Clinical OSCE

Counsel a woman started on labetalol for gestational hypertension

A 34-year-old at 32/40 with BP 152/98 mmHg × 2 readings, no proteinuria, no symptoms. Started on labetalol 100 mg BD by the ANC.

Prescribe MgSO4 for severe pre-eclampsia and monitor for toxicity

A 28-year-old at 35/40 with BP 168/112, protein 3+, headache, brisk reflexes.

Manage a massive obstetric haemorrhage (simulated arrest)

G3 P2 30 min post SVD, blood loss 1500 mL and continuing, uterus soft, BP 85/50, HR 128.

Counsel newly diagnosed GDM on management

26-year-old at 28/40. OGTT: fasting 5.9, 2-hour 9.4 mmol/L.

Prescribe VTE prophylaxis after LSCS

35-year-old, BMI 42, emergency LSCS at 39/40. Previous unprovoked DVT.

Manage threatened preterm labour at 30/40

G2 P1 at 30/40 with regular contractions, cervix 2 cm, fFN positive.

Contraception choice: migraine with aura

24-year-old with migraine with aura wanting reliable contraception. Non-smoker, BMI 24.

Admit and manage hyperemesis gravidarum

10/40, PUQE score 15, unable to tolerate fluids, ketones 3+, HR 110, dry mucosa.

Counsel on anti-D prophylaxis in a Rh-negative primigravida

Rh-negative primigravida at 12/40 following threatened miscarriage with bleeding.

Methotrexate for tubal ectopic — consent and follow-up

28-year-old with tubal ectopic, hCG 1800, no fetal cardiac activity, minimal symptoms.

Antenatal steroids and MgSO4 for anticipated preterm delivery of MCDA twins

MCDA twins at 28/40 with TTTS stage III; planned delivery within 48 h.

Disclosure of domestic abuse in antenatal clinic

Patient at 20/40 discloses ongoing intimate partner violence.

Prescribing safely in a breastfeeding woman

Postnatal woman with migraine and mild depression, breastfeeding a 3-week-old.

HRT counselling for perimenopausal woman with intact uterus

51-year-old with hot flushes, night sweats, mood swings, LMP 8 months ago. BMI 32.

Assess and manage suspected ovarian torsion

22-year-old sudden-onset RIF pain, vomiting, mass on TVS (6 cm dermoid) with reduced Doppler flow.

Antihypertensive Prescribing in Pregnancy

You are an ST3 obstetric registrar. Mrs Fatima Hassan, 32 years old, is 28 weeks pregnant. She has been admitted with a BP of 158/102 mmHg on two readings 30 minutes apart. She has no symptoms and no proteinuria. She has no known allergies. She is known to have mild asthma managed with a salbutamol inhaler (rarely needed). Her booking BP was 110/70 mmHg.

Eclampsia Management and MgSO4

You are called urgently to a woman on the postnatal ward. Mrs Sarah Thompson, 29 years old, delivered 18 hours ago by CS for pre-eclampsia. She is currently on MgSO4 1g/hr infusion (started at delivery). The midwife reports the patient has just had a 45-second generalised tonic-clonic seizure. She is now post-ictal. BP is 178/115. HR 102.

Emergency Contraception Counselling

Miss Emma Clarke, 23 years old, presents to the sexual health clinic. She had unprotected intercourse 52 hours ago. She is not on regular contraception. She weighs 85kg (BMI 32). She is currently taking carbamazepine for epilepsy. She is anxious and wants "the morning after pill."

Sodium Valproate Counselling (PPP)

Miss Aisha Patel, 26 years old, is attending your neurology clinic. She has epilepsy managed with sodium valproate 1000mg/day. She has been seizure-free for 3 years. She mentions she is in a new relationship and is thinking about having children "in the next year or two." She has never been counselled about valproate in pregnancy.

Postpartum Haemorrhage Drug Management

You are the registrar on call. You are called to the delivery suite. Mrs Grace Okafor, 34 years old, G3P2, has just delivered vaginally at 39 weeks. Estimated blood loss is now 1,400mL from uterine atony. She received 10 IU IM oxytocin at delivery of the anterior shoulder. She has a history of asthma (uses salbutamol inhaler). Her BP on admission was 168/105 (pre-eclampsia). The midwife is asking which drugs to give.

