During her active phase of labor, a -year-old nulliparous woman at weeks gestation experiences a change in fetal monitoring patterns. She is currently receiving a continuous oxytocin infusion to augment labor. Her cervix is cm dilated and effaced. The external fetal monitor shows a baseline heart rate of /min with moderate variability. Following the peak of several recent uterine contractions, the fetal heart rate gradually drops to /min and slowly returns to the baseline after the contractions have completely ended. The maternal blood pressure is mm Hg and temperature is C ( F). Which of the following is the most appropriate next step in the management of this patient?
- Stop the administration of oxytocinAnswer
- BTransfer the patient to the operating room for a cesarean birth
- CContinue current management and provide reassurance to the patient
- DAdminister intravenous broad-spectrum antibiotics
- EPerform an emergent vacuum-assisted vaginal delivery
Answer
Stop the administration of oxytocin
The correct answer is to stop the administration of oxytocin. The patient is experiencing late decelerations, defined as gradual decreases in the fetal heart rate where the nadir occurs after the peak of the uterine contraction. This pattern indicates uteroplacental insufficiency, which can lead to fetal hypoxemia and acidemia. The initial approach to late decelerations is intrauterine resuscitation to optimize fetal oxygenation. Core steps include discontinuing uterotonics like oxytocin (to reduce uterine activity and restore placental blood flow), repositioning the patient to the left lateral decubitus position (to relieve aortocaval compression), and administering an intravenous fluid bolus.
Step-by-Step Solution
Key Concept
Late decelerations on fetal heart rate monitoring indicate uteroplacental insufficiency. The initial management consists of intrauterine resuscitation, which includes discontinuing uterotonics (e.g., oxytocin), repositioning the mother, and administering intravenous fluids or supplemental oxygen.