09/11/2024 – Obstetrics and Gynaecology

Question Easy: A 32-year-old pregnant woman is in her 30th week of gestation. She comes to the clinic complaining of itching, particularly on her palms and soles. Her liver function tests show elevated bile acids. What is the most likely diagnosis? 🤰

A) Gestational diabetes
B) Pre-eclampsia
C) Cholestasis of pregnancy
D) Intrahepatic cholestasis of pregnancy
E) Acute fatty liver of pregnancy

Explanations & Answers:

Question Easy Answer: D

Question Easy Explanation: Intrahepatic cholestasis of pregnancy, often referred to as obstetric cholestasis, commonly presents with pruritus predominantly affecting the palms and soles and can be accompanied by elevated bile acids. It is important to manage appropriately as it can have implications for both the mother and the fetus. NICE guidelines recommend monitoring liver function and bile acid levels and considering the induction of labour depending on the severity.

Question Medium: A 25-year-old woman presents with heavy menstrual bleeding and pelvic pain. Her ultrasound scan reveals a 4 cm intramural fibroid. What is the first-line medical management to reduce her symptoms?

A) Tranexamic acid
B) Combined oral contraceptive pill
C) Myomectomy
D) GnRH analogues
E) Progestogen-only pill

Question Medium Answer: A

Question Medium Explanation: Tranexamic acid is often used as a first-line treatment for heavy menstrual bleeding in women with fibroids, according to NHS guidelines, especially in those who wish to retain fertility. It is an antifibrinolytic that helps reduce bleeding. Other options, like GnRH analogues, can reduce fibroid size but are typically considered second-line due to potential side effects and cost considerations.

Question Hard: A 35-year-old woman with a history of two previous C-sections is at 38 weeks of gestation. She presents with signs of labour and wants to attempt a vaginal birth after cesarean (VBAC). What is the most significant contraindication to proceeding with a trial of labour in this patient? 🤱

A) Previous classical cesarean section
B) Suspected macrosomia
C) Twins
D) Low-lying placenta
E) Short inter-delivery interval

Question Hard Answer: A

Question Hard Explanation: A previous classical cesarean section involves a vertical incision on the uterus, which significantly increases the risk of uterine rupture during a trial of labor. NHS guidelines advise against VBAC in women with a history of classical cesarean section. Low-lying placenta and other options also warrant careful evaluation, but classical C-section is a direct contraindication.

Medical fact of the day: Did you know that in the UK, intrauterine devices (IUDs) are one of the most effective forms of long-acting reversible contraception, with a failure rate of less than 1% per year? This makes them an excellent option for women seeking long-term birth control.

Quote of the day: “Healthcare is a form of love; it is where we extend our hands to heal and our hearts to comfort.”