GDM Pharmacological Management

Mrs Priya Sharma, 31 years old, G1P0, 30 weeks pregnant. She was diagnosed with gestational diabetes at 28 weeks. She has been on dietary modification for 2 weeks. Her glucose diary shows: - Fasting: 6.1, 6.4, 5.9, 6.5 mmol/L (targets <5.3) - 1-hour post-breakfast: 8.2, 9.1, 8.8 mmol/L (targets <7.8) - 1-hour post-lunch: 7.5, 8.0 mmol/L (targets <7.8) - 1-hour post-dinner: 7.9, 8.4 mmol/L (targets <7.8)

Pre-eclampsia Risk Counselling and Aspirin

Mrs Blessing Adeyemi, 35 years old, is attending her booking appointment at 11 weeks. This is her second pregnancy. Her first pregnancy was complicated by pre-eclampsia at 34 weeks requiring delivery by emergency CS. She has chronic hypertension managed with methyldopa 250mg BD. She is concerned about whether pre-eclampsia will recur.

Preterm Labour Management

Mrs Amina Ibrahim, 27 years old, G2P1, presents at 29+2 weeks with regular contractions every 5 minutes. Vaginal examination: cervix 2cm dilated, 60% effaced. Membranes are intact. Fetal CTG is reassuring. Temperature 36.8°C, CRP 8. No signs of infection. Her previous baby was born at 36 weeks by normal vaginal delivery. She has no known allergies.

Obstetric Cholestasis Management

Mrs Fatima Al-Rashid, 34 years old, G2P1, presents at 33 weeks with a 2-week history of pruritus affecting her palms and soles, worse at night. No rash. LFTs: ALT 78 IU/L (normal <35). Bile acids: 58 µmol/L. She is anxious and has read online that her baby could "die suddenly."

Anticoagulation in Pregnancy Counselling

Mrs Sophie Chen, 30 years old, is 10 weeks pregnant. She was diagnosed with an unprovoked DVT 4 years ago for which she was anticoagulated with warfarin for 6 months. She has no other medical history. She is not currently on any anticoagulant. She is anxious about her DVT history and asks "Will I need injections during pregnancy?"

Epilepsy in Pregnancy Counselling

Miss Rachel Williams, 24 years old, has focal onset epilepsy managed with sodium valproate 800mg/day. She attends pre-conception counselling with her partner. She has been on valproate for 5 years and is seizure-free. She asks: "Can I just stay on valproate during pregnancy? I've read it can be dangerous but I'm scared of having a seizure."

IVF Counselling and OHSS Prevention

Mrs Nadia Karim, 28 years old, has PCOS and is about to start her first IVF cycle. Her AMH is 62 pmol/L and AFC is 28. Her fertility specialist has told her she is "at high risk of OHSS." She has come to see you for information about OHSS prevention. She is anxious.

Breastfeeding Drug Safety Counselling

Mrs Helen Morrison, 31 years old, has just delivered by CS. She is breastfeeding. She has the following medications: 1. Codeine 30mg QDS (prescribed post-operatively) 2. Sertraline 100mg OD (pre-existing postnatal depression) 3. Labetalol 200mg BD (blood pressure) 4. Enoxaparin 40mg SC OD (VTE prophylaxis) The postnatal ward midwife has asked you to review her medications for breastfeeding compatibility.

Contraception Following DVT

Mrs Gemma Peters, 34 years old, has just completed 6 months of rivaroxaban for a DVT provoked by a long-haul flight. She is now off anticoagulation. She presents requesting to restart the combined oral contraceptive pill (Microgynon 30) which she was on prior to her DVT. She is not pregnant. She is otherwise healthy.

Neonatal Resuscitation Pharmacology

You are a senior registrar. A junior foundation doctor has just attended a difficult delivery and is now asking you to explain neonatal resuscitation pharmacology. The baby, born at 35 weeks, is being resuscitated. HR is 52 bpm despite 30 seconds of effective PPV and 30 seconds of chest compressions.

Thyroid Disease in Pregnancy

Mrs Yasmin Hussain, 29 years old, is 10 weeks pregnant. She has been diagnosed with Graves' disease this week (new diagnosis). TSH <0.01, free T4 38 pmol/L (normal 10–22). She is currently on no medications. She is concerned about treatment affecting her baby.

Postnatal Depression Pharmacology

Mrs Anna Kowalski, 28 years old, is 6 weeks postnatal. She presented to her GP with low mood, anhedonia, poor appetite, and sleep disturbance. Edinburgh Postnatal Depression Scale (EPDS) score is 18/30. She is breastfeeding her baby. She wishes to take medication but is worried about her baby "getting antidepressants through the milk."

