Pregnancy Medicine — MCQs
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A 35-year-old woman presents for her booking appointment at 13 weeks gestation in her first pregnancy. Her BMI is 33 kg/m². She has no previous history of gestational diabetes. Her sister had gestational diabetes in pregnancy. She is of Pakistani origin. Based on current guidelines, when should oral glucose tolerance testing be arranged for this patient?
A 30-year-old woman in her second pregnancy attends the antenatal clinic at 28 weeks gestation. Her booking blood pressure at 10 weeks was 118/72 mmHg. Today her blood pressure is 146/96 mmHg, confirmed on repeat measurement after 30 minutes rest. Urinalysis shows no proteinuria. She is asymptomatic with good fetal movements. Her booking bloods including renal function were normal. What is the most appropriate initial management?
What is the recommended target blood pressure for women with chronic hypertension during pregnancy according to current UK guidelines?
A 38-year-old woman with gestational diabetes is reviewed at 36 weeks gestation. She has been diet-controlled throughout pregnancy with excellent glycaemic control. Today's growth scan shows estimated fetal weight on the 45th centile with normal liquor volume and normal umbilical artery Doppler. She asks about timing of delivery. What is the most appropriate recommendation?
A 26-year-old primigravida presents to the emergency department at 37 weeks gestation with a severe frontal headache that started 6 hours ago. Her blood pressure is 162/108 mmHg. Urinalysis shows 2+ proteinuria. Blood tests show: platelet count 145 × 10⁹/L, ALT 52 U/L, creatinine 78 μmol/L. She is admitted and commenced on oral labetalol. Four hours later, her blood pressure is 155/102 mmHg despite two doses of labetalol. What is the most appropriate next step in management?
A 33-year-old woman in her third pregnancy attends the antenatal clinic at 34 weeks gestation. She has chronic hypertension and was taking lisinopril pre-pregnancy, which was changed to labetalol at booking. Her blood pressure today is 138/88 mmHg. Urinalysis shows no proteinuria. She reports good fetal movements and has no symptoms. Her booking blood pressure was 132/84 mmHg. What is the most appropriate management?
A 29-year-old woman attends her routine antenatal appointment at 16 weeks gestation. She asks about screening for gestational diabetes. She has no previous history of gestational diabetes, her BMI is 27 kg/m², and she is of British Caucasian ethnicity. Her mother developed type 2 diabetes at age 65. What is the most appropriate advice regarding gestational diabetes screening for this patient?
A 35-year-old woman with diet-controlled gestational diabetes attends at 38 weeks gestation. Her glucose monitoring over the past 4 weeks shows fasting values 4.6-5.1 mmol/L and 1-hour post-prandial values 6.8-7.4 mmol/L. Growth scan at 36 weeks showed estimated fetal weight on 48th centile. Today, symphysis-fundal height is 35 cm (on centile), BP is 128/76 mmHg, and urinalysis is normal. She has been offered induction of labour at 40 weeks but asks if she can wait for spontaneous labour beyond this. What is the most evidence-based response?
A 30-year-old woman presents to the emergency department at 37 weeks gestation with sudden-onset severe headache and visual disturbances. Her blood pressure is 178/118 mmHg. She has 3+ proteinuria on dipstick. Blood tests show: platelets 156 × 10⁹/L, ALT 45 U/L, AST 52 U/L, creatinine 88 μmol/L. CTG shows baseline 145 bpm with normal variability and no decelerations. She has become increasingly drowsy. What is the single most important immediate intervention?
A 40-year-old woman attends her booking appointment at 11 weeks gestation in her third pregnancy. Her previous pregnancies were uncomplicated with spontaneous vaginal deliveries at term. Her BMI is 35 kg/m², and her mother has type 2 diabetes. She is of South Asian ethnicity. According to NICE guidelines, when should she be offered OGTT screening for gestational diabetes?
Pregnancy Medicine UK Medical PG Practice Questions and MCQs
Question 91: A 35-year-old woman presents for her booking appointment at 13 weeks gestation in her first pregnancy. Her BMI is 33 kg/m². She has no previous history of gestational diabetes. Her sister had gestational diabetes in pregnancy. She is of Pakistani origin. Based on current guidelines, when should oral glucose tolerance testing be arranged for this patient?
