In addition to broad-spectrum antibiotics, which of the following is the best next step in management of this patient?

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11ec25c8_da22_c05c_bc81_b72f15190547_MD0003_00 Intra-amniotic infections (IAIs) are usually polymicrobial and ascend from the vagina, spreading through the amniotic fluid, membranes, placenta, uterine decidua, and umbilical cord. Treatment is with broad-spectrum intravenous antibiotics (eg, ampicillin, gentamicin, clindamycin) and immediate delivery via augmentation of labor (to remove the source of infection). These interventions reduce the risk of neonatal morbidity and maternal complications (eg, postpartum endometritis). Antipyretics (eg, acetaminophen) and intravenous fluids are administered to reduce maternal fever, which in turn improves fetal tachycardia. (Choice A) Corticosteroids are administered to patients at risk for preterm delivery (<37 weeks gestation) to promote fetal lung maturity and reduce the incidence of neonatal respiratory distress syndrome. (Choices B and D) Tocolytics (eg, nifedipine, indomethacin) are contraindicated in patients with an IAI, regardless of gestational age. Patients with an IAI are not managed expectantly as the risks of maternal and fetal complications of infection outweigh the risks of prematurity. (Choice C) Cesarean delivery is reserved for standard obstetric indications (eg, nonreassuring fetal tracing, breech presentation, prior uterine surgeries). Although this heart rate tracing indicates fetal tachycardia, it is reassuring overall due to moderate variability and no decelerations. Educational objective: Intra-amniotic infections are usually polymicrobial; treatment is with broad-spectrum intravenous antibiotics and expedited delivery to decrease neonatal and maternal morbidity. References: Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: summary of a workshop. (http://www.ncbi.nlm.nih.gov/pubmed/26855098) Chorioamnionitis: from pathogenesis to treatment. (http://www.ncbi.nlm.nih.gov/pubmed/21672080)

In Addition to Broad-Spectrum Antibiotics, Which of the Following Is