III.A. situational problems on diagnostics in obstetrics and gynecology
Diagnostic problem 1A
Pregnant with severe form of preeclampsia admitted into pathologic pregnancy department.
Complete blood count (CBC): Hb – 128 g/L, L – 7.5 x 109/L, PCV – 42%, platelets 150.000
Urinalysis: urinary protein 4 g/L, L- 3-4- in f/v
Total blood protein – 50 g/L
Urinary creatinine – 300 mmol/L
Oculist’ advice – spasm of retinal vessels, edema.
1. Estimate the result of laboratory investigations.
Estimate the result of oculist’ examination.
Diagnostic problem №1A
Estimate the results of examinations:
Increased packed cell volume (PCV) – 42%, and decreased platelet (150.000) in CBC, proteinuria (4g/L) – in urinalysis; hypoproteinemia (50g/L) , increased creatinine level (300 mmol/L) in biochemical investigations of blood prove severe Preeclampsia.
Estimate Oculist’ advice:
The spasm of vessels of retina and edema testifies to the initial signs of head cerebral edema that may lead to encephalopathy.
Diagnostic problem 2A
The pregnant with placenta previa and vaginal bleeding has been brought to the maternity hospital by ambulance.
CBC: Hb – 87 g/L, erythrocytes 2.5 x 1012/L, L – 8.5 x 109/L, ESR – 10 mm/h.
Total blood protein – 57 g/L
US – placenta located in the lower uterine segment, covering internal os.
Estimate the result of laboratory investigations.
Estimate the result of US.
Diagnostic problem №2A
1. Estimate the results of examinations: decreased Hb level (87g/L), red blood cells level (2,5х1012/L) in CBC; decreased whole protein (57g/L) prove the anemic condition in patient.
2. Estimate US data: placenta is in the lower uterine segment, the internal cervical os is totally covered up with placenta confirm the diagnosis of placenta previa.
Diagnostic problem 3A
The pregnant with severe preeclampsia admitted to maternity hospital.
CBC: Erythrocytes – 3.9 x 1012/L, Hb – 125 g/L, L – 7.3 x 109/L, PCV – 42%, platelets – 150x109/L.
Urinalysis: urinary protein – 4 g/L, L – 3-5 in f/v, hyaline casts – 2-3 in f/v.
Total blood protein – 52 g/L
Creatinine – 300 mmol/L
Cardiotocogram (CTG) of the fetus: nonstress test is positive. Index of the fetal condition – 2.5
Estimate the result of laboratory investigations.
Estimate the result of instrumental investigation.
Diagnostic problem №3A
1. Estimate the results of examinations: increased PCV ( 42%), decreased platelets (150.000) in CBC; proteinuria(4 g/L), cylindruria ( 2-3 in f/v) in urinalysis, decreased whole protein (52g/L), increased creatinine (300 mmol/L) confirm severe preeclampsia.
2. Estimate CTG results: increased index of the fetal condition (2.5) proves intrauterine fetal hypoxia because severe preeclampsia.
Diagnostic problem 4A
The patient with incomplete miscarriage in 10-11 weeks of gestation delivered into gynecological department.
CBC: Erythrocytes – 2.5 x 1012/L, Hb – 82 g/L, L – 6.5 x 109/L, ESR – 10 mm/hr/
Urinalysis: urinary protein, glucose is absent, L – 3-4 in f/v, urates.
US: echo-free formation 2x3 cm in size is founded in the uterine cavity
Estimate the result of laboratory tests.
Estimate the result of US.
Diagnostic problem №4A
1. Estimate the results of examinations.
Decreased red blood cells (2.5x1012 g/L), decreased HB (82 g/L) proves anemic condition because of hemorrhage.
2. Estimate US findings.
The hypoechogenic area 2x3centimeters in size in the uterine cavity proves remains of the fertilized ovum followed with hemorrhage.
Diagnostic problem 5A
The expectant mother with 43weeks of pregnancy admitted into pathologic pregnancy department.
CBC: erythrocytes – 4.5 x 1012/L, Hb – 135 g/L, L – 3.5 x 109/L, ESR – 12 mm/h, reticulocytes – 2%.
Urinalysis: urinary protein – 0.033 g/L, L -2-3 in f/v, hyaline casts – 2-3 in f/v., oxalates.
Colpocytology: superficial cells – 42%, intermediate – 58%.
US: petrifaction zones and hyaline degeneration are founded.
CTG: nonstress test is positive. Index of the fetal condition – 3, 0
Estimate the result of laboratory tests
Estimate the result of US and CTG.
Diagnostic problem №5A
1. Estimate the results of examinations.
1. Estimate result of examination: increased reticulocytes (2%) in CBC, prevalence of intermediate cells (58%) in colopocytology confirm post term pregnancy;
2. Estimate US and CTG findings.
Petrification and hyaline degeneration sites in placenta, increased index of the fetal condition (3.8) prove post term pregnancy and intrauterine fetal hypoxia, characteristic for post term pregnancy.
Diagnostic problem 6A
Intrauterine fetal hypoxia, which is happened due to anemia, was diagnosed in maternity welfare centre in pregnant with 30 weeks of gestation.
CBC: erythrocytes – 2.5 x 1012/L, Hb – 90 g/L, L – 3.5 x 109/L, ESR – 8 mm/h, anisocytosis, poikilocytosis.
Urinalysis: urinary protein – 0.5 g/L, L – 3-4 in f/v, glucose is not founded.
Total blood protein – 58 g/L
CTG: nonstress test is positive. Index of the fetal condition – 2.8
US: the 2nd degree of placental ripening.
Estimate the result of laboratory tests
Estimate the result of US and CTG.
Diagnostic problem №6A
1. Estimate the results of examination:
Decreased red blood cells count 92.5x1012/L), decreased HB level (90g/L), presence of anisocytosis and poikilocytosis in CBC; decreased whole protein (58 g/L) confirm anemia in pregnant woman.
2. Estimate CTG and US findings:
Increased index of the fetal condition (2.8), the 2nd degree of placental ripening confirm anemia in mother.
Diagnostic problem 7A
The pregnant women with 36 weeks of gestation, twins, and mild preeclampsia admitted into pathologic pregnancy department.
CBC: erythrocytes – 2.8 x 1012/L, Hb – 92 g/L, L – 7.3 x 109/L, ESR – 12 mm/h, PCV – 38%, platelets – 150 x 109/L.
Urinalysis: urinary protein – 1 g/L, L – 3-4 in f/v, glucose is not founded.
Total blood protein – 65 g/L
CTG of the 1st fetus: nonstress test is positive. Index of the fetal condition – 0.5
CTG of the 2nd fetus: nonstress test is positive. Index of the fetal condition – 2.5
Estimate the result of laboratory tests
Estimate the result of CTG.
Diagnostic problem №7A
1. Estimate the results of examination:
Decreased red blood cell count (2.8x1012/L), decreased HB level (92 g/L0, decreased platelets (150x109/L), increased hematocrit (38%); proteinuria (1 g/L0 in urinalysis confirm the diagnosis of mild preeclampsia and anemia.
2. Estimate CTG and US findings;
Increased index of the fetal condition (2.5) shows intrauterine fetal hypoxia.
Diagnostic problem 8A
The expectant mother was referred to maternity hospital with diagnosis: 36th week of pregnancy. Rh isoimmunization.
CBC: erythrocytes – 3.7 x 1012/L, Hb – 128 g/L, L – 6.8 x 109/L, ESR – 11 mm/h.
Antibody dilution - 1:64
US: “diadem” symptom, “Buddha” posture revealed, placenta’ size – 21 x 22 cm, thickness – 6 cm.
CTG of the fetus: nonstress test is negative. Index of the fetal condition – 3.5
Estimate the result of laboratory tests
Estimate the result of CTG.
Diagnostic problem №8 A
1. Estimate the results of examination:
Antibody titer 1.64 corroborates rh-incompatibility.
2. Estimate CTG and US findings:
“Crown: symptom and “Buddha position, increased placental size and thickness” help to corroborate rhesus incompatibility as well as increased index of the fetal condition (2.8) help to corroborate the rhesus incompatibility diagnosis.
Diagnostic problem 9A
The pregnant admitted into pathologic pregnancy department with diagnosis: 32 weeks of gestation, diabetes mellitus I type and moderate severity.
CBC: erythrocytes – 4.1 x 1012/L, Hb – 130 g/L, L – 3.8 x 109/L, ESR – 12 mm/h.
Blood glucose: 11.5 mmol/L.
Urinalysis: urinary protein – 0.033 g/L, L – 35-40 in f/v, urinary glucose 1.5%.
CTG: nonstress test is positive. Index of the fetal condition – 1.5. Basal rhythm – 175 bpm.
Diagnostic problem №9 A
1. Estimate the results of examination:
Glycemia (11.5 mmol/L) in blood tests, glucosuria (1.5%) in urinalysis, as well as leucocyturia (35-40) prove the diabetes mellitus in pregnant.
2. Estimate CTG findings:
Increased index of the fetal condition (1.5), as well as increased basal rhythm (175 bpm) corroborates intrauterine fetal distress.
Diagnostic problem 10A
The pregnant with 37 weeks of pregnancy, total placenta previa and vaginal bleeding has been brought to the maternity hospital by ambulance.
CBC: Erythrocytes – 2.3 x 1012/L, Hb – 90 g/L, L – 7.3 x 109/L, ESR – 13 mm/h.
Urinalysis: urinary protein and glucose are absent, L – 3-4 in f/v, urates.
US: echo-free tissue the internal uterine os fully covered with echo-free tissue.
CTG: nonstress test is positive. Index of the fetal condition – 1.5. Basal rhythm – 175 bpm.
Estimate the result of laboratory tests
Estimate the result of US and CTG.
Diagnostic problem №10A
1. Estimate the results of examination:
Decreased red blood cells (2,3х1012/L), decreased hemoglobin level (90 g/L) in CBC prove the diagnosis of bleeding
2. Estimate CTG and US findings:
Revelation of echo-free tissue, overlaying the internal os of the cervix; increased index of the fetal condition ( 1.5), as well as increased basal rhythm ( 175 bpm) indicate central placenta previa and intrauterine fetal distress.
Diagnostic problem 11A
The pregnant women with acute pyelonephritis and intrauterine fetal hypoxia admitted into pathologic pregnancy department.
CBC: Erythrocytes – 4.2 x 1012/L, Hb – 105 g/L, L – 15.7 x 109/L, ESR – 27 mm/h.
Urinalysis: urinary protein 0.33g/L, urinary glucose is absent, L – 35-40 in f/v.
US: placenta is of 16 x 16.5 cm in size, its thickness is 2 cm.
CTG of the fetus: Basal rhythm – 180 bpm. Index of the fetal condition – 2.7.
Estimate the result of laboratory tests
Estimate the result of CTG.
Diagnostic problem №11A
1. Estimate the results of examination:
Decreased HB level (1056 g/L), increased leukocyte number (15.7 x 109/L), increased ESR (27 mm/h) in CBC; proteinuria (0.33g/L), leukocyturia (35-40) in urinalysis; leukocyturia in Nechiporenco’ test indicate inflammatory process in kidney.
2. Estimate CTG and US findings:
Increased placental size (16x16.5 cm) and thickness (2 cm), increased index of the fetal condition (2.7) and increased basal rhythm (180 bpm) indicate intrauterine fetal hypoxia.
Diagnostic problem 12A
The pregnant woman with viral hepatitis A delivered into observation obstetrical department.
CBC: Erythrocytes – 3.2 x 1012/L, Hb – 126 g/L, L – 13.0 x 109/L, ESR – 18 mm/h.
Blood bilirubin – 26.2 μmol/L.
Alanine transaminase -2.86 μmol/L.
Aspartate aminotransferase, (AST)– 3.42 μmol/L.
CTG of the fetus: Basal rhythm – 180 bpm. Index of the fetal condition – 2.8
Estimate the result of laboratory tests
Estimate the result of CTG.
Diagnostic problem №12A
1. Estimate the results of examination:
Increased leukocyte number (13.0x109/L), increased ESR (18 mm/h) in CBC; increase bilirubin amount (26.2 micromole/L), (AST)
2. Estimate CTG findings:
Diagnostic problem 13A
The expectant mother was referred to maternity hospital with diagnosis: 34th week of pregnancy. Dropsy.
CBC: erythrocytes – 3.2 x 1012/L, Hb – 138 g/L, L – 7.3 x 109/L, ESR – 12 mm/h.
Urinalysis: urinary protein and urinary glucose are absent, L – 3-5 in f/v.
Total blood protein – 52 g/L.
Blood electrolytes: K – 4.23 mmol/L;
Na – 164.3 mmol/L;
Cl – 124 mmol/L.
US: monochorionic, biamniotic twins revealed.
Estimate the result of laboratory tests
Estimate the result of US.
Diagnostic problem №13 A
1. Estimate the results of examination:
Increased number of Na (164.3 mmol/L) and Cl (124 mmol/L), and decreased whole protein (52 g/L) in blood tests indicate dropsy in pregnancy.
2. Estimate US findings:
Revelation of twins indicates multiple pregnancy.
Diagnostic problem 14A
The pregnant women with exacerbation of chronic pyelonephritis admitted into pathologic pregnancy department.
CBC: erythrocytes – 3.7 x 1012/L, Hb – 127 g/L, L – 17.3 x 109/L, ESR – 25 mm/h.
Urinalysis: urinary protein – 0.033 g/L, L -50-60 in f/v, urates.
Nechiporenko urine test: L – 14.0 x 109/L, erythrocytes – 2.0 x 109/L.
Urea: 7.5 mmol/L.
Creatinine – 110 mmol/L.
CTG: basal rhythm – 140 bpm. Index of the fetal condition – 0.5
Estimate the result of laboratory tests
Estimate the result of CTG.
Diagnostic problem №14A
1. Estimate the results of examination:
Leukicytosus (17.3 x 109/L) and increased ESR ( 25 mm/h); proteinuria (0.33 g/L), leukocyturia (50-60 in f/v) in urinalysis: leukocyturia 14.0 x109/L): in Nechiporenko’ test, increased amount of urea (7.5 mkmol/L), increased creatinine (110 mmol/L) indicate exacerbation of chronic pielonephritis.
2. Estimate CTG findings:
Normal finding in CTG (index of the fetal condition 0.5 and basal rhythm 140) indicate satisfactory fetal condition.
Diagnostic problem 15A
The pregnant woman with puerperal sepsis delivered into observation obstetrical department.
CBC: erythrocytes – 2.3 x 1012/L, Hb – 87 g/L, L – 25.3 x 109/L, shift to the left, ESR – 42 mm/h.
Urinalysis: urinary protein – 0.165 g/L, urinary glucose is not founded, L – 3-5 in f/v.
Urea: 79.3 mmol/L
Blood bilirubin – 30 μmol/L.
Zimnitsky urinary test: nocturnal diuresis is prevalent, specific gravity – 1010 – 1020; diuresis – 1200 mL.
Electrocardiogram - sinus rhythm, electrical axis of heart is horizontal, apical systolic murmur.
Estimate the result of laboratory tests
Estimate the result of electrocardiogram.
Diagnostic problem №15 A
1. Estimate the results of examination:
Decreased red blood cells number (2.3x1012/L), decreased hemoglobin level (87 g/L), leukocytosis (25x109/L), increased ESR (42 mm/h), chift to the left in CBC, proteinuria (0.165 g/L) in urinalysis, increased level of urea 9.3 mkmol/L) increased bilirubin level (30 vvol/L) prevalence of nocturnal urination , isosthenuria (1010-1020) in Zimnitcky’ test indicate sepsis.
2. Estimate electrocardiogram (ECG) findings:
Changes of the electrical axis of heart, systolic noise on an apex also confirm the diagnosis of sepsis.
Diagnostic problem 16A
The patient with left pyosalpinx delivered into gynecological department.
CBC: erythrocytes – 4.5 x 1012/L, Hb – 135 g/L, L – 15.0 x 109/L, ESR – 30 mm/h., stab neutrophils – 15%.
US: to the left of the uterus there is a formation (uterine tube) 4 x 9 cm in size, with irregular echostructure, fluid-filled (pus?).
Estimate the result of laboratory tests
Estimate the result of US.
Diagnostic problem №16 A
1. Estimate the results of examination:
Leukocytosis (15.0x109/L), increased ESR (30 mm/h), increased banded neutrophil(15%) prove purulent process.
2. Estimate CTG findings:
Finding out tumor like formation leftward of uterus of inhomogeneous inUS and gap-filling liquid confirms a diagnosis of pyosalpinx.
Diagnostic problem 17A
The patient with chronic double-sided salpingitis, focal tuberculous endometritis, and primary infertility admitted into gynecological department.
CBC: without peculiarity
Urinalysis: without peculiarity.
Pirquet's reaction- -positive.
Mantoux test – negative.
Microbiological investigation: menstrual blood inoculation revealed Mycobacterium tuberculosis.
X-Ray examination: organs of thoracic cavity without pathological changes.
Metrosalpingography: uterine tubes are impassable, they view is varicose.
Estimate the result of tuberculin tests and microbiological investigation.
Estimate the result of metrosalpingography.
Diagnostic problem №17 A
1. Estimate the results of tuberculin test and inoculation of menstrual blood:
Positive Pirquet's reaction, detection of tuberculosis (T.B.) mycobacteria in menstrual blood indicate the diagnosis of T.B.
2. Estimate metrosalpingography findings:
Fallopian tubes’ obstructions, bead-like shape of the tube also prove T.B. of uterine tube.
Diagnostic problem 18A
The patient with dysfunctional climacteric bleeding admitted into gynecological department.
CBC: erythrocytes – 2.5 x 1012/L, L – 3.5 x 109/L, Hb – 90 g/L, ESR – 8 mm/h, anisocytosis, poikilocytosis.
Histological study of endometrial scraping revealed hyperplasia glandulocystica.
Estimate the result of laboratory tests
Estimate the result of histological study of endometrial scraping.
Diagnostic problem №18A
1. Estimate the results of examination:
Decreased red blood cells number (2.5x1012/L), decreased hemoglobin level (90 g/L), anisocytosis and poikilocytosis in CBC indicate anemia.
