Evaluating Intrapartum Fetal Heart Tracings

In Episode 62 of Med School Question of the Week for USMLE, Faustine Ramirez, MedSchoolCoach expert tutor, answers this medical school question:

A 30-year-old gravida 2, para 1 woman at 39 weeks’ gestation is admitted to the hospital in labor. She received good prenatal care throughout the pregnancy. She was admitted to the hospital for pyelonephritis in the second trimester which was treated with IV antibiotics. She was GBS positive in her prior pregnancy, which was otherwise uncomplicated. Upon arrival, she endorses regular, moderately painful contractions occurring every 3-5 minutes. Temperature is 37.7 C, heart rate is 102, respiratory rate is 20, and blood pressure is 92/60. The cervix is 100% effaced and 5 cm dilated, and the vertex is at 0 station. She has spontaneous rupture of membranes and the amniotic fluid is stained with thick meconium. The fetal heart tracing is shown in the video.

What is the most appropriate next step?

• No intervention is necessary
• Broad spectrum antibiotics
• GBS specific antibiotics
• Amniocentesis
• Packed RBC transfusion
• Maternal repositioning
• Amnioinfusion
• Emergency cesarean section