Vaginal birth after cesarean (VBAC) Quiz: Ace Your Exams

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A 35-year-old woman, gravida 3, para 2, at 37 weeks of gestational age, presents for induction of labor for gestational hypertension. She has no headaches, visual changes, shortness of breath, or right upper quadrant pain. Her first delivery was a cesarean birth due to breech presentation at term, and her second delivery was an uncomplicated vaginal birth after cesarean (VBAC). Her blood pressure on admission is 140/84 mm Hg, and her cervix is less than 1 cm dilated, thick, and high. Maternal-fetal cardiotocographic monitoring shows a baseline fetal heart rate of 140 bpm, moderate variability, and no accelerations, decelerations, or contractions. An ultrasound confirms the fetus is in a vertex presentation, and a single deepest vertical pocket of fluid is 3.5 cm. A urinalysis shows trace proteinuria and serum blood work is unremarkable. Which of the following should be part of her intrapartum management?

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Intrauterine pressure catheter during the active phase of labor

Avoidance of prostaglandins

Fetal scalp electrode during the active phase of labor

Avoidance of a Foley balloon for cervical ripening

Magnesium sulfate