CASE SCENARIO

A 37-year-old pregnant woman at 39 weeks and 2 days' estimated gestation is admitted to the labor and delivery department with spontaneous rupture of membranes and active labor. Her pregnancy has been uncomplicated. She is negative for group B streptococci and has O+ blood type. All other laboratory test results are normal. She has had two prior pregnancies, both with uncomplicated vaginal deliveries.

On admission, she has clear amniotic fluid, and the fetus is in cephalic presentation. Her cervix is 6-cm dilated, and she is having painful contractions. Her initial blood pressure is 142/78 mm Hg; repeat blood pressure measurement 15 minutes later is 124/72 mm Hg. She has no history of gestational or chronic hypertension. She reports no headache, visual changes, or right upper quadrant abdominal pain. Results of a nonstress test on admission show a baseline fetal heart rate of 125 beats/min, with moderate variability, three accelerations in 20 minutes, no decelerations, and uterine contractions every 3 minutes. Automatic cycling upper extremity blood pressure measurement and continuous external fetal monitoring are initiated. She asks if she can remove the monitors to shower for adjunctive pain relief.