If late decelerations persist after initial actions, what is the recommended step?

• A. Administer corticosteroids to mature fetal lungs
• B. Stop oxytocin, reposition, notify provider, and prepare for delivery
• C. Administer magnesium sulfate
• D. Increase IV fluids and tocolysis

Answer: (B)

Late decelerations signal uteroplacental insufficiency, meaning the fetus isn’t getting adequate oxygen during contractions. When these patterns persist after initial actions (repositioning the mother to improve placental blood flow and oxygen delivery, stopping the oxytocin to reduce contractions and oxygen demand, and supporting with fluids or oxygen as needed), the situation is nonreassuring and escalation is required. The best next step is to notify the obstetric team and prepare for delivery because ongoing distress often necessitates expediting birth to protect the fetus.

Corticosteroids to mature fetal lungs are not indicated for intrapartum distress and won’t correct the pattern. Magnesium sulfate is used for seizure prophylaxis in preeclampsia or neuroprotection in extremely preterm infants, not to treat late decelerations. Increasing IV fluids or using tocolysis aims to support the pregnancy but does not address persistent fetal distress and delaying delivery can worsen outcomes.