2. Estimate findings of histological examination of endometrial scraping specimen.
Glandulocystic hyperplasia of endometrium is characteristic for dysfunctional uterine bleedings
Diagnostic problem 19A
The patient with symptomatic myoma of the uterus and secondary amenorrhea
admitted into gynecological department.
CBC: erythrocytes – 1.3 x 1012/L, L – 6.2 x 109/L, Hb – 60 g/L, ESR – 23 mm/hr.
Colposcopy results: the mucosal coat of the cervix is not changed.
Histological study of endometrial scraping revealed hyperplasia glandulocystica.
1. Estimate the result of laboratory tests
2. Estimate the result of histological study of endometrial scraping.
Diagnostic problem №19A
1. Estimate the results of examination:
Decreased red blood cells number (1.3x1012/L), decreased hemoglobin level (60 g/L) indicate anemia with moderate degree.
2. Estimate finding of histological examination of endometrial scraping specimen.
Glandulocystic hyperplasia of endometrium indicates hormonal disturbance – hyperestrogenism.
Diagnostic problem 20A
The patient with uterine myoma and secondary amenorrhea hemorrhagic syndrome
admitted into gynecological department.
CBC: erythrocytes – 3.1 x 1012/L, Hb – 82 g/L, L – 7.8 x 109/L, ESR – 12 mm/h.
US: uterus sizes are 124x78x69, uterine cavity is deformed because of submucous myomatous nodes with eccentric growth.
Histological study: investigation of cervical scraping revealed cylindrical epithelium, in uterine scraping hyperplasia glandulocystica was revealed.
1. Estimate the result of laboratory tests
2. Estimate the result of histological study of endometrial scraping.
Diagnostic problem №20A
1. Estimate the results of examination:
Decreased number of red blood cells (3.2x1012/L), decreased HB level (82 g/L) indicate the diagnosis of bleeding.
2. Estimate US finding and results of histological examination of endometrial scraping specimen:
Increased uterine size till 124x78x69 mm, uterine deformation because of submucose and intramural myomatous nodes; glandulocystic endometrial hyperplasia also prove myomata uterus.
Diagnostic problem 21A
The patient with hydatidiform mole at 10th week of gestation admitted into gynecological department.
hCG level: the hCG titer is 1000 un.
X-Ray of thoracic cavity: lung fields are clear, sinuses are free.
US: uterus sizes are 75 x 45 x 61,there is heterogeneous contents with hyperechoic inclusions (“snowstorm” symptom) in the uterine cavity; thecalutein cysts on both sides revealed.
1. Estimate the result of laboratory tests
2. Estimate the result of US.
Diagnostic problem №21A
1. Estimate the results of examination:
Increased hCG titer in blood serum (1000 u) indicates the diagnosis of hydatidiform mole.
2. Estimate US findings:
Increased uterine size (75x45x61), detection of hyperechoic inclusions in uterine cavity and thecalutein cysts of both ovaries also prove the diagnosis of hydatidiform mole.
Diagnostic problem 22A
The patient with metastatic variant of chorionepithelioma admitted into gynecologic department.
CBC: erythrocytes – Hb – 47 g/L, hemogram is not changed, ESR – 12 mm/hr.
Urine examination on hCG – positive.
X-Ray of thoracic cavity: multiple, rounded, small metastatic nodes by 1 cm in diameter are founded.
1. Estimate the result of laboratory tests
2. Estimate the result of X-Ray examination.
Diagnostic problem №22A
1. Estimate the results of examination:
Decreased HB level (47 g/L), positive hCG reaction in urine validate the diagnosis of chorionepithelioma.
2. Estimate the chest X-ray findings:
Detection of multiple small and round lymphatic metastatic nodes indicate metastasis variant of chorionepithelioma.
Diagnostic problem 23A
The patient with cervical leucoplakia and Trichomonas colpitis addressed into female out-patient department.
Microbiological investigation of vaginal smears showed compound flora and Trichomonas vaginalis.
Colposcopy: two whitish spots by1 x 1.5 cm, located in anterior and posterior cervical lips, were founded. The Shiller’s test was negative.
1. Estimate the result of laboratory tests
2. Estimate the result of colposcopy.
Diagnostic problem №23A
1. Estimate the results of examination:
Cultural detection of trichomonads in vaginal discharge indicates Trichomonas colpitis
2. Estimate colposcopy findings:
The detection of a whitish spots on the cervix, negative in smearing with Lugol's iodine solution is characteristic for leukoplakia.
Diagnostic problem 24A
The patient with hemorrhage in menopausal period was admitted into gynecological department.
US: uterus sizes are 56 x 30 x 41, the thickness of endometrium is 12 mm, and the structure of endometrium is not uniform.
Histological study: in scraping from the cervical canal scraps of mucous layer and blood clots revealed, in uterine scraping multiple endometrial polyps without signs of malignancy revealed.
Diagnostic problem №24A
1. Estimate the results of examination:
Normal uterus’ size (56x30x41), thickened endometrial layer (12 mm) with irregular echostructure validate endometrial hyperplasiza
2. Estimate finding of histological examination of endometrial scraping specimen:
Multiple endometrial polips without sign of malignancy also validate hormonal failures.
Diagnostic problem 25A
The patient with suspicion of cancer of the uterus corpus admitted into gynecological department.
US: uterus sizes are 54 x 34 x 42, uterine cavity is enlarged, the thickness of the endometrium is 14 mm, and endometrial echogenicity is increased.
Histological study: adenomatous hyperplasia of the endometrium revealed.
Diagnostic problem №25A
1. Estimate the results of examination:
Widening of the uterine cavity with thickening of the endometrial layer to 14 mm, increased hyperechoic condition indicate hormonal disturbances.
2. Estimate finding of histological examination of endometrial scraping specimen:
Revealed adenomatous hyperplasia of endometrium validates the diagnosis of precancerous lesion of the endometrium.
III.B. situational problems on diagnostics in obstetrics and gynecology
Diagnostic problem 1B
The pregnant woman in 34 weeks of pregnancy with “acute gestational pyelonephritis” is admitted to the pathological obstetrics department.
General Blood Analysis :
RBC : 3, 2 x 1012 /L
Hb : 108 g/L
Leucocytes : 12, 7 x 109 /L
ESR : 27 mm/hour
General Urine Analysis:
Protein : 0,133 g/L
Leucocytes : 23-35 in v/f
Sugar is not found
Nechiporenko’s Test:
Leucocytes : 10 x 109 /L
RBC : 3, 1 x 109 /L
Ultrasound investigation : placenta 16cm x 16,5cm and thickness – 2cm
CTG : basal rhythm 180 beats/min
Fetal condition index : 2, 7
Estimate the results of findings.
Answer №1 B
Estimate the results of examinations:
In CBC -decreased hemoglobin (108 g/L), increased leukocytes (12,7х109 /L), increased ESR (27 mm/h); in urine alysis: proteinuria (0.133g/L), Leukocyturia (25-30).; Leukocyturia (10Х109/L) in urine analysis according to Nichiperenko, decreased size (16х16,5 cm) and thickness (2cm) of the placenta, increased CTG fetal index (2.7) and basal rhythm 180 b/min on CTG confirm the diagnosis of intra uterine hypoxia of fetus and gestational pyelonephritis.
Diagnostic problem 2B
A pregnant woman with viral Hepatitis A infection is admitted to the obstetrical department of maternity home.
General Blood Analysis:
RBC : 3, 1 x 1012 /L
Hb : 120 g/L
Leucocytes : 12, 0 x 109 /L
ESR : 30 mm/hour
Bilirubin : 46, 2 mmol/L
ALT : 3, 86 μmol/L
AST : 4, 42 μmol/L
CTG : basal rhythm 180 beats/min
CTG’ fetal index: 2,8
Estimate the results of findings.
Answer №2 B
Estimate the result of examination:
CBC: Increased leuocytes (12,0х109/l), increased ESR (30 mm/h);
Increased billurubin (46 µmol/L), ACT (4.42µm/l) in bipochemical investigations; increased CTG fetal index (2.8), basal rhythm (180/min): in summary validate the intrauterine fetal hypoxia and viral hepatitis.
Diagnostic problem 3B
A pregnant woman with 38 weeks of pregnancy with edema had consultation with the doctor in the maternity house.
General Blood Analysis:
RBC : 3, 1 x 1012 /L
Hb : 128 g/L
Leucocytes : 5, 3 x 109 /L
ESR : 12 mm/h
General Urine Analysis:
Protein and sugar are not found.
Leucocytes : 8-10 in v/f
Electrolytes in blood : K - 3, 28 mmol/L
Na - 164, 3 mmol/L
Cl - 142, 0 mmol/L
Common proteins in blood : 56 g/L
Estimate the results of findings.
Answer №3 B
Estimate the results of examination:
Increased Na (164, 3 ммоль/л) и Cl (142 mmol/l), and also decreased whole protein (56g/l) in biochemical examination of blood indicate the diagnosis of Edema of pregnancy.
Diagnostic problem 4B
A pregnant woman with 24 weeks of pregnancy is admitted to the pathological department of maternity house with recurrent chronic pyelonephritis.
General Blood Analysis:
RBC : 3, 4 x 1012 /L
Hb : 120 g/L
Leucocytes : 18, 3 x 109 /L
ESR : 30 mm/h
General Urine Analysis:
Protein : 0,033 g/L
Leucocytes : 50-60 in v/f
Nechiporenko’s Test:
Leucocytes : 24,0 x 109 /L
RBC : 3,0 x 109 /L
Creatinine : 110 mmol/L
Urea : 7, 0 μmol/L
CTG : basal rhythm 140 beats/min
Fetal condition index : 0, 5
Estimate the results of findings.
Answer №4 B
Estimate the results of examination:
Leukocytosis (18,3х109/L) and increased ESR (30 mm/h) in CBC; Proteinuria (0.033 g/L) and leukocyturia (50-60 in v/f) in urine analysis; Leukocyturia (24,0х106/L) in Nicheperenko’ test; and. increased Urea (7, 0 µmol/L), creatinine (110 mmol/L); Normal CTG fetal indexe (0.5) and basal rhythm (140 b/m). Prove the satisfactory condition of the fetus and concludes the diagnosis of exacerbation of chronic pyelonephritis.
Diagnostic problem 5B
A woman in puerperium period with “post partum sepsis” is admitted to the obstetric department of the maternity house.
General Blood Analysis:
RBC : 1, 8 x 1012 /L
Hb : 77 g/L
Leucocytes : 28, 3 x 109 /L
ESR : 62 mm/h
Shift to the left leucocytosis.
Urea : 9, 3 μmol/L
Bilirubin : 80, 6 mmol/L
General Urine Analysis:
Sugar is not found.
Protein : 0,165 g/L
Leucocytes : 3-5 in v/f
Zimnitsky Test:
Night diuresis more than day diuresis
Diuresis : 1200ml
ECG : sinus rhythm, horizontal electric axis of the heart and systolic
murmurs are present on the heart apex
Estimate the results of findings.
Answer №5 B
Estimate the results of examination:
Decreased erythrocytes (1,8х1012/L), decreased Hb (77g/L), Leukocytes (28.109/L), and increased ESR (62mm/h), left shift in CBC; Proteinuria (0,165g/L) in urinalysis; increased level of urea (9.3 µmol/L), increased billurubin (80,6 mmol/L) in biochemical blood.tests; prevalence of nocturnal urination on diurnal one; and isotenuria (1010-1020) in urine according to Zimitsky; Sinus rhythm, Changed electrical axis of heart, Systolic murmur on the heart apex on ECG validate Sepsis.
Diagnostic problem 6B
A woman with preeclampsia of severe stage is admitted to the pathological department of the maternity house.
General Blood Analysis:
Hb : 138 g/L
Leucocytes : 8, 5 x 109 /L
Thrombocytes : 150 x 109 /L
Hematocrit : 43%
Common protein in blood : 52 g/L
General Urine Analysis:
Protein : 5 g/L
Leucocytes : 3-4 in v/f
Creatinine : 300 mmol/L
Consultation from ophthalmologist : spasm of the retina vessels, edema of the retina
Estimate the results of the findings.
Answer №6 B
Estimate the results of examination:
Increased hematocrit (43%), decreased thrombocytes (150) in CBC, Proteinuria (5g/L) in urine alysis; Hypoproteinemia (52g/L), increased Creatininie (300 mmol/L) biochemical analysis of blood; Also spasm of retinal blood vessels and edema in eyes examination conclude diagnosis severe preeclampsia.
Diagnostic problem 7B
With the help of “Ambulance Emergency Aid”, a pregnant woman with bleeding and placenta privia is admitted to maternity house.
General Blood Analysis:
RBC : 2, 5 x 1012 /L
Hb : 97 g/L
Leucocytes : 7, 5 x 109 /L
ESR : 20 mm/h
Common protein in blood : 52 g/L
Ultrasound investigation : placenta is localized on the lower segment of the
uterus and covering the internal os
Estimate the results of findings.
Answer №7 B
Estimate the results of examination:
Decreased hemoglobin (97g/L) decreased Erythrocytes (2,5х1012/L), in CBC. Decrease of general protein in blood (52g/L) in biochemical investigation of blood reveals Anemia in patient.
Position of placenta in the lower uterine segment covering internal os validates the diagnosis of central placental previa.
Diagnostic problem 8B
A pregnant woman is admitted to the obstetrics department with pre-eclampsia of severe stage.
General Blood Analysis:
RBC : 3, 8 x 1012 /L
Hb : 130 g/L
Leucocytes : 8, 3 x 109 /L
Hematocrit : 43%
Thrombocytes : 120 x 109 /L
Common protein in blood : 50 g/L
General Urine Analysis:
Protein : 5 g/L
Leucocytes : 3-5 in v/f
Hyline cylinder : 2-3 in vf
Creatinine : 300 mmol/L
CTG : Non stress test is positive (+)
CTG fetal condition index : 3, 5
Estimate the results of findings.
Answer №8 B
Estimate the results of examination:
Increased hematocrit (43%), decreased thromobytes (120х109/L) in CBC, proteinuria (5 g/L), cylideruria (2-3 в v/f) in urinealysis, decreased protein (50g/L), increased creatinine (300 mmol/L) in biochemical analysis of blood; also increased CTG fetal index (3,5)validate severe preeclampsia and intrauterine fetal hypoxia.
Diagnostic problem 9B
A woman with incomplete abortion during 10-11 weeks of pregnancy is admitted to the gynecology department.
General Blood Analysis:
RBC : 2, 8 x 1012 /L
Hb : 72 g/L
Leucocytes : 6, 5 x 109 /L
ESR : 12 mm/h
General Urine Analysis:
Protein and sugar are not found.
Salts of uric acid are present.
Leucocytes : 2-4 in v/f
Ultrasound investigation: in uterine cavity present visible echo negative
Formation of 2-3 cm
Estimate the results of the findings.
Answer №9B
Estimate the results of examination:
Decreased rbc (2,8х1012/L), decreased Hb (72g/L) in CBC, and detection of the eco-negative formation with 2x3cm in size in the uterus in US reveal remnants of parts of placenta with bleeding.
Diagnostic problem 10B
A pregnant woman is admitted to the pathological department of the maternity house with the pregnancy of 43 weeks.
General Blood Analysis:
RBC : 3, 5 x 1012 /L
Hb : 130 g/L
Leucocytes : 4,5 x 109/L
ESR : 10 mm/h
Reticulocytes : 1-2%
General Urine Analysis :
Protein : 0,033 g/L
Leucocytes : 2-3 in v/f
Hyline cylinders : 1-2 in v/f
Vaginal colpocytology: upper cells – 32%
intermediate cells– 68%
US : present of focus of putrification and hylination
in the placenta
CTG : Non stress test is positive (+)
CTG fetal condition : 3,2
Estimate the results of findings.
Answer №10 B
Estimate the results of examination:
Increased reticulocytes (2.0%) in CBC, prevalence of intermediate cells in colpocytologic exam (68%), deformation of the placenta with focal prettifications, detection of hyalinosis US; and increased CTG fetal condition (3.2) reveal post term pregnancy and intra uterine hypoxia.
Diagnostic problem 11B
A pregnant woman in 34 weeks of pregnancy is diagnosed for intrauterine hypoxia of the fetus during a consultation at the reception ward of gynecology department.
General Blood Analysis:
RBC : 2, 8 x 1012 /L
Hb : 88 g/L
Leucocytes : 4, 5 x 109 /L
ESR : 18 mm/h
Common protein in blood : 52 g/L
Anisocytosis
Poikilocytosis
General Urine Analysis:
Sugar is not found
Protein : 0, 3 g/L
Leucocytes : 3-4 in visual field
CTG’ fetal index : 2, 8
US : the second degree of maturity placenta
Estimate the results of findings
Answer №11 B
Estimate the results of examination:
Decreased rbc (2,8х1012/L), and Hb (88 гg/L), appearance of anizocytosis and poykilocytosis in CBC, decreased whole blood protein (52g/L), and increased index of the fetal condition (2.8),the 2nd stage of placental ripening in US indicate maternal anemia and intra uterine hypoxia of fetus.
Diagnostic problem 12B
A pregnant woman with the diagnosis of pregnancy of 38 weeks, twins, pre-eclampsia mild form was admitted in the pathological department of the maternity house.
General Blood Analysis:
RBC : 2, 6 x 1012 /L
Hb : 98 g/L
Leucocytes : 6, 3 x 109 /L
ESR : 18 mm/h
Hematocrit : 32%
Thrombocytes : 160 x 109 /L
Common protein in blood : 55 g/L
General Urine Analysis:
Sugar is not found.
Protein : 0, 5 g/L
Leucocytes : 3-4 in v/f
CTG of the1st fetus : Non stress test is positive (+)
Fetal condition index : 0, 5
CTG of 2nd fetus : Non stress test is positive (+)
Fetal condition index : 2, 5
Estimate the results of findings.