Lichen Sclerosus Counselling

Mrs Patricia Hughes, 67 years old, is attending your gynaecology outpatients clinic. She has been diagnosed with vulval lichen sclerosus on biopsy. She has never had this diagnosis before and is very concerned. She asks: "Is this cancer? Do I need surgery? What treatment will I need?"

Antimicrobial Prescribing in Pregnancy

You are a senior obstetric registrar reviewing the admissions board. Three women require antibiotic prescriptions. Review each scenario and prescribe appropriately on the drug charts provided. Scenario A: Mrs Jasmin Osei, 30 years old, 37 weeks, UTI (E. coli — sensitive to nitrofurantoin and cefalexin). Previous normal birth. Scenario B: Mrs Sandra Lee, 28 years old, 28 weeks, P-PROM (no signs of infection). The FY2 has written up co-amoxiclav 625mg TDS on the drug chart. Scenario C: Mrs Hannah Cooper, 34 years old, 34 weeks, confirmed chlamydia trachomatis on NAAT.

Rheumatological Drug Safety in Pregnancy

Mrs Maria Santos, 31 years old, has rheumatoid arthritis managed with: - Methotrexate 20mg weekly - Hydroxychloroquine 400mg daily - Ibuprofen 400mg TDS as needed She attends pre-conception counselling wanting to start trying for a baby "as soon as possible." She is currently using the combined pill.

Induction of Labour and Prostaglandins

Mrs Zara Ahmed, 40 years old, G1P0, is 41+0 weeks pregnant. Her pregnancy has been uncomplicated. Bishop score today is 2. She has been offered IOL and has been told she will be given "a pessary." She is anxious about the process and asks what drugs will be used. She had a previous CS 6 years ago.

Massive Pulmonary Embolism in Pregnancy

Mrs Kezia Mensah, 26 years old, is 28 weeks pregnant. She is admitted with sudden onset dyspnoea, pleuritic chest pain, and haemoptysis after a 14-hour flight. On arrival: BP 78/42, HR 138, SpO₂ 84% on air. ECG: sinus tachycardia. ECHO at bedside: right ventricular dilation, D-shaped left ventricle. CTPA confirms massive bilateral pulmonary embolism.

Sepsis in Pregnancy

Mrs Chidera Obi, 24 years old, G1P0, is 32 weeks pregnant. She is admitted from A&E with a 24-hour history of fever (temperature 39.4°C), rigors, tachycardia (HR 128), hypotension (BP 88/52), and reduced urine output. She has offensive vaginal discharge. Lactate: 4.2 mmol/L. She appears unwell and confused.

Oncology Pharmacology Communication

Mrs Natalie Brown, 38 years old, has been diagnosed with FIGO IIIC high-grade serous ovarian cancer. She has undergone debulking surgery and is about to start chemotherapy. Her oncologist has told her she will receive "carboplatin and paclitaxel." She attends your clinic wanting to understand her treatment. She also tested positive for a BRCA1 mutation.

Postpartum Contraception Counselling

Mrs Amara Diallo, 29 years old, has just delivered her third baby by elective CS 18 days ago. She is exclusively breastfeeding. She is keen to start contraception. She would like "something effective that won't affect my milk." She is otherwise healthy with no medical history.

Anaphylaxis in Pregnancy

Mrs Yemi Adebayo, 26 years old, is 30 weeks pregnant. She is on the antenatal ward receiving IV co-amoxiclav for a skin infection. 5 minutes after starting the infusion, she develops urticaria, facial angioedema, bronchospasm, and her BP falls to 64/38. HR is 148.

Acute Severe Asthma in Pregnancy

Mrs Daniela Costa, 27 years old, is 25 weeks pregnant. She presents to A&E with acute asthma. She is struggling to speak in full sentences. Peak flow: 38% predicted. SpO₂ 92% on air. RR 28/min. She is on salbutamol inhaler and beclomethasone 200mcg inhaler. She has had 4 nebulisers in A&E with partial response.

Recurrent Miscarriage Counselling

Mrs Claire Robertson, 33 years old, attends your recurrent miscarriage clinic. She has had 4 consecutive first-trimester miscarriages. Investigations show: antiphospholipid antibodies positive on 2 occasions 12 weeks apart (lupus anticoagulant + anti-cardiolipin IgG). All other investigations normal. She is currently 6 weeks pregnant (confirmed intrauterine on scan).

