The advanced practice registered nurse (APRN) is seeing a pregnant patient at 26 weeks gestation. The patient reports absence of fetal movements in the last 24 hours. On physical examine the APRN confirms the absence of fetal movement. What is the most appropriate next step?

Decreased or absent fetal movement in the second and third trimester is a concerning finding that may indicate fetal compromise, intrauterine fetal demise, or placental insufficiency. Prompt evaluation is essential to confirm fetal viability and assess fetal well-being. The initial priority is noninvasive imaging to directly visualize fetal cardiac activity and structure. Ultrasound is the most appropriate immediate diagnostic tool in this situation. Rationale: A. Obtaining a complete blood cell count (CBC) is not the priority in the absence of maternal symptoms such as infection, bleeding, or systemic illness. While laboratory tests may be part of a broader evaluation later, they do not provide immediate information about fetal viability. The urgent concern here is assessing fetal status, not maternal hematologic status. B. Fetal ultrasound is the most appropriate next step because it allows direct visualization of fetal movement, cardiac activity, and overall fetal anatomy. It helps determine whether the fetus is viable or if there are signs of fetal demise or distress. Ultrasound is the first-line, noninvasive diagnostic tool in cases of absent fetal movement. C. A complete external and internal pelvic examination is not indicated in this situation because it does not provide information about fetal viability or movement. In addition, unnecessary cervical or pelvic manipulation may introduce risk without clinical benefit. The priority is assessing fetal health rather than evaluating the birth canal. D. Testing for sexually transmitted infections (STIs) is not relevant to the acute concern of absent fetal movement. While STI screening is part of routine prenatal care, it does not address the immediate concern of possible fetal compromise. Delaying fetal assessment for STI testing would be inappropriate in this urgent clinical scenario.