A 28-year-old woman presents at 12 weeks’ gestation for her dating scan. The radiographer calls you in to speak to the patient, as the gestational sac is small for dates and she is unable to demonstrate a fetal heart rate. On further questioning, the patient reports an episode of bleeding while abroad at nine weeks’ gestation, which settled spontaneously.
Which of the following is the most likely diagnosis?
You are called to see a 27-year-old primiparous woman who has just delivered via spontaneous vaginal delivery. She had an active third stage of labour with 10 mg of Syntocinon® administered intramuscularly. The placenta was delivered ten minutes ago and appears complete. The midwife has called you, as there is a continuous small stream of fresh red blood loss. It is estimated that the patient has lost 1050 ml of blood so far. You palpate the abdomen, and you cannot feel any uterine contractions.
Observations:
Heart rate (HR) 107 bpm
Blood pressure (BP) 158/105 mmHg
Temperature 37.1 °C
Respiratory rate (RR) 18 breaths per minute
Oxygen saturations 98% on air
Which of the following is the next step in this patient’s management?
A 33-year-old primiparous woman has been referred at 35+5 weeks’ gestation to the Antenatal Assessment Unit by her community midwife because of a raised blood pressure. On arrival, her blood pressure is 162/114 mmHg despite two doses of oral labetalol and her heart rate is 121 bpm. Examination reveals non-specific abdominal tenderness predominantly in the right upper quadrant; the uterus is soft and fetal movements are palpated. Urine dipstick reveals 3+ protein only. The cardiotocograph is normal.
Initial blood tests are as follows:
Investigation Result Normal value
Haemoglobin (Hb) 95 g/l 115–155 g/l
White cell count (WCC) 5.8 × 109/l 4–11 × 109/l
Platelets 32 × 109/l 150–450 × 109/l
Aspartate aminotransferase (AST) 140 IU/l 10–40 IU/l
Alanine aminotransferase (ALT) 129 IU/l 5–30 IU/l
Bilirubin 28 μmol/l 2–17 μmol/l
Lactate dehydrogenase (LDH) 253 IU/l 100–190 IU/l
Which of the following is the most definitive treatment in this patient?
A fit and well 36-week pregnant patient is admitted for a planned Caesarean section. Blood tests show the following:
Investigation Result Normal value
Haemoglobin 102 g/l 115–155 g/l
Mean corpuscular volume (MCV) 89 fl 82–98 fl
Platelets 156 × 109/l 150–400 × 109/l
White cell count (WCC) 11 × 109/l 4–11 × 109/l
With which of the following are these findings consistent?
A 27-year-old woman is eight weeks pregnant in her first pregnancy. She has had clinical hypothyroidism for the past four years and takes 50 micrograms of levothyroxine daily. She reports feeling well and denies any symptoms. You order thyroid function tests, which reveal the following results:
Free thyroxine (fT4) 20 pmol/l (11–22 pmol/l)
Thyroid-stimulating hormone (TSH) 2.1 μu/l (0.17–3.2 μu/l)
What is the most appropriate next step in managing this patient?
A 25-year-old primiparous woman attends her booking visit where she is given an appointment for her first scan at 12+4 weeks’ gestation. She wants to know what the appointment will involve.
Regarding the 11–13 week appointment, which of the following is correct?
A 28-year-old primigravida woman presents at 38+5 weeks’ gestation to the Labour Ward with regular contractions that have started about three hours ago.
On examination, she has a short, soft cervix which is 2 cm dilated. Contractions are roughly every 4–5 minutes and are palpable, demonstrated on cardiotocography, but are not very strong or painful at present.
Which of the following statements applies to the first stage of labour?
A 28-year-old woman comes to the General Practitioner three weeks after giving birth. She breastfeeds her baby mostly but uses formula milk when she is out in public as she feels uncomfortable breastfeeding in front of others. She wants to talk about contraception. She is the sole caregiver for her newborn during the day and finds it challenging to manage her sleep schedule and daily routine. There are no other significant medical histories.
What are the most feasible contraceptive options for this patient?
A 35-year-old primiparous woman with a body mass index (BMI) of 32 kg/m2 comes in for her 2-hour oral glucose tolerance test (OGTT) at 26 weeks’ gestation, as she is at high risk of developing gestational diabetes. Her results are as follows:
Fasting plasma glucose 7.3 mmol/l
2-hour plasma glucose 10.8 mmol/l
What is the most appropriate course of action for managing this patient?
In the Obstetric Outpatient Department, a patient with a history of hypertension and a BMI of 17 comes to you with concerns about pre-eclampsia. She is 28 years old, in her second pregnancy with the same partner, and has a four-year-old child. She has heard about pre-eclampsia from her friends and is worried about her risk. Which factor in her history is a risk factor for pre-eclampsia?