A -year-old primigravida at weeks gestation is evaluated in the labor and delivery unit. She is undergoing an induction of labor for gestational diabetes mellitus. She is currently receiving a continuous intravenous oxytocin infusion, and epidural anesthesia is in place. Her temperature is (), blood pressure is , and pulse is . A recent cervical examination revealed a dilation of , effacement, and station. Over the past minutes, the tocodynamometer records uterine contractions per -minute window, with each contraction lasting to seconds. The fetal heart rate tracing demonstrates a baseline of , minimal variability, and recurrent decelerations that begin after the peak of the contractions and take seconds to reach their nadir.
The nurse immediately discontinues the oxytocin infusion, repositions the patient to the left lateral decubitus position, and administers a intravenous bolus of lactated Ringer solution. Fifteen minutes later, the contraction frequency remains to per minutes, and the fetal heart rate tracing continues to show recurrent late decelerations with minimal variability.
Which of the following is the most appropriate next step in management?
- AProceed to cesarean delivery
- BInitiate a transcervical amnioinfusion
- CPerform artificial rupture of membranes
- Administer subcutaneous terbutalineAnswer
- EAdminister intravenous magnesium sulfate