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A 29-year-old G3P2 woman at 31 weeks’ gestation presents to the emergency department with a small amount of vaginal bleeding. She had been diagnosed with velamentous cord insertion by ultrasound earlier in the pregnancy. She denies abdominal pain, cramping, or contractions associated with the bleeding. Her temperature is 37.3°C (99.2°F), blood pressure is 105/68 mm Hg, pulse is 66/min, and respiratory rate is 10/min. Her abdomen is gravid but nontender. Fetal heart monitoring is worrisome for acute fetal anemia. Given the clinical picture and previous evidence of velamentous cord insertion, the attending obstetrician is suspicious of a fetal vessel rupture.
What is the best course of action?
A. Emergent cesarean section
B. Expectant management
C. Fetal umbilical blood transfusion
D. Immediate treatment with betamethasone, then cesarean section in 24 hours
E. Induction of vaginal labor with prostaglandins and oxytocin
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