One-Pager
Labor and Fetal Monitoring
Stages of labor, FHR strips, VEAL CHOP, NICHD categories, postpartum checks and Rh immune globulin
Download one-page PDFLetter landscape, ready to print or keep with your notes
Stages of labor
| Stage | Span | Key points |
|---|---|---|
| 1: latent | Onset to 6 cm | Contractions become regular |
| 1: active | 6 to 10 cm | Every 2 to 5 min, about 60 s each |
| 2 | 10 cm to birth | Prolonged: over 3 h pushing (nullipara), 2 h (multipara) |
| 3 | Birth to placenta | Usually 5 to 30 min; longer raises bleeding risk |
| 4 | 1 to 4 h after placenta | VS, fundus every 15 min for 1 h, then every 30 min |
Tachysystole: more than 5 contractions in 10 min, averaged over 30 min.
Older review books: active 4 to 7, transition 8 to 10 cm.
Reading the FHR strip
| Feature | Definition | Meaning |
|---|---|---|
| Baseline | Mean FHR over 10 min | Normal 110 to 160 bpm |
| Tachycardia | Over 160 for 10 min | Maternal fever, terbutaline, fetal hypoxia |
| Bradycardia | Under 110 for 10 min | Hypotension, cord prolapse, abruption |
| Variability | Absent, minimal (1 to 5), moderate (6 to 25), marked (over 25) | Moderate is normal |
| Accelerations | Up 15 bpm for 15 s (10 for 10 s before 32 weeks) | Reassuring |
Decelerations and VEAL CHOP
VEAL CHOP: Variable = Cord, Early = Head, Accelerations = OK, Late = Placenta.
| Type | Shape | Cause | Action |
|---|---|---|---|
| Early | Gradual; mirrors the contraction | Head compression | None; document |
| Late | Gradual; nadir after the contraction peak | Placental insufficiency | Resuscitate; notify |
| Variable | Abrupt; down 15 or more for 15 s to under 2 min | Cord compression | Reposition; check for prolapse |
| Prolonged | Down 15 or more for 2 to under 10 min | Hypotension, tachysystole, prolapse, abruption | Resuscitate; notify now |
Gradual: 30 s or more to nadir; abrupt: under 30 s. Recurrent: with half or more of contractions in 20 min.
NICHD categories and resuscitation
| Category | Criteria | Meaning |
|---|---|---|
| I | 110 to 160, moderate variability, no late or variable decels | Normal |
| II | Not I or III (tachycardia, minimal variability, prolonged decel) | Evaluate, treat the cause, notify; resuscitate if no accels or moderate variability |
| III | Absent variability with recurrent lates, recurrent variables or bradycardia; or sinusoidal | Resuscitate; expedite birth |
- Stop or reduce oxytocin
- Lateral position; avoid supine (vena cava compression)
- IV bolus, often 500 to 1,000 mL LR; epidural hypotension: vasopressor per order
- Vaginal exam for prolapse (RN); rule out maternal pulse
- Tachysystole that persists off oxytocin: terbutaline 0.25 mg subcut per order
- Recurrent variables: amnioinfusion per provider
- Notify the provider; document; reassess
Doses: follow your institution's protocols. Oxygen: ACOG (2025) advises against routine use without maternal hypoxia; older books still list it. LPN/LVN scope (varies by state): recognize, reposition and report to the RN, who interprets and calls the provider.
Postpartum assessment (BUBBLE-HE)
- Breasts: filling, nipples, latch
- Uterus: firm, midline, height
- Bladder, bowel: voiding, distention
- Lochia: color, amount, odor, clots
- Episiotomy: redness, edema, hematoma
- Homans/extremities: DVT signs (Homans unreliable)
- Emotions: bonding, blues versus depression
| Time | Fundus | Lochia |
|---|---|---|
| After placenta | Firm, midline, not above the umbilicus | Rubra |
| Days 1 to 3 | Stays firm; descends about 1 cm (a fingerbreadth) a day (classic teaching) | Rubra, red |
| Days 4 to 10 | About midway to the symphysis by day 5 to 7 | Serosa, pink-brown |
| To 6 weeks | Not palpable by 2 weeks; prepregnant size by 4 to 6 weeks | Alba, yellow-white, to 4 to 6 weeks |
Rh immune globulin
- Who: Rh-negative, not sensitized (negative antibody screen)
- 28 weeks: 300 mcg IM
- Within 72 h of birth of an Rh-positive newborn
- Within 72 h of: bleeding after 20 weeks, abdominal trauma, amniocentesis or CVS, external version, ectopic
- Loss at 12 weeks or more (earlier: provider decides)
- Large fetal bleed: Kleihauer-Betke test sizes extra doses
- Mother only, never the newborn; follow your institution's protocols
Practice Labor and Fetal Monitoring questions free in your browser14 exam-style questions with rationales. No account or download needed.
