Question Easy:
A 28-year-old pregnant woman at 38 weeks gestation comes to the clinic with mild contractions. This is her first pregnancy. She is experiencing no complications and has a normal scan history. What is the most appropriate advice to give her at this stage? 🍼
A) Admit her for immediate labour induction.
B) Advise her to wait until contractions become more regular.
C) Perform a CTG monitoring in the clinic.
D) Prescribe analgesics for pain management.
E) Schedule an emergency caesarean section.
Explanations & Answers:
Question Easy Answer:
B) Advise her to wait until contractions become more regular.
Question Easy Explanation:
In the UK, guidance suggests allowing labour to progress naturally unless there are complications. For first-time pregnancies, mild contractions could represent early or latent labour, and NICE guidelines recommend advising the expectant mother to stay home until contractions are stronger and more regular, approximately every 5 minutes lasting 60 seconds, before coming to the hospital or midwife unit.
Question Medium:
A 32-year-old woman presents with heavy menstrual bleeding and irregular cycles. An ultrasound reveals multiple small fibroids. She wishes to conceive. What is the first-line medical management to offer her? 🌸
A) Combined oral contraceptive pill
B) Tranexamic acid
C) Leuprorelin
D) Mirena (LNG-IUS)
E) Hysterectomy
Question Medium Answer:
B) Tranexamic acid
Question Medium Explanation:
For women with heavy menstrual bleeding and no submucosal fibroids who wish to conceive, the first-line management according to NICE guidelines is tranexamic acid, taken during the bleeding days. It is non-hormonal and does not prevent conception. The Mirena coil, although effective, is hormonal and not suitable for those actively trying to conceive.
Question Hard:
A 45-year-old woman presents with postmenopausal bleeding. A transvaginal ultrasound shows an endometrial thickness of 8 mm. What is the most appropriate next step in management? 🔍
A) Reassure and discharge her with a follow-up in 6 months
B) Initiate hormone replacement therapy
C) Perform an endometrial biopsy
D) Schedule for hysteroscopic polypectomy
E) Prescribe oral progestogens
Question Hard Answer:
C) Perform an endometrial biopsy
Question Hard Explanation:
Postmenopausal bleeding is considered suspicious for endometrial cancer until proven otherwise. According to NICE guidelines, an endometrial thickness of more than 4 mm in postmenopausal women warrants further investigation. An endometrial biopsy is crucial to rule out or confirm malignancy, making it the most appropriate step.
Medical fact of the day:
A fascinating fact about Obstetrics is that the UK has introduced maternity “buddy” systems where pregnant women can choose a friend or family member to support them through pregnancy, labour, and postpartum, enhancing psychological well-being and birth satisfaction.
Quote of the day:
“In the tapestry of healthcare, every interaction is a stitch that holds together the narrative of healing and hope. Weaving it with compassion is the art of our profession.”