Management of 37-Week Pregnancy with Intermittent Cramps
At 37 weeks gestation with intermittent cramps and normal vital signs, this patient is likely experiencing early labor contractions and should be evaluated for cervical change to determine if active labor has begun. 1
Immediate Assessment Required
Determine Labor Status
- Assess for cervical change in conjunction with contractions to confirm true labor, as labor is defined as contractions with cervical change, while active labor specifically begins when the cervix is dilated to 6 cm 1
- Document contraction frequency, duration, and intensity to distinguish between prodromal labor and true labor 1
Rule Out Preeclampsia
- Measure blood pressure immediately to exclude hypertensive disorders, as preeclampsia can present at term and requires immediate delivery at ≥37 weeks gestation 2, 3
- Check for proteinuria if any blood pressure elevation is detected (≥140/90 mmHg) 4, 3
- Assess for symptoms of severe features including headache, visual changes, right upper quadrant pain, or epigastric pain 4, 3
Fetal Assessment
- Perform electronic fetal monitoring to assess fetal heart rate and variability, as moderate fetal heart rate variability is the most reliable marker of fetal well-being 1, 5
- Consider ultrasound evaluation if there are any concerns about fetal growth, amniotic fluid volume, or placental function 4, 3
Management Based on Findings
If True Labor Confirmed
- Proceed with routine labor management including monitoring of maternal vital signs and continuous or intermittent fetal heart rate monitoring based on risk stratification 1, 5
- Provide pain management options including epidural analgesia if desired 1
If Preeclampsia Diagnosed
- Immediate delivery is indicated for preeclampsia at ≥37 weeks gestation regardless of severity 2, 3
- Initiate blood pressure control if severe hypertension (≥160/110 mmHg) is present using oral nifedipine or intravenous labetalol 4, 3
- Administer magnesium sulfate for seizure prophylaxis if severe features are present 4, 3
If Prodromal Labor (No Cervical Change)
- Reassure and discharge home with return precautions if vital signs remain normal and fetal assessment is reassuring 1
- Instruct patient to return for regular contractions (every 5 minutes for 1 hour), rupture of membranes, vaginal bleeding, decreased fetal movement, or severe headache 1
Critical Pitfalls to Avoid
- Do not dismiss intermittent cramps as benign leg cramps without proper evaluation, as leg cramps typically occur at night and affect the calf muscles, not the abdomen 6, 7
- Do not assume normal vital signs exclude preeclampsia, as serious organ dysfunction can develop at relatively mild levels of hypertension 2, 3
- Do not delay delivery if preeclampsia is confirmed at 37 weeks, as all cases can rapidly progress to emergencies 2, 3