Case history
Case history
A 22-year-old woman presents at 32 weeks' gestation in her first pregnancy with regular painful contractions for 6 hours. She has a BMI of 17 kg/m^2, smokes 10 cigarettes per day, and has a history of a large loop excision of her cervix following a diagnosis of cervical intraepithelial neoplasia grade II. She has had recurrent urinary tract infections, including two positive cultures during pregnancy, but no episodes of vaginal bleeding. She has no history of recreational drug use or domestic violence. There is no family history of early birth. Previous ultrasound showed normal fetal and uterine anatomy. Dipstick urinalysis demonstrates leukocytes and nitrites. A speculum exam reveals a closed cervix, <2 cm long, and a positive bedside fetal fibronectin swab.
Other presentations
Between 25% and 30% of pregnant women will present with preterm prelabor rupture of membranes. Atypical presentations may include nonspecific lower abdominal or back discomfort or pain. Systemic fever of any etiology, particularly malaria and listeriosis, may be associated with preterm labor. In women who present without pain, vaginal discharge may be due to a transudate through the exposed fetal membranes (which can mimic rupture of fetal membranes). Women may present with antepartum hemorrhage indicating placental abruption or separation, which is associated with pain, uterine activity, and contractions. Asymptomatic women at risk of preterm labor may be identified on routine ultrasound examination, or during screening of high-risk cases. Cervical lengths under 1.5 cm are associated with a considerable escalation of risk of preterm labor. Biochemical screening (e.g., fetal fibronectin) can also identify women at risk in asymptomatic cases. Higher-order multiple (multifetal) pregnancies (i.e., triplets) will nearly always deliver preterm.
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