- A. At booking and again at 24-28 weeks gestation (Correct Answer)
- B. At 20 weeks and again at 32 weeks gestation
- C. At booking, 24-28 weeks, and 32 weeks gestation
- D. At 16 weeks and again at 28 weeks gestation
- E. At 24-28 weeks gestation only
Explanation: ***At booking and again at 24-28 weeks gestation*** - This patient has multiple cumulative risk factors for **gestational diabetes mellitus (GDM)**, including a high **BMI (>30 kg/m²)**, **South Asian ethnicity** (Pakistani origin), and a **first-degree relative** with GDM. - Current clinical guidelines recommend early screening with an **Oral Glucose Tolerance Test (OGTT)** or **HbA1c** at the **booking appointment** (or soon after 10 weeks) for women with significant risk factors, followed by a repeat **OGTT** at **24-28 weeks gestation** if the initial test is negative. *At 20 weeks and again at 32 weeks gestation* - These specific timings are not aligned with standard GDM screening protocols, which prioritize screening around **24-28 weeks** when **insulin resistance** is physiologically at its peak in pregnancy. - Screening at **32 weeks** is generally too late for initial diagnosis and management, potentially delaying interventions for **fetal macrosomia** or other complications. *At booking, 24-28 weeks, and 32 weeks gestation* - While screening at booking and 24-28 weeks is appropriate, there is no evidence-based recommendation for a routine **third OGTT at 32 weeks** for asymptomatic patients. - Timely diagnosis and management, typically established by the **mid-second trimester**, are key to achieving glycemic control. *At 16 weeks and again at 28 weeks gestation* - Although 28 weeks is within the appropriate window for repeat screening, **16 weeks** is not the standard earliest screening point for high-risk patients to detect pre-existing diabetes. - For those with multiple risk factors, screening should ideally occur as early as the **booking visit** (typically 10-13 weeks). *At 24-28 weeks gestation only* - This single screening approach is usually reserved for women with **only one moderate risk factor** for GDM, not for those with multiple significant risk factors. - Given the patient's several risk factors, an **earlier screening at booking** is crucial to identify **undiagnosed Type 2 diabetes** or early-onset GDM.
Question 92: A 30-year-old woman in her second pregnancy attends the antenatal clinic at 28 weeks gestation. Her booking blood pressure at 10 weeks was 118/72 mmHg. Today her blood pressure is 146/96 mmHg, confirmed on repeat measurement after 30 minutes rest. Urinalysis shows no proteinuria. She is asymptomatic with good fetal movements. Her booking bloods including renal function were normal. What is the most appropriate initial management?
- A. Commence oral labetalol and arrange blood tests including full blood count, renal function, and liver function tests (Correct Answer)
- B. Admit for 24-hour blood pressure monitoring and investigation for pre-eclampsia
- C. Arrange ambulatory blood pressure monitoring over 24 hours and review results
- D. Commence low-dose aspirin 150 mg once daily and review in 1 week
- E. Reassure and arrange review in 2 weeks with repeat blood pressure measurement
Explanation: ***Commence oral labetalol and arrange blood tests including full blood count, renal function, and liver function tests*** - This patient has new-onset **gestational hypertension** (BP ">=" 140/90 mmHg after 20 weeks gestation) requiring **antihypertensive treatment** to prevent maternal and fetal complications. - **Labetalol** is a first-line agent, and baseline blood tests (FBC, renal, and liver function tests) are essential to screen for evolving **pre-eclampsia**, even without proteinuria. *Admit for 24-hour blood pressure monitoring and investigation for pre-eclampsia* - Admission is typically reserved for **severe hypertension** (BP ">=" 160/110 mmHg) or for symptomatic patients with suspected pre-eclampsia requiring immediate evaluation. - This patient's blood pressure is in the **non-severe range** and she is asymptomatic, making outpatient management with close follow-up more appropriate. *Arrange ambulatory blood pressure monitoring over 24 hours and review results* - **Ambulatory blood pressure monitoring (ABPM)** is primarily used for diagnosing **chronic hypertension** or differentiating white-coat hypertension, not for acute management of new-onset hypertension in the third trimester. - Delaying treatment to perform ABPM is not advisable in a 28-week pregnant woman with confirmed hypertension, as it can delay necessary intervention and increase risks. *Commence low-dose aspirin 150 mg once daily and review in 1 week* - **Low-dose aspirin** is indicated for the **prevention of pre-eclampsia** in high-risk individuals, ideally commenced before **16 weeks gestation**. - It is not an acute treatment for established hypertension and starting it at 28 weeks would not address the immediate need for blood pressure control. *Reassure and arrange review in 2 weeks with repeat blood pressure measurement* - Reassurance alone is inappropriate as a blood pressure of 146/96 mmHg at 28 weeks gestation requires active management and close monitoring. - Delaying re-evaluation for two weeks without intervention increases the risk of progression to **severe pre-eclampsia** or other hypertensive complications of pregnancy.
