Synopsis
Recognise an immediate threat during labour, correct reversible causes promptly, and organise the fastest safe birth with coordinated maternal and neonatal care.
- Category one means an immediate threat to maternal or fetal life.
- Deliver as soon as possible; the usual thirty-minute interval is not a waiting period.
- At three minutes of persistent bradycardia, request urgent review and prepare urgent birth.
- Expedite birth if bradycardia persists for nine minutes, earlier when significant risk factors or an acute event demand it.
- Correct maternal hypotension and excessive contractions while preparations for birth continue.
- Use maternal oxygen for maternal hypoxaemia, not routinely to treat an abnormal fetal trace.
- Reassess the whole clinical picture if the fetal heart recovers before birth.
Key red flags
Acute bradycardia or a single prolonged deceleration lasting three minutes or longer requires urgent obstetric review.
Bleeding, constant abdominal pain, maternal hypotension or loss of fetal station suggest a structural emergency.
A cord felt below the presenting part after membrane rupture requires immediate decompression and a birth plan.
Investigation priorities
Track the fetal response during immediate bedside interventions.
Management branches
A prolonged deceleration reaches three minutes or an acute threat is identified.
- Call senior obstetric, anaesthetic, midwifery and neonatal assistance; allocate a leader, communicator and timekeeper.
- Assess maternal airway, breathing and circulation; check the fetal signal against the maternal pulse and start continuous monitoring.
- Stop an oxytocin infusion, avoid the supine position, and perform a focused examination for prolapse, abruption or rupture.
- Prepare urgent birth at once; escalate sooner than a numerical threshold if the clinical cause indicates ongoing interruption of oxygen supply.
Key medicines
Terbutaline for excessive uterine activityNICE suggests 250 micrograms by subcutaneous injection as an acute tocolytic dose; reassess immediately, with any further treatment directed by the obstetrician.This acute intrapartum regimen is distinct from the product's intravenous premature-labour regimen. Check cardiac disease and tachyarrhythmia risk; monitor pulse and blood pressure, and recognise possible hypokalaemia and hyperglycaemia. Do not use it to defer necessary birth.
Caesarean antimicrobial prophylaxisGive the locally selected intravenous prophylactic regimen before skin incision, with dose determined by the agent, weight, allergies and renal function.Confirm allergy details and communicate administration timing. NICE advises against co-amoxiclav for pre-incision prophylaxis; an emergency indication does not create one universal antibiotic dose.