GY Emergency new

A 24-year-old Jehovah's Witness is brought to accident and emergency with a Glasgow coma scale (GCS) score of 3, BP 90/30 mmHg and pulse 110 bpm. Her husband reports that her last menstrual period was 8 weeks ago and she complained this morning of lower abdominal pain and vaginal spotting. Ultrasonography suggests a ruptured ectopic pregnancy. As part of the resuscitative measures employed before emergency laparotomy, a transfusion of group 0- negative blood is prepared .Her husband interrupts and says that as a Jehovah's Witness she would absolutely refuse all blood products even at risk of death, and has previously signed an advance directive stating this. What is the most appropriate option?

Avoid transfusion and volume-replace with colloids before emergency transfer to theatre

Avoid transfusion and use a Cell Saver auto-transfuser in theatre

Avoid transfusion and immediately transfer to theatre

Stabilize the woman in accident and emergency before transfer to theatre

Transfuse the woman with Group-O negative blood and immediately transfer to theatre

2. An unhooked 26-week pregnant woman sees you at the hospital to request a termination of pregnancy. She says that if she leaves here today without a termination she will try and do it herself by stabbing her abdomen. Your consultant arranges an urgent psychiatric review which finds no grounds under which to detain this woman in regards to her mental health. Under these circumstances, if a termination was performed, which part of the Abortion Act would it fall under?

The continu ance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were termi nated

The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman

The pregnancy has not exceeded its 24th week and continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated , of injury to the phy sical or mental health of the pregnant woman ;

The pregnancy has not exceeded the continuance of the pregnancy and would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing child (ren) of the famil y of the pregnant woman

E. There is a substanti al risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

3. A 46-year-old women in her fifth IVF cycle is admitted to the emergency department 4 days after egg collection. She is complaining of a swollen abdomen and shortness of breath. She is reviewed and a diagnosis of ovarian hyperstimulation syndrome (OHSS) is made. Which of the following is not a clinical feature/complication of OHSS?

4. A 19-year-old girl presents at the antenatal clinic. She is approximately six weeks pregnant and the pregnancy was unplanned. She has a two-year history of grand mal epilepsy for which she takes carbamazepine. She has had no fits for approximately six months. She wants to continue with her pregnancy if it is safe to do so. She is worried about the anticonvulsant therapy and its effects on the baby. She asks how she should be managed. Which of the following management plans is the most appropriate in this case?

Advise termination due to drug teratogenicity

Continue with carbamazepine

Stop carbamazepine until the second trimester

Switch therapy to phenytoin

Switch therapy to sodium valproate