Neonatal Jaundice and Drug History

Baby James was born at 38 weeks to Mrs Lucy Tanner, 28 years old, by normal vaginal delivery. He is now 3 days old and has significant jaundice. Total serum bilirubin is 285 µmol/L (above phototherapy threshold). The paediatrician asks you to review the maternal medication history for potential contributory factors.

Contraception for Medically Complex Patient

Mrs Leila Ahmadi, 31 years old, attends your gynaecology clinic requesting contraception. Her medical history: - SLE (currently on hydroxychloroquine 400mg daily and prednisolone 5mg daily) - Antiphospholipid antibodies positive (2 tests) - Previous DVT on warfarin 2 years ago — now off warfarin - Migraines with aura She is in a new relationship and needs "reliable contraception."

Methotrexate for Ectopic Pregnancy

Mrs Emily Clarke, 32 years old, is diagnosed with an unruptured ectopic pregnancy at 6 weeks. Serum β-hCG is 1,450 IU/L. TVUSS shows a 2.1cm right adnexal mass with no cardiac activity. She is haemodynamically stable. She wishes to avoid surgery if possible.

Heavy Menstrual Bleeding — Drug Management

Mrs Joanna Walsh, 38 years old, presents with heavy menstrual bleeding (HMB) for 18 months. She soaks through 8–10 pads per day for 7 days. Hb 95 g/L. TVUSS: normal uterus, no fibroids. She does not want to become pregnant for now. She prefers to try medical management before surgical options.

Medication Review in Third Trimester

Mrs Aisha Okonkwo, 34 years old, is 34 weeks pregnant. She has the following medications on her antenatal drug chart. Review each for safety and correct any errors. Drug Chart: 1. Ibuprofen 400mg TDS PRN — back pain 2. Codeine 30mg QDS PRN — pain 3. Nitrofurantoin 100mg BD — UTI (started today at 34 weeks) 4. Folic acid 400mcg OD 5. Sertraline 100mg OD — depression 6. Labetalol 200mg BD — gestational hypertension

Hyperemesis Gravidarum Management

Mrs Amara Johnson, 22 years old, G1P0, is 9 weeks pregnant. She has been vomiting 10–15 times daily for 3 weeks. She cannot keep down any food or fluids. She has lost 5kg. On examination: dry mucous membranes, HR 108, BP 100/65. Urinalysis: 3+ ketones. Bloods: Na 131, K 3.0, Cl 88, urea 8.2. She has been unable to tolerate oral medications.

Fertility Ovulation Induction Consultation

Mrs Priya Srinivasan, 30 years old, has PCOS. She has been trying to conceive for 18 months. She is anovulatory (LH:FSH ratio 2.5, AMH 65 pmol/L, AFC 28). BMI 29. Her husband's semen analysis is normal. She has been offered "a tablet to help her ovulate." She asks what her options are.

Neonatal Drug Exposure Assessment

Baby Maya, born at 37 weeks, is 3 days old. Her mother, Mrs Sara Blane, 29 years old, took the following medications throughout pregnancy: 1. Lamotrigine 300mg/day (epilepsy) 2. Sertraline 100mg/day (depression) 3. Labetalol 200mg BD (gestational hypertension) The neonatologist asks you to counsel Mrs Blane about what to watch for in her baby related to these medications.

HIV in Pregnancy Counselling

Mrs Amara Diallo, 27 years old, is newly diagnosed with HIV at 18 weeks gestation during routine antenatal screening. Her CD4 count is 480. Her viral load is 45,000 copies/mL. She is shocked and distressed. She asks: "Will my baby get HIV? Can I breastfeed?"

HRT Counselling and Prescribing

Mrs Frances Taylor, 52 years old, attends your menopause clinic. She is post-menopausal (last period 18 months ago). She has been experiencing severe hot flushes, night sweats, and vaginal dryness significantly affecting her quality of life. She has an intact uterus. Her BMI is 31. She had a DVT 5 years ago (provoked by surgery). She has no history of breast cancer.

Overactive Bladder Management

Mrs Dorothy Singh, 65 years old, attends urology outpatients with overactive bladder — urgency, frequency (voiding 12×/day, 4× at night), and urge incontinence. She has tried conservative management (bladder training, caffeine reduction) for 3 months without improvement. She also has mild cognitive impairment and is on donepezil for early dementia. Her BP is well-controlled on amlodipine.

