A 22-year-old G1P0000 woman at 38 weeks gestation is admitted due to spontaneous rupture of membranes. On admission, she is contracting once every 15 minutes and is dilated 4 cm with 70% effacement. The decision was made to augment her labor with oxytocin administration, and she was titrated to 8 mU/min. Which of the following interventions is the best management for the fetal heart rate pattern shown above?A Administer 1 L of lactated Ringer B Administer terbutaline 0.25 mg C Decrease oxytocin infusion rate D Discontinue oxytocin infusion
This fetal heart strip demonstrates tachysystole, defined as having five or more contractions in 10 minutes, averaged over 30 minutes. Tachysystole can be seen due to oxytocin infusion, misoprostol, maternal dehydration, preeclampsia, or intra-amniotic infection. To manage this patient’s tachysystole, it would be best to decrease the oxytocin infusion rate by half, to 4 mU/min. Although this fetal heart rate (FHR) pattern is category I, continuous tachysystole compromises uteroplacental perfusion, which can lead to fetal distress and nonreassuring fetal well-being. Consequently, during induction or augmentation of labor, it is best to alter management when tachysystole is present, even with a category I FHR pattern. Conversely, tachysystole without FHR abnormalities during spontaneous labor does not warrant intervention.
Since the FHR is category I, there is no need to discontinue oxytocin infusion (D) or to administer 1 L of lactated Ringer (A). Lactated Ringer infusion can be used as a resuscitative measure for a category II FHR. If there were variable, late, or prolonged decelerations, it would be appropriate to administer terbutaline 0.25 mg (B).
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