Question 93: What is the recommended target blood pressure for women with chronic hypertension during pregnancy according to current UK guidelines?
- A. 120/80 mmHg or less
- B. 130/80 mmHg or less
- C. 135/85 mmHg or less (Correct Answer)
- D. 140/90 mmHg or less
- E. 150/100 mmHg or less
Explanation: ***135/85 mmHg or less*** - According to **NICE guidelines (NG133)**, the target blood pressure for women with chronic hypertension during pregnancy is **135/85 mmHg or less**. - This target aims to reduce the risk of **maternal complications** such as stroke while avoiding aggressive reduction that could impair **placental perfusion**. *120/80 mmHg or less* - Setting a target this low is not recommended in pregnancy as it may cause **fetal growth restriction** due to reduced blood flow to the placenta. - **Aggressive antihypertensive therapy** below physiological needs for pregnancy can lead to adverse neonatal outcomes. *130/80 mmHg or less* - While this is a common target for non-pregnant adults with comorbidities, it is not the specific threshold defined by **UK maternity guidelines**. - Maintaining pressure at this level is not evidenced to provide superior outcomes compared to the **135/85 mmHg** standard in a pregnant population. *140/90 mmHg or less* - A blood pressure of **140/90 mmHg** or higher is the threshold used to **diagnose** hypertension in pregnancy rather than the therapeutic target. - Leaving blood pressure at this upper limit increases the risk of progression to **pre-eclampsia** or secondary organ damage. *150/100 mmHg or less* - This level is considered **severe hypertension** in pregnancy and requires urgent medical intervention and monitoring. - Targeting this range would be insufficient for preventing **maternal morbidity** and ensuring a safe pregnancy course.
Question 94: A 38-year-old woman with gestational diabetes is reviewed at 36 weeks gestation. She has been diet-controlled throughout pregnancy with excellent glycaemic control. Today's growth scan shows estimated fetal weight on the 45th centile with normal liquor volume and normal umbilical artery Doppler. She asks about timing of delivery. What is the most appropriate recommendation?
- A. Induction of labour should be offered at 37+0 weeks gestation
- B. Induction of labour should be offered at 38+0 weeks gestation
- C. She should await spontaneous labour up to 41+0 weeks gestation with routine monitoring (Correct Answer)
- D. Elective caesarean section should be recommended at 38 weeks due to gestational diabetes
- E. Induction of labour should be offered at 39+0 weeks gestation
Explanation: ***She should await spontaneous labour up to 41+0 weeks gestation with routine monitoring*** - According to **NICE guidelines**, women with **gestational diabetes (GDM)** managed by **diet alone** with no complications should be managed similarly to low-risk pregnancies regarding the timing of delivery. - Since her **glycaemic control** is excellent and the **fetal growth** is normal (45th centile), she can safely await spontaneous labor until **40+6 weeks**, with induction offered between 40+6 and 41+0 weeks. *Induction of labour should be offered at 37+0 weeks gestation* - Early induction at 37 weeks is typically reserved for cases with severe **maternal or fetal complications**, such as severe **preeclampsia** or significant **fetal growth restriction**. - Routine induction this early is not indicated for well-controlled, diet-managed GDM with normal fetal growth. *Induction of labour should be offered at 38+0 weeks gestation* - This timing is generally considered for women with GDM who require **insulin or metformin** for blood glucose control, which is not the case for this patient. - Inducing at 38 weeks in a diet-controlled patient with no complications unnecessarily increases the risk of **obstetric intervention**. *Elective caesarean section should be recommended at 38 weeks due to gestational diabetes* - **Gestational diabetes** itself is not an indication for an **elective caesarean section**; vaginal delivery is usually preferred unless there are specific obstetric contraindications. - A caesarean section might be discussed if there was significant **fetal macrosomia** (e.g., EFW > 4.5kg), but this fetus is on the **45th centile**. *Induction of labour should be offered at 39+0 weeks gestation* - Induction at 39 weeks is common for women on medical therapy (insulin/metformin), but it is not the standard recommendation for **diet-controlled GDM** with no other risk factors. - Current evidence and guidelines support waiting for **spontaneous labor** in this specific uncomplicated profile to improve birth outcomes.
