1. Hypertension at 32 weeks

• Probable diagnosis: Gestational hypertension.
• Diagnostic criteria:
  1. New-onset BP ≥140/90 mmHg after 20 weeks of gestation.
  2. Previously normal BP.
  3. No proteinuria or features of pre-eclampsia.
  Her BP is 150/100 mmHg at 32 weeks with no proteinuria, fitting gestational hypertension. ACOG criteria support this definition.
• Any two complications:
  • Progression to pre-eclampsia/eclampsia
  • Placental abruption
  • Preterm birth
  • Fetal growth restriction / low birth weight

2. Fatigue, weakness, giddiness and pallor at 28 weeks

• Condition: Garbhiṇī Pāṇḍu, clinically corresponding to anaemia in pregnancy, commonly iron-deficiency anaemia.
• Any two clinical features of Garbhiṇī Pāṇḍu:
  • Pandutva - pallor of skin, conjunctiva, tongue, nail beds, and palmar creases
  • Daurbalya - weakness
  • Shrama - easy fatigability
  • Bhrama - giddiness
  • Hṛdspandana - palpitations
  • Shwasa - breathlessness on exertion
• One investigation to confirm:
  Complete blood count, especially haemoglobin estimation. At 28 weeks, Hb <10.5 g/dL supports anaemia in pregnancy. Serum ferritin can help confirm iron deficiency. Merck diagnostic criteria

3. Visible part of Question 3

3. Elevated glucose after 75 g oral glucose test at 26 weeks

• Most likely diagnosis: Gestational diabetes mellitus (GDM).
• Any two risk factors:
  1. Previous history of GDM or previous macrosomic baby.
  2. Maternal obesity / overweight.
  Other acceptable answers: family history of type 2 diabetes, PCOS, advanced maternal age, previous unexplained stillbirth.
• One important management measure:
  Medical nutrition therapy with regular blood-glucose monitoring and appropriate exercise. Insulin is added if glucose targets are not achieved with diet and activity.

4. Male infertility with left-sided dilated tortuous veins

• Probable diagnosis: Left-sided varicocele.
• Effect on male fertility:
  Varicocele raises scrotal/testicular temperature and causes impaired spermatogenesis, resulting in reduced sperm count, decreased motility, and abnormal morphology, hence subfertility.
• Chikitsa siddhanta of Vandhyatva:
  Nidāna parivarjana followed by doṣha-pratyanīka chikitsā to restore normal Ārtava/Shukra and reproductive function. Shodhana or Shamana treatment may be selected according to doṣha and clinical condition.
• One treatment option for this condition:
  Varicocelectomy, preferably microsurgical varicocelectomy. Varicocele repair can improve fertility in men with clinical varicocele and abnormal semen parameters. Bailey & Love's Short Practice of Surgery, varicocele treatment section. Recent systematic reviews also support improved assisted-reproduction outcomes after varicocelectomy in selected infertile men (PubMed PMID 40293106).

5. Failure to conceive for 2 years with regular unprotected intercourse

• Definition of infertility:
  Failure to achieve pregnancy after 12 months of regular, unprotected sexual intercourse.
  This patient has primary infertility, since she has not conceived previously.
• Any four investigations for female infertility:
  1. Transvaginal ultrasonography of pelvis.
  2. Ovulation assessment by mid-luteal serum progesterone.
  3. Hormonal profile: FSH, LH, prolactin, TSH, and AMH if needed.
  4. Hysterosalpingography (HSG) for tubal patency.
  Other acceptable tests: diagnostic laparoscopy with chromopertubation, hysteroscopy, endometrial assessment, and ovarian reserve testing.
• Assessment of ovulation:
  • Mid-luteal serum progesterone, usually about 7 days before the next expected menses.
  • Alternatively, serial follicular ultrasonography or urinary LH surge kit.
• Assessment of tubal patency:
  • Hysterosalpingography (HSG) is the usual first-line test.
  • Laparoscopy with chromopertubation is used where indicated and is the confirmatory method.