Answer №12 B
Estimate the results of examination
Decreased erythrocytes ((2,6х1012/L) Hemoglobin (98g/L), thrombocytes (160х109/L), increased level of PCV (32%) in CBC; proteinuria (0.5g/L) in general analysis of urine; decreased general protein (55g/L) in bio chemical examination of blood; CTG index of the second fetus (2.5).indicate mild preeclampsia and intrauterine fetal hypoxia, and maternal anemia.
Diagnostic problem 13B
A pregnant woman was directed to the gynecology consultation in the maternity house with the diagnose: pregnancy of 38 weeks, Rh-incompatibility, intrauterine hypoxia of the fetus.
General Blood Analysis:
RBC : 3, 4 x 1012 /L
Hb : 120 g/L
Leucocytes : 5, 8 x 109 /L
ESR : 10 mm/h
Rh-antibody titer : 1:32
US : “crown”symptom and “Buddha: pose
were found
CTG of the fetus : Non stress test is negative (-)
Fetal condition index : 3,5
Estimate the results of findings.
Answer №13 B
Estimate the results of examination
Rhesus titer 1:32, detection of the “crown” symptom and “Buddha pose”, and increased size and thickness of the placenta in US; increased CTG fetal index (3.5) are characteristic for Rhesus incompatibility and intra uterine hypoxia of fetus.
Diagnostic problem 14B
In the department of “extragenital pathology” of the maternity house, a pregnant woman is admitted with the diagnosis: pregnancy of 33 weeks, diabetes mellitus type I, moderate stage of severity.
General Blood Analysis:
RBC : 3, 1 x 1012 /L
Hb : 130 g/L
Leucocytes : 3, 8 x 109 /L
ESR : 18 mm/h
Glucose in blood : 10, 5 mmol/l
General Urine Analysis:
Protein : 0,033 g/L
Sugar : 2, 5%
Leucocytes : 35-40 in visual field
CTG : Non stress test is positive (+)
Basal rhythm 175 beats/min
CTG’ fetal condition : 1, 5
index
Estimate the results of findings.
Answer №14 B
Estimate the results of examination.
Increased glycemia (10,5 mmol/L) in biochemical examination of blood, glucosuria (2.5%), and also leukocyturia (35-40)in urinalysis, and increased CTG fetal index (1.5) and basal rhythm up to 175 bpm are characteristic for Diabetes Mellitus in mother and intra uterine hypoxia of the fetus.
Diagnostic problem 15B
A pregnant woman with pregnancy of 38 weeks, central placenta praevia and bleeding is admitted to the maternity house by the help of ambulance.
General Blood Analysis:
RBC : 2, 3 x 1012 /L
Hb : 80 g/L
Leucocytes : 6, 3 x 109 /L
ESR : 12 mm/h
General Urine Analysis:
Protein and sugar are not found.
Leucocytes : 2-4 in v/f
Salts of uric acid are present.
Ultrasound investigation : echo negative completely covers the internal os
CTG : Non stress test is positive (+)
Basal rhythm 180 beats/min
Fetal condition index : 1, 5
Estimate the results of findings.
Answer №15B
Estimate the results of examination
Decreased rbc (2,2х1012/L), Hb (30g/L) in general analysis of blood, eco-negative tissue, and placenta, totally covering the internal os in US; increased CTG fetal condition (1.5) and also basal rhythm up to165 bpm reveal diagnosis of central f placenta previa with anemia in mother and intrauterine hypoxia.
Diagnostic problem 16B
A woman is admitted to the gynecology department with diagnosis of “purulent salpingitis of left side”.
General Blood Analysis:
RBC : 5, 5 x 1012 /L
Hb : 125 g/L
Leucocytes : 18, 0 x 109 /L
ESR : 32 mm/h
Stab neutrophils : 15%
Ultrasound investigation : complete fluid formation from the left side of the
uterus (fallopian tube)
size : 4 x 9cm
irregular echo confirmed
Estimate the results of findings.
Answer №16 B
Estimate the results of examination
Leukocytosis (18,0х109/L) increased ESR (32 mm/h). Increased Stab Neutrophills (15%) in CBC, tumor like formation to the left of uterus, ununiform in density and with liquid inside in US revealed diagnosis of pyosalpinx and purulent process.
Diagnostic problem 17B
In the gynecology department, a woman is admitted with the diagnosis “chronic both sides salpingitis”, focal tuberculosis, endometritis and primary fertility.
Blood and Urine Analysis : without pathological changes
Pirquet's test : positive (+)
Monteaux test : negative (-)
Microbiological analysis : mycobacteria tuberculosis is present in the
menstrual blood
X-ray examination : organs of thoracic cavity without any pathology
Metrosalpingography : tubes are obstructed, beaded form
Estimate the results of findings.
Answer №17 B
Estimate the results of examination
Positive Pirquet's test, detected Mycobacterium tuberculosis in menstrual blood, obstruction of fallopian tubules indicates Tuberculosis of Fallopian tubules.
Diagnostic problem 18B
A woman with “dysfunctional uterine bleeding of climacteric period” is admitted to the gynecology department.
General Blood Analysis:
RBC : 2,3 x 1012 /L
Hb : 88 g/L
Leucocytes : 4,5 x 109 /L
ESR : 12 mm/h
Anisocytosis
Poikilocytosis
Histological findings : glandular cystic hyperplasia of the endometrium is found
from the sample of mucous of the uterus
Estimate the results of the findings.
Answer №18 B
Estimate the results of examination
Decreased Erythrocytes (2,3х1012/L), Hemoglobin (88g/L), anicytosis and leukocytosis- in general blood analysis, glandulocystic hyperplasia of endometrium in histological examination after D&C reveal Anemia connected with dysfunctional uterine bleeding.
Diagnostic problem 19B
A woman is admitted with the symptom of myoma of the uterus and secondary anemia in the gynecology department.
General Blood Analysis:
RBC : 2, 3 x 1012 /L
Hb : 80 g/L
Leucocytes : 8, 2 x 109 /L
ESR : 23 mm/h
Ultrasound investigation : size of uterus – 13cm x 8cm x 8cm
heterogenous echostructure
Colposcopy : mucous of the neck of the uterus is without
any pathological changes
Histological findings : mucous of the cervical canal is found in the sample
of cervix of the uterus
glandular-cystic hyperplasia of endometrium in the
sample from uterine cavity
Estimate the results of the findings.
Answer №19 B
Estimate the results of examination
Decreased number of erythrocytes (2, 3х1012/L), hemoglobin (80g/L), increased uterus size in US, and glandulocystic hyperplasia of endometrium indicate myoma of uterus and anemia.
Diagnostic problem 20B
A woman is admitted to the gynecology department with the diagnosis of myoma of the uterus with hemorrhagic syndrome.
General Blood Analysis:
RBC : 2, 8 x 1012 /L
Hb : 78 g/L
Leucocytes : 7, 8 x 109 /L
ESR : 22 mm/h
Ultrasound investigation : size of uterus - 130mm x 80mm x 60mm
hard, deformed because of interstitial myometrium
modes with extracentral growth
Histological findings : cylindrical epithelium is found in the sample of the
uterus cervix
glandular-cystic hyperplasia of endometrium in the
sample from uterine cavity
Estimate the results of findings.
Answer №20 B
Estimate the results of examination
Decreased erythrocytes (2.8х1012/L), decreased hemoglobin (78g/L), enlarged uterus 130х80х60mm, deformation of its cavity with submucosal and intramural nodes in US, and hyperplasia glandulocystic hyperplasia of endometrium indicate the diagnosis of uterine myoma with hemorrhagic syndrome.
Diagnostic problem 21B
A woman suspected with cancer of the body of the uterus and anemia is admitted to the gynecology department.
General Blood Analysis:
RBC : 2, 6 x 1012 /L
Hb : 72 g/L
Common protein in blood : 58 g/L
Ultrasound investigation : size of uterus – 60mm x 30mm x 21 mm
thickness of the endometrium – 12mm
a homogenous echostructure is found
Histological findings : Adenocarcinoma
Estimate the results of findings.
Answer №21 B
Estimate the results of examination
Decreased erythrocytes (2.6х1012/L), decreased hemoglobin (72g/L) in CBC; hyproteinemia (58g/L) in biochemical examination of blood; enlarged uterus; thickened endometrium (12mm) with irregular structure in US, adenocarcinoma revealed in histological examination of specimen after curettage of the uterine cavity reveal diagnosis of cancer of uterus body.
Diagnostic problem 22B
A woman with cysts torsions of left ovary is admitted to the gynecology department.
General Blood Analysis:
Leucocytosis : 18, 0 x 109 /L
ESR : 34 mm/h
Ultrasound investigation : polycystic form 80mm x 60mm in size with
heterogenous content is found on the left side
of the uterus
Estimate the results of the findings.
Answer №22 B
Estimate the results of examination
Leukocytosis (18х1012/L) increased ESR (34 mm/h) in CBC; polycystic formation revealed to the left from the uterus (80 х60 mm in size) with non homogenous content confirm cyst of the ovary, complicated with torsion of the peduncle.
Diagnostic problem 23B
A woman with suspicion of cancer of the ovaries is admitted in the gynecology.
General Blood Analysis:
RBC : 2, 6 x 1012 /L
Hb : 95 g/L
Common protein in blood : 52 g/L
Ultrasound investigation : polycystic form size 100mm x 90mm with
the starting of papillary distension on the wall of the
uterus which is infiltrated with fluid is found on the right side of the uterus
Answer №23 B
Estimate the results of examination
Decreased erythrocytes (2.6х1012/L), and hemoglobin (95g/L), toxic granulosity in CBC, hypoproteinemia (52g/L) in biochemical examination of blood; polycystic formation revealed to the left from the uterus (100х90 mm in size) with capillary excrescence in walls and septum of tumor; and fluid in retrouterine space conclude the diagnosis of malignant formation.
Diagnostic problem 24B
A woman is admitted to the gynecology department with miscarriage of tubal pregnancy.
General Blood Analysis:
RBC : 2, 4 x 1012 /L
Hb : 98 g/L
ESR : 12 mm/h
Comon protein in the blood : 54 g/L
Histological findings : elements of chorionic fluid is absent in the sample
Ultrasound investigation : a formation of 60mm x 38 mm in size with irregular
contents is found on the left side of uterus;
free fluid is detected in the retrouterine space
Estimate the results of findings.
Answer №24 B
Estimate the results of examination
Decreased rbc (2.4х1012/L), decreased Hb (98g/L) in blood test, hypoproteinemia in biochemical investigation of blood; and nonhomogenous formation 60x38 mm revealed to the left from the uterus, free liquid in retrouterine space during in US; and absence of the chorione elements in specimen from the uterine cavity in histological investigation indicate the diagnosis of ectopic pregnancy.
Diagnostic problem 25B
A woman is admitted to the gynecology department with progressive left sided tubal pregnancy.
hCG in urine : positive (+)
Pathological findings : decidual metamorphosis of the endometrium, elements of
Absence of the fertilized ovum
Ultrasound investigation : a visible fertilized ovum is seen in
the left fallopian tube
Estimate the results of findings.
Answer №25 B
Estimate the results of examination
Positive results of HCG blood test, the dense egg and in the left fallopian tube and its absence in the uterine cavity , revealed in US confirm progressive tubal pregnancy.
Standard task No.1
A patient O, 29 y.o was taken 2 gynecology department. She complained of temperature rise, general weakness, pain in the lower part of abdomen.
Anamnesis : last menstruation was 3 months ago. The patient had 4 pregnancies, 2 was done 8 days ago. She was discharged 4m hosp d next day aft abortion. Objective observation : gen state is satisfactory, P 100 b/min, rhythmical. ABP – 120/80 mmHg, T- 38.2ᵒC. Her tongue is moist, slightly coated white. Abd is soft, rather painful over pubis. There is profuse purulent discharge 4m cervical canal.
PV: cervix of the uterus is of cylindrical form, external fauces is closed, body of womb is a bit larger than the normis, of soft consistency, palpatory tenderness. Appendages r x palpated.
Diagnosis : acute endometrosis aft artificial abortion
What treatment necessary? Anti inflammatory therapy of endometrosis : clindamycin 150-450mg peroral, gentamycin 1.2-2.5 mg/ kg IV 8 hrs.
No.2
A , 38y.o was taken 2 clinic. She complained of constant pain in the lower part of abd irradiating in the loin, temp rise up to 38ᵒc.
Anamnesis : last mens was 11 days ago. She’s sexually active since 26y.o. There were no pregnancies. She hasn’t preserved. Time and again she’s undergone treatment for oophoritis. Twice the puncture of post fornix was done, ther was pus in punctuate. Antibacterial therapy was undergone.
Obj observation : gen state is of medium severity, Ps – 104 b/min, satisfactory. ABP -120/70 mmHg, T- 39.4ᵒC. while examining : abd is swollen, takes part in the act of breathing, during palpation it is tense & painful in lower parts. Schyotkin-blumberg symptom +ve.
In speculum : cervix of the uterus is clean, pus is oozing 4m cervical canal of uterus.
PV : body of womb is not well contoured because of acute painfulness of abd. Left appendages r x palpable. Mass in 12 x 7 cm is palpated 2 d left & 4m behind of d womb; it’s sharply restricted in mobility, painful. The puncture of post fornix was done 20ml of pus was obtained.
Diagnosis : abcess of right tube, pelvic peritonitis
What is the plan of further treatment of patient? Surgical tt, antinflammatory therapy
No.3
A patient D, 36y.o, complains of excessive(profuse) mens. She is on the books because of hysterectomyoma. Womb was enlarged up 2 6-7 weeks of pregnancy. Bleeding began 10 days ago & has been continuing till now. She’s had mens since she was 10 y.o, regular, 4 the last yr hv been profuse & lasted 4 7-10 days. She’s sexually active since 20y.o. There were 2 pregnancies finished with medical abortions w/o any complications.
Obj observation : gen state is satisfactory Ps- 76b/min, ABP – 120/80mmHg, T – 39.4ᵒC. Abd is soft, painless.
PV : body of womb is enlarged up 2 11 weeks of pregnancy, dense, painless, appendages 4m both sides r x enlarged, discharge is bloody & profuse.
Diagnosis : rapid growth of myoma of uterus. Hemorrhage synd.
What is doc approach? Fraction diagnostic clensing of uterine cavity. Surgical treatment aft receiving results of histological investigation
No.4
A patient Z, 40y.o, was taken to gynecology dept. she complained of cramp-like (spasmodic) pain in the lower part of abd and profuse bloody discharge 4m genital tracts. She is inclined 2 belive that she has been ill 4 d last 4 yr when excessive mens wit grumes & pain in td lower part of abd began. She has suffered 4m anemia 4 3 yr, twice she was treated in the hosp. she had mens since 12y.o. regular. 4 d last 2 yr they hv lasted 4 15-16 days, profuse, painless. There were 2 pregnancies thaht finish wit medical abortions.
Obj observation : gen state is satisfactory, Ps – 92b/min, ABP – 110/60 mmHg. Skin & visible mucous tunic r pale, there is systolic murmur on the apex of heart. Abd is soft, painless.
PV : node of myoma comes 4m cervical canal of uterus, its diameter is up 2 3 cm, on thin limb (foot); womb is a bit larger than norm is, dense, painless. Appendages r x palpated. Discharge is bloody & profuse.
Diagnosis? Pedunculated submucous myoma
What is doc approach? Surgery
No.5
A patient 37y.o, complained of pain in th e abd in the region of postoperative cicatrix & bloody discharge out of it, especially b4 & aft mens pain in the lower part of abd on d right.
Anamnesis : she’s had mens since she was 13y.o regular. 4 d last 4 yr there has bben long lasting profuse & painful. There were 5 pregnancies : 2 easy deliveries, 2 medical abortions w/o complications & 1 abd pregnancy.
Obj observation : gen state is satisfactory Ps – 80b/min, ABP – 120/80 mmHg. Dense & painful nodules r palpated in d thickness of postoperative cicatrix. Cicatrix & skin above it is of cyanotic colour. Abd is soft, rather painful on d right.
PV : womb is of normal size, dense, painless, appendages on the left r x palpated 2 d right of the womb painful mass in 7 x 8 cm is palpated, it’s limited in mobility, discharge is mucous.
Diagnosis : extragenital endometritis, endometrial cyst of right ovary
Treatment : surgical treatment remove ovary. Treatment of metriosis
No.6
A patient L, 29y.o, consulted about the lack of mens during 8weeks.
Anamnesis : she’s had mens since 14y.o, regular. There were 4 pregnancies – 2 of them finished with delivery at term (partus matures), 2 with medical abortions w/o any complications. The patientmentions aching (dull) pain in the lower part of the abd 4 d last week; there was no bloody discharge.
Obj observation : x pathology in organs & systems.
PV : while palpating womb is of rounded form, painful, tense, enlarged up 2 10 – 11 weeks of pregnancy. 4m both sides enlarged appendages r palpated. Discharge is light, moderate.
Provisional (working) diagnosis?
US shows : elements of cystic(grape) mole occupy all cavity of uterus.
Diagnosis? Trophoblastic disease. Hydatiform mole
Treatment? Surgical removal of the mole.
No.7
A pt. 27 y.o, went 2 antenatal(martenity welfare) clinic wit complains of general weakness, dyspnea, palpitation, cough, & dark discharge 4m vagina.
Anamnesis : she had mens since 14 y.o. regular. Last mens was 5 months ago. There were 3 pregnancies :- 1> finish wit easy delivery, 2> with medical abortions w/o complications. 3 months ago there was spontaneous miscarriage in the term 6-7 weeks; curettage of uterine cavity was mad. 2 weeks later the pt consulted about bloody discharge. Repeated curettage of uterine cavity was made. Elements of fetal egg were x discovered in d scrape. A week later aft curettage dyspnea, cough appeared.
Obj observations : gen state is of medium severity, Ps- 98b/min, ABP -100/70mmHg, hem – 47g/l, ESR – 47mm/hr
PV : womb is enlarged up 2 14 weeks of pregnancy, hs uneven surface. Appendages r palpated. Discharge is dark, bloody.
Pneumonography shows : metastatic involvement of lungs.
Final diagnosis : chorion epithelioma. Metastasis in lungs. Anemia.
