A 35-year-old woman is 32 weeks pregnant and meets with her midwife to discuss her birth plan. Her pregnancy has been uncomplicated with a fundal placenta seen on ultrasound scans. She has no pre-existing medical conditions. The patient had one previous pregnancy three years ago and delivered a healthy baby via low transverse caesarean section. She is eager to plan for a vaginal delivery this time around if feasible. What advice should the midwife provide to the patient?
A 38-year-old woman visits her GP complaining of itching symptoms. She is currently 29 weeks pregnant and has had no complications thus far. She reports that her palms and soles of her feet have been extremely itchy for the past few days, and the sensation has now spread to her abdomen. However, she feels otherwise healthy and denies experiencing nausea, vomiting, or abdominal pain.
During the examination, the patient appears to be in good health, without signs of jaundice or rash. Her vital signs are normal, and her blood tests are generally unremarkable, except for a slightly elevated bilirubin level.
Based on the likely diagnosis, what is the most appropriate topic to discuss with her regarding definitive management?
A 33-week gestation woman presents for a follow-up ultrasound scan after her 20-week scan revealed a low-lying placenta. The repeat scan conducted in the department indicates that the placenta is partially covering the cervix’s top. The obstetric consultant counsels her on the recommended mode of delivery. She has had four previous pregnancies, all of which she delivered vaginally, and has no medical or surgical history.
What is the appropriate recommendation that should be offered to her regarding the mode of delivery?
A 28-year-old woman with her first pregnancy comes to you at 32-weeks gestation complaining of itchiness. Upon examination, there is no rash present. After being referred to an obstetrician, she is diagnosed with intrahepatic cholestasis of pregnancy and prescribed ursodeoxycholic acid. During her visit, the patient mentions that her obstetrician mentioned something about her labor, but she didn’t quite understand.
What plans need to be made for this patient’s labor?
A 28-week pregnant primiparous woman comes to your clinic for a routine check-up. She has been diagnosed with intrahepatic cholestasis and is currently taking ursodeoxycholic acid while being closely monitored by her maternity unit. She asks you about the likely plan for her delivery.
What is the most probable plan for delivery for a 28-week pregnant primiparous woman with intrahepatic cholestasis? Is normal vaginal delivery possible, or will an elective caesarian section be planned? Will induction of labour be offered at 37-38 weeks, or will it be delayed until 40 weeks if she has not delivered by then? Is an emergency caesarian section indicated?
A 35-year-old woman is 39 weeks pregnant with twins (dichorionic diamniotic). During labor, the midwife observes the umbilical cord protruding from the vagina. The emergency button is pressed, and the woman is rushed for an emergency C-section. What is the most probable cause of umbilical cord prolapse?
A 35-year-old woman who is 16 weeks pregnant presents with gradual onset abdominal pain that has been getting progressively worse for 4 days. She reports feeling nauseated and has vomited twice today. Her temperature is 38.4ºC, blood pressure is 116/82 mmHg, and heart rate is 104 beats per minute. The uterus is palpable just above the umbilicus and a fetal heartbeat is heard via hand-held Doppler. On speculum examination, the cervix is closed and there is no blood. She has a history of menorrhagia due to uterine fibroids. This is her first pregnancy. What is the most likely diagnosis?
A 36-year-old woman at 38 weeks gestation is in the labour suite and undergoing a cardiotocography (CTG) review. Her waters broke 10 hours ago and she has been in labour for 6 hours. This is her first pregnancy and it has been uncomplicated so far. Her Bishop score is 6.
The CTG findings are as follows:
– Foetal heart rate 120 bpm (110 – 160)
– Variability 10 bpm (5 – 25)
– Decelerations Late, with 50% of contractions absent
– Contractions 3 per 10 minutes (3 – 4)
These findings have been consistent for the past 30 minutes. What is the most appropriate management?
A 27-year-old woman gives birth vaginally to a healthy baby girl after a normal pregnancy. What is a third-degree tear of the perineum?
A 28-year-old primigravid woman is rushed to the hospital due to preterm premature rupture of membranes. During assessment, it is observed that the cord is protruding below the level of the introitus. What is the most suitable immediate course of action to take while preparing for a caesarian section?