Soru

A 29-year-old woman, gravida 3, para 2, is evaluated on the labor and delivery unit at 38 weeks of gestation. She reports a sudden gush of clear vaginal fluid occurring 20 minutes ago, followed by the onset of strong, painful uterine contractions. Her previous deliveries were full-term, uncomplicated vaginal births. Her temperature is 37.1 C (98.8 F), blood pressure is 112/70 mm Hg, and pulse is 85/min. On pelvic examination, the cervix is 5 cm dilated and 80% effaced. The fetal presenting part is ballottable at a -3 station, and a smooth, pulsatile, rope-like mass is palpated in the vaginal vault extending through the cervical os. Simultaneously, continuous electronic fetal monitoring demonstrates an abrupt decrease in the fetal heart rate to 80/min that has lasted for the past 90 seconds. Which of the following is the most appropriate next step in the management of this patient?