A 30-year-old woman G2 P2002 at 32 weeks' gestation presents to the Emergency Department complaining of lower abdominal and back pain which has increased in frequency and intensity... A 30-year-old woman G2 P2002 at 32 weeks' gestation presents to the Emergency Department complaining of lower abdominal and back pain which has increased in frequency and intensity over the last few hours. Abdominal examination shows fundal height equals 32 cm, longitudinal lie fetus and cephalic presentation. Fetal heart was positive and cardiotocography is reactive with 2-3 uterine contractions/10 minutes. Vaginal examination shows 1 cm dilated cervix, 70% effacement, -3 station and cephalic. Which of the following is the next step to confirm the diagnosis? A. Continuous cardiotocography. B. Lecithin-sphingomyelin ratio. C. Repeat vaginal assessment in two hours. D. Cervical length assessment by ultrasound scanning
Understand the Problem
The question provides a clinical presentation of a pregnant woman and asks for the next step in confirming the diagnosis. We need to consider the symptoms and examination findings to determine the most appropriate diagnostic step.
Answer
C. Repeat vaginal assessment in two hours
The next step to confirm the diagnosis is repeat vaginal assessment in two hours.
Answer for screen readers
The next step to confirm the diagnosis is repeat vaginal assessment in two hours.
More Information
The patient is presenting with signs of preterm labor, given the gestational age of 32 weeks, the contractions, and cervical changes. To assess the progression of labor, a repeat vaginal examination in two hours is appropriate.
Tips
A common mistake is to choose continuous cardiotocography, but this is already being done and is reactive. Lecithin-sphingomyelin ratio assesses fetal lung maturity and not the immediate diagnosis of preterm labor. Cervical length assessment could be useful, but a repeat vaginal exam is more appropriate as the next step in this scenario.
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