A 31-year-old woman, gravida 2, para 1, is evaluated in the labor ward at 40 weeks gestation. She is currently in the active phase of the first stage of labor. Uterine contractions are occurring every 3 minutes. The continuous electronic fetal heart rate tracing demonstrates a baseline of 135/min with moderate variability. Following each of the last four contractions, the fetal heart rate gradually decreases to a nadir of 115/min and then returns to the baseline roughly 20 seconds after the contraction has finished. Which of the following is the most appropriate initial step in the management of this patient?
- Repositioning the patient onto her sideCevap
- BProceeding to an immediate cesarean delivery
- CContinuing observation with no acute intervention
- DPerforming artificial rupture of the chorioamniotic membranes
- EAdministering a broad-spectrum intravenous antibiotic
Cevap
Repositioning the patient onto her side
The correct answer is repositioning the patient onto her side. The clinical presentation describes recurrent late decelerations, which are characterized by a gradual, symmetric decrease in the fetal heart rate that begins at or after the peak of a uterine contraction and returns to baseline after the contraction ends. This specific pattern is indicative of transient uteroplacental insufficiency. The mandatory initial management for late decelerations involves intrauterine resuscitative measures designed to immediately improve blood flow and oxygen delivery to the fetus. Placing the mother in a left or right lateral decubitus position is the primary maneuver; it relieves the mechanical compression of the gravid uterus on the inferior vena cava and descending aorta, thereby rapidly increasing maternal venous return, cardiac output, and subsequent uteroplacental perfusion.
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Anahtar Kavram
Intrauterine resuscitation for late decelerations caused by uteroplacental insufficiency