A primigravida is in two hours of cervical full dilation. The fetal head is 1/5th palpable on abdominal examination. The vertex is at level of ischial spine, the occiput is at left maternal pelvis with fetal head sutures overlapped and not reducible. The contraction is 3 in 10 minutes on oxytocin.

Which is your most immediate action?

A 30-year-old G2P1 with grade 3 haemorrhoid had vacuum assisted delivery due to prolonged second stage of labour. Post delivery, she is not able to sit due to severe pain at the perineum. Her pulse rate is 120 bpm. However, her blood pressure is 90/50mmHg. Abdominal examination reveals contracted uterus at 20 weeks size. There is no active bleeding from the vagina.

What is the most likely diagnosis?

A 35-year-old woman, Para 3+1, three months post suction and curettage for molar pregnancy presents with profuse vaginal bleeding. She defaulted follow up after the surgery. Pelvic ultrasound shows enlarged uterus with an intracavitary heterogeneous mass and beta human chorionic gonadotropin level is increasing in trend.

What is the next management?

A 35-year-old lady, G1P0 at 38 weeks delivered her first twin baby three minutes ago. The second twin is in an oblique lie with the head in maternal right iliac fossa. The fetal heart rate is normal. The amniotic membrane is intact.

What is your next step in management?

A 21 years old lady presents with severe vulva pain and inability to pass urine for the past 24 hours. On examination, she has significant bilateral labial oedema and multiple small ulcers on both labia minora.

What is the most likely causal organism for her condition?

A 22-year-old single sexually active lady, presents to emergency department with fever, lower abdominal pain and evidence of genital tract tenderness on examination.

What is your immediate investigation?

A 45-year-old Para 4 is admitted for symptomatic anaemia secondary to heavy menstrual bleeding associated with dysmenorrhoea. This is the second admission for similar symptoms. Her body mass index is 37 kg/m2. Examination reveals suprapubic mass equivalent to 12 weeks size of gravid uterus. Ultrasound examination shows asymmetrical thickening of the posterior uterine wall with normal endometrial lining.

What is the most suitable management option for this patient?

A 27-year-old lady who is on combined oral contraceptive pill misses one of her pills. She started the current pack four days ago. She had unprotected sexual intercourse a day prior to the missed pill.

What is the next immediate step of management?

You are the medical officer in charge of labour room and the staff nurse informs you of a newborn with ambiguous genitalia.

What is the most immediate investigation you would review?