A 30-year-old white primigravida asks you about the benefits and drawbacks of corticosteroid therapy for premature labor at 30 weeks gestation.
Which one of the following statements is most accurate?
Correct Answer A:
Treatment of premature labor with betamethasone or dexamethasone has been associated with up to a 65% reduction in necrotizing enterocolitis in the neonate.
→ Weekly treatment is not generally accepted. Increasing reports of adverse consequences with repeated courses of treatment has caused most experts to recommend a single course of antenatal corticosteroids for women at risk of preterm birth at 24-34 weeks gestation.
→ Reported benefits of antenatal steroid therapy for preterm labor include reduced rates of intraventricular hemorrhage and persistent patent ductus arteriosus.
→ Both neonatal mortality and the incidence of respiratory distress syndrome are also reduced.
A 25-year-old female at 31 weeks gestation presents to the labor wing with painful uterine contractions every 3 minutes. On examination her cervix is 3 cm dilated and 50% effaced. Her membranes are intact and fetal heart monitoring is reassuring. She is treated with tocolysis, betamethasone, antibiotics, and intravenous hydration, and cultured for group B Streptococcus. The neonatal intensive care unit is notified, but the contractions ease and eventually stop. After 2 days of observation, her cervix is unchanged and she is discharged home.
One week later, the patient presents with contractions for the last 8 hours. Her cervical findings are unchanged. Her group B Streptococcus culture was negative.
Which one of the following would be the most appropriate next step in the management of this patient?
Correct Answer E:
The purpose of obstetric management of preterm labor before 34 weeks gestation is to allow time to administer corticosteroids. Treatment does not substantially delay delivery beyond 1 week. Repeated administration of corticosteroids does not confer more benefit than a single course. Antibiotics are administered for prophylaxis of group B Streptococcus and are useful for delaying delivery if membranes are ruptured. They do not add any benefit otherwise, even though subclinical amnionitis may be a causative factor in many cases of preterm labor. Prolonged and repeated tocolysis is believed to be harmful. Tocolysis would not be indicated in this patient because she has had no cervical change and is therefore having preterm contractions, not preterm labor. Careful monitoring for fetal compromise, consultation with obstetric colleagues, and neonatal intensive-care unit involvement should be part of expectant management of preterm labor cases.
A 24-year-old white female in her first trimester of pregnancy presents with low-grade fever, myalgias, headache, and a rash consistent with erythema migrans. Ten days ago she was hiking in an area where deer ticks are present. She remembers being bitten by a tick which she discovered and removed 2 days after her hike.
Which one of the following is the most appropriate treatment option?
Amoxicillin is preferred for the treatment of Lyme disease in children, as well as for pregnant or lactating women. Doxycycline is effective, but should not be used in pregnant women. Macrolides are not considered first-line agents because controlled trails of azithromycin or erythromycin in patients with erythema migrans found a high rate of clinical failure.
The most frequently reported symptom of vulvar cancer is which one of the following?
The most common symptom of vulvar cancer is longstanding pruritis. The other symptoms mentioned occur less frequently.
When a woman less than 50 years of age develops vulvar cancer, which one of the following associated conditions is most frequently present?
There has been an increase in vulvar cancer in women 35-65 years of age over the last decade. This increase is associated with human papillomavirus infection, particularly involving subtypes 16 and 18. Lichen sclerosus is associated with vulvar cancer in older women. Hypertension, diabetes mellitus, and obesity may coexist, but are not felt to be independent risk factors. Syphilis and other granulomatous diseases have been associated with vulvar cancer in the past; they are not currently considered to be significant risk factors, but are considered markers for sexual behavior associated with increased risk.
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