What are the immediate recommendations for a 37-week pregnant woman presenting with intermittent cramps and normal vital signs?

Immediate Management of 37-Week Pregnant Woman with Intermittent Cramps

Immediately measure blood pressure and assess for preeclampsia, as this condition requires urgent delivery at 37 weeks gestation regardless of severity, and can present with seemingly benign symptoms like intermittent cramps. 1

Critical First Steps: Rule Out Preeclampsia

The most urgent priority is excluding preeclampsia, which mandates immediate delivery at ≥37 weeks gestation. 1, 2

Blood Pressure Assessment

• Measure blood pressure immediately to detect hypertensive disorders, as preeclampsia can present at term with non-specific symptoms. 1
• If BP ≥140/90 mmHg, check for proteinuria using urine protein/creatinine ratio (abnormal if ≥30 mg/mmol or 0.3 mg/mg). 3
• If BP ≥160/110 mmHg, initiate urgent blood pressure control with oral nifedipine or intravenous labetalol. 1, 3

Assess for Severe Features

• Ask specifically about headache, visual changes, right upper quadrant pain, or epigastric pain, as these indicate severe features requiring magnesium sulfate prophylaxis. 1, 3
• Do not assume normal vital signs exclude preeclampsia—serious organ dysfunction can develop at relatively mild hypertension levels. 1, 2

Laboratory Testing if Preeclampsia Suspected

• Complete blood count focusing on hemoglobin and platelet count. 3
• Comprehensive metabolic panel including liver enzymes, creatinine, and uric acid. 3
• Urinalysis and urine protein/creatinine ratio. 3

If Preeclampsia Confirmed at 37 Weeks

Proceed with immediate delivery—do not delay, as all preeclampsia cases can rapidly progress to emergencies. 1, 2

• Administer magnesium sulfate for seizure prophylaxis if severe features are present (severe hypertension or neurological symptoms). 1, 3
• Target blood pressure: systolic 110-140 mmHg and diastolic 85 mmHg. 3
• The American College of Obstetricians and Gynecologists recommends against classifying preeclampsia as "mild" versus "severe" clinically, as all cases may rapidly progress. 2

If Preeclampsia Excluded: Assess Labor Status

Evaluate Contraction Pattern

• Determine if cramps represent true labor contractions (regular, increasing in frequency/intensity) or Braxton Hicks contractions (irregular, non-progressive). 4
• Assess cervical dilation and effacement to determine labor stage. 4

Fetal Assessment

• Initiate electronic fetal monitoring to assess fetal heart rate patterns. 5, 4
• Category I tracing (baseline 110-160 bpm, moderate variability 6-25 bpm, presence of accelerations, no decelerations) is reassuring and requires no intervention. 6, 5
• Perform ultrasound to assess fetal biometry, amniotic fluid volume, and umbilical artery Doppler if growth restriction is suspected. 7

Management Based on Labor Status at 37 Weeks

If in Active Labor with Normal Findings

• Continue routine intrapartum monitoring per institutional protocol. 4
• Structured intermittent auscultation is appropriate for low-risk labor. 5

If Not in Active Labor

• Provide reassurance and discharge home with return precautions. 4
• Instruct to return for regular contractions (every 5 minutes for 1 hour), rupture of membranes, vaginal bleeding, or decreased fetal movement. 4

Key Pitfalls to Avoid

• Never assume normal vital signs exclude preeclampsia—measure BP in every pregnant woman presenting with any symptom at term. 1, 2
• Do not delay delivery if preeclampsia is confirmed at 37 weeks—immediate delivery is indicated regardless of severity. 1, 2
• Blood pressure alone does not reliably stratify risk in preeclampsia; serious organ dysfunction can occur at relatively mild hypertension. 2, 3
• Neither serum uric acid nor proteinuria levels should be used as sole indications for delivery timing. 2