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Difficulty: EasyLabor, Delivery, and Puerperium

A nulliparous woman at 40 weeks gestation presents to the maternity triage area with painful uterine contractions occurring every 3 minutes. Her pregnancy has been uncomplicated. Vital signs are within normal limits. On pelvic examination, the cervix is dilated to 8 cm and is fully effaced. The fetal presenting part is at +1 station. External fetal monitoring displays a baseline heart rate of 145/min with moderate variability. Symmetrical, gradual decreases in the fetal heart rate are noted, which precisely mirror the uterine contractions; the onset, nadir, and recovery of each deceleration coincide directly with the beginning, peak, and end of the corresponding contraction. The minimum fetal heart rate during these episodes is 125/min. Which of the following is the most appropriate next step in the care of this patient?

  1. A
    Apply maternal supplemental oxygen via face mask
  2. B
    Begin a normal saline amnioinfusion
  3. C
    Administer subcutaneous terbutaline
  4. Continue routine labor monitoringAnswer
  5. E
    Assist the patient into a lateral decubitus position

Answer

Continue routine labor monitoring
The correct response indicates continued routine care. This patient's fetal heart rate tracing demonstrates early decelerations, characterized by a gradual decrease in fetal heart rate that symmetrically mirrors the uterine contraction. Early decelerations are a benign, physiologic response caused by fetal head compression during contractions, which leads to altered cerebral blood flow and a subsequent vagal response. Because they do not indicate fetal hypoxia or acidemia, no specific intervention is required, and routine labor monitoring should be continued.

Step-by-Step Solution

1
Identify the fetal heart rate pattern described in the vignette.
The tracing shows gradual, symmetrical decreases in the fetal heart rate that perfectly match the onset, peak, and recovery of the uterine contractions.
Accurate pattern recognition is required to classify the decelerations and determine if they are benign or pathologic.
2
Determine the etiology of this specific pattern.
This pattern defines early decelerations, which are caused by fetal head compression resulting in a physiologic vagal response.
Understanding the underlying physiology helps differentiate these from late or variable decelerations.
3
Decide on the appropriate clinical management.
Because early decelerations are benign and do not indicate fetal hypoxia, expectant management and routine monitoring are indicated.
Intervening for physiologic findings exposes the patient to unnecessary medical risks.

Key Concept

Early decelerations are benign, uniform fetal heart rate decreases that mirror uterine contractions, caused by fetal head compression, and require no intervention.
Estimated Time:45s
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Topics

Labor, Delivery, and Puerperium

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