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Betamethasone
59%
10/17
Terbutaline
18%
3/17
Oxytocin
0%
0/17
RhoGAM
Expectant management
24%
4/17
Select Answer to see Preferred Response
This patient is presenting with premature rupture of membranes prior to 36 weeks gestation with a lecithin:sphingomyelin ratio (L/S ratio) < 2.0. The next best step in management is administration of betamethasone for fetal lung development. Betamethasone should be administered to patients < 34 weeks gestation, or in any case < 36 weeks gestation with a L/S ratio < 2.0. The L/S ratio suggests fetal lung maturity and should be greater than 2.0. For patients with a L/S ratio < 2.0, betamethasone should be administered to accelerate fetal lung maturity and increase surfactant production. Incorrect Answers: Answer 2: Terbutaline is a beta2-agonist and a tocolytic. Tocolysis is not necessary in this situation. Answer 3: Oxytocin can be used to augment labor, in particular, if the cause is due to weak uterine contractions. There is no evidence suggesting delayed/prolonged labor in this patient. Answer 4: RhoGAM could be an appropriate management if the mother is Rh- and the fetus is Rh+. There is no evidence suggesting this; however, if RhoGAM was indicated, this would be an appropriate next step in management once betamethasone is administered. Answer 5: Expectant management would be appropriate in this patient if their L/S ratio was > 2.0 and RhoGAM was not necessary. Bullet Summary: Betamethasone should be administered to accelerate fetal lung maturity when the lecithin:sphingomyelin ratio is < 2.0.
4.8
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