A 26-year-old primigravida at 39 weeks gestation is admitted to the hospital in spontaneous labor. Her pregnancy has been uncomplicated. Her cervix is 6 cm dilated and 90% effaced. The patient is receiving continuous external fetal monitoring. Over the last 30 minutes, the fetal heart rate baseline is 135/min with moderate variability. However, there are recurrent, symmetric decreases in the fetal heart rate that begin after the peak of each uterine contraction and return to baseline only after the contraction has completely finished. The patient's blood pressure is 120/80 mm Hg and her pulse is 85/min. Which of the following is the most appropriate initial step in the management of this patient?
- Placement of the patient in a lateral decubitus positionCevap
- BTransfer to the operating room for surgical delivery
- CStart an intravenous oxytocin infusion
- DInstillation of sterile fluid into the uterine cavity
- EContinue continuous fetal monitoring without acute intervention
Cevap
The most appropriate initial step is to place the patient in a lateral decubitus position.
The clinical scenario describes a patient in spontaneous labor whose fetus is experiencing late decelerations (decreases in fetal heart rate that begin after the peak of a contraction and recover after the contraction ends). Late decelerations indicate uteroplacental insufficiency. The first-line management involves intrauterine resuscitation to optimize blood flow to the placenta. The most appropriate initial step is to reposition the mother (typically into the left lateral decubitus position) to alleviate aortocaval compression, which maximizes maternal cardiac output and consequently improves uteroplacental perfusion.
Adım Adım Çözüm
Anahtar Kavram
The initial management of late decelerations consists of intrauterine resuscitation measures, prominently maternal lateral repositioning, to improve uteroplacental blood flow before considering operative delivery.