39-year-old woman, gravida 3 para 2, comes to the office at 20 weeks gestation for prenatal care and follow-up of a prenatal
ultrasound. The patient has had no pelvic pain, leakage of fluid, or vaginal bleeding Fetal movement has been normal. Prior
pregnancies were uncomplicated and delivered vaginally at term. This pregnancy was conceived via in vitro fertilization with normal
preimplantation genetic testing. Blood pressure is 110/60 mm Hg and pulse is 78/min. BMI is 32 kg/m2
. Ultrasound performed earlier
today showed a single fetus in the breech presentation, a placenta covering the internal cervical os, and a cervical length of 4.2 cm.
The anatomical survey is normal, and estimated fetal weight is at the 50th percentile. Based on the ultrasound findings, which of the
following is the best next step in the treatment of this patient?
- QA Cerclage placement
- 0 B. Complete bedrest
- 0 C. Intramuscular hydroxyprogesterone
- 0 D. Routine obstetric care
- 0 E. Vaginal progesterone
- 0 F Weekly Doppler ultrasound