Intrapartum fetal heart rate monitoring Quiz: Ace Your Exams
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A 28-year-old woman, gravida 3, para 2, presents in spontaneous labor at 38 weeks’ gestation. She is healthy, and her pregnancy has been uncomplicated. She has a history of two prior cesarean births—the first for malpresentation and the second was an elective repeat procedure. After extensive counseling, she elects to undergo a trial of labor after cesarean (TOLAC). An epidural is in place, although she has become more uncomfortable over the past hour. Vital signs are within normal limits, and the most recent cervical exam shows 6 cm dilation, 75% effacement, and 0 station. The fetal heart rate (FHR) tracing shows a baseline rate of 130 bpm, without rapid fluctuations from baseline or visually apparent accelerations. There are recurrent abrupt decreases in FHR of 30 to 60 bpm below baseline that last approximately 30 seconds and begin at the onset of each contraction. Contractions are regular and occur every 2 to 4 minutes. How should this FHR pattern be classified?
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