A 26-year-old primigravid woman presented to the labor and delivery ward for induction of labor at 42 weeks gestation. The prenatal course was significant for a positive group B Streptococcus culture performed at 35 weeks. Antenatal testing over the past two weeks has been unremarkable. The patient is started on lactated Ringer's IV solution.
Sterile vaginal examination shows that the patient's cervix is long, thick, and closed. Prostaglandin (PGE2) gel is placed into the vagina, and electronic fetal heart rate monitoring is continued. In approximately 60 minutes, the fetal heart rate falls to the 90s, as the tocodynamometer shows the uterus to be contracting every one minute, with essentially no rest in between contractions.
