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A 34-Year-Old Woman, Gravida 1 Para 0, Comes to the Office

Question 795
Multiple Choice
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Multiple Choice

A 34-year-old woman, gravida 1 para 0, comes to the office at 35 weeks gestation for a routine prenatal visit.  The patient reports good fetal movement and has no contractions, vaginal bleeding, or leakage of fluid.  She has type 2 diabetes mellitus that was managed with oral medication prior to pregnancy.  She was started on an insulin regimen during her first trimester due to poor glycemic control.  This pregnancy has also been complicated by fetal growth restriction diagnosed at 28 weeks gestation when fundal height measured 24 cm and ultrasound revealed an estimated fetal weight at the 3rd percentile for gestational age.  Since the diagnosis, the patient has been followed with weekly ultrasounds.  She does not use tobacco, alcohol, or illicit drugs.  Blood pressure is 130/80 mm Hg and pulse is 92/min.  BMI is 34 kg/m2.  The fetal heart rate is 150/min by bedside Doppler.  Fundal height is 31 cm.  An ultrasound prior to the patient's appointment revealed a fetus in vertex presentation with oligohydramnios.  Doppler studies of the umbilical artery showed a new onset of reversed end diastolic flow.  A nonstress test showed moderate variability; there are no accelerations.  A 2-hour postprandial blood glucose level is 155 mg/dL.  A Group B Streptococcus rectovaginal culture has not yet been collected.  Which of the following is the best next step in management of this patient?

A)Administer corticosteroids and magnesium sulfate
B)Administer penicillin and perform amnioinfusion
C)Admit to hospital for corticosteroids and improved glycemic control
D)Admit to hospital for induction of labor
E)Continue expectant management and repeat ultrasound in a week

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