Soru

A $26$-year-old primigravida at $40$ weeks gestation is evaluated in the labor and delivery unit. She is undergoing an induction of labor for gestational diabetes mellitus. She is currently receiving a continuous intravenous oxytocin infusion, and epidural anesthesia is in place. Her temperature is $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), blood pressure is $122/78\text{ mmHg}$, and pulse is $88/\text{min}$. A recent cervical examination revealed a dilation of $6\text{ cm}$, $90\%$ effacement, and $0$ station. Over the past $20$ minutes, the tocodynamometer records $7$ uterine contractions per $10$-minute window, with each contraction lasting $60$ to $80$ seconds. The fetal heart rate tracing demonstrates a baseline of $145/\text{min}$, minimal variability, and recurrent decelerations that begin after the peak of the contractions and take $\geq 30$ seconds to reach their nadir.

The nurse immediately discontinues the oxytocin infusion, repositions the patient to the left lateral decubitus position, and administers a $500\text{-mL}$ intravenous bolus of lactated Ringer solution. Fifteen minutes later, the contraction frequency remains $6$ to $7$ per $10$ minutes, and the fetal heart rate tracing continues to show recurrent late decelerations with minimal variability.

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