Treatment : chemotherapy general strengthening therapy
No.8
A pt. , 45 y.o, complained of bloody discharge 4m vagina aft coitus.
Anamnesis : inheritance is x overburdened. There were 5 pregnancies :- 2 – finish wit easy delivery, 3 – with med abort w/o complications
In speculum : cervix is hypertrophied. There is tuberous cauliflower-like tumor on its ant lip in 2 x 2, it bleeds when touching.
PV : body of womb is of norm size, appendages r palpated. Through rectum : supravaginal part of womb is firm(dense), there is tumor-like pelvic mass, infiltrates r x detected.
Diagnosis : cancer of cervix of uterus. 1st stage
What is 2 b done 2 make d diagnosis more exact? Biopsy 4m uterine cervix
Treatment ? Wertheim op. (surgery + radiotherapy)
No.9
A pt A 60 y.o, complains of pains in the left inguinal region & left hip, especially at nite pain is “gnawing” character. Painful urination. Obstructed defecation. There is blood in urine & feces. She has been ill 4 more than 1 yr. her state is grave Ps- 90b/min, ABP – 90/60mmHg, T – 37.2 ᵒC, emaciated. Imoble mass is palpated in epigastric region.
In speculum : in the cupulla of vaginathere is crater t necrotic incrustation. Discharge is “meat-slops like”
PV : 2/3 of wall of vagina r infiltrated. In small pelvis there is conglomerate of dense consistency comin 2 wall of pelvis 4m both sides, immobile, painful.
Through rectum : mucous tunic of rectum is immobile. Infiltrates r seen in parametrias 4m both sides reaching the walls of pelvis. Bloody discharge.
Diagnosis? Cancer of cervix of uterus, III-IV stage
Tt? Symptomatic therapy
No.10
A pt Zh 53 y.o, was taken 2 d gynecological clinic. Complains of bloody discharge 4m vagina.
Anamnesis : inheritance is x overburdened. Menopause – 3 yr. there were 4 pregnancies :- 3 – finish at term, 1 – wit artificial abortion w/o complications. She denies gynecological disorder. Periodically moderate bloody discharge appears 4m vagina 4 d last 3 months.
Provisional diagnosis?
Histological studies : multiple polys of endometrium w/o signs of malignization
Final diag : polyposis of endometrium.
Treatment : Hormonal therapy
No. 11
A pregnant woman 21y.o, was taken 4 delivery. Pregnancy – 1 at full term. Duration of delivery -12hr. amniotic fluid moved away 2hr ago. Active labor pains began, 4 55-60 sec every 2-3 min.
Pelvis size : 27 : 28 : 32 : 18. Abd circumference -95cm, height of elevation of fundus of uterus -35cm. back is on the right, small parts of fetus r on the left. Head is pressed 2 d opening in2 small pelvis. Fetal heartbeats r distinct, up2 140b/min, rhythmic.
Vaginally : opening is full, there is x fetal bladder, cephalic presentation, head is pressed 2 d opening in2 small pelvis. Arrow-shaped suture in transverse insicion is 2cmcloser 2 promontory. Small frontanel is on the right, large one is on the left. Diagonal conjugate is 11cm.
Diag? contracted pelvis, rachitic flat pelvis
Definite head’s fitting & doc approach?
No.12
A pt 12y.o, complains of excessive bloody discharge 4m genital tracts. She had mens since 11y.o, irregular; there is delay of mens 4 2-3 weeks whereupon bleeding is observed. She denies sexual life. Gen state is satisfactory, Ps- 80b/min, ABP – 100/60mmHg.
Ext inspection : ext genitals r hypoplastic, adult woman pattern of hair distribution.
Hymen is intact.
Through rectum : body of womb is small, mobile 7 painless. Appendages r x palpated. Discharge is bloody & profuse.
Diag? juvenile dysfunction uterine bleeding
Tt? Arrest bleeding > coagulants, hormone therapy
No.13
A py 40y.o, complains of excessive mens. She’s been on the books b’coz of hysteromyoma 4 6yr. last time mens she went 2 gynecologist a yr ago. Size of myoma 8 weeks.
In speculum : womb is enlarged up 2 10 weeks of pregnancy, nodular, appendages r x palpated, discharge is mucinous.
Diag? fibromyoma
Tt? Surgical / conservative
No.14
A pt hs T - 39ᵒC 3 days later aft c-sec, tachy – 120b/min. in gen blood analysis there is leukocytosis & formula shift 2 d left. Diagnosis : peritonitis aft c-sec. relaparotomy was made. There is serous effusion in abd cavity, intestinal loops r swollen, injected. Womb is x changed, post op cicatrix is in good stage.
What’s doc’s approach? Post op peritonitis, anti-inflammatory.
No.15
A pt. E 21y.o, has complained of pain 7 bloody discharge aft sexual connection 4 d last 4 months. She’s had mens since 11y.o, during 3-4 days, moderate, painless, every 28days. In anamnesis there is 1 artificial abortion & 1 easy delivery.
In speculum : on the cervix of d uterus there is ruby erosion granular 2 x 2 cm, it bleeds when palpating.
PV : vagina is capacious, cervix of d uterus is cylindrical, dense, ext fauces is closed. Body of womb is of norm size, dense, mobile, painless. Fornixes r high. Appendages r x palpated, discharge is sanious.
Diag? precancerous cervix
What examination methods? Doc’s approach? Chemotherapy
Standard task No 16
A girl, 11 years old. She complains of crampy abdominal pains. Pains recur every 3,5-4 weeks and last for 3-4 days, then pains disappear.
When examining pudendum it was detected: there is outpouching (protrusion) between leaves of
small lips of pudendum through which violet contents is seen. There is no opening in hymen.
US (ultrasonic scanning) detected haematometra
Doctor’s approach?atresia of hymen-hymenectomy-after consult 3 docs
Standard task No 17
A patient B., 48 years old, complains of dull ache in the lower part of abdomen, mostly on the left.
There are hot flushes, headache. Anamnesis: She’s had menstruations since she was 13, every 28 days, regular, painless. There was 1 delivery, 3 abortions without any complications.
PV: vagina is capacious, cervix of the uterus is of cylindrical form, body of womb is not enlarged, of usual (common) consistence, mobile, painless. Right appendages are not palpated. On the left and from behind tight and elastic mass in 10 x 12cm is palpated; it is mobile and painless. Serous discharge.
Diagnosis? Cyst of left ovary
Doctor’s approach?cystectomy
Standard task No 18
A patient Y., 30 years old. She complains of poor (scanty) bloody discharge from genital tracts.
Anamnesis: She’s had menstruations since she was 12, for 3-4 days, every 28 days. They are regular, painless. Last menstruation was 6 weeks ago. There were 2 deliveries, 2 abortions without any complications.
General state is satisfactory, P- 80 strokes/minute, Arterial blood pressure (ABP) – 120/80 mm of mercury. Skin and visible mucous tunics are of usual color.
PV: vagina of parous, capacious. Cervix of the uterus is of cylindrical form, rather soft, fauces admits (is patulous for) cupula of a finger. Body of womb is enlarged up to 6 weeks of pregnancy. While palpating it gets into tonus, mobile, sensitive. Appendages are not palpated. Poor (scanty), sanious discharge.
Diagnosis? Isryhmico-cervical insufficiency
Plan of management? Treatment? Hormonal therapy
Standard task No 19
A patient D., 20 years old. She complains of lack of menstruation. Sexual life during one year. There have been no pregnancies.
Genital state: external genitals are hypoplastic. Vagina of nullipara, narrow. Fornixes are not evident (feebly marked). Cervix of the uterus is conical, long, is ½ larger than the body of womb. Womb is dense, painless, mobile in retroflexion. Appendages are not palpated, discharge is scanty, serous.
Diagnosis? hysteromyoma
Doctor’s approach under this pathology? Histological investigation, operative method
Standard task No 20
A patient D, 45 years old. She is on the books because of hysteromyoma. She hasn’t been examined by gynaecologist for the last 3 years. She complains of excessive (profuse) menstruation with grumes for the last 2 years. Anamnesis: She’s had menstruations since she was 12 years old, duration - for 3-4 days, moderate, painless. She’s had sexual life since she was20 years old. There were 3 deliveries, 3 abortions without any complications.
PV: vagina is capacious. Cervix of the uterus is of cylindrical form, body of womb is enlarged up to 15-16 weeks of pregnancy, painless when palpating, limited in mobility, tuberous. Discharge is usual.
Diagnosis? Sarcomatous degeneration
What is doctor’s approach?
Standard task No 21
A pregnant woman, 23 years old, was taken for delivery. Pregnancy – 1, full-term. Labor pains has been lasting for 5 hours, amniotic fluid is intact. Growth – 148cm. Abdominal circumference – 100 cm, height of elevation of fundus of uterus- 37cm. Pelvis size: 23-25-28-17. Labor pains are regular, intense for 45-50 seconds every 2-3 minutes. Between birth pangs pains appeared in the lower part of abdomen. Fetal lie is longitudinal, cephalic presentation, head is pressed to the opening into small pelvis. Urination is difficult. Fetal heartbeats are up to132 strokes/min., distinct, rhythmic.
Diagnosis? Contracted pelvis.justa minor pelvis. Hypoxia of fetus
Doctor’s approach?
Standard task No 22
A pregnant woman, 25 years old, was taken for delivery with regular birth activity. Labor pains has been lasting for 8 hours. Amniotic fluid moved away 8 hours ago. Pregnancies -2, deliveries – 2.
Pelvis size: 26-29-33-21. Fetal lie is longitudinal, large balloting head is palpated at the bottom of the womb, pelvic end is palpated over the opening into small pelvis.
Vaginally: opening of uterine fauces is full. There is no fetal bladder. Leg of fetus and pulsatile (beating) loop of cord are palpated in vagina. Light fluid is running.
Diagnosis? Bridge presentation, footling
Doctor’s approach in this situation? Tsoyanov’s method
Standard task No 23
A pregnant woman, 28 years old, was taken for delivery with regular birth activity and complaints of bloody discharge from genital tracts. Amniotic fluid is intact. Pregnancies -3, delivery – 1. Two pregnancies finished with medical abortions.
General state is satisfactory, P-90 strokes/minute. Arterial blood pressure (ABP) – 100/70 mm of mercury. Skin is pale. Fetal lie is longitudinal, cephalic presentation, head is pressed to the opening into small pelvis. Fetal heartbeats are distinct, rhythmic, up to140 strokes/min.
Vaginally: opening of uterine fauces is 8cm, fetal bladder is intact, to the left and from behind margin of placenta is palpated. Head pushes off. There are grumes in vagina.
Diagnosis? Placenta previa marginal hemorrhage
Doctor’s approach? Urgent c-sec
Standard task No 24
A pregnant woman, 24 years old, was taken for delivery. Delivery – 1, at full term. It has been lasting for 14 hours. Labor pains became weaker. Amniotic fluid moved away 2 hours ago.
Pelvis size: 26-29-31-21. Fetal lie is longitudinal. Fetal heartbeats are up to180 strokes/min., muffled. Head with a large segment is in the cavity of small pelvis.
Vaginally: opening of uterine fauces is full. Arrow-shaped suture is in left oblique incision. Small fontanel is on the right ahead. Discharge is light fluid.
Diagnosis? Premature rupture of amniotic fluid,labour weakness
Doctor’s approach in this pathology?...amniotomy > conservative think bout clinic contracted pelvis after dilation cervix 9-10cm . :vasten symptom = if +ve =c-sect. if –ve=conservative way delivery
Standard task No 25
A pregnant woman, 22 years old, was taken for delivery with regular birth activity that has been lasting for 8 hours. Amniotic fluid is intact. Delivery -1 at full term (partus matures). State is satisfactory. P – 80 strokes /min. ABP –115/70 mm of mercury.
Pelvis size: 23-25-28-18. Abdominal circumference – 95 cm, height of elevation of fundus of uterus- 35cm. Supposed fetus mass according to US – 3200,0.
Fetal lie is longitudinal, cephalic presentation, head is pressed to the opening into small pelvis. Fetal heartbeats are distinct, rhythmic, up to140 strokes/min. Labor pains are good, for 40-45 seconds, every 3-4 minutes.
Vaginally: cervix of the uterus is smoothed, opening of uterine fauces is up to 6 cm, fetal bladder is intact, head is pressed to the opening into small pelvis. Arrow-shaped suture is in the left oblique incision. Small fontanel is on the right ahead. Promontory of sacral bone (sacrum) is accessible. Diagonal conjugate is 11cm.
Diagnosis?transverse contracted pelvis
Doctor’s approach? The size of real conjugate?urgent c-sect. > conjugate vera=9cm
Standard task No 26
A primigravida, 19 years old, was taken to maternity ward for delivery. Pregnancy – 1, term of pregnancy – 37 weeks. There were two fits of convulsions (spasms) at home. No birth activity.
Objective observation: state is grave. A pregnant woman is slowed-down. ABP –180/120 mm of mercury. P – 90 strokes /min. Evident general (diffuse) edema. Womb is out of (has no) tonus. Fetal lie is longitudinal, cephalic presentation. Fetal heartbeats are distinct, rhythmic, up to136 strokes/min.
Vaginally: cervix of the uterus exists, external fauces is closed, head is palpated through fornixes. It is mobile over the opening into small pelvis. Discharge is mucous, moderate.
Diagnosis? Pre-eclampsia, acute hypoxia of the fetus
Doctor’s approach under this pathology?
Standard task No 27
A pregnant woman, 26 years old, was taken for delivery with regular birth activity that has been lasting for 3 hours. Pregnancy -3, delivery -3. First two pregnancies finished with easy deliveries.
Objective observation: state is satisfactory. Form of abdomen is elongated in transverse size. Abdominal circumference – 110 cm, height of elevation of fundus of uterus- 28cm. head is palpated on the right, on the left in the lateral part of womb there is pelvic end. Labor pains – for 30-35 seconds every 4-5 min.
Pelvis size: 26-29-31-21.
Vaginally: cervix of the uterus is smoothed, opening of uterine fauces is up to 6 cm, fetal bladder is intact, presenting part is not palpated. Promontory of sacral bone (sacrum) is not accessible.
Diagnosis? Transverse lie of fetus
Doctor’s approach at this stage of delivery? C-sect.
Standard task No 28
A pregnant woman, 32 years old, was taken for delivery with mature fetus. There is no birth activity. Amniotic fluid has been leaking for 2 days. Pregnancies -4, deliveries – 4.
Objective observation: general state is of medium gravity. P-96 strokes/minute. Arterial blood pressure (ABP) – 120/80 mm of mercury. T – 38C. Womb is out of tonus.
Fetal lie is longitudinal, cephalic (cranial) presentation, fetal heartbeats are not heard.
Vaginally: Cervix of the uterus is shortened up to 1,5cm, external fauces is patulous for 2 cm. There is no fetal bladder. Head is pressed to the opening into small pelvis. Discharge is putreform.
Diagnosis? Death of fetus.intrauterine fetal death
Doctor’s approach?
Standard task No 29
A primipara, 21 years old, was taken for delivery with active birth activity that has been lasting for 16 hours. Amniotic fluid moved away 2 hours ago.
Objective observation: labor pains occur every 1-2 minutes, of expulsive character for 55-60 seconds. Fetal lie is longitudinal, cephalic (cranial) presentation, head is pressed to the opening into small pelvis. Fetal heartbeats are muffled, up to110 strokes/min.
Vaginally: opening of uterine fauces is full, head cuts in, arrow-shaped suture is in square cut. Leading point is small fontanel. High perineum is paid attention to.
Diagnosis? Perineal injury
Doctor’s approach? perinectomy
Standard task No 30
A pregnant woman, 28 years old, was taken for delivery with mature fetus. She complains of profuse bloody discharge from genital tracts. There is no birth activity. Pregnancy-4th, 39-40 weeks. In anamnesis there are three medical abortions complicated with haematometra and endometritis.
Objective observation: general state is of medium gravity. P-90 strokes/minute. Arterial blood pressure (ABP) – 100/60 mm of mercury. Fetal lie is longitudinal, cephalic (cranial) presentation, head is pressed to the opening into small pelvis. Fetal heartbeats are muffled, up to 105-110 strokes/min.
Vaginally: maternal (generative) passages are closed. Through fornixes along the whole length pasty mass (consistence) is palpated. Head is high over the opening into small pelvis. Bloody discharge.
Diagnosis? Central placenta previa. Intrauterine fetal hypoxia
Doctor’s approach? Peculiarities of examination of pregnant women having this pathology? laparotomy
Standard task №36.
Patient 29 years old was hospitalized into gynecological department with complains of bloody discharges from genital tracts last three weeks, pain in low region of abdomen, general weakness, fatigue, loss of weight, body temperature increase, chest pain, heavy breathing.
Objectively: skin and visible mucous tunics have usual color.
Hemodynamics is stable. In indices of red blood – mild anemia.
In anamnesis: there was a therapeutic abortion in term 6-7 weeks of pregnancy 5 weeks ago.
Per vaginum: uterus is enlarged to 7-8 weeks of pregnancy, soft. Both side appendages are enlarged: in the right - 6×7 cm, in the left - 8×9 cm. HCG-test is positive.
What is the diagnose?trophoblastic disease.hydatiform mole
What must be the doctor’s tactics? Dilatation n curettage to remove mole
Standard task №37.
Patient 27 years old complains of sterility, menstrual disorders. Sterility 5 years.
Objectively: obesity, hypertrichosis.
Per vaginum: uterus is smaller than standard, both-side appendages are enlarged, dense.
Basal temperature is monophase.
In ultrasound examination: cystic degeneration of both ovaries, they are enlarged: right ovary - 4×6 cm, left ovary - 4×5 cm.
What is the diagnose?
What must be the doctor’s tactics?
Standard task 38.
Pregnant woman, 2nd pregnancy, was hospitalized into department of pathology of pregnancy in term 34 weeks with complains of weakness, dizziness, rapid fatigability, exercise dyspnea.
Pregnancy – 5th, delivery – 5th. Last delivery were complicated by bleeding.
