🎯 Theme 6 Exam Practice

A woman attends her postnatal follow-up after vaginal delivery complicated by uterine atony and postpartum haemorrhage. She asks whether this event will affect future pregnancies. Which counselling advice is most appropriate?

A 29-year-old woman with gestational diabetes returns at 30 weeks after receiving dietary counselling and guidance regarding physical activity. Her home glucose monitoring record continues to show fasting and postprandial values above the agreed pregnancy targets. Ultrasound demonstrates increasing fetal abdominal circumference. What is the most appropriate next management principle?

A woman in established labour has reassuring maternal observations and a normal initial fetal heart assessment. During subsequent monitoring, the fetal heart tracing shows recurrent late decelerations with reduced baseline variability. Which is the most appropriate interpretation?

A 26-year-old woman in established labour reports increasingly painful contractions. Her membranes are intact, fetal movements have been normal, and maternal observations are stable. During reassessment, she reports persistent severe abdominal pain between contractions. Which interpretation is most appropriate?

A 32-year-old pregnant woman is found to be hepatitis B surface antigen positive during routine antenatal screening. She receives appropriate specialist assessment during pregnancy. At delivery, the neonatal team prepares preventive treatment because the infant is at risk of acquiring infection. Which intervention is most appropriate for the newborn?

A 33-year-old woman at 32 weeks presents to the maternity emergency unit with moderate vaginal bleeding. She has a history of a previous caesarean delivery, and a recent ultrasound reported a low-lying placenta. Her blood pressure is 110/70 mmHg, pulse is 94/min, and fetal heart activity is present. The team begins maternal and fetal assessment. Which examination should be deferred until placental location has been safely evaluated?

A 26-year-old woman develops heavy bleeding immediately after delivery. Her uterus is soft, pulse is 118/min and blood pressure is falling. The midwife requests urgent assistance. Which immediate management approach is most appropriate?

A 29-year-old woman at 37 weeks of gestation has a persistent breech presentation confirmed by ultrasound. The pregnancy is otherwise uncomplicated, fetal growth is appropriate, and the membranes are intact. She wishes to avoid a caesarean delivery if a safe alternative is available. Which management option should be discussed?

A term pregnant woman has regular contractions and a cervix dilated to 5 cm. Four hours later, reassessment shows further cervical dilatation and fetal descent. Her temperature is normal, maternal pulse is stable and fetal monitoring remains reassuring. Which is the most appropriate next step?

A 26-year-old multiparous woman in labour develops inadequate cervical progress despite ongoing contractions. Repeat assessment shows poor fetal head descent and suspected mechanical obstruction. Maternal and fetal conditions are being closely monitored. Which interpretation should guide subsequent management?

A 26-year-old woman at term has a normal haemoglobin level documented during antenatal care and a known blood group. She enters uncomplicated labour with reassuring maternal and fetal findings. Which approach to laboratory investigations is most appropriate?

A 25-year-old woman at 18 weeks of gestation has a positive antenatal screening test for syphilis, confirmed by further testing. She has no history of penicillin allergy. She is counselled about the possibility of transplacental infection, fetal loss and congenital disease. Which intervention offers the most appropriate protection against these complications?

A woman with postpartum haemorrhage receives uterine massage, appropriate uterotonics, tranexamic acid and intravenous fluid resuscitation. Despite these interventions, bleeding continues and her haemodynamic condition is deteriorating. Which is the most appropriate next management principle?

A woman develops clinically diagnosed postpartum haemorrhage 30 minutes after vaginal delivery. Uterine massage, oxytocin and resuscitative measures have been initiated. Which additional pharmacological intervention should be administered promptly to reduce bleeding-related morbidity?

A 26-year-old G2P1 woman at 39 weeks and 4 days presents with painful uterine contractions for six hours. She reports progressively increasing contraction frequency and intensity. Her previous pregnancy ended in an uncomplicated vaginal delivery. Which additional historical feature is most important for determining whether she has entered established labour?

A 26-year-old woman with pre-existing Type 1 diabetes delivers a large-for-gestational-age infant at 38 weeks. Two hours after birth, the newborn develops jitteriness, poor feeding and lethargy. Capillary glucose is markedly reduced. Which mechanism most likely explains this neonatal complication?

A woman at term is undergoing monitoring during the first stage of labour. Her cervix has progressed from 5 cm to 8 cm over several hours. The fetal head is descending, maternal vital signs remain stable and fetal heart assessment is reassuring. Which finding provides the strongest evidence of satisfactory labour progress?

Following vaginal delivery, a woman develops heavy vaginal bleeding and tachycardia. Her uterus is poorly contracted. The obstetric team is called, resuscitation is initiated and uterine atony is suspected. Which investigation combination is most appropriate to support emergency management?

A woman in the second stage of labour has a persistent abnormal fetal heart rate pattern despite appropriate initial measures. The cervix is fully dilated, the fetal head is low and engaged, its position is known, and there is no evidence of obstruction. An experienced obstetrician is available. Which management option is most appropriate to consider?

A 32-year-old woman at 33 weeks has marked abdominal distension and discomfort. Ultrasound confirms polyhydramnios, and further examination identifies a fetal upper gastrointestinal abnormality affecting swallowing. Which physiological disturbance most directly explains the excessive amniotic fluid?

A 28-year-old woman at 32 weeks is found to have oligohydramnios and a fetus measuring below the 10th centile. Doppler assessment suggests impaired placental blood flow. Her membranes are intact, and she has no urinary symptoms. Which mechanism best explains the association between poor fetal growth and reduced amniotic fluid?

