Soru

During a busy shift on the labor and delivery unit, a 28-year-old primigravida at 39 weeks gestation is evaluated for labor progression. Her prenatal course was unremarkable. Recent routine laboratory studies showed a hemoglobin level of $10.5 \text{ g/dL}$ and a serum bicarbonate of $20 \text{ mEq/L}$.

She is currently receiving an oxytocin infusion for labor augmentation. Vital signs show a blood pressure of $118/76 \text{ mmHg}$, heart rate of $88/\text{min}$, and a temperature of $37.2^\circ\text{C}$ ($99.0^\circ\text{F}$). Uterine contractions are occurring every 3 minutes and are strong to palpation.

Review of the continuous fetal monitor reveals a baseline heart rate of $130/\text{min}$ with absent variability. Symmetrical, gradual decreases in the fetal heart rate to a nadir of $100/\text{min}$ are noted, consistently beginning after the peak of each uterine contraction and resolving only after the contraction has ended. There are no spontaneous accelerations.

The nursing staff has already repositioned the patient to the left lateral decubitus position, administered an intravenous normal saline bolus, and discontinued the oxytocin infusion. Reassessment 20 minutes later shows no improvement in the fetal heart rate tracing. Cervical examination demonstrates dilation at $5 \text{ cm}$, $90\%$ effacement, and the fetal vertex at a $-1$ station.

Which of the following is the most appropriate next step in management?