Soru

A 26-year-old primigravid patient at 40 weeks gestation is admitted to the labor and delivery unit in active spontaneous labor. Her prenatal course was uncomplicated. Spontaneous rupture of membranes occurred 4 hours ago, revealing thick meconium-stained amniotic fluid. Her temperature is 37.1°C (98.8°F), blood pressure is 118/76 mmHg, and pulse is 82/min.

Pelvic examination demonstrates the cervix is 6 cm dilated, 100% effaced, and the fetal vertex is at 0 station. No structures are palpable ahead of the presenting part.

Continuous external fetal monitoring over the last 30 minutes shows a baseline heart rate of 140/min and moderate variability. There are recurrent, abrupt decreases in the fetal heart rate to 80/min that last for 45 to 60 seconds before returning rapidly to baseline. These decreases do not have a consistent temporal relationship with the uterine contractions. The contractions are occurring every 3 to 4 minutes and last 60 seconds.

The nurse assists the patient into the left lateral, right lateral, and hands-and-knees positions, and administers a 500 mL intravenous bolus of lactated Ringer solution. Despite these resuscitative maneuvers, the fetal heart rate pattern remains unchanged for the next 20 minutes. A repeat cervical examination shows no change in dilation.

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