A 27-year-old woman is in the second stage of labour. The fetal head is not descending, and the obstetrician decides to perform a ventouse extraction. He injects local anaesthetic into a nerve that crosses the ischial spine. This nerve then passes along the lateral wall of the ischiorectal fossa embedded in the obturator internus fascia in Alcock’s canal.
Which of the following is this nerve?
A 32-year-old woman attends the Antenatal clinic for a check-up. She is 32 weeks into her pregnancy. Her blood pressure is recorded as 160/128 mmHg. She reports suffering from headaches over the last 2 days. A urine sample is immediately checked for proteinuria, which, together with hypertension, would indicate pre-eclampsia. Her urine sample shows ++ protein. The patient is admitted for monitoring and treatment.
What is the meaning of proteinuria?
A 28-year-old woman who has never given birth is currently 35 weeks pregnant and has been admitted to the hospital due to severe pre-eclampsia. The obstetric team is worried about the possibility of eclampsia.
What is the recommended treatment for this patient?
A 35-year-old woman in her fifth pregnancy has been diagnosed with gestational diabetes at 28 weeks and presents for a fetal growth scan, as per the gestational diabetes protocol. She has had three normal vaginal deliveries, but the last time, she needed an elective Caesarean section for breech presentation. The sonographer calls you into the room to see the patient because the placenta is seen to involve more than half of the myometrium.
What is the correct diagnosis?
A 29-year-old woman in her first pregnancy presents at 30 weeks’ gestation with an episode of antepartum haemorrhage. She noticed fresh red blood on wiping this morning and followed by spotting since. She denies any pain, and the abdomen is soft and non-tender on examination. The baby is moving well. This is the first episode of bleeding in this pregnancy. She is under midwifery-led care but tells you she has a scan booked for 32 weeks. Urinalysis is unremarkable, and her observations are stable.
Which of the following is the most likely cause of this patient’s antepartum haemorrhage?
A 29-year-old primiparous woman, who is a smoker and has been diagnosed with pre-eclampsia, presents to the Antenatal Assessment Unit at 34 weeks’ gestation with sudden-onset lower abdominal pain, associated with a small amount of dark red vaginal bleeding. The pain has gradually worsened and is constant. On examination, she looks a bit pale; her heart rate is 106 bpm, and blood pressure 104/86 mmHg. The uterus feels hard; she is tender on abdominal examination, and there is some brown discharge on the pad.
What is the likely cause of this woman’s symptoms?
A 38-year-old woman, G1P0, presents with constant pelvic pain at 33 weeks’ gestation. The pain started in early morning and has an intensity of 9/10. There is frequent, intermittent uterine contraction, but no vaginal bleeding. Vital signs are blood pressure of 110/70 and heart rate of 90 bpm. Respiratory rate and body temperature are within normal limits. Investigations revealed a diminished platelet count. D-dimer is elevated. Prothrombin time (PT) and partial thromboplastin time (PTT) are increased. Schistocytes are noted in the peripheral blood smear.
What is the most likely diagnosis?
A 28-year-old woman at 36 weeks’ gestation presents with severe abdominal pain and a small amount of vaginal bleeding. The pregnancy has been uncomplicated and previous scans have been normal. On examination, she has tenderness over the uterine fundus, plus:
Investigation Result Normal value
Blood pressure (BP) 90/60 mmHg < 120/< 80 mmHg
Heart rate 110 beats per minute 60–100 beats per minute
Respiratory rate (RR) 18 breaths per minute 12–20 breaths per minute
O2 Saturation 98% 95–100%
What is the diagnosis?
A 29-year-old pregnant woman has presented for her 36-week antenatal care check. On the ultrasound scan (USS), there is a possibility of oesophageal atresia. The patient has been having an uneventful pregnancy so far and this is her first pregnancy. Her blood tests have all been normal, without signs of any infections or diabetes. Her blood pressure at the antenatal care check was 124/87 mmHg and she is not obese.
What finding would you expect on fetal USS?
A 32-year-old multiparous woman presents very anxious on day 10 postpartum. She is struggling with breastfeeding; her nipples are sore, and she feels her son is not feeding enough, as he is fussy and crying for most of the day. Breast examination reveals bilateral breast engorgement, but no evidence of infection. The patient tells you she felt embarrassed to ask the nurse for advice when she had her first postnatal visit, as she did not want her to think she was incompetent as a mother.
What is the most appropriate course of action for this patient?