A 27-year-old woman comes in for her regular prenatal check-up at 30 weeks gestation. She reports feeling well and has had an uncomplicated pregnancy thus far. Her vital signs are as follows:
Respiratory rate: 18 breaths/min
Heart rate: 70 beats/min
Blood pressure: 130/88 mmHg
Temperature: 37.2ºC
Oxygen saturation: 97% on room air
Urinalysis results show:
Protein: +
Glucose: –
Nitrites: –
What is the most appropriate course of action for this patient?
A 32-year-old woman presents to your GP clinic, 6 months after giving birth. She complains of persistent palpitations, a weight loss of 4 kg since delivery, and some tremors in her hands. She mentions that her baby is healthy and she is bottle feeding. After conducting thyroid function tests, the results are as follows:
TSH 3.2 mU/L
T4 21 pmol/L
What is the most suitable treatment for the likely diagnosis?
A 32-year-old woman gives birth to her second child. The baby is born via normal vaginal delivery and weighs 3.8 kg. The baby has a normal Newborn and Infant Physical Examination (NIPE) after birth and the mother recovers well following the delivery. The mother wishes to breastfeed her baby and is supported to do so by the midwives on the ward.
They are visited at home by the health visitor two weeks later. The health visitor asks how they have been getting on and the mother explains that she has been experiencing problems with breastfeeding and that her baby often struggles to latch on to her breast. She explains that this has made her very anxious that she is doing something wrong and has made her feel like she is failing as a mother. When her baby does manage to latch on to feed he occasionally gets reflux and vomits afterward. The health visitor weighs the baby who is now 3.4kg.
What is the next most appropriate step?
A 25-year-old woman who is 28 weeks pregnant attends the joint antenatal and diabetes clinic for a review of her gestational diabetes. She was diagnosed with gestational diabetes at 24 weeks gestation after glucose was found on a routine urine dipstick. Despite a 2-week trial of lifestyle modifications, there was no improvement. She was then started on metformin for the past 2 weeks, which has also not improved her daily glucose measurements. During examination, her symphysio-fundal height measures 28 cm and foetal heart rate is present. What is the next appropriate step in her management?
A 32-year-old patient who is currently 20 weeks pregnant presents to your clinic with an itchy rash on her back and legs, which began last night. She had been in contact with her nephew who was diagnosed with shingles. She is unsure if she has had chickenpox before. Upon examination, there are red spots and blisters on her back and legs. She reports feeling well and all vital signs are normal.
What would be your next course of action?
A 30-year-old primigravida gives birth to her male infant at 40+1 weeks via ventouse-assisted vaginal delivery. The estimated blood loss is 650ml and her uterus is well contracted. An episiotomy was performed during delivery, and a tear involving perineal skin and muscle with less than 50% damage to the external anal sphincter is found on postpartum vaginal examination. What is the best course of action for this patient?
During a routine examination of a woman who is 35 weeks pregnant, she reports feeling short of breath. Which of the following cardiac examination findings would require further evaluation and not be considered normal?
You are urgently called to the labour ward to attend to a 23-year-old woman who has undergone an artificial rupture of membranes. She is at 39-weeks gestation and has had an uneventful pregnancy thus far. The midwife reports an abnormal foetal heart rate. Upon examination, you detect the presence of the umbilical cord. You promptly order a caesarean section. What medication can you administer while waiting to prevent any complications?
A 34-year-old multiparous patient has an uncomplicated delivery at 39 weeks gestation. One hour following delivery, the patient experiences severe postpartum hemorrhage that is immediately managed in the labor ward. After seven weeks, the patient reports difficulty breastfeeding due to insufficient milk production. What is the most probable explanation for this medical history?
A 26-year-old primigravida at 32 weeks gestation presents with vaginal bleeding and severe abdominal pain. The abdominal pain started suddenly in the night, about 3 hours ago. It is a severe dull pain in the suprapubic region and doesn’t radiate anywhere. The pain has not settled at all since onset and is not positional. She rates the pain as 10/10 in severity. She passed about 2 cupfuls of blood 1 hour previously. She reports that the bleeding has soaked through 2 sanitary pads. She also complains of back pain and is exquisitely tender on suprapubic palpation. She has not noticed any decreased foetal movements, although says that her baby is not particularly active usually. What is the most likely diagnosis?