Oncology Treatment Decision — Cervical Cancer

Mrs Ngozi Eze, 42 years old, has been diagnosed with FIGO IIB locally advanced cervical cancer (squamous cell carcinoma). She is otherwise healthy. Her case has been discussed at the MDT and the recommended treatment is concurrent chemoradiation. She attends your clinic to discuss the planned treatment.

Gestational Trophoblastic Disease

Mrs Emma Pearce, 28 years old, had a complete molar pregnancy evacuated 8 weeks ago. She is being followed up in the GTD surveillance clinic. Today, her β-hCG is 2,800 IU/L (was 1,400 two weeks ago — rising, not falling). She meets criteria for gestational trophoblastic neoplasia (GTN). She is distressed and asks: "Do I have cancer? What treatment will I give me?"

Drug Allergy Management in Obstetrics

Mrs Yetunde Adio, 32 years old, is 38 weeks pregnant and in labour. GBS was found on a vaginal swab at 35 weeks. She reports a penicillin allergy — "my arm swelled up last time I had penicillin." The midwife asks you what antibiotic to use for GBS prophylaxis.

Acute Kidney Injury in Pre-eclampsia

Mrs Sarah Fleming, 31 years old, at 36 weeks with severe pre-eclampsia is in the HDU. Her creatinine has risen from 72 to 198 µmol/L over 48 hours. She is on the following medications: 1. IV Labetalol 60mg/hr 2. MgSO4 1g/hr 3. Enoxaparin 40mg SC OD 4. Oral nifedipine MR 60mg/day

Medication Counselling: Starting Metformin in GDM

Mrs Fatimah Bello, 33 years old, is 30 weeks pregnant and has been diagnosed with GDM. Dietary modification for 3 weeks has not achieved glucose targets. She is being started on metformin today. She is worried: "I don't want to take tablets that will harm my baby."

Managing Drug Toxicity in Pregnancy

You are called urgently by the midwife in the delivery suite. Mrs Carmen Lopez, 30 years old, G2P1, 40 weeks, has been on IV MgSO4 2g/hr (maintenance dose prescribed was 1g/hr — a prescribing error has occurred). She is unresponsive, respiratory rate is 6/min, and she has no patellar reflexes. Her SpO₂ is 88% on air.

Urogynaecology — Duloxetine Counselling

Mrs Nicola Grant, 48 years old, has moderate stress urinary incontinence affecting her quality of life. She has completed 4 months of supervised pelvic floor muscle training with limited improvement. She has been offered duloxetine. She asks: "What is this drug? Is it an antidepressant? Will it help me?"

Prescribing for Postnatal Contraception After Breast Cancer Treatment

Mrs Victoria Hughes, 38 years old, was treated for breast cancer 3 years ago (right breast lumpectomy + radiotherapy + tamoxifen). She is now in remission. She has recently delivered her second baby by CS 6 weeks ago (planned pregnancy was carefully discussed with her oncologist). She is formula-feeding and requests contraception.

Metoclopramide Prescribing Error

You are reviewing the obstetric drug charts on the postnatal ward. You discover that Mrs Rachel Brown, 26 years old, G1P1, has been prescribed metoclopramide 10mg TDS. According to the drug chart, she has been on it for 10 days since being admitted with hyperemesis. She is now 12 weeks pregnant and improving. She has had no documented side effects so far.

Pharmacology of Peripartum Cardiomyopathy

Mrs Hadiza Bello, 33 years old, G2P1, delivered 5 days ago by CS. She presents with progressive dyspnoea, orthopnoea, and bilateral ankle oedema. Echo confirms LVEF 28% (significantly reduced). Diagnosis: peripartum cardiomyopathy (PPCM). She is breastfeeding.

Final Integration Station: Complex Pharmacological Decision

Mrs Jemima Osei, 34 years old, attends at 32 weeks pregnant. She has the following medical history: - Epilepsy — on lamotrigine 350mg/day (escalated from 200mg) - Type 1 diabetes — insulin pump therapy - Asthma — salbutamol + beclomethasone - Pre-eclampsia diagnosed today: BP 162/108, urine PCR 78mg/mmol, headache She has no other allergies. You must manage her pre-eclampsia while being mindful of her complex background.

Manage Shoulder Dystocia

You are the obstetric registrar called to a spontaneous vaginal delivery where the fetal head has delivered but retracted against the perineum ('turtle sign'), and gentle traction has failed to deliver the shoulders.