Objectively: skin and visible mucous tunics have usual color. Pulse rate – 100 per minute, rhythmic, blood pressure – 100/60 mm.Hg.
Labor activity is absent. Position of fetus is longitudinal, head presents, fetal heartbeats are clear, rhythmic, 140 per minute.
General blood test: Hb – 82 g/l, Er – 2.5×1012/l, color index – 0.6, serum iron – 8.0 mmol/l.
What is the diagnose? Iron def. anemia
What must be the doctor’s tactics? Ferrous sulphate orally
Standard task №39.
Woman U. in conferment, 32 years old was hospitalized to maternity home with regular labor activity during 6 hours, amniotic fluid has discharged 4 hours ago.
Pregnancy – 2nd, delivery – 1st. The first pregnancy was terminated by therapeutic abortion.
Objectively: general status of the woman is good, Hemodynamics is stable. Circumference of abdomen – 110 cm, uterine fundus high – 42 cm. Sizes of pelvis: 25-28-30-19 cm.
Birth pains in 45-50’’, intervals – 3-4 minutes, strong.
Position of fetus is longitudinal, presenting head is crowded to pelvic inlet. Fetal heartbeats are clear, rhythmical, 140 per minute.
Vasten’s symptom is positive.
Per vaginum: non-parous, narrow vagina, cervix is smoothed, cervix is dilated up to 8 cm, presenting head push itself off, discharges – light amniotic waters.
What is the diagnose? Cephalopelvic disproportion
What must be the doctor’s tactics? Abdominal hysterectomy
Standard task №40.
Primipara, 25 years old, was hospitalized into department of pathology of pregnancy with complains of active movements of the fetus.
Term of pregnancy – 35 weeks. There was threatened abortion during this pregnancy, woman received repeatedly therapy for it.
Objectively: general status of the woman is good, Hemodynamics is stable. Uterus has normal tone. Position of fetus is longitudinal, head presentation.
Fetal heartbeats is rhythmic, muted, 130 per minute.
Data of ultrasound examination: hyperplasia of placenta.
Data of cardiotocography: basal rhythm is 100 per minute, PSP-index – 2.0.
What is the diagnose?
What must be the doctor’s tactics?
Standard task №41.
Pregnant woman 25 years old, 9 weeks of pregnancy. Glycosuria was revealed during woman is registered on the books in maternity welfare centre.
In anamnesis: woman’s mother and grandmother suffer from diabetes mellitus.
Objectively: Skin and visible mucous tunics have usual color, clean. Body height is 160 cm, body weight – 80 kg. Hemodynamics is stable.
Per vaginum: uterus is enlarged up to 9-10 weeks of pregnancy, has no tone, soft, both-side appendages are without complications. Discharges are mucous.
Data of laboratory examination: glucose level in blood on an empty stomach is 6.9 mmol/l, two hours after load – 7.8 mol/l.
What is the diagnose?
What must be the doctor’s tactics?
Standard task №42.
Woman in conferment, 23 years old. 30 minutes ago delivery of mature girl has body weight 4000.0 g took place. Condition of newborn is 9-10 points of Apgar score.
Symptoms of placental separation are negative. Bleeding is absent.
What is the diagnose? Pathological in placental separation
What must be the doctor’s tactics? Manual removal of placenta
Standard task №43.
Woman in conferment, 30 years old, was hospitalized for delivery. Pregnancy – 3rd, delivery – 3rd, at term. Labor activity takes place last 3 hours, amniotic sac is whole.
Objectively: presenting part is absent. On the right the big dense roundish ballotable part of fetus, on the left – big softish non-ballotable part of fetus is founded. Fetal heartbeats are 134 per minute, auscultated on the level of navel, clear, rhythmical.
Per vaginum: cervix is 5 cm dilated, amniotic sac is whole. Presenting part is not determinable. Promontory is not palpable.
What is the diagnose?
What must be the doctor’s tactics?
Standard task №44.
Woman C. in conferment, 21 years old, was hospitalized with labor activity continues during 12 hours. Discharge of amniotic fluid took place 3 hours ago.
Body temperature is normal.
Sizes of the pelvis: 25-27-31-18 cm.
Position of fetus is longitudinal, presenting head is crowded to pelvic inlet. Fetal heartbeats are 134 per minute, clear, rhythmical.
Per vaginum: complete cervical dilation, amniotic sac is absent. Head is crowded to pelvic inlet. Sagittal suture is in transverse diameter, 2 cm closer to promontory. Small fontanel is on the right, big fontanel is on the left. Promontory is palpable, the diagonal conjugate is 10 cm long.
What is the diagnose? Contracted pelvis 2nd degree
What must be the doctor’s tactics? C-sect. if necessary, if x cervical delivery
Standard task №45.
Woman in conferment, 25 years old, was hospitalized for delivery. Pregnancy – 1st, delivery – 1st. Labor activity takes place last 5 hours, amniotic sac is whole.
Objectively: presenting part is absent. On the left the big dense roundish ballotable part of fetus, on the right – big softish non-ballotable part of fetus is founded. Fetal heartbeats are 134 per minute, auscultated on the level of navel, clear, rhythmical.
Per vaginum: cervix is 7 cm dilated, amniotic sac is whole. Presenting part is not determinable. Promontory is not palpable.
What is the diagnose?
What must be the doctor’s tactics?
Standard task №46.
Pregnant woman E. was hospitalized for delivery with mature pregnancy. Delivery is the first. Labor activity is absent. Discharge of amniotic fluid took place 6 hours ago.
Body temperature is normal, pulse rate is 72 per minute, has good characteristics.
Sizes of the pelvis: 26-26-32-20 cm. Circumference of abdomen is 95 cm, uterine fundus high - 36 cm.
Position of fetus is longitudinal, presenting head is crowded to pelvic inlet.
Fetal heartbeats are 134 per minute, clear, rhythmical.
Light amniotic waters leak.
Per vaginum: cervix is shortened up to 1.5 cm, soft. An external os is passable to 1 cm. Amniotic sac is absent. Fetal head push itself off the pelvic inlet. Light amniotic waters discharges. Promontory is not palpable.
What is the diagnose? Contracted pelvis flat rachitic
What must be the doctor’s tactics? C-sect.
Standard task №47.
Pregnant woman C., 21 years old, was hospitalized with good labor activity continues 12 hours. Discharge of amniotic fluid took place 3 hours ago.
Body temperature is normal.
Sizes of the pelvis: 25-27-31-17 cm.
Position of fetus is longitudinal, presenting head is crowded to pelvic inlet.
Fetal heartbeats are 138 per minute, clear, rhythmical.
Per vaginum: complete cervical dilation, amniotic sac is absent. Head is crowded to pelvic inlet. Sagittal suture is in transverse diameter, 2 cm closer to promontory. Small fontanel is on the right, big fontanel is on the left. Promontory is palpable, the diagonal conjugate is 11 cm long.
What is the diagnose? Contracted pelvis
What must be the doctor’s tactics? Delivery thru natural birth canal
Standard task №48.
Patient A., 22 years old, complains of absence of menstruations. Woman has sexual life during 2 years, had no pregnancies.
Genital status: external genital organs are hypoplastic. Non-parous external opening of vagina. Corpus of uterus is greatly lesser then cervix, dense, painless, in position “retroflexion”. Appendages are not palpable. Discharges are serous, poor.
What is the diagnose?
What must be the doctor’s tactics?
Standard task №49.
Patient E., 23 years old, was hospitalized with complains of sickness and vomiting. Woman loose 4 kg last two weeks. Last menstruation was 9 weeks ago.
Last day the patient have had vomiting about 15 times a day.
Objectively: Skin is pale with icteritiousness. Body temperature – 37.5°C, pulse rate – 100 per minute, blood pressure – 90/60 mm.Hg. Palpatory tenderness in right hypochondrium is revealed.
Per vaginum: sizes of uterus corresponds to term of pregnancy, vaginal discharges are usual.
What is the diagnose? Gestosis. 1st part of pregnancy. 9weeks of pregnancy (up 20 weeks of gestation
What must be the doctor’s tactics?
Standard task №50.
Patient U., 28 years old, was hospitalized with complains of bloody discharges, persistent pain in lower part of abdomen. Last menstruation was 12 weeks ago. Pregnancy is long wished for. In anamnesis – sterility during 7 years.
Objectively: hemodynamics is stable.
Per vaginum: non-parous vagina, cervix is formed, an external fauces is passable for a tip of finger. Uterus is enlarged up to 12 weeks of pregnancy, has an increased tone, tender at palpation. Appendages are not enlarged. Discharges are bloody, moderate.
Emergency task
Standard task No 36
Patient 57 years old address to gynecologist with complains of acute pains are progresses in the low parts of abdomen, body temperature increase up to 38.0º С, general weakness.
In anamnesis: was registered on the gynecologist’s books due to hysteromyoma. Did not address to doctor last 3 years.
Objectively: tongue is clear, dry, abdomen is a little tympanitic, painful in palpation in low regions of abdomen. Peritoneal symptoms are positive.
Per vaginum: uterine corpus is enlarged to 11-12 weeks of pregnancy due to plural nodes of myoma, sharply painful in palpation and movement. Both side appendages are not palpable.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Standard task No 37
Woman E. in conferment, 23 years old, was hospitalized for delivery with good labor activity. Delivery – 1st, pregnancy – 3rd. Previous pregnancies were interrupted by therapeutic abortion without complications.
Hemodynamics is stable. Body height – 148 cm, circumference of abdomen – 100 cm, uterine fundus high – 37 cm. Sizes of pelvis: 22-25-28-17 cm.
Labor pains are present during 5 hours, regular, intensive. Amniotic fluid has discharged 3 hours ago.
Complains of pain in low part of abdomen between labor pains.
Position of fetus is longitudinal, presenting head is crowded to pelvic inlet.
Fetal heart rate is muted, rhythmic, 110 per minute.
Per vaginum: cervix is 2 cm dilated, is smoothed not completely, dense, low-elastic. Presenting head push itself off. Light amniotic waters leak. Promontory is palpable.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Standard task No 38
Woman D. in conferment was hospitalized with active labor activity.
Delivery – 2nd, pregnancy – 2nd. First delivery - without complications.
Hemodynamics is stable. Birth pains in 45-50’’, intervals – 3-4 minutes, strong. Labor activity is present during 6 hours. Amniotic fluid has discharged during hospitalization.
Position of fetus is longitudinal, breech presentation. Fetal heart rate is 140 per minute, clear, rhythmic.
Per vaginum: cervical dilatation is complete. Amniotic sac is absent. There is a leg of fetus and pulsing loop of umbilical cord inside the vagina. Buttocks are compressed to pelvic inlet.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Standard task No 39
Woman K. in conferment, 35 years old. Was hospitalized to maternity home with active labor activity during 10 hours. Amniotic fluid has discharged 2 hours ago.
Delivery – 5th, pregnancy – 9th. Circumference of abdomen – 105 cm, uterine fundus high – 39 cm.
Position of fetus is longitudinal, presenting head is crowded to pelvic inlet.
During one of labor pains acute pain in the abdomen, cold sweat, rapid pulse have come.
Objectively: skin is pale, weak pulse – 98 per minute. Tympanitic abdomen, peritoneal symptoms are positive and full-blown.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Standard task No 40
Woman in conferment, 28 years old, was hospitalized to maternity home for delivery. Delivery – 1st, pregnancy – 1st, mature.
Birth activity is present during 8 hours. Amniotic fluid has discharged 6 hours ago at home.
Objectively: general status of the woman is good, pulse rate – 72 per minute, blood pressure – 120/70 mm.Hg. Sizes of pelvis: 25-27-30-19 cm.
Position of fetus is transverse. Head is on the left, pelvic part of fetus is on the right. Presenting part is absent. Fetal heart rate is not auscultated.
Per vaginum: cervical dilatation is complete. Amniotic sac is absent. Shoulder of the fetus is determined inside the pelvic inlet. Promontory is not palpable.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Standard task No 41
Woman in conferment, 24 years old. Was hospitalized to maternity home with good labor activity. Pregnancy – 3rd, delivery – 3rd. First delivery was ended by embryotomy, second delivery – by operation of cesarean section.
Circumference of abdomen – 105 cm, uterine fundus high – 37 cm. Sizes of pelvis: 23-26-29-17 cm.
Position of fetus is longitudinal, presenting head is movable above the pelvic inlet.
Fetal heart rate is 140 per minute, clear, rhythmic. Birth pains in 45-50’’, intervals – 2-3 minutes. Amniotic sac is whole.
Per vaginum: cervix is smoothed, cervical dilatation is 5 cm. Presenting head push itself off. Amniotic sac is whole. Promontory is palpable. Diagonal conjugate is 11 cm long.
During one of labor pains acute pain in the abdomen, cold sweat, rapid pulse have come. Shape of uterus has changed: in the left of centerline – roundish corpus of uterus, in the right – fetus.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Standard task No 42
Woman in conferment, 28 years old. Was hospitalized with mature pregnancy and good labor activity.
Pregnancy – 5th, delivery – 3rd, there are two therapeutical abortions without complications in anamnesis. Labor pains continue during 12 hours, waterless period – 6 hours.
General status of the woman is good, Body temperature is 37,5°С, pulse rate – 94 per minute, rhythmic.
Position of fetus is longitudinal, presenting part is not palpated. Fetal heartbeats are not auscultated.
Per vaginum: cervical dilation is complete, there is a hand and not-pulsing loop of cord inside the vagina.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Standard task No 43
Patient, 26 years old. Was hospitalized to gynecological department with complains of profuse bleeding with grumes from genitals. Woman considers herself pregnant, last menstruation was 8 weeks ago.
General status of patient is good. Body temperature is normal, pulse rate – 78 per minute, rhythmic.
Per vaginum: non-parous, narrow vagina. Cervical canal is passable for 2 cm, corpus of uterus is enlarged to 6-7 weeks of pregnancy. Discharges are profuse, bloody with grumes.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Standard task No 44
Woman in conferment, 29 years old. The third delivery continues 7 hours.
Complains of bloody discharges with grumes.
General status of patient is good. Skin and visible mucous tunics have usual color. Body temperature is normal. Blood pressure – 100/70 mm.Hg., pulse rate – to 94 per minute, rhythmic.
Position of fetus is longitudinal, presented head is situated high above the pelvic inlet.
Fetal heart rate is 134 per minute, clear, rhythmic.
Per vaginum: cervix is dilated to 5 cm. In the right-posterior side placental tissue is determined. Amniotic sac is whole. Head is high above the pelvic inlet. There are grumes in vagina.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Standard task No 45
Pregnant woman K., 23 years old, was hospitalized into maternity home for delivery. The first mature pregnancy. Blood pressure arise up to 140/100 mm.Hg. repeatedly during the pregnancy, woman did not ask for help. She visited the maternity welfare centre infrequently.
Complains of head ache, stuffiness in nose, blurred vision, pain in epigastric region.
Objectively: body temperature is normal, pulse rate – 90 per minute, blood pressure – 180/110 mm.Hg., edema of legs and anterior abdominal wall. Urine protein – 6 g/l. Attack of convulsions happened at home.
Position of fetus is longitudinal, cephalic presentation, fetal heart rate is 100 per minute, muted.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Standard task No 46
Pregnant woman C. was hospitalized for delivery with mature pregnancy. Labor activity is absent. Pregnancy is the first.
Woman complains of head ache, sickness, “scales in front of her eyes”, there were one vomiting at home.
Objectively: General status of patient is moderate, Blood pressure – 170/110 mm.Hg., urine protein – 3 g/l, edema of legs and anterior abdominal wall.
Presenting part is not palpated, head of fetus is on the right, back is on the left, fetal heartbeats are auscultated on the level of navel, dull, to 130 per minute, rhythmical.
Attack of convulsions has started 20 minutes after admission.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Standard task No 47
Patient A., 28 years old, was hospitalized into gynecological department with complains of profuse bloody discharges with grumes.
Last menstruation was 2.5 months ago. Woman is registered on the books with pregnancy, pregnancy is desired. She thinks her condition has the cause in psycho-emotional stress.
Objectively: general status of patient is good. Pulse rate – 120 per minute, blood pressure – 90/60 mm.Hg. Skin and mucous tunics have usual color.
Per vaginum: cervix is shortened up to 1.5 cm, cervical canal is opened, embryo is situated there. Uterus is enlarged up to 4-5 weeks of pregnancy, discharges are bloody, profuse, with grumes.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Standard task No 48
Patient B., 35 years old. Was hospitalized with complains of bloody discharges from genital tracts after coitus.
In anamnesis: menstruations since 11 years, every 28 days, moderate. There were one pregnancy was ended by therapeutic abortion without complications.
Per speculum: there is a cup (crater) on the cervix, which bleeds profusely. Uterus has normal sizes, appendages are not palpated.
After the doctor’s manual examination profuse bleeding has started.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Standard task No 49
Patient N., 25 years old. Complains of low abdominal pains, nausea, vomiting. Therapeutic abortion in term 3 weeks of pregnancy was done day before.
Objectively: general condition is severe, pulse rate – 120 per minute, body temperature – 37.5°C, Blood pressure – 90/60 mm.Hg., skin is pale. Abdomen is tensed, peritoneal signs are positive. Dullness on percussion in low regions of abdomen is revealed.
Per vaginum: cervix is passable for 2 cm, uterus is enlarged up to 7-8 weeks of pregnancy, soft, painful, fornicis of vagina are tensed, painful. Discharges are bloody, moderate.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Standard task No 50
A girl, 12 years old, complains of spastic pain 4-5 days every week in the course of half a year. During admission to hospital: severe pain in is resistant to analgesics.
In examination of external genitals: there are protrusion between leafs of small lips of pudendum throw what the violet fluid is seen.
The foramen of hymen is absent.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
Tactical schemes of emergent situation in obstetrics and gynecology
Tactical scheme 1
A 34-year-old expectant mother has been brought into maternity hospital with
vaginal bleeding, which was happened suddenly, without any visible reason, without pain. The date of gestation is 38 weeks. There were 2 artificial abortions, complicated with endometritis, in her previous history. At the moment of admission to the hospital the condition is satisfactory; the pulse rate is 89 bpm, ABP is 110/70 - 115/70 mm Hg. The uterus is in normal tone, painless; fetal lie is oblique; fetal heartbeats are rhythmical, clear, 150bpm. There is hemorrhage with blood clots from vagina. The loss of blood is about 500 mL.