Question 95: A 26-year-old primigravida presents to the emergency department at 37 weeks gestation with a severe frontal headache that started 6 hours ago. Her blood pressure is 162/108 mmHg. Urinalysis shows 2+ proteinuria. Blood tests show: platelet count 145 × 10⁹/L, ALT 52 U/L, creatinine 78 μmol/L. She is admitted and commenced on oral labetalol. Four hours later, her blood pressure is 155/102 mmHg despite two doses of labetalol. What is the most appropriate next step in management?
- A. Increase the frequency of oral labetalol dosing
- B. Add oral nifedipine modified release to labetalol
- C. Give intravenous labetalol bolus and consider starting magnesium sulphate (Correct Answer)
- D. Switch from oral labetalol to oral methyldopa
- E. Commence intravenous hydralazine infusion only
Explanation: ***Give intravenous labetalol bolus and consider starting magnesium sulphate*** - The patient has **severe pre-eclampsia** (BP 162/108 mmHg, 2+ proteinuria, severe headache) that has failed to respond to initial oral labetalol therapy, with BP still above the severe threshold. - **Intravenous labetalol** is required for rapid control of acute severe hypertension, and **magnesium sulphate** is indicated for seizure prophylaxis to prevent **eclampsia** in patients with severe features like a persistent headache. *Increase the frequency of oral labetalol dosing* - Oral medications have a **slower onset of action** and are generally inadequate for the urgent management of **acute severe hypertension** in pregnancy, especially when initial oral therapy has failed. - Relying on increased oral dosing delays the necessary rapid blood pressure reduction, increasing the risk of maternal complications such as **stroke** or **eclampsia**. *Add oral nifedipine modified release to labetalol* - While **nifedipine** is an appropriate antihypertensive in pregnancy, oral modified-release formulations are not suitable for the **acute stabilization** required in symptomatic severe pre-eclampsia. - Guidelines prioritize **intravenous agents** (such as labetalol or hydralazine) when blood pressure remains persistently elevated above the severe threshold despite initial oral therapy. *Switch from oral labetalol to oral methyldopa* - **Methyldopa** is a slow-acting antihypertensive with a delayed onset of effect, typically taking 24–48 hours to achieve its full effect, making it unsuitable for managing **acute hypertensive emergencies**. - Switching to another oral agent does not address the immediate need for **parenteral therapy** to rapidly control blood pressure and neurological symptoms. *Commence intravenous hydralazine infusion only* - While **IV hydralazine** is an appropriate alternative to IV labetalol for acute blood pressure control in severe pre-eclampsia, this option overlooks the critical need for **magnesium sulphate**. - Management of severe pre-eclampsia with severe features (like severe headache) requires both **antihypertensive therapy** and **seizure prophylaxis** to mitigate both hemodynamic and neurological risks.
Question 96: A 33-year-old woman in her third pregnancy attends the antenatal clinic at 34 weeks gestation. She has chronic hypertension and was taking lisinopril pre-pregnancy, which was changed to labetalol at booking. Her blood pressure today is 138/88 mmHg. Urinalysis shows no proteinuria. She reports good fetal movements and has no symptoms. Her booking blood pressure was 132/84 mmHg. What is the most appropriate management?
