Soru

A 22-year-old nulliparous woman presents to the labor unit at 38 weeks and 5 days of gestation complaining of intense, frequent contractions. Her prenatal care has been routine and uncomplicated. Vital signs are within normal limits, with a blood pressure of 118/74 mmHg and a heart rate of 88/min. She declines epidural analgesia. On digital cervical examination, she is 6 cm dilated and 100% effaced, and the fetal vertex is at 0 station. There is no evidence of vaginal bleeding.

Electronic fetal monitoring demonstrates a baseline heart rate of 145/min with minimal variability. The tocodynamometer records 7 to 8 uterine contractions per 10-minute window. Each contraction lasts approximately 80 seconds, though the uterus is soft to palpation between contractions. Symmetrical, gradual decreases in the fetal heart rate that reach their nadir after the peak of the contraction are seen repeatedly. In response, the clinical team implements left lateral maternal positioning, administers a rapid intravenous fluid bolus, and provides supplemental oxygen. Fifteen minutes later, the high contraction frequency and the abnormal fetal heart rate pattern persist.

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