The results of vaginal examination, which is made in operative room: the cervix is shortened to 1.5 cm, the cervical canal is dilated till 2 cm; the soft, cancellous tissue is palpated through internal cervical os. During vaginal examination the hemorrhage is intensified.
Blood test: Hb –105 g/L, L – 7, 3×109/л, ESR – 10 mm/h.
Urinalysis: Protein- 0.033g/L; white blood cells- 1-2 visual field (f/v).
US – placenta is localized in the lower segment of the uterus.
What is the diagnosis?
What is the urgent treatment?
Answer for scheme № 1
Pregnancy at 38th week. Total placenta previa
Urgent cesarean section. Blood replacement. Prophylaxis of DIC syndrome
Tactical scheme 2
A 24-year-old pregnant has been brought to the hospital by ambulance with complaints of headache, single vomiting, and scintillating scotoma. It was the 40th week of her 1st pregnancy. Following 32 weeks of gestation edemata, arterial hypertension, and proteinuria were noted. On admission to hospital: ABP 170/ 100, 160/100 mm/Hg; there were edema of legs and abdominal wall. Labor pains were absent. The fetal lie was longitudinal; the presenting head was at the pelvic inlet. The fetal heartbeats were clear, rhythmical, 150bpm.
Blood test revealed: PCV - 42%, platelet count 180.000.
Urinalysis: WBCs: 30 in f/v, protein - 2g/L
1.What is the diagnosis?
2.What is the urgent treatment?
Answer for scheme № 2
Severe preeclampsia.
Halothane narcosis, nitrous oxide. Immediate cesarean section. Catheterizarion of 2 veins. Treatment of generalized vasospasm, and hypovolemia, multiple organ failure
Tactical scheme 3
An expectant mother with 36 weeks of gestation has been brought into the hospital by ambulance with complaints of general weakness, dizziness, abdominal pain, and bloody discharge from vagina. She is ill with essential hypertension. The pregnancy is as complicated with preeclampsia; because of this complication she had a treatment in the hospital. When admitted: general condition is of moderate severity, skin and visible mucous membranes are pallid; pulse rate is 100bpm, rhythmical; BP is 150/100 – 160/100 mm Hg. Uterus tonicity is increased, uterus is painful in the left tubal area in palpation. The fetal lie is longitudinal; the presenting part is the head, positioned above the pelvic inlet. Fetal heartbeats are 100 bpm, arrhythmic, muffled.
Vaginal examination: cervix isn’t changed, the external os is closed, and fetal head is palpable through the anterior vaginal vault. Vaginal discharges are bloody, dark in color.
Blood test: Hb – 90 g/L, PCV – 42%, platelet count – 182000.
US: at the left side near the uterus fundus there is retroplacental hematoma 3х4 cm in sizes.
What is the diagnosis of urgent state?
What is the urgent treatment?
Answer for scheme № 3
Severe preeclampsia, combined (associated form). Premature separaqtion of no0rmlly implanted placenta. Acute fetal distress.
Immediate cesarean section. Complex therapy of preeclampsia.
Tactical scheme 4
A 25-year-old patient safely delivered alive and mature girl. Baby’s weight at birth was 3450 grams, the length of a newborn was 50 cm. In maternal past history there were 1 labor and two artificial abortions complicated with inflammation. The 1st stage of the labor was complicated with primary weakness of labor pains. In 10 minutes after placental birth the uterine hemorrhage was appeared. The uterus was soft and flabby; uterus fundus was 6 cm higher than the navel. By external massage the uterus first contracted, and then it relaxed again and hemorrhage with the blood clots recommenced. The amount of blood loss ran up to 800 ml.
Blood test: Hb - 89 g/L; WBC – 6.3x 109 /L; ESR- 10 mm/h.
Urine analysis: protein - 0,033 g/L; WBC - single in the field of vision.
1. Formulate diagnosis of this urgent state.
2. Determine tactics and rendering emergency medical aid.
Answer for scheme № 4
Early puerperal period. Hypotonic hemorrhage.
Catheterization of bladder, external massage of the uterus, uterotonic agent IV, Manual exploration of the uterine cavity. If no effect – hysterectomy (extirpation of the uterus with tubes. Blood replacement.
Tactical scheme 5
Parturient S., aged 26, with full term pregnancy was admitted to the hospital because of the beginning of labor pains. Within 1, 5 hours excessive labor pains were developed and in 6 hours alive and mature girl was delivered. Baby’s weight at birth was 3600 g, the length of a newborn was 50 cm. The third stage of labor coursed without any complications. In 30 minutes after birth shivering, hyperthermia up to 39.5 °С, dyspnea, and acrocyanosis appeared. The pulse rate was 115bpm, rhythmical, the arterial blood pressure (ABP) dropped to critical level (70/0, 75/20 mm Hg). Brigade of special medical aid was caused to the patient.
Blood test: Hb - 115 g/L; WBC - 12.6x 109 /L; ESR - 34 mm/h.
Urine analysis: protein 0,033 g/L; WBC - 1-3 in f/v.
1. Formulate diagnosis of this urgent state.
2. Determine tactics and rendering emergency medical aid.
Answer for scheme № 5
The1st full termed labor, oxytocia. Excessive labor pains. Amniotic fluid embolism.
Artificial lung ventilation (ALV), treatment of cardiopulmonary arrest, Infusion-transfusion therapy, resustitation measures.
Tactical scheme 6
Recently confined woman, aged 23, transferred to the observation department at the 4th day of puerperal period with complaints about temperature rise to 39-40°С, fever, profuse sweat, weakness, lack of appetite; muscular pains. Labor process was complicated with weakness of labor pains, prolonged term after Bag of Water (BOW) expulsion, hypotonic hemorrhage, and manual control of uterine cavity.
Objective data: general condition is grave, there is paleness, acrocyanosis, adynamia, the skin of lower extremities has marble-like pattern. Pulse is 110 bpm, rhythmical, of satisfactory properties. ABP is 90/60 mmHg -100/65mmHg. Respiratory rate is 25 per min. Tongue is dry. The stomach is soft and painless. Palpation of the liver and spleen is painful. Oliguria is present.
Vaginal examination: Uterine cervix is formed, cervical canal is opened to 2 cm, and uterine body is enlarged up to 14-15 weeks of pregnancy, soft in consistency, painful in palpation. Appendages are not determined, vaginal discharges are bloody, turbid with musty smell.
Blood test: Hb 100 g/L, WBC -23.5x109 /L; ESR- 42 mm/h.
Urine analysis: protein 0,033 g/L; WBC - 3-4 into f/v,
US - sub involution of uterus.
Answer for scheme № 6
Puerperal period. Sepsis.
Preoperative treatment (intensive infusion antibiotic therapy). Extirpation of the uterus. Complex therapy of the septicemia.
Tactical scheme 7
Patient Z., aged 23, with full term pregnancy was admitted to the hospital because of the beginning of labor pains. This is her 1st labor. She had sterility, chronic bilateral adnexitis in her previous history. There is no tendency to intensification of uterine contractility during 6 hours. The duration of labor pains is about 25-30 seconds, the duration of interval between contractions is about 5-8 min, and contractions are weak. There is longitudinal lie of the fetus, cephalic presentation, and fetal head is fixed to the pelvic inlet. Fetal heartbeats are clear, rhythmical, 140 bpm. Amniotic fluid did not discharge.
Vaginal examination: uterine cervix is softened, cervical canal is opened for 3,5 cm, amniotic bag is safe. The presentation is cephalic, the presenting head is fixed to the pelvic inlet, the engagement of the fetal head is correct. Promontory is not palpable.
Blood test: Hb - 130 g/L; WBC - 7.5x 109 /L; ESR - 10 mm/h.
Urinalysis: sugar, protein are not reveal; wbc - 1 in f/v.
1. Formulate diagnosis of this urgent state.
2. Determine tactics and rendering emergency medical aid.
Answer for scheme № 7
The 1st labor at term, the 1st stage. Primary weakness of labor pains.
Augmentation of labor with oxitocinIV. Prevention of intrauterine fetal distress and pathological hemorrhage in placental stage of labor.
Tactical scheme 8
Patient S., aged 27, gave birth to mature boy with 3600 g. of body weight, and 50 cm of height, without asphyxia. In her previous history there are 2 abortions, complicated with adnexitis. 15 minutes after delivery, bleeding from vaginal was appeared. The uterus fundus is palpated at the level of navel, uterus is contracted, and the signs of placental separation are negative. Blood loss ran up to 500 ml.
Blood test: Hb - 118 g/L; WBC – 7.5x109 /L; ESR - 10 mm/h.
Urinalysis: sugar, protein are not reveal; wbc- 2-3 in f/v.
1. Formulate diagnosis of this urgent state.
2. Determine tactics and rendering emergency medical aid
Answer for scheme № 8
The placental stage of labor. Partial adherence of the placenta or partially fused placenta.
Manual removal of the placenta under the IV narcosis. The final diagnosis will be made during the manual exploration of the uterus and removal of the afterbirth. Then management will depend on results of manual removal of the afterbirth. Replacement of blood loss.
Tactical scheme 9
Multipara N, aged 27, admitted to the maternity ward with regular labor pains, within 5 hours. Pelvic sizes: 25-28-31-20 cm. The fetal lie is longitudinal, presentation is cephalic, and fetal head is fixed to the pelvic inlet. Fetal heartbeats are clear, rhythmical, 145 bpm. The expected body weight of the fetus is 4100 g. In 3, 5 hours she delivered baby boy, with 4150 gr. of weight, and 52 cm of height, without asphyxia. Just after the delivery vaginal hemorrhage with fresh blood and continuous flow, was happened. Hemorrhage was continued even after the delivery of afterbirth, which was happened in 5 min after baby birth.
1. Formulate diagnosis of this urgent state.
2. Determine tactics and rendering emergency medical aid.
Answer for scheme № 9
Early puerperal period.Rupture of the cervix, the 3rd degree.
Suture of the cervical rupture. Replacement of blood loss, if need.
Tactical scheme 10
Multipara patient with 35 weeks of gestation complained about abdominal pains, moderate bloody discharges from the vagina, intensive moving of the fetus, complications appeared after trauma.
Objective: general condition is satisfactory; pulse rate is 76 bpm, rhythmical. ABP is 125/70 mmHg - 120/80 mmHg. Uterus is in increased tone and locally painful to the left of fundus. The fetal lie is longitudinal, presentation is cephalic, fetal head is above the pelvic inlet. Fetal heartbeats are rhythmical, by 110 bpm, unvoiced in sound.
Vaginal examination: uterus cervix without structural changes, external os is closed; the presenting head is above the pelvic brim, determined through anterior fornix of the vagina. Discharges are blood-containing, moderate, and dark in color.
Blood test: Hb - 100 g/L; WBC – 8.5x109 /L; ESR - 11 mm/h.
Urinalysis: urinary glucose and protein are not revealed; wbc- 1 in f/v.
US: Retroplacental hematoma to the left, 6x7 cm size.
1. Formulate diagnosis of this urgent state.
2. Determine tactics and rendering emergency medical aid.
Answer for scheme № 10
Pregnancy at 35th week. Premature separation of normally implanted placenta. Acute fetal distress.
Urgent cesarean section. Prevention of DIC syndrome.
Tactical scheme 11
Primipara, K. aged 28, was admitted to maternity home because of frequent and long pains, 60-70 seconds in duration, and every 1-1, 5 min. She had 1 labor and 4 abortions in her previous history. The external sizes of the pelvis are: 23-26-28-18 cm. The presumptive fetal mass is 3900g. On the peak of contraction the patient suddenly felt knife-like pain in lower abdomen. Sudden worsening of the general condition, paleness, acrocyanosis, tachycardia (120 bpm), arterial hypotension (90/40 - 85/50 mmHg), and decreased consciousness happened rapidly. The abdomen became moderately bloated, painful in palpation. Fetal small parts became palpable in the left abdomen just under abdominal wall. Whereas to the right small contracted uterus was determined. Fetal heartbeats disappeared. Moderate bloody discharge from the vagina was happened. Vaginal examination: cervical os is closed, presenting part of the fetus can’t be determined, discharges are bloody.
Blood test: 70g/L, erythrocytes-3,5x109/L, ESR-10mm/h
Urinalysis: protein-0,033g/L, fresh erythrocytes
Formulate the diagnosis of this urgent condition.
Determine the tactics and rendering of special medical help.
Answer for scheme № 11
The 1st confinement at term, the II stage of labor. Justo-minor pelvis. Cephalopelvic disproportion. Uterine rupture.
Immediate laparotomy. Extirpation of the uterus. Replacement of blood loss. Prevention of DIC.
Tactical scheme 12
In patient G, 25 year old, after the second month of delayed menstruation and appearance of bloody discharge, acute pain in the right lower abdomen occurred. Pain was accompanied by nausea, vomiting and unconscious state. She was immediately delivered to gynecological department.
Objective findings: There is paleness of skin; pulse rate is 105 bpm, rhythmical; APB is 90/60 mm Hg, body temperature is 36.7 C, abdomen is moderately bloated in the lower part, it is more painful to the right. Discharges from vagina are bloody.
Vaginal investigation: cervix of the uterus is cylindrical in form, external os is closed. The body of the uterus enlarged for 5 weeks of gestation, soft in consistency, left appendages are not palpable, to the right palpation is painful, something pasty may is founded at this area. Promptov’ symptom is positive.
Blood test: Hb - 95g/L, L - 8.5x109/L, ESR - 9mm/h
Urinalysis: protein - 0.033g/L, L - 2-3 in v/f.
Blood group is B (III) Rh positive.
Puncture of the abdominal cavity at the posterior свод received 20 ml of dark bloody fluid.
Formulate the diagnosis of this urgent condition.
Determine the tactics and rendering of special medical help.
Answer for scheme № 12
Interrupted right tubal pregnancy. Anemia (the 1st degree).
Immediate laparotomy. Tubectomy or tube reconstruction
Tactical scheme 13
Primipara M, 22 year old, complaints of frequent, painful, and long contractions, every 1-2 min for 60-70 seconds, pain in the lower abdomen out of contractions, difficulty of urination. The labor at term, the duration of labor 14 hours. Objective findings: patient is pale, pulse rate is 105 bpm, rhythmical, and ABP is 130/90 - 135/90 mm Hg. Uterus is painful in the lower segment; having “8” shaped form (“hourglass”shape). The contraction ring is on the level of umbilicus. Pelvic sizes are 25-25-31-17, 5. The fetal head is pressed to pelvic inlet. Vasten’ symptom is positive. Fetal heartbeats are of 165 bpm, rhythmical, probable fetal weight is 4050g.
Vaginal examination: the uterine os is dilated for 10 cm, the bag of membranes is absent, the presenting part is the head, which is pressed to the pelvic inlet, there is swelling of the head’s soft tissue, the diagonal conjugate is 10,5cm, and discharges are mucus. Urine is excreted with help of catether-150ml, saturated.
Blood test: Hb-100g/L, L7, 3x109/L, ESR-10 mm/h
Urinalysis: sugar, protein is absent; L-single in f/v
Formulate the diagnosis of this urgent condition.
Determine the tactics and rendering of special medical help.
Answer for scheme № 13
The 1st labor, at term, the 1st stage. Flat rachitic pelvis. Big fetus. Cephalopelvic disproportion. Threatened uterine rupture.
Halothane or nitrous oxide inhalation. Immediate cesarean section. Prevention of a hypotonic hemorrhage.
Tactical scheme 14
In gynecology department a patient with complaints of spasmodic pains in lower abdomen and vaginal bleeding delivered. She thought she is pregnant of 12 weeks. Complaints appeared after influenza.
Objective findings: the condition of the patient is moderate. The skin is pale, pulse rate is 98 bpm, rhythmical, and ABP is 100/70mm Hg. The abdomen is soft, painless.
Vaginal examination: uterine cervix is shortened to 1.5 cm. dilated for 2 cm., freely lying ovum can be founded in the cervical canal, the uterus enlarged to 11-12 weeks of pregnancy, soft in consistency. Uterine appendages are not determined. There is bleeding with fresh blood.
Blood test: Hb – 90g/L, L – 8,5x109/L, ESR – 10mm/h
Urinalysis: Sugar, protein is not found, L 3 -4 fv.
Blood group: AB(IV), Rh(+)
Formulate the diagnosis of this urgent condition.
Determine the tactics and rendering of special medical help.
Answer for scheme № 14
Pregnancy at 11-12th week. Spontaneous abortion in progress.
Curettage of the uterine cavity.
Tactical scheme 15
A primipara C, 22 years old, just delivered alive, full-term boy with 3650-grams of body weight, 50 cm of length. The general condition of new born is moderate: pulse rate is 98 bpm, breathing is poor, muscular tonus – certain degree of flexure, reflex – grimace, skin is pink with acrocyanosis.
The labor was complicated with primary weakness of labor pains and premature discharge of amniotic fluid; the duration of labor was 18.5 h.
Formulate the diagnosis of this urgent condition.
Determine the tactics and rendering of special medical help.
Answer for scheme № 15
The first childbirth, at term. Primary weakness of labor pains. Preterm expulsion of amniotic fluids. Asphyxia of newborn, mild degree (APGAR score 5). Neonatal resuscitation.
Tactical scheme 16
A recently confined woman B, 25 years old, gave birth to a life, full-term girl with 3400 grams of body weight, 50 cm of height, without asphyxia. There are 2 artificial abortions in her anamnesis.
The placenta was delivered without complications. But visual inspection of the afterbirth revealed the defect of placental tissue. Uterine fundus was founded 2 cm lower then the navel in external palpation. The uterus was dense, painless in palpation. Vaginal discharge was moderate and bloody.
Formulate the diagnosis of this urgent condition.
Determine the tactics and rendering of special medical help.
Answer for scheme № 16
Early puerperal stage. Remnant of the placental lobes in the uterus.
