Intrapartum Fetal Assessment

(M2.OB.17.4867) A 28-year-old G1P0 woman at 42 weeks gestation is admitted to the maternity ward for induction of labor. She states that her prenatal care has been notable for gestational hypertension. She has been taking her multivitamin daily. She feels fetal movement and denies any vaginal bleeding. Her temperature is 98.6°F (37°C), blood pressure is 107/54 mmHg, pulse is 72/min, and respirations are 20/min. Her cervix is 0 cm dilated, and the fetus is in cephalic position. The fetal heart monitor shows a heart rate of 130/min. She agrees to have an epidural catheter placed for analgesia. Shortly thereafter, amniotomy is performed. No vaginal bleeding is observed. While attending to documentation of the procedure, the nurse calls your attention to a change in the fetal heart monitor, shown in Figure A. What is the most likely cause for this finding?

(M2.OB.17.4867) A 28-year-old G1P0 woman who is 30 weeks pregnant presents to the women's health center for a prenatal checkup. She is concerned that her baby is not moving as much as usual over the past five days. She thinks she only felt the baby move eight times over an hour long period. Her prenatal history was notable for morning sickness requiring pyridoxine. Her second trimester ultrasound revealed no abnormal placental attachment. She takes a multivitamin daily. Her temperature is 98.6°F (37°C), blood pressure is 120/70 mmHg, pulse is 80/min, and respirations are 16/min. The patient's physical exam is unremarkable. Her fundal height is 28 cm, compared to 26 cm two weeks ago. The fetal pulse is 140/min with no accelerations. The patient undergoes external fetal monitoring. With vibroacoustic stimulation, the patient feels eight movements over two hours with no fetal heart rate accelerations. What is the best next step in management?

(M2.OB.15.95) You are the intern on the labor and delivery floor. Your resident asks you to check on the patient in Bed 1. She is a 27-year-old prima gravida with no significant past medical history. She has had an uncomplicated pregnancy and has received regular prenatal care. You go to her bedside and glance at the fetal heart rate tracing (Image A). What is the most likely cause of this finding?

(M2.OB.13.195) A 29-year-old G2P1001 woman at 39 weeks gestation presents to labor and delivery triage with intermittent lower abdominal pain. Her pregnancy has been followed and she is currently taking folate and a multivitamin. Her temperature is 98.0°F (36.7°C), blood pressure is 129/82 mmHg, pulse is 110/min, respirations are 22/min, and oxygen saturation is 98% on room air. The fetal heart rate monitoring strip depicted in Figure A is obtained. Which of the following best explains this fetal heart rate tracing?