Intrapartum fetal heart rate monitoring Quiz: Ace Your Exams

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A 37-year-old woman, gravida 2, para 1, presents in labor at 37 weeks’ gestation. She had a spontaneous vaginal delivery 4 years ago. Her temperature is 37.4°C (99.3°F), pulse is 90/min, respirations are 16/min, and blood pressure is 126/86 mmHg. Clinically, she appears well. A fetal heart rate (FHR) tracing shows a baseline rate of 160 bpm with rapid, irregular fluctuations between 155 bpm and 165 bpm. All transient increases in FHR above baseline last less than 15 seconds. The FHR gradually decreases starting at the onset of a contraction, reaching a nadir of 145 bpm simultaneously with the peak of the contraction, and returns to baseline as the contraction ends. Which of the following clinical findings best explains this patient's fetal heart rate tracing?

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