- A. Continue current dose of labetalol and review in 1 week (Correct Answer)
- B. Increase labetalol dose and arrange twice-weekly blood pressure monitoring
- C. Admit for blood pressure monitoring and investigation for pre-eclampsia
- D. Switch from labetalol to methyldopa and review in 2 weeks
- E. Add nifedipine to labetalol and review in 1 week
Explanation: ***Continue current dose of labetalol and review in 1 week*** - The patient's blood pressure of **138/88 mmHg** is well-controlled and below the threshold for intervention (**140/90 mmHg**), with no **proteinuria** or symptoms, indicating stable **chronic hypertension**. - Current guidelines recommend aiming for a blood pressure of **135/85 mmHg** or less; as her current readings are near this target and she is stable, routine **weekly antenatal review** is appropriate. *Increase labetalol dose and arrange twice-weekly blood pressure monitoring* - Increasing the dose of **labetalol** is only indicated if blood pressure consistently exceeds **140/90 mmHg** or if there are signs of clinical deterioration. - Unnecessary dose escalation can lead to **maternal hypotension** or potential adverse **fetal effects**, without additional benefit given her current stable BP. *Admit for blood pressure monitoring and investigation for pre-eclampsia* - Admission is typically reserved for cases of **severe hypertension** (≥160/110 mmHg) or strong suspicion of **pre-eclampsia**, which would involve new-onset significant **proteinuria** and/or maternal symptoms. - This patient's blood pressure is stable, she is asymptomatic, and has no proteinuria, ruling out the immediate need for admission or extensive pre-eclampsia workup. *Switch from labetalol to methyldopa and review in 2 weeks* - **Labetalol** is a highly effective and **first-line antihypertensive** in pregnancy; there is no medical indication to switch agents when the current regimen is stable and well-tolerated. - A **2-week review interval** is too prolonged for a patient with chronic hypertension at **34 weeks gestation**, where closer, typically weekly, monitoring is standard. *Add nifedipine to labetalol and review in 1 week* - **Combination therapy** with an additional antihypertensive like **nifedipine** is typically initiated when monotherapy fails to control blood pressure despite optimal dosing. - Adding a second agent unnecessarily at this stage could lead to **maternal hypotension** or other adverse effects without clinical justification, given her controlled blood pressure.
Question 97: A 29-year-old woman attends her routine antenatal appointment at 16 weeks gestation. She asks about screening for gestational diabetes. She has no previous history of gestational diabetes, her BMI is 27 kg/m², and she is of British Caucasian ethnicity. Her mother developed type 2 diabetes at age 65. What is the most appropriate advice regarding gestational diabetes screening for this patient?
- A. She does not meet criteria for gestational diabetes screening and should not have an oral glucose tolerance test (Correct Answer)
- B. She should have an oral glucose tolerance test at 24-28 weeks gestation only
- C. She should have an oral glucose tolerance test now and again at 24-28 weeks if the first test is normal
- D. She should have fasting glucose measured at each antenatal visit
- E. She should have random glucose measured at booking and at 28 weeks gestation
Explanation: ***She does not meet criteria for gestational diabetes screening and should not have an oral glucose tolerance test***- According to **NICE guidelines**, screening for **gestational diabetes (GDM)** is risk-factor based; this patient’s **BMI of 27 kg/m²** is below the **>30 kg/m²** threshold.- She lacks other triggers such as a **previous macrosomic baby** (≥4.5kg), history of **GDM**, or being from a **high-prevalence ethnic group**.*She should have an oral glucose tolerance test at 24-28 weeks gestation only*- An **Oral Glucose Tolerance Test (OGTT)** at 24-28 weeks is reserved for patients with at least one **risk factor**, which this patient does not possess.- Her mother's diagnosis of **Type 2 Diabetes** at age 65 is common and does not automatically trigger screening unless it is a **first-degree relative** with early-onset or significant diabetic history in specific contexts.*She should have an oral glucose tolerance test now and again at 24-28 weeks if the first test is normal*- This intensive screening schedule is only indicated for women with **previous gestational diabetes**, who require an OGTT or **HbA1c** at booking.- Since this is her first pregnancy without known risk factors, performing an **early OGTT** at 16 weeks is clinically unnecessary.*She should have fasting glucose measured at each antenatal visit*- **Fasting glucose** is not used as a repetitive serial screening tool for GDM in the absence of risk factors or clinical signs like **glycosuria**.- Standard care involves monitoring for **glucose in the urine** during routine visits, but not formal blood glucose testing unless symptoms arise.*She should have random glucose measured at booking and at 28 weeks gestation*- **Random blood glucose** is not a recommended screening method for GDM as it lacks the sensitivity and standardization of the **75g OGTT**.- Routine screening in the UK is **targeted** rather than universal, so patients without risk factors do not receive glucose testing at these intervals.
