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A 35-year-old primigravida with abnormal triple screen results should first?

  1. Order an ultrasound

  2. Order a computed tomography (CT) scan of the abdomen

  3. Order a 24-hour urine for protein clearance

  4. Assess for a history of illicit drug or alcohol use

The correct answer is: Order an ultrasound

In the case of a 35-year-old primigravida who has abnormal triple screen results, the first step is to order an ultrasound. Abnormal results from a triple screen, which is used to assess the risk of certain fetal conditions (like Down syndrome and neural tube defects), often warrant further investigation to clarify potential issues and determine the health and anatomical structure of the fetus. An ultrasound can provide critical information regarding the fetal development, the presence of any physical anomalies, and can also help assess the gestational age more accurately, which is especially important in the context of abnormal screening results. This non-invasive imaging technique allows healthcare providers to visualize the fetus and can guide further decision-making about additional testing or interventions that may be necessary. While the other options may be relevant in different scenarios, they are not the immediate next step following abnormal triple screen results. For instance, a CT scan of the abdomen is generally not indicated in obstetrical evaluations due to radiation exposure risks. A 24-hour urine protein clearance is typically used for evaluating kidney function or preeclampsia rather than initial assessment after a screening test. Assessing for a history of illicit drug or alcohol use is important in prenatal care but does not specifically address the abnormalities identified in the