Intrapartum fetal heart rate monitoring Quiz: Ace Your Exams
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A 30-year-old primigravid woman presents in labor at 38 weeks’ gestation. Her membranes have grossly ruptured, and she is having contractions every 30 minutes. The pregnancy has been uncomplicated. She has a history of chronic hypertension managed with nifedipine. Labor is progressing spontaneously, and she has an epidural in place. Temperature is 36.7°C (98.1°F), pulse is 88/min, respirations are 16/min, blood pressure is 128/92 mmHg, and oxygen saturation of 97% on room air. She appears well, and cervical exam reveals 7 cm dilation with 80% effacement, and the fetal vertex is at 0 station. The baseline fetal heart rate (FHR) is 150 bpm with beat-to-beat variability of 10 bpm. There are no accelerations. The patient soon develops recurrent decelerations with each contraction that descend abruptly and become progressively deeper. Contractions are now occurring every 2 to 3 minutes. The nurse repositions the patient and administers an IV fluid bolus with no improvement in the decelerations. Which of the following is the most appropriate next step in management?
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