Manual removal of remnants and exploration of the uterine cavity. Uterine massage “on the fist”.
Tactical scheme 17
The parturient H, 24 years old, is on the 5th day of puerperal period. The labor process was complicated with primary weakness of labor pains and premature discharge of amniotic fluid. The labor process was continued for 17 hours and 45 minutes.
Now she has complaints about subfebrile temperature in evenings and moderate bloody discharge. In vaginal investigation: uterus cervix is soft, cervical canal is open to 2 cm; the uterus corpus is enlarged to 15-16 weeks of pregnancy and is soft in consistency, painless. The lochia is blood-containing, dark colored, dull and without smell.
Blood test: Hb – 105g/L, L – 8,3x109/L, ESR – 13mm/h
Urinalysis: Sugar, proteins are not found. Lymphocytes: 1 in f/v.
Formulate the diagnosis of this urgent condition.
Determine the tactics and rendering of special medical help.
Answer for scheme № 17
The 5th day postpartum, subinvolution of the uterus.
Antibiotic therapy, uterotonic drugs.
Tactical scheme 18
A female patient B, aged 23, was admitted to the gynecological department by an ambulance with a temperature of 39°С, pain in the lower abdomen, nausea, an episode of vomiting, flatulence, constipation. The complaints appeared after weight-lifting.
Objectively: Body temperature is 39, 2°С, pulse rate is 102 bpm, rhythmic. ABP is130/90mm Hg, the tongue is dry. There is significant bloating of the lower abdomen, which is painful in palpation, the symptom of peritoneal irritation is positive. Vaginal discharge s are mucopurulent in character.
Vaginal examination: uterus cervix cylindrical in from, uterus size is normal; displacements of the uterus are painful. A tumor-like growth 6x7cm in size is revealed in palpation to the right of uterus; it is limited in movements, painful, with clear contours. The left appendage is not determined.
Blood test: Hb – 125g/L; Leucocytes – 13, 5×109/L; ESR – 32 mm/h.
Urinalysis: protein- 0,033; Leucocytes – single in v/f.
Formulate the diagnosis of the emergency situation.
Determine the tactics and the rendering of emergency medical help.
Answer for scheme № 18
Torsion of ovarian cyst pedicle. Pelvioperitonitis.
Urgent laparotomy. Removal of ovarian cyst.
Tactical scheme 19
A multipara M., aged 30, applied to the doctor of maternity welfare clinic with complaints about headache, pain in the epigastric area, worsened vision, edema in the lower extremities. There is chronic pyelonephritis in her previous anamnesis.
The term of pregnancy is 38 weeks. The general condition is moderate, ABP is 180/120 mm Hg - 175/115 mm Hg, and there are edema of lower extremities and general excitement. The fetal lie is longitudinal, the presenting part is the head, and it is pressed to the pelvic bream, fetal heartbeats are muffled, rhythmical, 150/min. During external obstetrical investigation, the doctor noticed fibrillar twitching of the mimic musculature and muscles of the upper extremities.
Blood test: Hb – 126 g/L; Ht – 41%, thrombocytes: 155.000.
Urinalysis: proteinurea 4, 5 g/л, cylinderurea.
Formulate the diagnosis of the emergency situation.
Determine the tactics and the rendering of emergency medical help.
Answer for scheme № 19
Eclampsia. Preconvulsive stage.
Halothane or nitrous oxide inhalation. Immediate cesarean section. Resustitation measurements (according to the Protocol)
Tactical scheme 20
A primipara G, aged 29, was admitted to maternity home in the 2 stage of term labor. The expulsive pains are affective: every 2 minutes with 60 sec of duration. Fetal lie is longitudinal, the presenting part is the head, and it is pressed to the pelvic inlet, fetal heartbeats are clear, rhythmical, 140 bpm. The forewaters expulsed in the in the admitting office, pure.
Vaginal investigation: the cervix is fully dilated, the bag of membranes is absent, and the presenting head is in the 3rd plane of pelvis, the sagittal suture is on the right oblique diameter, the small fontanel is to the left side, turned interiorly.
The patient was completely examined and consulted with needed specialists in antenatal clinic.
Establish the diagnosis of the emergency situation.
2. Determine the tactics and the rendering of emergency medical help.
Answer for scheme № 20
Primipara. The 2nd stage of labor.
Management of the 2nd stage of labor:
monitoring of the general condition of woman in childbirth (pulse rate, blood pressure, skin color, complaints);
character of bearing down efforts;
fetal heart sounds,
fetal descent (crowning, disengagement);
vaginal discharge;
prevention of the perineal laceration
Tactical scheme 21
A primipara B., aged 21, just delivered live full-term newborn with 3400 gr. of body weight, 50 cm of length, without asphyxia. Now she is in the 3rd stage of labor. The uterus body is at the level of navel, firm in palpation. The umbilical cord, clamped with clips just near the vaginal orifice, is drooping from pudendal fissure. The hemorrhage is absent. Urine, excreted with the help of catheter, is pure, 150 ml.
The complete clinical and biochemical investigations of blood and urine were performed in the antenatal clinic.
Blood group is 0 (I), Rh positive.
Blood test: Hb – 95 g/L; L – 7, 6×109/L; ESR – 10 mm/h.
Formulate the diagnosis of the emergency situation.
Determine the tactics and the rendering of emergency medical help.
Answer for scheme № 21
Primipara. The 3rd stage of labor.
Management of the 3rd stage of labor:
monitoring of the general condition of woman in childbirth (pulse rate, blood pressure, skin color, complaints);
observation and evaluation of the signs of placental separation (Alfeld’sign, Shreder’sign, , Custner’s sign, Clein’s sign etc.),
inspection of the afterbirth and membranes after delivery,
external methods of the afterbirth delivery(Abuladze”, Henter’, Crede” methods), if indicated (failure of delivery of the spontaneously separated afterbirth).
Tactical scheme 22
A gravida C., aged 28, was admitted to the department of pregnancy’ pathology with the complaints of aching, dull pains in lower abdomen, increased with fetal movements. This is her 2nd pregnancy. The term of this pregnancy is 35 weeks. Her 1st pregnancy ended with cesarean section one year ago. There is longitudinal scar from the pubis till the navel in abdominal wall. In palpation of the scar the local pain and niche is revealed in the lower third of the scar. Fetal lie is longitudinal; the presenting head is mobile, located above the pelvic inlet. Fetal heartbeats are muffled, rhythmical 145 bpm. Vaginal discharges are mucous.
Blood test: Hb – 118 g/L; L – 7, 6×109/L; ESR – 12 mm/h.
Urinalysis: glucose, protein are not determined; L – 2-3 in v.f.
Formulate the diagnosis of the emergency situation.
Determine the tactics and the rendering of emergency medical help.
Answer for scheme № 22
The 25th week of pregnancy. Threatened rupture of the uterus over the scar after previous CS
Urgent cesarean section. Prevention of the fetal distress
Tactical scheme 23
A gravida M., aged 26, was admitted to the department of extragenital pathology in pregnancy with the complaints about decreasing of fetal movement, thirst, dry mouth. She is ill with diabetes mellitus, type II, moderate severity. It is her 1st pregnancy; the term of pregnancy is 33 weeks. Fetal lie is longitudinal; the presenting part is the head, which is situated above the pelvic inlet and freely mobile. Fetal heartbeats are muffled, rhythmical, 160 bpm.
Doppler investigation revealed the disorder of maternal-placental blood circulation, and signs of intrauterine fetal hypoxia.
US revealed hyperplasia of placenta.
Blood test: Hb – 105g/L; L – 8, 7×109/L; ESR– 11 mm/h
Urinalysis: glucose, protein are not determined; L – 8-10 in v.f.
Blood glucose is 6, 6 mmol/L.
Formulate the diagnosis of the emergency situation.
Determine the tactics and the rendering of emergency medical help.
Answer for scheme № 23
Pregnancy of 33 weeks, diabetes mellitus, insulin dependent form, moderate degree. Fetoplacental insufficiency. Intrauterine fetal distress.
Management:
oxygen inhalation
глюкоза 10% - 500 мл капельно в/венно;
аскорбиновая кислота 5% - 5 мл в/венно;
эуфиллин 2,4% - 10,0 в/венно;
курантил 4 мл в/венно;
сигетин 2-4 мл 1% раствор в/венно;
витамин В6 5% - 1 мл в/мышечно;
гидрокарбонат натрия 5% - 100 мл в/венно капельно.
При отсутствии эффекта – оперативное родоразрешение.
Tactical scheme 24
In recently confined women C., aged 27, the postpartum period was complicated with purulent endometritis. In the 4th day of the disease the condition of the patient was abruptly worsened: body temperature increased till 40°С, chills, and symptoms of intoxication appeared. Pulse rate increased till 135bpm, rhythmical, ABP dropped till 80/40 - 70/20 mm Hg. Muscular pains, diarrhea, auditory and visual hallucinations, general excitement, mental confusion occurred.
The skin is of crimson red color, mucous membranes and nail bed with cyanotic tint.
Blood test: Hb – 103 g/L; PCV (Packed Cell Volume) – 40%, L – 25.3×109/L; ESR – 42 mm/hour, shift to left, toxic granules.
Urinalysis: protein 0,165 g/L; L – 8-10 in v.f..; erythrocytes 5-8 in v.f.; hyaline cylinders 2-3 in v.f., general protein 52 g/L; urea 12,3 mmol/L.
Formulate the diagnosis of the emergency situation.
2. Determine the tactics and the rendering of emergency medical help.
Answer for scheme 24
Послеродовый период. Гнойный эндометрит. Септический шок.
Лечение:
Антибактериальная терапия (2-3 антибиотика широкого спектра действия, 2-внутривенно, 1-внутримышечно);
Инфузионная терапия (лечение гиповолемии) – коллоиды, кристаллоиды, белковые препараты крови, солевые растворы, гидрокарбонат натрия, эритроцитарная масса;
Глюкокортикоиды в больших дозах (преднизолон, гидрокортизон);
Гепаринотерапия. Профилактика ДВС – синдрома;
Ингибиторы протеаз;
Лечение полиорганной недостаточности.
При отсутствии эффекта от лечения в течение 4-6 часов показана экстирпация матки с трубами.
Tactical scheme 25
Parturient, A., aged 21, was admitted to the obstetrical department with full term pregnancy and the beginning of labor. Uterine contractions regular, every 3-4 minutes with the duration of 40-50 s, force is moderate. Pelvic sizes: 25-28-31-20. The lie of the fetus is longitudinal; presenting part is the head, which is pressed to the pelvic inlet. Fetal heartbeats are clear, rhythmical, 130 bpm. Forewaters not discharged.
Vaginal examination: uterus cervix is taken up. The dilatation of uterine os is 3 cm, the bag of membranes is safe, the presenting part is the head, pressed to the pelvic inlet, the sagittal suture is in the left oblique diameter, and the leading point is small fontanel, which is founded to the right nearer to the symphysis. Sacral promontory is not reachable.
Blood Group: is 0 (I), Rh positive.
Blood test: Hb - 125 g/L; L – 7, 5×109/L, ESR - 11 mm/h.
Urinalysis: glucose, protein are not founded; L – absent in f/v.
Formulate the diagnosis of the emergency situation.
Determine the tactics and the rendering of emergency medical help.
Answer for scheme 25
Роды I, срочные, I период (латентная фаза).
Ведение I периода родов. Следить за:
общим состоянием роженицы (пульс, АД, t°С, цвет кожных покровов, поведением, обезболивание);
родовой деятельностью;
сердцебиением плода;
продвижением предлежащей части;
выделениями из половых путей;
IV. Tasks on typical problems in obstetrics and gynecology
TYPICAL PROBLEM 1
Pregnant woman E, aged 25 years old is admitted to obstetric department with active labor pains at term.
OBJECTIVES: general condition is satisfactory, pulse rate (PR) is 80 bpm, ABP – 150/100 mm Hg, there are edemas of lower extremities and lower part of abdomen, proteinuria 0.66 g/L, Vision is not changed.
Abdominal circumference (AC) is 103 cm. The symphysiofundal height (SFH) – 35 cm.
The external pelvimetry – 26-29-31-21cm.
Lie of fetus is longitudinal, cephalic presentation, fetal head engaged to the inlet of pelvis, Fetal heart sound is clear, rhythmic at the rate of 140 beats per min. Contraction of uterus every 2-3 min, continues to 50 – 60 sec during 5 hours. Amniotic membrane is not ruptured (amniotic fluid is not coming out).
Vaginal exam (VE): cervical opening of cervix is 4 cm, amniotic membrane is not ruptured, presenting part engaged to the inlet of pelvis with smaller segment, sagittal suture in the left oblique diameter, right anterior position of the posterior fontanel, sacral promontory is not palpable.
What is the diagnosis? Administer the treatment.
typical problem №1
Diagnosis: The 1st labor at term. The 1st stage of labor. Preeclampsia of mild degree.
Management: Artificial amniuotomy
Treatment of preeclampsia
Prevention of the fetal distress and maternal hemorrhage.
TYPICAL PROBLEM 2
Patient F, 26 years old, is admitted to obstetrics department with term pregnancy, labor pains, started 8 hours ago; 2hours ago amniotic fluid came out and after that contraction of uterus became weak. Pregnancy is mature.
Anamnesis: G4 P1 0 2 1.
Objective findings: general condition is normal, the body is normal, the PR is 72 bpm, ABP is 115/70 mmHg.
The results of external pelvimetry: 26-29-30-20 cm.
AC – 106 cm.
FH (SFH) – 32 cm.
Lie of fetus is longitudinal, the presentation is cephalic, the fetal head station is +2 (the larger segment of the fetal head is engaged into the pelvic cavity); the fetal heart sounds are clear, rhythmic, the fetal heart rate is up to 140 bpm. Uterus contractions are regular: every 5 – 6 min, with 30 – 35 sec in durations, and weak.
VE: the dilatation of the cervix is up to 7 cm, the amniotic membranes are absent, the presenting part is the head, which is on the 1st plane of pelvis, the sagittal suture is in the right oblique diameter, the posterior fontanel turned to the left.
What is the diagnosis? What is the management?
typical problem № 2
Diagnosis: The 2nd labor at term; the 1st stage of labor. Secondaruy weakness of labor pains.
Management: Augmentation of labor
TYPICAL PROBLEM 3
The 22 years old patient was admitted to maternity hospital with full termed pregnancy and active labor pains, which started 8 hours ago. The reproductive history: G 1 P0 000.
Objective findings: general condition is satisfactory, ABP – 115/70 mmHg, PR is 80 bpm.
The results of external pelvimetry: 22-25-27-18 cm.
AC –98 cm.
FH (SFH) - 28 cm.
Lie of fetus is longitudinal; presentation is cephalic, fetal head above the pelvic brim. Vasten’s sign is negative (-), fetal heart sounds are rhythmic, up to 140 bpm. Uterine contractions are regular, every 2 – 3 min, with 50– 60 sec in duration. EFW is about 2800 grams.
VE: uterus’ cervix is dilated for 6 cm, BOW is not ruptured, the presenting part is the head of fetus and it is above the inlet, and the sagittal suture is in the right oblique diameter, the small fontanel is under the pubis and turned the left. The sacral promontory is reachable, the diagonal conjugate is 10 cm.
What is the diagnosis? What is the management?
typical problem № 3
Diagnosis: The 1st labor at term; the 1st stage of labor. Justo-minor pelvis
Management: Expectant management of labor
TYPICAL PROBLEM 4
The 36 eyrs old patient is admitted to maternity home with full term pregnancy, active labor pains which were started 6 hours ago.
The reproductive anamnesis: G3 P2 0 0 2.
There were no complications in previous confinements.
Objective findings: general condition is satisfactory, ABP –120/80 mmHg, PR is 76 bpm. Abdomen is distended to transverse form.
The results of external pelvimetry – 26-29-31-21 cm.
AC – 110 cm.
FH (SFH) – 28 cm.
On palpation of the right lateral side of the uterus the hard circular and balloted part of the fetus was detected. The presenting part of the fetus was not determined. FHS are clear; the rate is up to 136 bpm, detected on the right side near the umbilical area. Amniotic membranes are not ruptured. Contractions of the uterus are of moderate force, every 4 – 5 min, with 30-35 sec in duration.
VE: the cervical opening is 6 cm, BOW is not ruptured, presenting part is not determined. The sacral promontory is not reachable.
What is the diagnosis? What is the management?
typical problem № 4
Diagnosis: The 3rd labor, at term; the 1st stage of labor. Transverse lie of the fetus.
Management: Cesarean section.
TYPICAL PROBLEM 5
Patient O, aged 29, is admitted to gynaecologic department with complaints of increased body temperature, overall weakness, pain in the lower abdomen.
Previous history: Menstrual function is from 12 years old, the duration of the menstrual cycle is 26 days the duration of flow is 5 days, and last menstruation was 3 months ago. The reproductive history: G 5 P2 0 2 2 (Patient had 4 pregnancies, 2 of them were finished with normal deliveries, 2-with artificial abortions). The last abortion was done 8 days ago; she was discharged from the hospital the next day after abortion.
Objective findings: general condition is satisfactory, PR is 92 bpm, ABP –120/80 mmHg. The body temperature is 38, 2; the tongue is moist with white coat; abdomen on palpation is soft and painful in the lower part.
Speculum examination: cervix of uterus is without any pathological changes, discharge is purulent and plentiful.
VE: cervix is of cylindrical form, the external os is closed, the uterus body is slightly increased according the norm, the consistency is soft, and uterus is painful in palpation. Uterine appendages are not palpable.
What is the diagnosis? What is the management?
typical problem № 5
Diagnosis: Acute endometritis after artificial abortion.
Management: Conservative treatment of endometritis
TYPICAL PROBLEM 6
Pregnant woman O, 39 years old is admitted to obstetrical department with watery flow during 3 hours, and absence of labor pains.
Reproductive history: G6 P3 0 2 3 without any complication.
Objective findings: the general condition is satisfactory, the body temperature is 36,6°, the PS is 72 bpm, ABP –115/70mmHg.
AC is 95 cm
FH (SFH) - 36 cm,
External pelvimetry results: 26-29-32-21.
