A 34-year-old woman, gravida 2 para 1, at 34 weeks

A 34-year-old woman, gravida 2 para 1, at 34 weeks gestation comes to the office to establish prenatal care. The patient recently

moved but had routine prenatal care in another state. She has had no contractions, vaginal bleeding, or leakage of fluid. Fetal

movement is normal. The patient had a classical cesarean delivery at 25 weeks gestation due to eclampsia and fetal growth

restriction. This pregnancy has been uncomplicated, and her only med ications are a daily aspirin and prenatal vitamin. Blood

pressure is 118/70 mm Hg Fetal heart tones are 145/min and fundal height is 38 cm. Urine dipstick is negative for protein and

glucose An ultrasound is performed due to a uterine size/dates discrepancy The ultrasound shows a posterior placenta, normal

amniotic fluid volume, and a fetus in a frank breech presentation with an estimated fetal weight at the 50th percentile for gestational

age. The patient would like to attempt a vaginal delivery with this pregnancy. Which of the following is the best next step in

management of this patient?

  • Q A Await spontaneous labor and perform internal podalic version
  • Q B. Induce labor for breech vaginal delivery at 40 weeks gestation
  • Q C. Perform external cephalic version at 36 weeks gestation
  • Q D. Repeat ultrasound in 2 weeks to determine mode of delivery
  • Q E. Schedule a cesarean delivery at 37 weeks gestation

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