Obstetrics Gynaecology

A 30-year-old woman presents to the emergency department with sudden-onset severe right iliac fossa pain that began 30 minutes ago while she was at work, followed by a brief syncopal episode. She is six weeks pregnant by last menstrual period and reports light vaginal spotting over the past two days but no prior antenatal ultrasound. She has a history of chlamydia treated three years ago. On examination she is pale and diaphoretic, HR 128 bpm, BP 80/50 mmHg, RR 24/min, and she has marked right iliac fossa tenderness with guarding and cervical motion tenderness on speculum examination. Point-of-care urine β-hCG is positive. Bedside transabdominal ultrasound shows an empty uterus with free fluid in the pouch of Douglas and no intrauterine pregnancy. What is the most appropriate next step in management?

A 28-year-old woman, G2P1, presents to her GP at 20 weeks gestation with a two-week history of malaise, low-grade fevers and mild cervical lymphadenopathy. She recalls her toddler having a non-specific viral illness with fever and coryza three weeks earlier. She is otherwise well, observations are normal, and fundal height is consistent with dates. Routine antenatal serology returns positive CMV IgM with positive IgG. Anatomy ultrasound performed the same day is unremarkable. What is the most appropriate next step in management?

A 19-year-old woman presents to the emergency department 30 hours after a single episode of unprotected intercourse, requesting the most effective form of emergency contraception. Her BMI is 34 kg/m^2. Which of the following options carries the lowest failure rate for preventing pregnancy?

A 30-year-old G2P1 woman at 30 weeks gestation is referred by her midwife after her symphysis-fundal height measured 4 cm greater than expected for dates. She reports mild abdominal tightness but denies leaking fluid, vaginal bleeding or reduced fetal movements. She has no known diabetes and her first pregnancy was uncomplicated. Observations are normal: BP 118/76 mmHg, HR 82 bpm, afebrile. Formal ultrasound demonstrates an amniotic fluid index of 28 cm (single deepest pocket 9 cm), a structurally normal-appearing fetus on initial survey, and estimated fetal weight appropriate for gestation. Which of the following represents the most appropriate next step in her management?

A 30-year-old woman, G2P2, presents to the emergency department 8 weeks after an uncomplicated vaginal delivery with a several-week history of small-volume urine leakage whenever she coughs, sneezes or laughs. She denies urgency, frequency, dysuria or nocturia, and has not noticed any leakage without a preceding trigger. She had a spontaneous vaginal delivery of a 3.8 kg infant with a second-degree perineal tear that was repaired without complication. She is breastfeeding, has returned to light exercise, and reports no fevers, back pain or neurological symptoms. Observations are normal. Abdominal examination is unremarkable, and there is no palpable bladder distension. Urinalysis is clear, with no evidence of infection. Pelvic examination confirms leakage of urine with Valsalva but no pelvic organ prolapse or mass. What is the most appropriate first-line management for this patient?

A 30-year-old G2P1 woman at 34+2 weeks gestation with known gestational diabetes mellitus presents to the antenatal day assessment unit for review. She has been on metformin and dietary modification but reports home capillary blood glucose readings consistently between 10-14 mmol/L over the past two weeks, with an HbA1c of 8.5%. She denies reduced fetal movements. Observations are BP 128/82 mmHg, HR 88 bpm, RR 16/min, T 36.8°C, and urinalysis is unremarkable. Symphysio-fundal height measures 38 cm (large for dates), and CTG is reactive. Bedside ultrasound estimates fetal weight above the 90th percentile for gestation. What is the most important next step in this woman's management?