## Clinical Context This patient presents with threatened preterm labor (TPL) at 32 weeks with vaginal bleeding, abdominal pain, and cervical dilation but without active labor (no regular contractions). The fetus is hemodynamically reassuring with normal heart rate. ## Management of Threatened Preterm Labor **Key Point:** Threatened preterm labor is defined as regular uterine contractions with cervical changes (dilation and/or effacement) before 37 weeks of gestation. In this case, the patient has cervical dilation but is not in active labor. **High-Yield:** The cornerstone of TPL management at viable gestational age (≥24 weeks) includes: 1. Corticosteroids (betamethasone or dexamethasone) for fetal lung maturity 2. Tocolytic agents to delay delivery 3. Hospitalization and fetal monitoring ## Rationale for Correct Answer At 32 weeks gestation, the priority is to: - Administer corticosteroids (betamethasone 12 mg IM × 2 doses, 24 hours apart) to accelerate fetal lung maturity and reduce neonatal morbidity/mortality - Use tocolytics (nifedipine, labetalol, or indomethacin) to suppress contractions and prolong pregnancy - Admit for continuous fetal monitoring - Investigate the cause of bleeding (ruled out placental abruption on ultrasound) **Clinical Pearl:** Corticosteroids reduce respiratory distress syndrome by 60%, intraventricular hemorrhage by 50%, and neonatal mortality by 30% when given between 24–34 weeks. **Mnemonic — STOP PTL:** Steroids, Tocolytics, Observation, Prophylaxis (antibiotics if indicated), Progesterone (if recurrent PTL). ## Why Observation Alone Works Here The patient is hemodynamically stable, the fetus is reassuring, and there is no evidence of placental abruption or intrauterine infection (no fever, normal WBC assumed). Expectant management with corticosteroid coverage is appropriate. [cite:Williams Obstetrics 26e Ch 42]
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