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Anemia of chronic inflammation — USMLE Step 2 CK MCQ

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HardInternal MedicineAnemia of chronic inflammationUSMLE Step 2 CK

At 31 weeks, transvaginal ultrasonography shows fetal vessels traversing the membranes directly over the internal cervical os, confirming vasa previa. The patient has no bleeding, contractions or ruptured membranes. Which delivery plan best reduces fetal exsanguination risk?

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Correct answer: B — Plan cesarean delivery before labor or membrane rupture in the late-preterm window

In vasa previa, unprotected fetal vessels over the cervical os can rupture with labor or membrane rupture, causing rapid fetal hemorrhage. Prenatal diagnosis permits planned cesarean before either event; surveillance and exact timing are individualized, commonly within the 34- to 37-week range. Induction, amniotomy and waiting for bleeding expose the vessels to rupture. Operative vaginal delivery cannot protect vessels that lie ahead of the presenting part.

Reference: ACOG: Indications for outpatient antenatal fetal surveillance. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/06/indications-for-outpatient-antenatal-fetal-surveillance