A 24-Year-Old Woman, Gravida 2 Para 1, at 28 Weeks

question 165

Multiple Choice

A 24-year-old woman, gravida 2 para 1, at 28 weeks gestation comes to the office with her husband because she has felt no fetal movement for 3 days.  She has no pain, leakage of fluid, or bleeding.  All testing during this pregnancy has been normal, including an anatomy ultrasound at 20 weeks gestation.  Her first child was delivered vaginally at term.  Temperature is 36.7 C (98 F) , blood pressure is 120/80 mm Hg, and pulse is 94/min.  Fetal heart tones are not heard by Doppler.  Ultrasound demonstrated an absence of fetal cardiac activity and a small for gestational age fetus in breech presentation.  A digital cervical examination shows the cervix to be long and closed.  Laboratory results are as follows: Which of the following is the most appropriate management advice for this patient?

• A)Cesarean delivery is the safest mode of delivery
• B)Dilation and evacuation under general anesthesia is recommended
• C)External cephalic version should be performed because the baby is breech
• D)Labor can be induced in the hospital when you feel ready
• E)Spontaneous labor provides the best outcome

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