Question Easy:
A 25-year-old woman is 8 weeks pregnant and complains of intense nausea and vomiting. She is unable to keep any food or drinks down. 🤢 Her urine dipstick shows ketones. What is the most likely diagnosis?
A) Gastroenteritis
B) Ectopic pregnancy
C) Hyperemesis gravidarum
D) Urinary tract infection
E) Normal morning sickness
Question Medium:
A 34-year-old woman presents at 28 weeks of gestation with painless vaginal bleeding. On examination, her uterus is soft, and the fetal heart rate is normal. Which condition is most likely causing her symptoms?
A) Placenta praevia
B) Placental abruption
C) Vasa praevia
D) Preterm labour
E) Cervical ectropion
Question Hard:
A 29-year-old woman is in labour and after 8 hours of active labour, she is fully dilated. Two hours later, the fetal head has not descended below the ischial spines. What is the most appropriate management at this point?
A) Augmentation with oxytocin
B) Vacuum-assisted delivery
C) Cesarean section
D) Encourage ambulation
E) Wait for spontaneous descent
Explanations & Answers:
Question Easy Answer: C) Hyperemesis gravidarum
Question Easy Explanation: Hyperemesis gravidarum is a condition characterised by severe nausea and vomiting in pregnancy, leading to dehydration and weight loss. It is more severe than typical morning sickness, and the presence of ketones in the urine suggests ketosis due to inadequate nutrition and hydration. NICE guidelines recommend considering antiemetic treatment and possibly hospitalisation for IV fluids.
Question Medium Answer: A) Placenta praevia
Question Medium Explanation: Placenta praevia involves the placenta covering the internal os, causing painless vaginal bleeding in the second half of pregnancy. The soft uterus and normal fetal heart rate are key distinguishing features from placental abruption, which presents with a tense uterus and fetal distress. Placenta praevia management is based on the degree of bleeding and gestational age, with C-section delivery often necessary, according to NHS guidelines.
Question Hard Answer: C) Cesarean section
Question Hard Explanation: In cases where there is failure to progress in the second stage of labour (arrest of descent), particularly with the fetal head still above the ischial spines after more than two hours of full dilation, a cesarean section is often the most appropriate intervention. This decision aligns with NICE labour care guidelines, which suggest operative delivery when there is no descent of the fetal head.
Medical fact of the day: The UK has seen a significant decrease in maternal mortality over the past few decades, thanks in part to improved antenatal care and management of high-risk pregnancies. Current trends focus on reducing inequality in maternal health care access and outcomes.
Quote of the day: “In the delicate dance of bringing life into the world, your compassion is the music that reassures every step.”