Question 98: A 35-year-old woman with diet-controlled gestational diabetes attends at 38 weeks gestation. Her glucose monitoring over the past 4 weeks shows fasting values 4.6-5.1 mmol/L and 1-hour post-prandial values 6.8-7.4 mmol/L. Growth scan at 36 weeks showed estimated fetal weight on 48th centile. Today, symphysis-fundal height is 35 cm (on centile), BP is 128/76 mmHg, and urinalysis is normal. She has been offered induction of labour at 40 weeks but asks if she can wait for spontaneous labour beyond this. What is the most evidence-based response?
- A. She should be strongly advised to have induction at 38 weeks due to gestational diabetes
- B. She can wait beyond 40 weeks but requires twice-weekly CTG monitoring
- C. Induction should be recommended by 40+6 weeks even with diet-controlled gestational diabetes (Correct Answer)
- D. She requires caesarean section rather than induction due to gestational diabetes
- E. She can safely wait until 42 weeks with standard monitoring as her diabetes is well-controlled on diet
Explanation: ***Induction should be recommended by 40+6 weeks even with diet-controlled gestational diabetes***- This recommendation aligns with **NICE guidelines (NG3)**, which suggest offering **induction of labour** by **40+6 weeks** for women with diet-controlled gestational diabetes.- This strategy aims to mitigate the slightly increased risk of **stillbirth** associated with GDM, while still allowing a window for spontaneous labour in low-risk cases.*She should be strongly advised to have induction at 38 weeks due to gestational diabetes*- Induction between **37+0 and 38+6 weeks** is typically recommended for women with GDM requiring **insulin or oral hypoglycemics**, or those with complications.- This patient's **glucose control is excellent** on diet, and fetal growth is normal, so early induction at 38 weeks is not indicated.*She can wait beyond 40 weeks but requires twice-weekly CTG monitoring*- While increased fetal surveillance may be considered if a patient declines induction, waiting *beyond* **40+6 weeks** for delivery is not the standard evidence-based recommendation for diet-controlled GDM.- The primary aim is to ensure timely delivery to minimize the risk of **late-term complications** associated with gestational diabetes.*She requires caesarean section rather than induction due to gestational diabetes*- **Gestational diabetes** is not an automatic indication for a **caesarean section**; vaginal delivery is usually the preferred route.- The **estimated fetal weight is on the 48th centile**, indicating no **macrosomia** that would necessitate a surgical birth.*She can safely wait until 42 weeks with standard monitoring as her diabetes is well-controlled on diet*- Waiting until **42 weeks** significantly increases the risk of **stillbirth** and other adverse perinatal outcomes, even in diet-controlled GDM.- Despite good glucose control, the underlying metabolic changes in GDM still warrant delivery by **40+6 weeks** to prevent these risks.
Question 99: A 30-year-old woman presents to the emergency department at 37 weeks gestation with sudden-onset severe headache and visual disturbances. Her blood pressure is 178/118 mmHg. She has 3+ proteinuria on dipstick. Blood tests show: platelets 156 × 10⁹/L, ALT 45 U/L, AST 52 U/L, creatinine 88 μmol/L. CTG shows baseline 145 bpm with normal variability and no decelerations. She has become increasingly drowsy. What is the single most important immediate intervention?
