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Obstetrics
prenatal care
cervical insufficiency
A 32-year-old G1P0 presents to her high-risk obstetrics clinic at 12 weeks and 3 days gestation for her initial consultation. She expresses significant anxiety regarding the potential for preterm birth, particularly given her past medical history of a loop electrosurgical excision procedure (LEEP) performed five years ago for high-grade cervical dysplasia. She reports no prior pregnancies or second-trimester losses. Her current pregnancy has been uncomplicated thus far, with only typical early pregnancy symptoms like nausea and mild fatigue. She denies any uterine contractions, vaginal bleeding, or fluid leakage. Her vital signs are stable: temperature 37.1°C, pulse 72 beats/min, blood pressure 122/68 mmHg, and respirations 14/min. Physical examination reveals a soft, non-tender abdomen with a fundal height consistent with her gestational age. Pelvic examination shows a closed, posterior cervix with no effacement or dilation. No adnexal tenderness or masses are noted. Considering her history, what is the most appropriate initial management strategy and subsequent monitoring approach to mitigate the risk of preterm birth?
| Lab Parameter | Value | Reference Range |
|---|---|---|
| Hemoglobin | 125 g/L | 120-160 g/L |
| White Blood Cell Count | 8.5 x 10^9/L | 4.5-11.0 x 10^9/L |
| Urine Dipstick | Negative for protein, glucose, leukocytes | Negative |
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