A patient with known human immunodeficiency virus (HIV) presents at her booking visit at 38 weeks’ gestation. Her booking blood tests include a CD4 count of 480 and a viral load of 40 copies/ml. She is not currently on any antiretrovirals. She wishes to have a vaginal delivery if possible.
Which of the following best describes this patient’s HIV management during her pregnancy?
A 25-year-old primiparous patient is seen at home by the community midwife for a routine antenatal visit. She is 34 weeks pregnant and has had an uneventful pregnancy to date. On examination, she is well and has a symphysis fundal height of 33 cm. Her blood pressure is 155/92 mmHg and she has 2++ protein in the urine.
What is the most likely diagnosis?
A 27-year-old woman is currently in labour and giving birth to her first child on the Labour Ward. She has been in labour for a while now and has just had a vaginal delivery, with a healthy baby boy born 30 minutes ago. The midwife contacts you as the placenta has not yet been delivered, although the woman’s observations are stable and there is minimal blood loss.
What would be the most appropriate course of action to take next in managing this situation?
You are conducting a study on the hypothalamic–pituitary–gonadal axis in pregnant women. Some of the hormone concentrations are observed to increase during this stage. Your team observes that one hormone in particular shows a more significant increase than the others.
Which hormone is most likely to display this greater increase?
You are asked to review a 32-year-old woman, who is breastfeeding on day two post-emergency Caesarean section, because her wound is tender. On examination, you notice that the skin surrounding the wound is erythematosus, with a small amount of yellow discharge. There is no wound dehiscence. The area is tender on examination. Observations are stable, and the patient is apyrexial. You send a swab from the wound for culture. She has an allergy to penicillin.
Which of the following is the best next step in this patient’s management?
A 28-year-old woman with gestational diabetes delivered at 39+2 weeks’ gestation by an uncomplicated elective Caesarean section for macrosomia. The baby weighed 4.8 kg at delivery. The Apgar score at 1 and 5 minutes was 10. Eight hours later, she pulls the emergency alarm because her baby became lethargic and started shaking.
What is the most probable reason for this newborn’s seizure activity and lethargy?
A 35-year-old G1P0 woman is brought to the hospital at 39 weeks of gestation by her husband because she is experiencing strong uterine contractions. She delivers a healthy baby with an Apgar score of 8, 5 min after birth. However, she experiences significant bleeding with an estimated blood loss of six litres and is hypotensive with a BP of 60/24 mmHg despite aggressive resuscitation. The placenta appears to be adherent to the uterine wall and the surgeons are unable to separate it. It is noted that she was treated with ceftriaxone for a gonococcal infection 5 years ago, although she had lower abdominal pain for some time after.
What is the definitive treatment for this patient’s present condition?
A 25-year-old woman is on her second day postpartum, following a Caesarean section. She is taking regular paracetamol for pain around the wound site, which has not alleviate her symptoms.
She is breastfeeding and is asking whether there are any other safe analgesics to help with her pain.
What is the recommended medication for this patient’s pain management?
A 30-year-old pregnant woman presents with a complaint of dyspnoea that has been worsening with physical activity for the past month. She is currently 16 weeks pregnant and has had normal prenatal testing. Upon examination, her vital signs are stable, and her lungs are clear bilaterally without cardiac murmur. Mild dependent oedema is noted in her lower extremities. What is the probable cause of her dyspnoea?
A 29-year-old primip is brought in by ambulance at 38+2 weeks’ gestation. She has had an uncomplicated pregnancy so far, and she is a smoker. This morning, she had sudden-onset abdominal pain, which has become very severe. The uterus is hard and contracted. There is no vaginal bleeding, and the os is closed, with a long cervix. She looks clammy and pale.
Her observations are as follows: heart rate (HR) 130 bpm, blood pressure (BP) 98/56 mmHg, respiratory rate (RR) 20 breaths per minute, oxygen saturations 96% on air, and temperature 37.1 °C. The cardiotocogram shows fetal distress, and fetal movements cannot be palpated.
Which of the following is the most appropriate management?