Knowledge Area 7 | Management of Labour

Knowledge Area 7 | Management of Labour

(Aligned with RCOG Core Curriculum 2019)

This knowledge area focuses on the diagnosis, monitoring and safe progression of labour, emphasising maternal and fetal wellbeing, escalation, and multidisciplinary coordination.

What the RCOG Curriculum Expects 

The curriculum expects you to demonstrate:

• Accurate diagnosis of labour
• Risk assessment and intrapartum planning
• Interpretation of fetal monitoring
• Safe use of induction and augmentation
• Recognition of delay and deterioration
• Escalation and teamwork

Labour questions in MRCOG often test prioritisation and interpretation rather than recall.

Diagnosis and Assessment of Labour

• You must know: Definition of latent vs established labour; Admission criteria; Initial maternal assessment; Risk stratification (low vs high risk pathway); Birth setting selection
• The curriculum emphasises individualised care and shared decision-making.

Intrapartum Monitoring

Maternal Monitoring

• It comprises: Observations and early warning scores; Fluid balance; Analgesia review; Risk of sepsis

Fetal Monitoring

• CTG interpretation is heavily tested.
• You must: Apply NICE CTG classification; Identify baseline, variability, accelerations, decelerations; Recognise pathological patterns; Decide when to escalate
• The exam often tests trend interpretation, not isolated CTG features.

Induction of Labour (IOL)

• You must know: Indications; Contraindications; Cervical ripening methods (mechanical vs pharmacological); Use of prostaglandins; Balloon catheter; Oxytocin infusion protocols; Risks (hyperstimulation, uterine rupture)
• Special scenarios include: Advanced maternal age; Previous Caesarean birth; Diabetes; Reduced fetal movements
• Understand counselling points and documentation requirements.

Augmentation of Labour

• You should understand: Diagnosis of delay (partogram interpretation); Criteria for amniotomy; Oxytocin titration; Monitoring during augmentation; When to abandon augmentation
• “Use and abuse of oxytocin” is a common exam theme.

Analgesia and Anaesthesia in Labour

• Know options and indications of : Entonox; Opioids; Epidural analgesia; Spinal; General anaesthesia (rare in labour stage)
• Be clear about: Contraindications; Hypotension management; Impact on labour progression; Consent and risks

Labour Ward Management & Safety

• Curriculum emphasis: Maternity dashboard; Escalation policy; Consultant presence; Handover quality; Situational awareness
• You must know: When to call senior help; Documentation standards; Communication with neonatology

Obstetric Emergencies During Labour

• Must know initial management of: Shoulder dystocia; Umbilical cord prolapse; Maternal collapse; Severe fetal compromise
• Focus on: First steps; Escalation; Time-critical decisions

Delayed Labour and Obstructed Labour

• You must understand: Causes of delay (Power, Passenger, Passage); Malposition; When to proceed to operative delivery

How This Knowledge Area Is Tested

• Expect questions on:
  • CTG interpretation
  • Oxytocin misuse
  • Delay in labour
  • Escalation timing
  • Counselling before IOL
  • Intrapartum sepsis
• Read every word carefully — labour scenarios are subtle.

Final Words

• Clinical judgement is key.
• Think:
  • Is labour progressing safely?
  • Is the fetus coping?
  • Should I escalate?
  • Is intervention justified?

All the reading material, along with comprehensive summaries, is provided in our courses.