Complicated Pregnancy: The Daily PANCE Blueprint

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Complicated Pregnancy: The Daily PANCE Blueprint

A 29-year-old woman, gravida 2 para 1, at 35 weeks gestation comes to the hospital due to frequent, painful uterine contractions. The patient started to have contractions three hours ago but has had no vaginal bleeding or leakage of fluid. Her prior pregnancy ended in a term vaginal delivery. Blood pressure is 122/78 mm Hg, and pulse is 85/min. Fetal heart tracing is reassuring. The tocodynamometer shows contractions every 4 minutes. On digital cervical examination, the cervix is 3 cm dilated and 70% effaced with the fetal head at -2 station. In addition to corticosteroids, which of the following is the best next step in the management of this patient?

A. Intravenous magnesium sulfate
B. Expectant management
C. Administer 17-hydroxyprogesterone
D. Emergency cervical cerclage
E. Nifedipine tocolysis

Answer and topic summary

The answer is B. Expectant management

In patients with preterm labor at ≥34 weeks gestation who have no contraindications to vaginal delivery, the best next step is expectant management. At this gestational age, the risks associated with delaying labor (such as the use of tocolytics) typically outweigh the potential benefits. Antenatal corticosteroids are given to help mature the fetal lungs, but further interventions are generally not recommended unless there are specific indications.

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Covered under ⇒ PANCE Blueprint Reproductive System ⇒ Complicated Pregnancy

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