A 32-Year-Old Primigravid Woman at 21 Weeks Gestation Comes to the Office

A 32-year-old primigravid woman at 21 weeks gestation comes to the office due to increased vaginal discharge.  The discharge started a week ago and initially was clear but turned slightly bloody today.  The patient has had no abdominal pain or heavy vaginal bleeding.  The patient has no chronic medical conditions and has had no prior surgeries.  Temperature is 36.8 C (98.2 F) , blood pressure is 96/62 mm Hg, and pulse is 92/min.  BMI is 19 kg/m².  The uterus is nontender, fundal height is 19 cm, and fetal heart tones are 155/min.  Speculum examination shows scant blood and discharge; a bulging bag with fetal parts is protruding through the cervix, which is dilated 4 cm.  Microscopy of the vaginal discharge shows squamous epithelial cells and few leukocytes.  Nitrazine testing is negative.  Which of the following is the most likely diagnosis in this patient?

A) Abruptio placentae
B) Cervical insufficiency
C) Incomplete abortion
D) Preterm labor
E) Preterm prelabor rupture of membranes

Correct Answer:

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