A 36-year-old woman, gravida 3 para 2, at 38 weeks gestation comes to the emergency department due to regular, painful
contractions. The contractions began an hour ago, immediately after the patient had a “gush” of fluid. She has had no vaginal
bleeding, and fetal movement has been normal. The patient’s last prenatal visit was 6 weeks ago. She has no known medical
conditions and does not use alcohol, tobacco, or illicit drugs. Vital signs are normal. Fetal heart rate tracing shows a baseline of
140/min with multiple accelerations and no decelerations. Contractions occur every 2 minutes on tocodynamometer. Pelvic
examination shows a cluster of clear vesicles with an erythematous base on the right labium minus. Speculum examination shows a
pool of clear fluid in the posterior vagina. The cervix is 6 cm dilated and 100% effaced with the fetal head at O station. Which of the
following is the best next step in management of this patient?
- QA Administer tocolytics
- 0 B. Continue expectant management
- 0 C. Initiate augmentation of labor
- 0 D. Perform cesarean delivery
- 0 E. Place fetal scalp electrode
- 0 F Start antiviral therapy
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