A 35-year-old multiparous woman at 31 weeks has repeated blood pressure readings of 154/98 mmHg. Her antenatal records demonstrate hypertension diagnosed two years before conception. Urinalysis shows no proteinuria, and platelet count, renal function and liver enzymes are normal. Which interpretation best explains her current condition?

A woman is reviewed five days after vaginal delivery complicated by postpartum haemorrhage. She reports fever, increasing lower abdominal pain and offensive vaginal discharge. Examination reveals uterine tenderness. Which complication should be suspected?

A 30-year-old primigravida at 33 weeks of gestation is admitted with a blood pressure of 168/112 mmHg, persistent epigastric pain and nausea. Laboratory investigations reveal a platelet count of 78,000/µL, elevated AST and ALT, and evidence of haemolysis on peripheral blood film. Which complication best explains the combination of clinical and laboratory findings?

A 34-year-old woman with polyhydramnios and an unstable fetal lie presents following spontaneous rupture of membranes at 37 weeks. Shortly afterward, fetal heart rate monitoring shows persistent severe bradycardia. Vaginal examination by the obstetric team identifies a pulsating structure below the presenting part. What is the most appropriate immediate management principle?

A 31-year-old pregnant woman at 29 weeks presents with sudden pleuritic chest pain, tachycardia and shortness of breath. She has a previous history of venous thromboembolism. Clinical assessment raises strong suspicion of pulmonary embolism, but lower-limb compression ultrasound is negative. She is haemodynamically stable. Which investigation is most appropriate to establish or exclude pulmonary embolism?

A 26-year-old woman has recovered from primary postpartum haemorrhage caused by uterine atony. She is haemodynamically stable, bleeding has settled and she wishes to return home. Which discharge plan best addresses her immediate recovery needs?

A woman develops brisk vaginal bleeding immediately after delivery. Her pulse rises from 88/min to 126/min, blood pressure falls to 85/55 mmHg, and she becomes pale and restless. Which complication is most strongly suggested by these findings?

A 38-year-old woman attends antenatal booking at 11 weeks. Her previous pregnancy was complicated by severe pre-eclampsia requiring preterm delivery. She also has chronic hypertension. The obstetric team plans preventive care because of her substantially increased risk of recurrent pre-eclampsia. Which intervention is most appropriate?

A 36-year-old woman with chronic hypertension and pre-existing diabetes attends a primary healthcare centre at 31 weeks. She reports reduced fetal movements since the previous evening. Her blood pressure is 158/100 mmHg, and antenatal growth measurements have recently fallen below expectations. The primary care physician suspects evolving uteroplacental dysfunction. Which combination of actions best reflects appropriate integrated antenatal care?

An unsensitized Rh-negative woman presents at 29 weeks after a minor road traffic accident. She reports abdominal discomfort but no vaginal bleeding. Ultrasound demonstrates a viable fetus without an obvious placental abnormality. Her antenatal records confirm that she has not developed anti-D antibodies. Which additional preventive consideration is most appropriate?

A 24-year-old woman at 15 weeks of pregnancy presents with persistent vomiting, inability to retain fluids and a weight loss of 5 kg over three weeks. She is tachycardic and clinically dehydrated. Urine examination demonstrates ketonuria, and laboratory testing reveals electrolyte abnormalities. Which management approach is most appropriate?

A 30-year-old woman is evaluated seven days after an emergency caesarean delivery. She has obesity and remained relatively immobile following surgery. She reports increasing discomfort in one leg but has no respiratory symptoms. The obstetric team identifies several risk factors for venous thromboembolism. Which combination of physiological changes best explains her increased thrombotic risk?

A 27-year-old woman with established maternal anti-D antibodies is referred at 30 weeks because of increasing concern about fetal haemolytic disease. Ultrasound shows a viable fetus, and the specialist plans non-invasive assessment for fetal anaemia. Which investigation provides the most useful information for this purpose?

A multiparous woman at term presents with regular contractions. She reports normal fetal movements and no vaginal bleeding. Her antenatal records are unavailable. Which historical finding would most significantly alter her current delivery planning because of the risk of uterine rupture?

A woman delivers a healthy term infant vaginally following normal labour. The placenta is delivered completely. Within minutes, she develops brisk vaginal bleeding. Examination reveals a soft, enlarged uterus. Which is the most likely underlying mechanism?

A 28-year-old woman at 35 weeks presents with severe abdominal pain and a small amount of vaginal bleeding. She is pale, tachycardic and hypotensive. Her uterus is tender and tense, and continuous fetal monitoring shows persistent bradycardia. The amount of visible bleeding seems insufficient to explain her circulatory instability. Which interpretation is most appropriate?

A term pregnant woman presents with three uterine contractions per 10 minutes. Examination reveals a longitudinal fetal lie, cephalic presentation, a cervix dilated to 5 cm and reassuring fetal heart findings. Maternal observations are normal. Which clinical interpretation best integrates these findings?

A multiparous woman develops primary postpartum haemorrhage after an otherwise uncomplicated vaginal delivery. Uterine massage and uterotonic treatment improve uterine tone, but significant bleeding continues. The placenta appears complete. Which additional cause should be actively investigated?

A woman with eclampsia is receiving magnesium sulfate following an emergency admission. Several hours later, she becomes drowsy, her respiratory rate falls to 9/min, and her deep tendon reflexes are absent. The infusion is stopped, and supportive measures are initiated. Which treatment is most appropriate to reverse the suspected drug toxicity?