Practice free in your browser2,150+ exam-style questions with rationales. No account, no ads. Also free on the App Store and Google Play.
Related one-pagers
- Obstetric EmergenciesPPH, preeclampsia and eclampsia, late-pregnancy bleeding, delivery emergencies and maternal arrest
- Postpartum and Newborn NormalsFundus and lochia, BUBBLE-HE, PPH, Rh and vaccines, newborn vital signs, Apgar, jaundice, glucose, screening and discharge teaching
- Newborn Care and ResuscitationApgar, NRP 9th edition steps, SpO2 targets and newborn vital signs for exam review
- Pediatric Assessment and EmergenciesPAT, vital signs, airway infections, febrile seizures, dehydration, arrest, choking and abuse
- Pediatrics: Growth, Vital Signs and ImmunizationsMilestones, Erikson and play, vital signs, vaccines, safety, pain scales and dehydration for NCLEX
Sources
- American College of Obstetricians and Gynecologists. Intrapartum Fetal Heart Rate Monitoring: Interpretation and Management. Clinical Practice Guideline No. 10. Obstet Gynecol. 2025;146(4):583-599. doi:10.1097/AOG.0000000000006049 Link
- Macones GA, Hankins GDV, Spong CY, et al. The 2008 NICHD workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines. Obstet Gynecol. 2008;112(3):661-666. Link
- Arnold JJ, Gawrys BL. Intrapartum Fetal Monitoring. Am Fam Physician. 2020;102(3):158-167. Link
- American College of Obstetricians and Gynecologists. First and Second Stage Labor Management. Clinical Practice Guideline No. 8. Obstet Gynecol. 2024;143(1):144-162. Link
- Moldenhauer JS. Management of Normal Labor; Management of Spontaneous Vaginal Delivery. Merck Manual Professional Edition. Full review March 2024, updated September 2026. Link
- Moldenhauer JS. Postpartum Care. Merck Manual Professional Edition. Full review April 2024, updated July 2026. Link
- MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine). Vaginal delivery - discharge. Reviewed 11/2024. Link
- Royal College of Obstetricians and Gynaecologists. Umbilical Cord Prolapse. Green-top Guideline No. 50, 2nd ed. November 2014 (reviewed December 2024). Link
- Evensen A, Anderson JM, Fontaine P. Postpartum Hemorrhage: Prevention and Treatment. Am Fam Physician. 2017;95(7):442-449. Link
- Raghuraman N, Temming LA, Doering MM, et al. Maternal Oxygen Supplementation Compared With Room Air for Intrauterine Resuscitation: A Systematic Review and Meta-analysis. JAMA Pediatr. 2021;175(4):368-376. Link
- Carter EB, Chu CS, Thompson Z, et al. True knot at the time of delivery: electronic fetal monitoring characteristics and neonatal outcomes. J Perinatol. 2018. Link
- Fresenius Kabi USA. Terbutaline Sulfate Injection, USP, prescribing information, revised 4/2022. DailyMed. Link
- Kedrion Biopharma. RhoGAM Ultra-Filtered PLUS and MICRhoGAM Ultra-Filtered PLUS [Rho(D) Immune Globulin (Human)] prescribing information, revised 7/2025. DailyMed. Link
- American College of Obstetricians and Gynecologists. The Rh Factor: How It Can Affect Your Pregnancy (patient FAQ). Last updated September 2024; reviewed October 2025. Link
- American College of Obstetricians and Gynecologists. Prevention of Rh D Alloimmunization. Practice Bulletin No. 181, 2017 (reaffirmed 2026; December 2024 Clinical Practice Update). Link