5.0 of 2 Ratings
A 29-year-old G2P0010 at 33 weeks and 2 days gestation presents to the labor floor after experiencing a gush of clear fluid while at dinner one hour ago. She denies vaginal bleeding, contractions, or changes in fetal movement. Aside from anxiety about her leakage of fluid, she feels well. Her prenatal course has been complicated by gestational diabetes, for which she is managed with insulin therapy. The patient has a past medical history of mild intermittent asthma, for which she uses albuterol every few weeks. She also had a hysteroscopic myomectomy two years ago, and her obstetric history is notable for one induced abortion by medication. On exam, the patient’s temperature is 98.5°F (36.9°C), pulse is 80/min, blood pressure is 121/82 mmHg, and respirations are 13/min. Cardiopulmonary exams are unremarkable, and her abdomen is gravid without tenderness. Pelvic exam reveals a cervix that is 0.5 centimeters dilated, four centimeters long, and -3 station. There is a pool of clear fluid in the vaginal vault, and a swab turns nitrazine paper blue and appears as Figure A under the microscope. Which of the following is the best next step in management?
Administration of betamethasone
Administration of magnesium sulfate for neuroprotection
Administration of misoprostol
Discharge home with close follow-up
Select Answer to see Preferred Response
A woman presents to the emergency department due to abdominal pain that began 1 hour ago. She is in the 35th week of her pregnancy when the pain came on during dinner. She also noted a clear rush of fluid that came from her vagina. The patient has a past medical history of depression which is treated with cognitive behavioral therapy. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you note a healthy young woman who complains of painful abdominal contractions that occur every few minutes. Laboratory studies are ordered as seen below.Hemoglobin: 12 g/dLHematocrit: 36%Leukocyte count: 6,500/mm^3 with normal differentialPlatelet count: 197,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 24 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL Lecithin/Sphingomyelin: 1.5 AST: 12 U/L ALT: 10 U/L Which of the following is the best next step in management?