A 25-year-old primigravida at 36 weeks gestation with pre-gestational diabetes has a nonstress test showing minimal variability with no accelerations and no decelerations over 40 minutes. Biophysical profile score is 4 out of 10 (deducted points for nonstress test, amniotic fluid index of 3 cm, and absent fetal breathing). What is the most appropriate next step?

• A Continue expectant management with repeat testing in 24 weeks because biophysical profile of 4 is equivocal
• B Proceed with delivery without delay; biophysical profile of 4 or less with oligohydramnios indicates fetal compromise ✓
• C Administer betamethasone and deliver within 48 hours after steroid completion
• D Perform a contraction stress test to confirm fetal well-being before deciding on delivery timing

Explanation

A biophysical profile score of 4 or less with oligohydramnios (AFI less than 5 cm) is an indication for delivery, as it suggests fetal compromise. At 36 weeks, the fetus is mature enough for delivery. Distractor A is wrong because a score of 4 with oligohydramnios is not equivocal and requires delivery. Distractor C is wrong because steroids are for immature lungs at earlier gestations; at 36 weeks delivery is indicated. Distractor D is wrong because contraction stress testing is contraindicated when the biophysical profile is already abnormal, and it delays necessary delivery.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.