Intrapartum care (1st, 2nd, 3rd, and 4th stages) Quiz: Ace Your Exams
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A 31-year-old primigravid woman, at 39 weeks of gestational age with an uncomplicated pregnancy, presents with regular uterine contractions that have been getting progressively more intense over the past 5 hours. The patient prefers a “natural birth experience” and wants to avoid interventions such as a fetal scalp electrode or intrauterine pressure catheter unless they are necessary. She has no medical issues and takes prenatal vitamins. Temperature is 36.5°C (97.7°F), pulse is 80/min, respirations are 18/min, and blood pressure is 112/70 mmHg. During a sterile speculum exam, the membranes grossly rupture, spilling clear fluid. The cervix is 6 cm dilated, 80% effaced, with the fetal vertex palpable at 0 cm station. A non-stress test (NST) in triage is reactive and reassuring, and the patient is then monitored with intermittent auscultation and uterine palpation every 15 minutes. Two hours later, she has a contraction every 4-5 minutes, a baseline fetal heart rate of 150, and no decelerations are heard. However, her cervical exam is unchanged, and oxytocin is initiated. She continues to decline pharmacologic pain management. Which of the following is the most appropriate monitoring strategy at this time?
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