A 32 yo woman, gravida 5, para 4, at 21 weeks' gestation comes to the emergency department because of bright red vaginal bleeding for 4 hrs. She has received no prenatal care. Vital signs are within normal limits. The fetal heart rate is 140/min. External fetal monitoring shows no contractions. Speculum examination shows bright red blood in the posterior fornix of the vagina. There is no bleeding from the cervix. Visual examination of the vagina and cervix shows no other abnormalities. Which of the following is the most appropriate next step in management?
A. Vaginal swab for fetal fibronectin
B. Cervical cultures
C. Fetal ultrasound
D. Digital examination
E. Cesarean delivery
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