While rounding on the labor and delivery unit, an attending physician evaluates a full-term pregnant woman undergoing a trial of labor after a previous low transverse cesarean section. The pregnancy has been entirely uncomplicated to date. Over the last six hours, her labor progressed normally, and the fetal head was documented at a station. Suddenly, the patient reports a severe, tearing pain in her lower abdomen that persists between contractions. On physical examination, the fetal presenting part is now palpated at a station. The continuous fetal heart rate monitor, which previously showed a category I tracing, now demonstrates a sustained fetal heart rate of beats per minute lasting for over four minutes. Vaginal bleeding is scant, but the patient's heart rate has increased to beats per minute and her blood pressure is mmHg. Which of the following is the most appropriate next step in the management of this patient?
- Emergent laparotomy and cesarean deliveryAnswer
- BTransport to the radiology suite for a comprehensive obstetric ultrasound
- CTransvaginal amnioinfusion
- DIntravenous administration of terbutaline and expectant management
- EApplication of an internal fetal scalp electrode