Self-Assessment Questions

37. Labor abnormalities

• A 19-year-old woman who is 30 weeks pregnant comes in to the hospital with a fever, foul-smelling vaginal discharge and frequent contractions. Upon further workup, she is found to have uterine tenderness and an elevated white blood cell count. The fetal heart monitor shows fetal tachycardia. Her mother is concerned of possible preterm labor and asks if tocolytics should be given at this time. What is your response?

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  Correct answer:
  The patient's clinical presentation is suggestive of possible intrauterine infection. Though her current gestational age would otherwise qualify her for tocolysis, it may be inappropriate in this case to interfere with the uterine attempt to expel the fetus from a hostile environment. Such prevention of delivery could place the fetus in further danger for adverse outcomes.