As the junior doctor on the labour ward, you are summoned to attend a first delivery of a 26-year-old patient. The patient experienced spontaneous preterm rupture of membranes at 34 weeks, and now the umbilical cord is palpable above the level of the introitus. What is the appropriate course of action for managing this patient?
A 28-year-old female patient comes to the rheumatology clinic seeking guidance on starting a family. She and her partner are both diagnosed with rheumatoid arthritis and are currently undergoing weekly methotrexate treatment. The patient was informed about the need for pregnancy advice when she began taking the medication. What recommendations should you provide?
You receive a call from a 27-year-old woman who is 8-weeks pregnant with twins. Last week she had severe nausea and vomiting despite a combination of oral cyclizine and promethazine. She continued to vomit and was admitted to the hospital briefly where she was started on metoclopramide and ondansetron which helped control her symptoms.
Today she tells you she read a pregnancy forum article warning about the potential risks of ondansetron use in pregnancy. She is concerned and wants advice on whether she should continue taking it.
How would you counsel this woman regarding the use of ondansetron during pregnancy?
A 25-year-old woman has a vaginal delivery of her first child. Although the birth was uncomplicated, she suffers a tear which extends from the vaginal mucosa into the submucosal tissue, but not into the external anal sphincter. Which degree tear is this classed as?
A 32-year-old woman is 24 weeks pregnant and she receives a letter about her routine cervical smear. She asks her obstetrician if she should make an appointment for her smear. All her smears in the past have been negative. What should the obstetrician advise?
A 20-year-old primigravida at 8 weeks comes in with suprapubic pain and vaginal bleeding. She has passed tissue through her vagina and blood is pooled in the vaginal area. The cervix is closed and an ultrasound reveals an empty uterine cavity. What is the diagnosis?
A 28-year-old presents to the GP after a positive pregnancy test. She reports her last menstrual period was 7 weeks ago and this is her first pregnancy. She has a medical history of SLE and asthma. After discussing vitamin D and folic acid supplements, you advise her to schedule a booking appointment with the midwife. What other advice would be appropriate to provide?
A 33-year-old woman who is 28 weeks pregnant arrives at the emergency department with painless vaginal bleeding. She had her second baby three years ago, which was delivered via a c-section, but otherwise was a normal pregnancy. Upon obstetric examination, her uterus was non-tender, however, her baby was in breech presentation. The foetal heart rate was also normal, and she denied experiencing any contractions during the bleeding episode. What is the recommended next investigation for the most probable diagnosis?
A 22-year-old woman comes to your clinic at 14 weeks into her second pregnancy. Her pregnancy has been going smoothly thus far, with a regular dating scan at 10 weeks. She came in 24 hours ago due to severe nausea and vomiting and was prescribed oral cyclizine 50 mg TDS. However, she is still unable to consume any oral intake, including fluids. Her urine dip shows ketones.
What would be the most suitable course of action to take next?
A 28-year-old female who is 14 weeks in to her first pregnancy comes for a check-up. Her blood pressure today reads 126/82 mmHg. What is the typical trend of blood pressure during pregnancy?