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Administration of betamethasone
88%
14/16
Administration of magnesium sulfate for neuroprotection
6%
1/16
Administration of misoprostol
0%
0/16
Discharge home with close follow-up
Cesarean section
Select Answer to see Preferred Response
This patient presents with preterm premature rupture of membranes (PPROM), or rupture of membranes remote from delivery and prior to 37 weeks. At a gestational age between 24 and 34 weeks, patients with PPROM should receive two doses of betamethasone for fetal lung maturity. Betamethasone has been shown to decrease respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and sepsis in neonates, and it should be given if delivery is considered imminent in the next 7 days. Late term betamethasone (between 34 and 37 weeks) is optional, but administration at less than 34 weeks is considered standard of care. Patients with PPROM should receive betamethasone, as well as a 7-day course of antibiotics to increase latency to delivery and group B streptococcus prophylaxis. Tocolysis is not typically indicated. Figure A shows ferning, which results from sodium chloride crystallization in amniotic fluid. Incorrect Answers: Answer 2: Administration of magnesium sulfate for neuroprotection is indicated if the gestational age is less than 32 weeks. This patient is already beyond 32 weeks, and magnesium sulfate has not been shown to protect against cerebral palsy at this gestational age. Answer 3: Administration of misoprostol is a common method of cervical ripening to prepare for induction. Given that this patient is preterm, induction of labor is inappropriate. Answer 4: Discharge home with close follow-up is not a treatment option for PPROM given the risk of preterm labor and infection such as chorioamnionitis. Patients should stay inpatient until they reach 34 weeks, at which time they should be delivered. Answer 5: Cesarean section is not indicated at this time, as the patient is preterm and not in labor. Furthermore, the patient’s history of a hysteroscopic myomectomy is not a reason to have a cesarean section – only a myomectomy with entry into the uterine cavity would necessitate this mode of delivery. Bullet Summary: Administration of betamethasone is indicated prior to 34 weeks gestation if delivery is felt to be imminent within the next seven days.
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