A 27-year-old woman, gravida 2, para 1, at 37 weeks' gestation is admitted to the hospital in active labor. She has received routine prenatal care, but she has not been tested for group B streptococcal (GBS) colonization. Pregnancy and delivery of her first child were complicated by an infection with GBS that resulted in sepsis in the newborn. Current medications include folic acid and a multivitamin. Vital signs are within normal limits. The abdomen is nontender and contractions are felt every 4 minutes. There is clear amniotic fluid pooling in the vagina. The fetus is in a cephalic presentation. The fetal heart rate is 140/min. Which of the following is the most appropriate next step in management?
AObtain vaginal-rectal swab for nucleic acid amplification testing
BObtain vaginal-rectal swab for GBS culture
CAdminister intrapartum intravenous penicillin
DReassurance
EObtain vaginal-rectal swab for GBS culture and nucleic acid amplification testing
A 29-year-old G1P0 presents to her obstetrician for her first prenatal care visit at 12 weeks gestation by last menstrual period. She states that her breasts are very tender and swollen, and her exercise endurance has declined. She otherwise feels well. She is concerned about preterm birth, as she heard that certain cervical procedures increase the risk. The patient has a gynecologic history of loop electrosurgical excision procedure (LEEP) for cervical dysplasia several years ago and has had negative Pap smears since then. She also has mild intermittent asthma that is well controlled with occasional use of her albuterol inhaler. At this visit, this patient’s temperature is 98.6°F (37.0°C), pulse is 69/min, blood pressure is 119/61 mmHg, and respirations are 13/min. Cardiopulmonary exam is unremarkable, and the uterine fundus is just palpable at the pelvic brim. Pelvic exam reveals normal female external genitalia, a closed and slightly soft cervix, a 12-week-size uterus, and no adnexal masses. Which of the following is the best method for evaluating for possible cervical incompetence in this patient?
ATransabdominal ultrasound in the first trimester
BTransvaginal ultrasound in the first trimester
CSerial transvaginal ultrasounds starting at 16 weeks gestation
DTransabdominal ultrasound at 18 weeks gestation
ETransvaginal ultrasound at 18 weeks gestation
A 23-year-old G1P0 primigravid woman at 28 weeks estimated gestational age presents for a prenatal checkup. She says she has been having occasional headaches but is otherwise fine. The patient says she feels regular fetal movements and mild abdominal pain at times. Her past medical history is unremarkable. Current medications are a prenatal multivitamin and the occasional acetaminophen. Her blood pressure is 148/110 mm Hg today. On her last visit at 24 weeks of gestation, her blood pressure was 146/96 mm Hg. On physical exam, the fundus measures 28 cm above the pubic symphysis. Laboratory findings are significant for the following: Serum Glucose (fasting) 88 mg/dL Sodium 142 mEq/L Potassium 3.9 mEq/L Chloride 101 mEq/L Serum Creatinine 0.9 mg/dL Blood Urea Nitrogen 10 mg/dL Alanine aminotransferase (ALT) 18 U/L Aspartate aminotransferase (AST) 16 U/L Mean Corpuscular Volume (MCV) 85 fL Leukocyte count 4,200/mm3 Reticulocyte count 1% Erythrocyte count 5.1 million/mm3 Platelet count 95,000mm3 Urinalysis show: Proteins 2+ Glucose negative Ketones negative Leucocytes negative Nitrites negative Red Blood Cells (RBCs) negative Casts negative Which of the following medications would be the next best step in the treatment of this patient?
AMagnesium sulfate
BPhenobarbital
CValproic acid
DEthosuximide
EDiazepam
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