Stages of labor — MCQs

Question 11: A 28-year-old primigravid woman at 36 weeks' gestation comes to the emergency department for 2 hours of contractions. Her pregnancy has been uncomplicated. The contractions occur once every 20–30 minutes, last less than 30 seconds, and have been consistent in intensity and duration since onset. During that time there has been an increase in fetal movements. Her temperature is 37.1°C (98.8°F), pulse is 98/min, and blood pressure is 104/76 mm Hg. Pelvic examination shows clear cervical mucus and a firm uterus consistent in size with a 36-week gestation. The cervix is 0% effaced and undilated; the vertex is at -3 station. The fetal heart rate is reassuring. After an hour of monitoring in the emergency department, the character of the contractions and pelvic examination findings remain unchanged. Which of the following is the most appropriate next step?

• A. Admit for continuous monitoring
• B. Reassurance and discharge (Correct Answer)
• C. Administer tocolytics
• D. Perform cesarean delivery
• E. Offer local or regional anesthesia

Explanation: ***Reassurance and discharge*** - The patient's symptoms (contractions every 20-30 minutes, lasting less than 30 seconds, consistent in intensity and duration, **no cervical changes**) are consistent with **Braxton Hicks contractions** rather than true labor. - Given the reassuring fetal movements, normal vital signs, and unchanged cervical examination after an hour of monitoring, **reassurance and discharge** with instructions to return for signs of true labor are appropriate. *Admit for continuous monitoring* - Admission for continuous monitoring is indicated for **true labor**, suspected fetal distress, or complications requiring close observation. - This patient's findings, including lack of cervical change and stable contraction pattern, do not meet criteria for admission. *Administer tocolytics* - **Tocolytics** are used to stop or slow down premature labor. - This patient is at **36 weeks' gestation** (near term) and is not in true labor, making tocolytic administration inappropriate and unnecessary. *Perform cesarean delivery* - **Cesarean delivery** is indicated for obstetric emergencies, fetal distress, or failed vaginal delivery. - There are no indications for an operative delivery at this time; the patient is not in active labor and both mother and fetus are stable. *Offer local or regional anesthesia* - **Local or regional anesthesia** (e.g., epidural) is typically offered for pain management during active labor. - Since the patient is not in active labor, pain management for labor is not necessary.