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Nursing QUESTION #9129
Question 1
A woman is in the second stage of labor for 2.5 hours (nullipara, epidural in situ). CTG shows late decelerations with reduced variability. Fetal scalp pH is 7.19. The MOST appropriate action is:
  • Continue monitoring for another 30 minutes
  • Perform operative vaginal delivery (vacuum or forceps) immediately✔️
  • Administer O₂ by mask and change maternal position only
  • Perform immediate cesarean section
Correct Answer Explanation

This scenario describes Fetal Distress in the Second Stage of labor:

  • Late decelerations = uteroplacental insufficiency (ominous)
  • Reduced variability = compromised fetal CNS oxygenation
  • Fetal scalp pH 7.19 = Pre-acidosis/borderline acidosis (Normal: \(\geq 7.25\); Borderline: \(7.20{-}7.24\); Acidosis: \(<7.20\))

Since the patient is in the second stage with a deliverable presenting part, and no absolute contraindications:

  • Operative vaginal delivery (forceps/vacuum) is faster and safer than CS in second stage.
  • CS is reserved if operative delivery is not feasible (high station, asynclitism).
  • A pH of 7.19 demands immediate action — not continued observation.

Conditions for operative delivery: fully dilated cervix, engaged head, known position, no CPD, consent obtained, skilled operator.