Case of the week

Clinical picture

A 29-year-old primigravida at 32+4 weeks presents with two days of severe headache and "flashing lights" in her vision. Blood pressure 168/112 mmHg, urine protein 3+, platelets 88,000/µL, ALT 96 U/L.

What is the most appropriate next step?

• AOutpatient monitoring with review in 48 hours
• BAdmission, magnesium sulphate, antihypertensive therapy and planning for delivery
• CAntihypertensive therapy alone, with delivery at 37 weeks
• DImmediate caesarean section under general anaesthesia

Clinical picture

A 34-year-old in her second pregnancy at 21 weeks with monochorionic diamniotic twins. Ultrasound shows the donor twin with an MVP of 1.4 cm and no visible bladder; the recipient has an MVP of 9.2 cm.

What is the most likely diagnosis and the required action?

• ASelective growth restriction — monitor every two weeks
• BTTTS (Quintero stage II) — refer to a fetal therapy centre
• CNormal variation — repeat in four weeks
• DAnomaly in one twin — proceed to amniocentesis

Clinical picture

A 27-year-old has lost 1,200 mL of blood 20 minutes after a vaginal birth. The uterus is soft, the placenta is complete and the genital tract is intact.

Which sequence is correct?

• AImmediate hysterectomy
• BUterine massage + uterotonics + tranexamic acid + IV access and preparation for transfusion
• CFluid therapy and observation only
• DUterine artery embolisation as the first step