A 32-Year-Old Primigravida at 28 Weeks Gestation Comes to the Emergency

question 145

Multiple Choice

A 32-year-old primigravida at 28 weeks gestation comes to the emergency department due to painful contractions that began 2 hours ago and are now occurring every 5 minutes.  She has had no leakage of fluid or vaginal bleeding; fetal movement is normal.  The patient was last seen in the office a few days ago for a routine prenatal visit; she had some increasing pelvic pressure, but her pregnancy has otherwise been uncomplicated.  She has no chronic medical conditions, and her only medications are a daily prenatal vitamin and folate supplement.  Temperature is 37 C (99 F) , blood pressure is 114/60 mm Hg, and pulse is 80/min.  The fetal heart rate tracing has moderate variability, multiple accelerations, and no decelerations.  Tocodynamometry shows contractions every 5 minutes.  On digital pelvic examination, the cervix is 3 cm dilated and 90% effaced with the fetus in vertex presentation.  Betamethasone and indomethacin are administered.  Which of the following is the best next step in management of this patient?

• A)Magnesium sulfate
• B)Nifedipine
• C)Observation and repeat cervical examination in 2 hours
• D)Progesterone
• E)Ultrasound to measure cervical length

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Definitions:

Fair Value Hedge

A risk management technique that uses financial instruments to mitigate the risk associated with changes in the fair value of an asset or liability.

Firm Commitment

An agreement between a buyer and an underwriter in which the underwriter guarantees the sale of a certain amount of securities.

Cash Flow Hedge

A hedging strategy used to manage risk associated with variability in cash flows, typically related to interest rates or currency exchange rates.

Inventory Purchase

The process of acquiring goods that a company will sell to customers or use in the production of goods to be sold.