Pregnancy Medicine — MCQs

A 34-year-old woman with gestational diabetes at 30 weeks gestation has consistently elevated fasting glucose readings of 5.8-6.2 mmol/L despite maximal dietary modifications. Her post-prandial readings are within target. She is already taking metformin 2 g daily in divided doses. What is the most appropriate next step in management?

What is the recommended folic acid supplementation dose for women with a previous child affected by neural tube defect who are planning pregnancy?

A 26-year-old primigravida attends her 20-week anomaly scan. The sonographer reports that the placenta is covering the internal cervical os. The woman is asymptomatic with no vaginal bleeding. What is the most appropriate management plan?

A 33-year-old woman attends her booking appointment at 12 weeks gestation. Her BMI is 34 kg/m². She has no previous history of gestational diabetes but her mother has type 2 diabetes. When should oral glucose tolerance testing be offered?

A 30-year-old woman at 28 weeks gestation presents with headache and visual disturbances. Her blood pressure is 156/98 mmHg. Urinalysis shows 2+ protein. Blood results show: platelets 145 × 10⁹/L, ALT 42 U/L, creatinine 78 μmol/L. She reports normal fetal movements. What is the most appropriate initial management?

A 37-year-old woman presents at 19 weeks gestation with blood pressure 146/94 mmHg. This is repeated 4 hours later and is 148/96 mmHg. She is asymptomatic and urine dipstick shows no proteinuria. Blood tests including renal function, liver function, and full blood count are normal. Her booking BP at 8 weeks was 156/98 mmHg. What is the most appropriate initial management of her blood pressure?

A 35-year-old woman at 24 weeks gestation is referred after screening OGTT shows fasting glucose 4.8 mmol/L and 2-hour value 10.2 mmol/L. She has a BMI of 42 kg/m² and previous macrosomia (birthweight 4.6 kg). She begins dietary management and home glucose monitoring. One week later, her glucose diary shows fasting values 5.1-5.5 mmol/L and 1-hour post-prandial values 7.2-8.4 mmol/L. Ultrasound shows estimated fetal weight on 78th centile with normal liquor volume. What is the most appropriate management?

A 40-year-old woman with pre-existing type 2 diabetes presents for pre-pregnancy counselling. She is currently on metformin 1000 mg twice daily and sitagliptin 100 mg once daily. Her HbA1c is 58 mmol/mol (7.5%). She is also on atorvastatin 20 mg daily for hyperlipidaemia. What is the most appropriate advice regarding her medications before conception?

A 32-year-old woman in her second pregnancy attends for routine antenatal care at 26 weeks gestation. Her oral glucose tolerance test shows fasting glucose 4.9 mmol/L and 2-hour glucose 11.8 mmol/L. She is started on dietary management and glucose monitoring. After 1 week of optimal dietary compliance, her glucose levels show: fasting 5.2-5.4 mmol/L (all values), 1-hour post-prandial 6.8-7.2 mmol/L. What is the most appropriate management?

A 25-year-old primigravida at 38 weeks gestation presents to the antenatal day unit with severe headache and visual disturbances. Her blood pressure is 172/114 mmHg. Blood tests show: platelets 82 × 10⁹/L, ALT 156 U/L, AST 178 U/L, bilirubin 28 μmol/L, creatinine 124 μmol/L, urea 8.2 mmol/L. Urine protein:creatinine ratio is 68 mg/mmol. What is the most appropriate immediate management?