Med Student Finals Category: Obstetrics

MSFinals-3572

A 25-year-old woman is currently being assessed in the labour ward. She is at 38 weeks gestation and reports that her waters broke 1 hour ago. This is her first pregnancy, and she has had an uncomplicated pregnancy without significant medical history. Upon examination, her Bishop’s score is calculated to be 9, and a vaginal exam confirms that her amniotic sac has ruptured. There are no signs of contractions at this time, and the foetal heart rate is reassuring at 135/min. What is the most appropriate immediate management plan for this patient?

MSFinals-3573

Sarah is a 28-year-old woman who has recently given birth to a baby boy 6 weeks ago. At the 6 week check, you can see from her records that she has previously been on sertraline for moderate depression, however, this was stopped before her pregnancy. She tells you that she is finding it difficult to cope and is feeling extremely low. On examination, she is tearful and has a flat affect. She denies any thoughts to harm herself or her baby but is keen to try a medication that would be safe to use with breastfeeding.
Which of the following medications may be appropriate for her to start?

MSFinals-3574

A 35 year old type 2 diabetic comes to the diabetics clinic seeking advice on her desire to conceive. The patient has well-managed blood sugar levels and is currently taking metformin and gliclazide. What recommendations should you provide regarding potential medication adjustments during pregnancy?

MSFinals-3575

A 30-year-old multiparous female at 10 weeks gestation visits her general practitioner to book her pregnancy. She has a history of gestational diabetes and returns the next day for an oral glucose tolerance test. Her blood results show a fasting glucose level of 7.2 mmol/L and a 2-hour glucose level of 8.9 mmol/L. What is the recommended course of action based on these findings?

MSFinals-3576

A 32-year-old woman of Chinese Han ethnicity contacts her GP to discuss her planned pregnancy, estimated to be at 6 weeks gestation. She has a BMI of 31 kg/m² and smokes 10 cigarettes per day. Her mild asthma is well-controlled with inhaled beclomethasone. The GP recommends taking folic acid 5mg daily for the first 12 weeks of pregnancy.
What would warrant prescribing high-dose folic acid for this patient?

MSFinals-3561

A 28-year-old woman presents for guidance as she has just discovered she is expecting her first child. She has a family history of diabetes (mother, aunt, grandmother). Apart from taking folic acid, she is healthy and not on any regular medications. What screening should be recommended to her?

MSFinals-3577

Sarah is a 26-year-old woman who is 28 weeks pregnant with her first child. She has not felt the baby move for 2 hours. Her pregnancy has been normal, but her baby is slightly underweight for its gestational age. She visits the obstetric emergency walk-in unit at her nearby hospital.

What is the most appropriate course of action for managing this patient?

MSFinals-3562

You are observing an antenatal clinic and your next patient is a 26-year-old woman who is 16 weeks pregnant with her first child. Take a brief history of this patient.

The patient has a past medical history of coeliac disease and hypothyroidism. She takes no regular medications and has no known drug allergies. Her family history is relevant for her father has type 1 diabetes. She has never smoked and since pregnancy, has stopped drinking alcohol.

What additional tests, if any, should be arranged for this patient based on her medical history?

MSFinals-3578

A 19-year-old primiparous woman is being monitored on the labour ward after a midwife raised concerns about her CTG tracing. She is currently in active second stage labour for 2 hours and is using gas and air for pain relief. At 39 weeks gestation, her CTG shows a foetal heart rate of 90 bpm (110 – 160), variability of 15 bpm (5 – 25), and no decelerations. She is experiencing 6-7 contractions per 10 minutes (3 – 4) for the past 7 minutes. What is the most appropriate immediate next step?

MSFinals-3563

A 25-year-old woman who is 9 weeks pregnant presents for a review of her booking bloods. Her haemoglobin level is 105 g/L and the mean cell volume (MCV) is 70 fL, which is below the normal range of 77-95 fL. What is the best course of action in this situation?