations. Vaginal examination reveals cervical dilation of 5 cm and intact membranes. What is the most appropriate next step? A) Amnioinfusion B) Continue monitoring C) Immediate caesarean section D) Artificial rupture of membranes E) Change maternal position and give oxygen Correct Answer: E) Change maternal position and give oxygen Explanation: Late decelerations = Uteroplacental insufficiency First response: Improve placental perfusion Left lateral position High-flow oxygen IV fluids if needed A) Amnioinfusion → Incorrect. Used for variable decelerations (cord compression), not late decels. B) Continue monitoring → Incorrect. Requires intervention. C) Immediate C-section → Incorrect. Not needed unless fetal distress persists. D) Artificial rupture of membranes → Incorrect. Could worsen distress. Key Tips for PLAB 1: ✅ Late decelerations = Uteroplacental insufficiency ✅ First: Change position, give oxygen, fluids ✅ If persistent distress → Consider urgent delivery
