Soru

A 24-year-old nulliparous patient presents to the labor unit at 39 weeks and 4 days of gestation with painful uterine contractions. Her prenatal course was unremarkable. On admission, her cervical examination demonstrates 5 cm of dilation, 90% effacement, and -1 station. Two hours later, she requests neuraxial analgesia, and a continuous epidural infusion is successfully initiated. Shortly after the procedure, the patient complains of dizziness and nausea. Her blood pressure drops to 80/45 mm Hg from a baseline of 118/74 mm Hg, and her heart rate increases to 112/min. Concurrently, the continuous fetal monitor demonstrates a sudden decrease in the fetal heart rate baseline from 145/min to 85/min, which persists for 4 minutes with minimal variability. The nursing staff immediately places the patient in the left lateral decubitus position and administers a rapid intravenous bolus of isotonic crystalloid, but her blood pressure only marginally improves to 84/48 mm Hg. The fetal heart rate remains at 85/min. Which of the following is the most appropriate next step in the management of this patient?