QUESTION 18

 A 38-year-old woman, gravida 7 para 6, at 33 weeks gestation comes to the emergency department for evaluation of leakage of clear

fluid from her vagina. The leakage began yesterday and occurs when she stands from a sitting position. The patient did not

experience this during her other pregnancies, all of which were uncomplicated During this pregnancy, she was treated for chlamydia

at 10 weeks gestation. Blood pressure is 110/70 mm Hg. Weight is 105 kg (231.5 lb) Urine dip is negative for protein and glucose.

Fetal heart rate tracing is normal, and tocometry shows no contractions. Speculum examination shows a slightly open cervix and a

scant amount of clear fluid in the posterior vagina, but no fluid emerges from the cervix when the patient coughs. The vaginal fluid

does not turn nitrazine paper blue; a dried smear shows no terning under magnification Which of the following is the most likely

diagnosis?

QA Bacterial vaginosis

0 B. Chlamydia! cervicitis

0 C. Preterm premature rupture of membranes

0 D. Trichomoniasis

0 E. Urinary incontinence

0 F Vesicovaginal fistula

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