01/02/2025 – Obstetrics and Gynaecology

Question Easy:
A 28-year-old woman, who is 30 weeks pregnant, presents to the antenatal clinic with itchiness on her palms and soles. She denies any rash. Her liver function tests show elevated bile acids. What is the most likely diagnosis? 🩺🤰
A) Preeclampsia
B) Obstetric cholestasis
C) PUPPP (pruritic urticarial papules and plaques of pregnancy)
D) Intrahepatic cholestasis of pregnancy
E) Acute fatty liver of pregnancy

Question Medium:
A 32-year-old woman presents to her GP with menorrhagia. Upon examination, the uterus is found to be enlarged and irregular. An ultrasound shows multiple uterine fibroids. She wishes to retain her fertility. What is the first-line medical treatment according to NICE guidelines? 🌿
A) Tranexamic acid
B) Mefenamic acid
C) Ulipristal acetate
D) GnRH analogues
E) Combined oral contraceptive pill

Question Hard:
A 37-year-old woman attends the fertility clinic having experienced 3 consecutive miscarriages, all occurring before 12 weeks’ gestation. Investigations reveal a prolonged aPTT and the presence of anticardiolipin antibodies. What is the most appropriate management to prevent further miscarriages in her next pregnancy? 🧬
A) Aspirin alone
B) Low molecular weight heparin alone
C) Warfarin
D) Low molecular weight heparin and aspirin
E) Progesterone supplementation

Explanations & Answers:

Question Easy Answer: B) Obstetric cholestasis
Question Easy Explanation: Obstetric cholestasis, also known as intrahepatic cholestasis of pregnancy, is characterized by itching without a rash, particularly on the hands and feet, and elevated serum bile acids. It typically presents in the third trimester.

Question Medium Answer: A) Tranexamic acid
Question Medium Explanation: NICE guidelines recommend tranexamic acid as a first-line treatment for menorrhagia in women wishing to retain fertility and in whom osteopenic change or symptoms of endometriosis are not a concern. It is non-hormonal and helps to reduce bleeding.

Question Hard Answer: D) Low molecular weight heparin and aspirin
Question Hard Explanation: Recurrent miscarriage associated with antiphospholipid syndrome is best managed with low molecular weight heparin and aspirin during pregnancy to increase live birth rates, as per safety and efficacy guidelines from NICE and NHS recommendations.

Medical fact of the day: The UK was the first country in the world to approve the use of mitochondrial donation to prevent the transmission of mitochondrial diseases. This remarkable advance helps women who carry these diseases to have healthy babies free of mitochondrial disorders.

Quote of the day: “Every patient, every challenge, and every diagnosis is an opportunity to learn, serve, and heal.”