Samantha is a 28-year-old woman who has been diagnosed with epilepsy and is currently taking carbamazepine. She has just given birth to a baby boy and is uncertain about breastfeeding. Samantha is worried that her medication may harm her baby if she continues to breastfeed. What guidance would you offer Samantha regarding her antiepileptic medication and breastfeeding?
A 30-year-old Caucasian woman who is 26 weeks pregnant with her first child presents to antenatal clinic. She had been invited to attend screening for gestational diabetes on account of her booking BMI, which was 32kg/m². Prior to her pregnancy, she had been healthy and had no personal or family history of diabetes mellitus. She takes no regular medications and has no known allergies.
During her antenatal visit, she undergoes an oral glucose tolerance test (OGTT), which reveals the following results:
– Fasting glucose 6.9mmol/L
– 2-hour glucose 7.8 mmol/L
An ultrasound scan shows no fetal abnormalities or hydramnios. She is advised on diet and exercise and undergoes a repeat OGTT two weeks later. Due to persistent impaired fasting glucose, she is started on metformin.
After taking metformin for two weeks, she undergoes another OGTT, with the following results:
– Fasting glucose 5.8 mmol/L
– 2-hour glucose 7.2mmol/L
What is the most appropriate next step in managing her glycaemic control?
A 36-year-old pregnant woman has a vaginal swab taken at 34 weeks gestation despite being asymptomatic. She informs you that during her previous pregnancy a bacteria which can cause sepsis in babies was detected on one of her swabs, which is why she needs to be tested again.
The microbiology report reads as follows:
Sample: Positive (awaiting sensitivities)
Gram stain: Positive
Morphology: Cocci in chains
Growth requirements: Facultative anaerobe
What is the most likely organism present based on this report?
As a newly graduated doctor in obstetrics and gynaecology, you are attending to an emergency call for a midwife-led delivery. The delivery has been stalled for some time, and the midwife informs you that it is a case of shoulder dystocia. You determine that performing McRobert’s manoeuvre is necessary.
What is the appropriate position for the woman to be in to carry out this manoeuvre?
A 29-year-old primigravida is currently in labor for ten hours and has progressed through the first stage without any complications. However, the midwife has observed CTG abnormalities and palpated the umbilical cord. The obstetric registrar is called and upon checking the CTG, variable decelerations are noted. What is the primary course of action for addressing the cause of these decelerations?
You are evaluating a 23-year-old female who is 8 weeks pregnant and experiencing severe vomiting, making it difficult for her to retain fluids. What is the best method to determine the severity of her symptoms?
A 32-year-old woman who is 28-weeks pregnant arrives at the emergency department with a swollen and tender left calf, which is confirmed as a DVT. Suddenly, she experiences acute shortness of breath and complains of pleuritic chest pain. What is the best initial management step for the most probable diagnosis?
A 32-year-old woman is ready to leave the postnatal ward after giving birth to her daughter through normal vaginal delivery 12 hours ago. She asks about contraceptive options as she feels her family is complete. She has a clean medical history and had no complications during her pregnancy or labour. She has previously used the intrauterine system (IUS) and wishes to continue with it. What recommendations should she receive?
A 25-year-old woman is being assessed in the postpartum unit, 48 hours after a vaginal delivery. The delivery was uncomplicated and she is eager to be discharged. She has initiated breastfeeding and is forming a strong attachment with her newborn.
When inquired about birth control, she reports that she previously used the progesterone-only pill and wishes to resume this method. What is the soonest she can restart this contraception?
A woman at 28 weeks gestation presents to the maternity assessment unit with complaints of reduced fetal movements (RFM). She reports that she has not felt her baby move for the past 10 hours. There is no history of vaginal bleeding or pain. The midwife is unable to detect a fetal heartbeat using the handheld Doppler. What further investigations would be carried out to assess the reduced fetal movements?