A 32 year old pregnant woman presents with 36 week pregnancy with complaints of pain abdomen and decreased fetal movements. Upon examination PR= 96/min, BP = 156/100 mm Hg, FHR = 128 bpm. On per-vaginum examination there is altered blood seen and cervix is soft 1 cm dilated. What is the preferred management?
**Core Concept**
The patient is presenting with symptoms of preterm labor, which is a leading cause of maternal and fetal morbidity. Preterm labor is defined as the onset of labor before 37 weeks of gestation. The patient's presentation, including abdominal pain, decreased fetal movements, and altered blood on per-vaginum examination, suggests a possible placental abruption, which is a life-threatening condition that requires immediate medical attention.
**Why the Correct Answer is Right**
The patient's symptoms and examination findings are consistent with a placental abruption, which is a condition where the placenta separates from the uterus. This can lead to fetal distress and maternal hemorrhage. The patient's tachycardia (PR=96/min) and hypertension (BP=156/100 mm Hg) are also consistent with this diagnosis. The presence of altered blood on per-vaginum examination suggests vaginal bleeding, which is a common symptom of placental abruption. The fetal heart rate (FHR) of 128 bpm is also elevated, indicating fetal distress.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not address the immediate need for stabilization of the patient's condition. A non-stress test (NST) may not provide sufficient information to guide management in this situation.
**Option B:** This option is incorrect because it does not take into account the patient's symptoms and examination findings, which suggest a more serious condition such as placental abruption.
**Option C:** This option is incorrect because it is not the most appropriate initial management for a patient presenting with symptoms of preterm labor and possible placental abruption.
**Clinical Pearl / High-Yield Fact**
In cases of suspected placental abruption, it is essential to stabilize the patient's condition with intravenous fluids and oxygen, and to perform a rapid sequence cesarean section if necessary. The patient's blood type and cross-match should also be checked to ensure availability of blood products if needed.
**Correct Answer: C. Immediate stabilization and preparation for cesarean delivery**