A 28-year-old woman who is 20 weeks pregnant visits the obstetric clinic for a routine ultrasound scan. During the examination, it is observed that the mother’s uterus is smaller than expected for her stage of pregnancy, and the ultrasound scan confirms the presence of intrauterine growth restriction (IUGR). The medical team inquires about any potential risk factors for IUGR that the mother may have.
What is a known maternal risk factor for intrauterine growth restriction?
A 22-year-old woman who is 36 weeks pregnant presents to the Emergency Department (ED) with a 2-day history of worsening headache despite taking painkillers. She has no significant medical history. Her pregnancy has been uneventful, but she reports increasing swelling in her hands and feet over the past week. Her blood pressure at her last prenatal visit two weeks ago was 120/80 mmHg. On examination, her blood pressure is 162/110 mmHg, heart rate 108 beats per minute, and temperature 37.2°C. Urine dipstick reveals protein ++++. What is the most appropriate medication to manage her condition?
On a night shift at the labour ward, the nursing staff pulls the emergency cord for a patient who is experiencing bleeding after giving birth. The severity of the postpartum hemorrhage can be determined based on the amount of blood loss and the time elapsed since delivery. What is the defining parameter for a major primary postpartum hemorrhage?
A woman attends at three weeks post-delivery with her baby for the general practitioner (GP)’s 3-week postnatal test. She had an elective Caesarean section for breech presentation and is currently breastfeeding.
Which of the following should be deferred until six weeks after delivery?
A 26-year-old primip presents at 28 weeks’ gestation, extremely worried as she attended her 5-year old nephew’s birthday party three days ago and stayed over at her sister’s house.
Today, her sister called to say that her nephew has developed a vesicular rash all over his body, and the general practitioner (GP) diagnosed him with chickenpox.
The patient denies any viral symptoms at present, but is unsure whether she has had chickenpox herself.
Which of the following should be performed?
A 32-year-old woman presents to the Labour Ward at 38 weeks’ gestation for an elective Caesarean section. She has human immunodeficiency virus (HIV), had been taking combined highly active antiretroviral therapy (HAART) during pregnancy, and her viral load today is 60 copies/ml. She is asking about breastfeeding and also wants to know what will happen to the baby once it is born.
Which of the following statements best answers this patient’s questions?
A 29-year-old G1P0 woman is brought to the Emergency Department by her husband at 12 weeks’ gestation because she has been experiencing severe morning sickness, palpitations and heat intolerance. Ultrasound of her uterus reveals a ‘snow storm’ appearance and complete absence of fetal tissue.
What is the most suitable parameter to monitor for effective treatment of this patient’s condition?
A 35-year-old primigravida, at 39+3 weeks’ gestation, presented to the Labour Ward in spontaneous labour. The midwife has asked you to review the patient, as the latter has only dilated 2 cm in the last six hours. She is now at 4 cm of cervical dilation at 10 hours since onset of labour. Cardiotocography shows no evidence of fetal distress; uterine contractions are palpable, but irregular and not very strong, and the patient’s observations are stable.
What is the next step in managing this patient?
A 35-year-old primigravida, who is 12 weeks pregnant, comes to your Antenatal clinic for counselling about Down syndrome screening, as her sister has the genetic condition. After discussing the various tests with her, she decides to opt for the earliest possible diagnostic test that will tell her whether her baby has Down syndrome.
What is the test that you are most likely to advise her to have?
A 30-year-old woman, mother of three, presents on day eight postpartum with difficulties breastfeeding. She has exclusively breastfed her other two children. She tells you her baby has problems latching, is feeding for a long time and is always hungry. She has sore nipples as a result of the poor latch.
On examination, you notice that the baby cannot bring his tongue past the lower lip and there is restriction in movement. On lifting the tongue, it acquires a heart shape with a central notch, but you cannot visualise the frenulum.
Which of the following is the most likely diagnosis?