Case Discussion
Clinical teaching and practical ideas for your next study session.
ICP Bile Acid Trends: What a Rising Result After UDCA Means
When itching and serial bile-acid results diverge, separate symptom response from the lab trend, standardize sampling, and interpret results after UDCA with the assay in mind.
Appendectomy at 22 Weeks: Make Fetal Monitoring Actionable
At 22 weeks, the obstetric task around urgent appendectomy is not blanket monitoring or prophylactic tocolysis. Build a periviable plan that makes surveillance actionable and responds to actual labor.
Repaired Tetralogy of Fallot in Labor: Plan Around RV Dysfunction
A repaired Tetralogy of Fallot does not automatically call for cesarean or forceps. Learn how residual pulmonary regurgitation and right-ventricular function shape labor analgesia, the second stage, and postpartum monitoring.
After Preeclampsia at 33 Weeks: Build the Postpartum Handoff
A delivery for severe preeclampsia should lead to more than a discharge diagnosis. Learn how to hand off postpartum blood-pressure care, long-term risk assessment, and planning for another pregnancy.
Fetal Goiter in Graves Pregnancy: Read the Thyroid Before Changing the Dose
An enlarged fetal thyroid in a Graves pregnancy does not reveal whether the fetus is hyperthyroid or hypothyroid. Learn how antibodies, medication exposure, and ultrasound findings shape the next step.
Gestational Diabetes and a Large 32-Week Fetus: Does Size Mean Cesarean?
A 32-week fetus above the 95th percentile in a gestational-diabetes pregnancy raises concern, but it does not choose cesarean birth. Separate fetal size from the 4,500-g counseling threshold and account for ultrasound uncertainty.
Oligohydramnios Does Not Dictate the Cervical-Ripening Method
At 42+3 weeks with decreased fetal movement and a 1.6-cm deepest fluid pocket, delivery is the direction of travel. But low fluid alone does not make a Foley balloon mandatory or prostaglandins forbidden.
Fever After PPROM: When One Additional Sign Changes Management
An illustrative 31-week PPROM case tests a specific threshold: fever of 38.0–38.9°C plus fetal tachycardia supports suspected intra-amniotic infection. Learn why that changes management without requiring culture confirmation or cesarean delivery.
Preterm Labor at 29 Weeks: What a Short Delay Can—and Cannot—Buy
At 29 weeks, the key question is whether a short delay is safe—and what it will accomplish. Separate the roles of tocolysis, steroids, magnesium, GBS prophylaxis, and transfer.
After Trauma in Pregnancy, What the Kleihauer-Betke Test Should Change
After trauma with bleeding, the Kleihauer-Betke test estimates fetomaternal hemorrhage to refine RhIG dosing. Learn why it cannot diagnose abruption, replace fetal monitoring, or decide whether prophylaxis is indicated.
Low TSH in Hyperemesis Gravidarum: When to Treat the Thyroid
At 10 weeks, a suppressed TSH and mildly elevated free T4 may reflect hCG-mediated gestational transient thyrotoxicosis rather than Graves disease. Learn which clues change the work-up and when thyroid-directed treatment is warranted.
Before Methotrexate: Is the Adnexal Finding Really Ectopic?
An empty uterus, a slow β-hCG rise, and an adnexal finding raise concern—but do they establish ectopic pregnancy? Learn what evidence should guide the next step before methotrexate.