The 2027 Obstetrics & Gynaecology ST3 Interview Revision Platform: Question Bank, Live Practice and Mocks with Other Candidates

I'd see Patient 3 first, then Patient 1, then Patient 4, then Patient 2.

Patient 3 first: severe hypertension at 172/122 in the context of pre-eclampsia is an immediate maternal risk that can progress quickly to eclampsia, HELLP, stroke, pulmonary oedema or abruption, so she needs urgent assessment and blood pressure control even though the CTG is currently normal. Patient 1 next: pushing with no presenting part visible and intermittent decelerations raises concern about malposition or obstructed labour. Patient 4 third: a high-risk pregnancy with a growth-restricted fetus, but labour is progressing and the CTG is reassuring. Patient 2 last: latent labour with a normal CTG and no acute maternal or fetal concern.

I'd confirm the reading with an appropriate cuff and check it's sustained at 160/110 or above, take full maternal observations, and screen for features of severe disease: headache, visual disturbance, epigastric or right upper quadrant pain, nausea or vomiting, oliguria and altered mental state. On examination I'd check reflexes and clonus, assess the abdomen and fundal height, keep continuous CTG monitoring and dip the urine. Investigations: FBC for platelets, U&Es, LFTs, a coagulation screen and group and save, a protein:creatinine ratio to quantify proteinuria, and urate to help gauge severity.

I'd escalate early to the consultant obstetrician and anaesthetic team and manage her in a maternity HDU setting. To stabilise her: left lateral tilt, two cannulas, fluid restriction to around 80ml/hour to avoid pulmonary oedema, and a catheter with hourly urine output on a strict fluid-balance chart. For blood pressure, aiming for roughly 135 to 145 over 85 to 95 and avoiding sudden drops, I'd start oral labetalol first line, add nifedipine if needed, and escalate to IV labetalol or hydralazine if she doesn't respond. Given the severe hypertension I'd give magnesium sulphate for seizure prophylaxis, typically a 4g loading dose followed by 1g per hour, continued for 24 hours. I'd monitor closely, plan delivery with continuous CTG, continue the epidural unless she's thrombocytopenic, avoid ergometrine and use an oxytocin infusion for the third stage, and I would not delay delivery if she or the baby deteriorated.

I'd check the platelet count and, importantly, whether she's on low molecular weight heparin and at what dose. Regional anaesthesia should be avoided within 12 hours of a prophylactic dose and 24 hours of a therapeutic dose, so that timing would shape whether an epidural is safe.

Patient 1: a full abdominal and vaginal examination to assess for malposition or obstructed labour, escalating if there's no descent after two hours of active pushing or sooner if the CTG becomes abnormal, with instrumental delivery or a category 2 caesarean as appropriate. Patient 2: confirm the timing of her last LMWH dose, avoid an epidural within 12 hours of a prophylactic dose, and give routine intrapartum monitoring. Patient 4: continuous CTG given the growth-restricted fetus, checking labour is progressing with normal observations, and escalating early if the trace is non-reassuring.