prenatal care/uteroplacental insufficiency

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Obstetrics

prenatal care

uteroplacental insufficiency

A 28-year-old G1P0000 female presents to the labor and delivery unit, admitted for active labor. She reports regular, painful uterine contractions and a spontaneous gush of clear fluid earlier. Her prenatal course has been uncomplicated, with her Rh-negative status addressed at 28 weeks with Rhogam. Upon admission, her temperature is 36.90C, blood pressure 130/70 mmHg, pulse 78/min, and respirations 16/min. She appears calm between contractions, with a soft abdomen and minimal peripheral edema. The fetal position is cephalic. Following successful epidural analgesia, the patient's blood pressure drops slightly to 110/60 mmHg, and subsequent fetal heart rate monitoring, as depicted in a tracing similar to Figure B, reveals persistent late decelerations. What is the most appropriate immediate management for this patient, and what is a potential severe fetal complication if these measures are ineffective?

Lab ParameterValueReference Range
Hemoglobin115 g/L120-150 g/L
Sodium138 mmol/L135-145 mmol/L
Platelets250 x 10^9/L150-400 x 10^9/L

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