Which of the following is the next step to confirm the diagnosis for a 30-year-old woman, G2 P2002 at 32 weeks' gestation, presenting to the Emergency Department complaining of low... Which of the following is the next step to confirm the diagnosis for a 30-year-old woman, G2 P2002 at 32 weeks' gestation, presenting to the Emergency Department complaining of lower abdominal and back pain, with increased 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.
Understand the Problem
The question presents a clinical scenario of a pregnant woman presenting to the emergency department with signs of possible preterm labor. The question asks us to determine the most appropriate next step to confirm the diagnosis.
Answer
Repeat vaginal assessment in two hours.
The next step to confirm the diagnosis is a repeat vaginal assessment in two hours.
Answer for screen readers
The next step to confirm the diagnosis is a repeat vaginal assessment in two hours.
More Information
Given the patient's presentation at 32 weeks with signs of possible preterm labor (lower abdominal and back pain, uterine contractions, cervical dilation and effacement), the most appropriate next step is to reassess the cervix after a defined period (in this case 2 hr) to evaluate the rate of cervical change.
Tips
A common mistake is to choose continuous cardiotocography, while it is important it is not the most immediate step in confirming the diagnosis of preterm labor. Also, lecithin-sphingomyelin ratio is used to assess fetal lung maturity, which is not the immediate concern in this scenario.
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