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A 22-Year-Old Woman, Gravida 1 Para 0, at 36 Weeks

Question 308

Multiple Choice

A 22-year-old woman, gravida 1 para 0, at 36 weeks gestation comes to the office for a routine prenatal visit.  The patient has had no contractions, vaginal bleeding, or leakage of fluid.  Fetal movement is normal.  The patient has a history of genital herpes simplex virus but has not had an outbreak in several years.  She has had no vulvar pain or pruritus and has not noticed any vulvar lesions.  Her pregnancy has otherwise been uncomplicated, and her only medication is a daily prenatal vitamin.  Vital signs are normal.  Fetal heart rate is 145/min.  Fundal height is 36 cm.  On pelvic examination, no lesions are noted on the vulva, vagina, or cervix.  The remainder of the physical examination is unremarkable.  Which of the following is the best next step in management of this patient?


A) Administer acyclovir suppressive therapy until delivery
B) Continue routine prenatal care only
C) Initiate acyclovir therapy only if lesions develop
D) Schedule cesarean delivery at 39 weeks gestation
E) Schedule induction of labor at 37 weeks gestation

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