Which of the following actions best addresses late decelerations in labor?

• A. Increase maternal activity
• B. Oxygen administration, left or right lateral reposition, stop oxytocin if infusing, and IV fluid bolus
• C. Administer tocolytics
• D. Immediate cesarean delivery

Answer: (B)

Late decelerations reflect fetal hypoxemia from uteroplacental insufficiency, often worsened by contractions. The best initial management aims to improve placental blood flow and maternal oxygenation while reducing fetal oxygen demand. Repositioning the mother to a left or right lateral position enhances venous return and uteroplacental perfusion. Providing supplemental oxygen increases the oxygen available to the fetus. Discontinuing oxytocin if it’s infusing helps reduce excessive uterine activity that can compromise blood flow. Administering an IV fluid bolus expands circulating volume, improving placental perfusion. Together, these steps directly address the underlying issue of reduced fetal oxygenation and are the first-line actions for nonreassuring fetal heart rate patterns like late decelerations. If the tracing remains nonreassuring after this bundle, escalation to more definitive measures, including delivery, may be necessary.