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Stroke thrombolysis eligibility — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardEmergency MedicineStroke thrombolysis eligibilityUSMLE Step 3

A 30-year-old at 31 weeks 2 days has a gush of clear fluid and positive ferning. Temperature is 36.8°C, fetal heart tracing is reassuring, the cervix is closed, and there is no uterine tenderness, bleeding, or labor. Ultrasound shows cephalic presentation and adequate residual fluid. Which management bundle is most appropriate?

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Correct answer: A — Admit for expectant management with antenatal corticosteroids and latency antibiotics

The best answer is “Admit for expectant management with antenatal corticosteroids and latency antibiotics”. Stable PPROM before 34 weeks is generally managed expectantly in hospital with corticosteroids for fetal maturation and a 7-day latency-antibiotic regimen. Delivery is indicated for infection, abruption, nonreassuring fetal status, or labor. Routine prolonged tocolysis, scheduled 32-week delivery, discharge after brief observation, and repeated digital examinations add risk without improving the standard pathway.

Reference: ACOG Practice Bulletin: Prelabor Rupture of Membranes: https://pubmed.ncbi.nlm.nih.gov/32080050/