A patient at 39 weeks gestation with contractions about 3 minutes apart and ruptured membranes should do which next step after precautions?

• A. Transport immediately.
• B. Check fetal heart tones.
• C. Prepare for delivery by episiotomy.
• D. Assess her for crowning.

Answer: (D)

Recognizing imminent delivery by identifying crowning is the main idea here. At term with contractions every few minutes and ruptured membranes, seeing the baby’s head at the vaginal opening means birth is minutes away. The immediate priority is to be ready to assist with the delivery and to support the mother through the final stages. So the next step is to assess for crowning to decide that delivery is imminent and then prepare for on-scene delivery: gather supplies, position and reassure the mother, and have help ready to assist. If crowning isn’t present yet, you’d continue monitoring and transport while watching fetal heart tones.

Transporting immediately isn’t ideal if delivery is imminent on scene, as you should be ready to deliver. Checking fetal heart tones is important, but it doesn’t by itself indicate what to do next as clearly as confirming crowning. Episiotomy is not performed in the field and is not the appropriate next action; it requires skilled personnel and a controlled setting.