Manage Umbilical Cord Prolapse

A woman at 38 weeks has spontaneous rupture of membranes on the labour ward. The midwife calls you urgently — the umbilical cord is visible at the introitus and the CTG shows a prolonged deceleration.

Recognise and Manage Acute Uterine Inversion

Immediately after delivery of the placenta by controlled cord traction, the woman becomes acutely hypotensive and complains of severe abdominal pain. On examination, the uterine fundus is not palpable abdominally and a mass is visible at the introitus.

Assess Antepartum Haemorrhage

A woman at 34 weeks presents with sudden painless vaginal bleeding, approximately 200mL. She is haemodynamically stable. Placental location is not yet known this pregnancy.

Counsel on Breech Presentation at Term

A woman at 36 weeks is found to have a breech presentation on routine examination, confirmed by ultrasound (frank breech, no other complicating factors).

Consent for Instrumental Vaginal Delivery

A woman in the second stage of labour has an epidural in situ and is now fully dilated with a prolonged active second stage. The fetal head is at station +2, direct occipito-anterior position. You plan an instrumental delivery.

Manage Retained Placenta

A woman has just delivered vaginally. 45 minutes later, the placenta has not delivered despite active management of the third stage, and she has ongoing minimal bleeding.

Consent for Repair of Third-Degree Perineal Tear

A woman has sustained a 3b degree perineal tear (>50% external anal sphincter torn) following vaginal delivery. It requires formal repair in theatre.

Assess Reduced Fetal Movements

A woman at 32 weeks presents reporting reduced fetal movements over the past day, first pregnancy, otherwise low risk.

Counsel on Monochorionic Twin Pregnancy Surveillance

A woman is newly diagnosed with a monochorionic diamniotic (MCDA) twin pregnancy at 12 weeks.

Break News of Suspected Intrauterine Death

A woman at 36 weeks attends with reduced fetal movements. Ultrasound confirms no fetal cardiac activity.

Counsel on PCOS Management and Fertility Options

A 27-year-old with PCOS (irregular cycles, hirsutism, BMI 33) is not currently trying to conceive but wants to understand her condition and options.

Counsel on Endometriosis Management Options

A 24-year-old presents with severe dysmenorrhoea, dyspareunia, and chronic pelvic pain, with a clinical suspicion of endometriosis.

Discuss Surgical Options for Heavy Menstrual Bleeding

A 44-year-old with heavy menstrual bleeding has failed medical management (LNG-IUS not tolerated, tranexamic acid insufficient). Fibroids and malignancy have been excluded.

Counsel on Fibroid Management Options

A 38-year-old with a single 6cm intramural fibroid presents with heavy menstrual bleeding and pelvic pressure. She wishes to preserve fertility.

Counsel on Osteoporosis Risk and HRT in Early Menopause

A 42-year-old presents with premature ovarian insufficiency, confirmed on hormone testing, and is concerned about long-term health risks.

Counsel on an Abnormal Cervical Screening Result

A 32-year-old's routine cervical screening shows high-risk HPV positive with high-grade dyskaryosis. She is anxious and has read online that this means cervical cancer.

Counsel on Ovarian Mass Risk Assessment (RMI)

A 58-year-old postmenopausal woman is found to have a complex ovarian cyst on ultrasound, with an elevated CA125.

Counsel on Options for Termination of Pregnancy

A woman at 9 weeks gestation has decided she wishes to end her pregnancy and has come to discuss her options.

Counsel Following Third Consecutive Miscarriage

A woman has just had her third consecutive first-trimester miscarriage. She is distressed and asks 'why does this keep happening to me?'

Initial Fertility Assessment Consultation

A couple, both 31 years old, have been trying to conceive for 14 months without success. Female partner has regular cycles.

Counsel on Suspected Vasa Praevia

A routine anomaly scan at 20 weeks identifies findings suspicious for vasa praevia, confirmed on targeted ultrasound with colour Doppler.

Counsel on Cervical Cerclage for Cervical Insufficiency

A woman with a history of a previous second-trimester loss attributed to painless cervical dilation is now 13 weeks in a new pregnancy.

Manage Primary Genital Herpes in the Third Trimester

A woman at 34 weeks presents with a first episode of genital herpes, confirmed on swab.

Recognise and Manage Suspected Amniotic Fluid Embolism

During active labour, a woman suddenly becomes acutely breathless, hypotensive, and confused, followed rapidly by cardiovascular collapse and coagulopathy.