A 23-year-old woman, gravida 2 para 1, at 30 weeks gestation comes to the emergency department after she noticed a sudden gush
of clear fluid from her vagina The patient has no pain or bleeding, and the baby is moving She has a history of vaginal delivery at
term, and the current pregnancy has been uncomplicated Temperature is 37.2 C (99 F} and blood pressure is 110/70 mm Hg The
fundus is nontender. Sterile speculum examination shows a closed cervix and vaginal pooling of nitrazine-positive clear fluid.
Ultrasound reveals a fetal weight consistent with gestational age and breech presentation The fetal heart rate tracing is normal.
Tocometry shows no contractions. Which of the following is the most appropriate next step in management of this patient?
QA Cerclage
0 B. Cesarean delivery
0 C. External cephalic version
0 D. Induction of labor
0 E. Intramuscular betamethasone
0 F. Vaginal progesterone
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