- A. Administer magnesium sulphate (Correct Answer)
- B. Perform immediate caesarean section
- C. Give oral nifedipine 10 mg
- D. Commence intravenous labetalol infusion
- E. Arrange urgent CT head scan
Explanation: ***Administer magnesium sulphate*** - This patient presents with **severe pre-eclampsia** (BP 178/118 mmHg, 3+ proteinuria) and neurological symptoms (severe headache, visual disturbances, increasing drowsiness), indicating an imminent risk of **eclampsia** (seizures). - **Magnesium sulphate** is the cornerstone for **seizure prophylaxis** in severe pre-eclampsia, significantly reducing the risk of eclamptic seizures. *Perform immediate caesarean section* - While delivery is the definitive treatment for pre-eclampsia, the mother's condition must first be **stabilized** with magnesium sulphate and antihypertensives to mitigate perioperative risks. - Proceeding to immediate surgery without adequate stabilization increases the likelihood of **maternal stroke** or seizures during the procedure. *Give oral nifedipine 10 mg* - Oral nifedipine 10 mg is generally not the ideal choice for acutely managing severe hypertension in this context due to potentially **unpredictable absorption** and risk of **precipitous blood pressure drops**. - **Intravenous antihypertensives** or controlled-release oral formulations are preferred for safer and more controlled blood pressure reduction in an emergency. *Commence intravenous labetalol infusion* - Managing severe hypertension is crucial, but given the neurological symptoms, preventing **eclampsia** with magnesium sulphate is the single most important immediate priority. - While labetalol effectively lowers blood pressure and reduces **vascular risk**, it does not provide the **neuroprotection** against seizures that magnesium sulphate offers. *Arrange urgent CT head scan* - Although neurological changes like drowsiness warrant consideration of intracranial pathology, the clear diagnosis of **severe pre-eclampsia** means immediate **stabilization** takes precedence. - A CT head scan should only be considered after **seizure prophylaxis** has been initiated and blood pressure is actively being managed, or if symptoms persist despite treatment.
Question 100: A 40-year-old woman attends her booking appointment at 11 weeks gestation in her third pregnancy. Her previous pregnancies were uncomplicated with spontaneous vaginal deliveries at term. Her BMI is 35 kg/m², and her mother has type 2 diabetes. She is of South Asian ethnicity. According to NICE guidelines, when should she be offered OGTT screening for gestational diabetes?
- A. At booking and at 24-28 weeks
- B. Immediately at booking, then repeat at 28 weeks if normal
- C. At 16-18 weeks, then repeat at 28 weeks if normal
- D. At 24-28 weeks only (Correct Answer)
- E. At 20-24 weeks, then repeat at 32 weeks if normal
Explanation: ***At 24-28 weeks only***- According to **NICE guidelines**, women with risk factors such as a **BMI ≥30 kg/m²**, **South Asian ethnicity**, or a **first-degree relative with diabetes** should be offered an **OGTT at 24-28 weeks**.- This patient does not have a history of **previous gestational diabetes**, which would necessitate earlier or repeat screening.*At booking and at 24-28 weeks*- Screening at **booking** (or shortly after) is specifically indicated for women who have had **gestational diabetes (GDM)** in a previous pregnancy.- Since this patient's previous pregnancies were uncomplicated, **early screening** is not the standard recommendation despite her other risk factors.*Immediately at booking, then repeat at 28 weeks if normal*- This specific protocol is not part of the standard **NICE screening pathway** for women without a **prior history of GDM**.- High risk based on **ethnicity and BMI** alone still follows the singular **24-28 week window** unless clinical symptoms develop earlier.*At 16-18 weeks, then repeat at 28 weeks if normal*- This early screening window is specifically reserved for women with **previous GDM** to detect early-onset glucose intolerance.- For a woman whose only risk factors are **BMI**, **family history**, and **ethnicity**, the standard physiological peak of **insulin resistance** at 24-28 weeks is the targeted time for testing.*At 20-24 weeks, then repeat at 32 weeks if normal*- These timeframes do not align with **NICE (NG3) recommendations** for routine gestational diabetes screening.- Routine screening is most effective during the **late second/early third trimester** (24-28 weeks), and 32 weeks is typically too late for primary screening.
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