A 19-year-old primigravid woman at 42 weeks' gestation comes the labor and delivery ward for induction of labor. Her prenatal course was uncomplicated. Examination shows her cervix to be long, thick, closed, and posterior. The fetal heart rate is in the 140s and reactive. The fetus is vertex on ultrasound. Prostaglandin (PGE2) gel is placed intravaginally. One hour later, the patient begins having contractions lasting longer than 2 minutes. The fetal heart rate falls to the 70s. Which of the following is the most appropriate next step in management?

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Quizplus · Accepted Answer

EThe scenario describes a case of uterine hyperstimulation caused by prostaglandin (PGE2) gel, leading to prolonged contractions and a resultant drop in fetal heart rate. The immediate management involves relieving the hyperstimulation to alleviate the stress on the fetus. Administering terbutaline, a beta-agonist, can relax the uterus and stop the contractions, addressing the immediate cause of fetal distress. However, given the severity of the situation with a significant drop in fetal heart rate to the 70s, which indicates fetal distress, and the failure of the situation to improve rapidly, performing a cesarean delivery is the most definitive action to ensure the safety of the fetus. This dual approach addresses both the immediate need to relieve uterine hyperstimulation and the overarching need to safely deliver the fetus in the context of distress.

A 19-Year-Old Primigravid Woman at 42 Weeks' Gestation Comes the Labor