Tonus of the uterus is normal, the lie of the fetus is longitudinal with cephalic presentation, and the station of the head is above the pelvic brim. FHS is clear and rhythmic- 136 bpm.
VE: cervix of the uterus is shortened to 1,5 cm, the cervical os opening is 2 cm, BOW is absent, the presenting part is the head located above the pelvic inlet. The sacral promontory is not palpable. Discharges are clear amniotic fluid.
What is the diagnosis? What is the management?
typical problem № 6
Diagnosis: Full term pregnancy. Preterm rupture of BOW.
Management: Labor induction.
TYPICAL PROBLEM 7
Pregnant woman D, 35 years old is admitted to maternity home with term pregnancy and complaints of watery flow within 2 days. Labor pains are absent.
The reproductive history: G6 P3 0 2 3 No complications in her anamnesis
Objective findings: the general condition is of moderate severity, PR is 94 bpm, and the body temperature is 38°, ABP –110mmHg. Tonus of the uterus is normal, the fetal lie is longitudinal with cephalic presentation, the presenting part is above the pelvic inlet. FHS can’t be detected.
VE: cervix of the uterus is shortened to 1,5 cm, the os is dilated up to 2 cm, BOW is absent, the presenting part is the head of the fetus and it is situated above the pelvic inlet. Palpation of sutures and fontanels is not possible because cervix is opened to a very less extent. Vaginal discharge is purulent.
What is the diagnosis? What is the management?
typical problem № 7
Diagnosis: Full term pregnancy. Preterm rupture of BOW. Chorionamnionitis. Intrauterine fetal death.
Management: Antibacterial treatment.
Augmentation of labor
Craniotomy ( when possible)
TYPICAL PROBLEM 8
Patient Z, admitted to clinic with complaints of permanent pain in lower abdomen, irradiating to the loin, and increased body temperature up to 38°C.
Anamnesis: Mensrual function started from age of 16. Menstrual cycle is regular; the last menstruation was 11 days ago, normal. She has sexual life for 26 years. No pregnancy in her history. More than once she was treated in the hospital concerning an inflammatory process in area of uterine appendages. Culdocentesis was done 2 times in her anamnesis and pus consistency was received.
Objective findings: general condition is of moderate severity, PR is 104 bpm, rhythmic. The body temperature is 38°C. ABP –120/70mmHg.
Abdomen is distended to moderate degree in the lower part, restrictes part involved in respiratory act, symmetrical. On palpation: pain in lower abdomen, positive Shotkin-Blumberg’ symptom revealed.
Speculum exam: uterus cervix without any pathological changes. The discharge is purulent. The external os is closed. the uterine body can not be palpated exactly, because of severe abdominal pain.
VE: the uterine body can not be palpated exactly, because of severe abdominal pain.
The left appendages of the uterus can’t be determined. To the right and behind the uterus tumor like formation measuring 12x7 cm was determined, restricted in movements and painful in palpation. On culdodentesis 20 ml of pus were obtained.
What is the diagnosis? What is the management?
typical problem № 8
Diagnosis: Tubo-ovarian abscess. Pelviperitonitis
Management: Surgical intervention.
TYPICAL PROBLEM 9
Patient B, aged 36, referred to doctor of out-patients department with complaints of plenty menstruation. She has been registered to a gynecologist due to myoma, which was first revealed 6 years ago, at that time the uterus was enlarged to 6-7 weeks of pregnancy.
Last time she attended a doctor 6 months ago, at that time the uterus size was 10 weeks of pregnancy. Last menstruation began 10 days ago and continues up today.
Anamnesis: the menstruations from 10 years of age, regular. During the last year the menstrual flows are plenty, with 7-10 days duration.
The sexual life from age 30.
The reproductive history: G2P0 0 2 0. Artificial abortions were done without any complication.
Objective findings: the general condition is satisfactory, PR is 76 bpm, ABP-120/80 mmHg. Abdomen is soft and painless in palpation.
VE: the vagina is narrow; the uterus enlarged up to 12 weeks of gestation, dense in consistency. Both adnexas are not enlarged. Discharges are plentiful and bloody.
What is the diagnosis? What is the management?
typical problem № 9
Diagnosis: Myoma of the uterus Hemorrhagic syndrome
Management: Separate diagnostic D&C
Surgical treatment
TYPICAL PROBLEM 10
Pregnant woman P aged 28, was admitted to maternity home with complaints of regular pains in lower abdomen during 12 hours. BOW was ruptured 2 hours ago.
The reproductive history: G2 P1 001 The previous labor was normal; with baby’ weight 2500 g.
Objective findings: the general condition is satisfactory, PR is 80 bpm, ABP-120/70 mmHg.
AC – 100 cm.
FH (SFH) – 38 cm.
External pelvimetry: 26-26-30-18 cm.
The lie of the fetus is longitudinal with cephalic presentation, fetal head above the pelvic inlet. FUS 140 bpm, rhythmic. Uterine contractions are regular, every 3-4 min, with 40-45 sec. of duration, painful. Vasten’s symptom is positive.
VE: the cervical canal is fully dilated, BOW is absent. The fetal head is above the pelvic inlet. The sacral promontory is palpable, the diagonal conjugate is of 9cm.
What is the diagnosis? What is the management?
typical problem № 10
Diagnosis: The 2nd labor, at term; The 2nd stage of labor. Flat rachitic pelvis. CPD
Management: Cesarean section
TYPICAL PROBLEM 11
Expectant mother O, aged 30, was admitted to maternity home with active labor pains.
The reproductive history: G2 P1 0 0 1
Objective findings: the general condition is satisfactory, PR is 80 bpm, ABP-120/80 mmHg.
AC – 105 cm.
FH (SFH) – 42 cm.
In palpation: 2 fetuses wee determined, both with longitudinal lie. The 1st fetus is in cephalic presentation, the 2nd fetus is in breech presentation. The first fetus was born in satisfactory condition with Apgar score 8-9, 30 minutes after admitting to maternity home, with 3000 g of body weight.
VE: cervix is fully dilated; BOW of the 2nd fetus is not ruptured.The presenting part of the 2nd baby is above the pelvic inlet. The sacral promontory is not palpable.
What is the diagnosis? What is the management?
typical problem № 11
Diagnosis: The 2nd labor, at term; The 2nd stage of labor. Twins. Breech presentation of the 2nd fetus.
Management: Artificial amniotomy.
Management of labor by Tsovianov 1
TYPICAL PROBLEM 12
Patient H aged 32 years referred to a gynecologist with complaints of pain and bleeding in area of postoperative scar on the days of menstruation.
Anamnesis: Menstruation for 13 years, regular. For the past 4 years menstruations were plentiful, prolonged and painful. Sexual life for 22 years.
G5 P2 0 3 2. Confinements and abortions were not complicated.
Objective findings: the general condition is satisfactory; PR is 80 bpm, ABP-120/80 mmHg. On palpation of the scar the dense and painful nodes were detected, the skin above nodes is dark blue in color. Abdomen is soft, moderately painful to the right side.
VE: Uterus is of normal size, dense and painless. Left adnexa is not determined. To the right and behind of uterus the mass 7x8 cm in size, painful and fixed, was detected.
Cervical discharge is mucous.
What is the diagnosis? What is the management?
typical problem № 12
Diagnosis: Endometriosis of a postoperative scar. External endometriosis of genitals. Endomtrioid cyst of the right ovary.
Management: Surgical intervention
TYPICAL PROBLEM 13
Pregnant woman G aged 21 was admitted to maternity home with regular uterine contractions which were started 18 hours ago. The fore waters were expulsed 2 hours ago. G1 P0 00 0
Obgective findings: the general condition is satisfactory, PR 74 bpm, ABP-115/70 mmHg.
Fetal lie is longitudinal with cephalic presentation, the fetal head engaged to the inlet. FHS is 110 bpm. Labor pains every 2-3 min for 50-60 sec.
VE: the cervix is fully dilated, BOW is absent, and head station is 5 (the head is on the 4th plain of anatomical outlet, sagittal suture in anteroposterior diameter, the small fontanel is under the pubis. The perineum is of 9 cm in height.
What is the diagnosis? What is the management?
typical problem № 13
Diagnosis: The 1st labor, at term; The 2nd stage of labor. Intrauterine fetal distress. The high perineum.
Management: Median episiotomy
Outlet forceps delivery.
TYPICAL PROBLEM 14
Patient H aged 32 referred to gynecologist with complaints of absence of menstruation during 8 weeks.
Anamnesis: Menstruations from age14, regular. Sexual life regular, from age 24.
G4 P2 0 1 Confinements and artificial abortion were without any complication.
Last week patient complained of dull pain in lover abdominal region. Bloody discharge was absent.
VE: the vaginal walls are cyanotic. The uterus is round in form, painful, enlarged up to 10 – 11 weeks of gestation, both appendages are enlarged.
Discharge is whitish and moderate.
UE: The “snow storm” is detected.
What is the diagnosis? What is the management?
typical problem № 14
Diagnosis: Hydatidiform mole
Management: D&C
TYPICAL PROBLEM 15
Patient A aged 27 referred to gynecologist with complains of general weakness, dyspnea, palpitation, cough and bloody discharge from vagina within last week.
Anamnesis: Menstruation from age 14, regular. Sexual life from age 20, regular.
Three months ago spontaneous abortion at term 6-7 weeks was happened, curettage of uterine cavity was made, after which she had bloddy discharge during 2 weeks. One week after curettage of uterine cavity dyspnea and cough were onset.
Objective findings: the general condition of patient is of moderate severity. PR is 98 bpm, ABP is 100/70 mm of Hg.
Blood test: Hb 47g/L ESR: 47mm/h
Speculum exam: there is a node 4x6 cm in size which is located to the right in vaginal entrance. The uterus cervix is not visible because of node.
VE: Uterus enlarged for 14 weeks of gestation, its surface is tuberous. Adnexas on both sides are not palpable. Discharge is dark-bloddy in color.
X-ray of lung: Lung’ metastasis detected.
hCG test is positive.
What is the diagnosis? What is the management?
typical problem № 15
Diagnosis: Chorioepithelioma. Anemia.
Management: Chemotherapy.
TYPICAL PROBLEM 16
Patient E aged 29 admitted to maternity home with active labor pains, continued for 5 hours. Amniotic fluids are is not expulsed.
Anamnesis: G5 P2 0 2 2. No complication in labor and abortions. Now she has multiple pregnancy (twins).
Objective findings: General condition is satisfactory, PR 76 bpm, ABP 110/70 mmHg
AC - 106cm
FH (SFH) - 43 cm
Labor pains character: every 2 min, with 50 sec of duration. In 10 min the 1st new born delivered with body weight of 2900 g and satisfactory general condition.
External palpation of uterus: thehead of 2nd fetus is on right side, breech is to the left; fetal heart sound 136 bpm, clear and rhythmic.
VE: Fully dilated uterine os, BOW of the 2nd fetus is not ruptured, the presenting part is not determined.
What is the diagnosis? What is the management?
typical problem № 16
Diagnosis: The 3rd labor, at term; The 2nd stage of labor. Twins. Transverse lie of the 2nd fetus.
Management: Amniotomy
Internal version of the fetus to the leg.
TYPICAL PROBLEM 17
Patient B aged 45 referred to gynecologist with complaints of bloody discharge after coitus.
Anamnesis: hereditary history is not compromised.
G 5 P2 0 3 2. Last gynecologic examination was done six years ago.
Speculum exam: cervical hypertrophy is revealed. There is finely tuberous formation on anterioir cervical lip looked like cauliflower, 2x2 cm in size, bleeding if touched.
VE: uterus is of normal in size, adnexas are not palpable.
Rectal exam: supravaginal part of cervix is infiltrated. No tumor in the pelvic cavity.
What is the diagnosis? What is the management?
typical problem № 17
Diagnosis: Cancer of the uterus’ cervix.
Management: Cervical biopsy
Combined treatment (surgery and radiation therapy)
TYPICAL PROBLEM 18
Primipara J aged 31 was admitted to obstetrics department with pregnancy at term and active labor pain, which were started 4 hours ago. BOW was ruptured together with starting of uterine contractions
Objective findings: general condition is satisfactory. PR 72 bpm, ABP is 110/70 mm of Hg. The body temperature is 36.6ºC.
AC is 102cm, FH (SFH) is 33cm. External pelvic sizes are 27-27-32-19cm.
The fetal lie is longitudinal with cephalic presentation; the head of the fetus is above the inlet. FHS100 bpm, arrhythmic, dull. Labor pains: every 4-5 min , the duration is 30 sec.
VE: cervix is opened till 5cm, BOW is absent. The presenting part is the head, located abovethe pelvic inlet. The loops of pulsated umbilical cord are detected in vaginal.
Discharge is light amniotic fluid.
The diagonal conjugate is of 10cm
What is the diagnosis? What is the management?
typical problem № 18
Diagnosis: The 1st labor, at term; the 1st stage of labor. Flat rachitic pelvis. Intrauterine fetal hypoxia. Delivery of umbilical cord loops.
Management: Cesarean section
TYPICAL PROBLEM 19
Patient B aged 60, admitted to gynecological department with complains of pain in left inguinal region and left thight, especially at nighttime. Pain is of acute character, micturation is painful and defecation too. There are blood inclusions in urine and feces.
Patient didn’t consulted to doctor for more than a year.
Objective findings: general condition is of moderate severity, PR 90 bpm, ABP 90/60 mm Hg. Body temperature is 37.2ºC.
Patient is cachexic, in abdominal palpation hard tumour with irregular border, fixed and tubourous, was find in hypogastric area.
Speculum exam: there is a crateriform formation with necrotic coat in place of cervix.
Discharge like a meat slops.
VE: 2/3 of vaginal wall are edematous. Tumor conglomerate, hard in consistency, is palpated in the pelvic cavity; spread to the pelvic wall on both sides, fixed, slightly painful in palpation.
Rectal exam: the mucous membrane of the rectum is fixed. There is an infilteration in parametrial space on both sides which is spread to the pelvic wall.
What is the diagnosis? What is the management?
typical problem № 19
Diagnosis: Cancer of the uterus cervix III-IV degree.
Management: Multisystem treatment.
TYPICAL PROBLEM 20
Patient B, aged 53, was admitted in gynecological department with complains of bloody discharge from vagina.
Anamnestic data: no hereditary report, menopause during 3 years.
In previous history there were 4 pregnancies. No gynecological disease in previous history. During the last 3 months there are periodic bloddy discharges from vagina.
VE: Cervix is of cylindrical form, the external os is closed, the uterus body is not enlarged, uterus is freely movable and painless, adnexas are not determined.
Histological examination of maternal taken from curettage of uterine mucosa: multiple polyps in without any sign of malignancies.
What is the diagnosis? What is the management?
typical problem № 20
Diagnosis: Endometrial polyposis.
Management: Hormonal treatment
TYPICAL PROBLEM 21
Patient M. aged 53, admitted to gynecological department with complaints of moderate bloody discharge from vagina.
Anamnesis: during the last year the menstrual cycle became: two times a month with small amount of bloody discharge, continues for 8- 10 days. She consulted about this problem in woman consultation, where she was prescribed uterine contractive drugs.
Objective findings: general condition is satisfactory, ABP 110/70 mmHg, skin and mucous are pale in color.
Blood test: Hb 95 g/L
In physical exam: abdomen is soft and painless on palpation
VE: Cervix of the uterus is of cylindrical form, body of the uterus is enlarged, dense, movable and painful. Adnexal area is free of any changes.
Histological exam: in material taken from D&C cells of glandular epithelium with signs of malignancies were determined.
What is the diagnosis? What is the management?
typical problem № 21
Diagnosis: Cancer of the uterine body.
Management: Surgical intervention
Radiation treatment.
TYPICAL PROBLEM 22
Pregnant woman aged 34 admitted to the maternity home with complains of pain in abdomen, weakness, dizziness, moderate bleeding from vagina. The pregnancy is at term, regular labor pains started 4 hours ago.
In previous history: G 2 P2 002
2 weeks before the admission to maternity home oedema on lower extremities appeared, ABP rised up to 140/90 mmHg; proteinuria up to 0.33g/L appeared.
Objective findings: skin and mucosal layers are pale in color, lower extremities are edematous, the body temperature is 35.8º C, PR 96/min, ABP 100/70 mmHg.
Tonus of uterus is increased, uterus is painful in palpation, especially on fundal area, fetus is not palpable because of hypertonicity of the uterus. FHS are not audible.
VE: cervix is fully opened; BOW is not ruptured and tense. The presenting part is fetal head, which is above the inlet plane. The sacral promontory is not palpable. Discharges are moderate bloody.
What is the diagnosis? What is the management?
typical problem № 22
Diagnosis: The 3rd labor, at term; the 2nd stage of labor. Mild preeclampsia. Premature separation of normally implanted placenta. Intrauterine fetal death.
Management: Amniotomy
Craniotomy
Prevention of DIC
TYPICAL PROBLEM 23
Pregnant women K, aged 36, admitted to obstetrics department with complaints of regular uterine contractions, which started 5 hours ago. The amniotic fluids were not discharged.
Reproductive history: G6 P2 0 3 2.
Objective findings: the fetal lie is longitudinal with cephalic presentation, the large segment of the head in the first plane of small pelvis; FHS is clear, rhythmic up to 140 bpm.
Labor pains character: every 2 minutes, duration is 50 – 60 sec.
VE: cervix is fully dilated, BOW is intact. The presenting part if the fetal head, which is in the 2nd plane of pelvis. Discharges are sanious. The sacral promontory is not palpable.
What is the diagnosis? What is the management?
typical problem № 23
Diagnosis: The 3rd labor, at term; the 2nd stage of labor. Post term rupture of BOW.
Management: Amniotomy
TYPICAL PROBLEM 24
Patient B. admitted to gynecological department with complaints of pain in left iliac region, which irradiates to left thigh.
Anamnesis: Menstruation and fertility without any changes. Two weeks ago the tumor in the left ovarian region was determined, size were 9x8 cm. Six hours ago, just after physical overstrain, acute pain in left lower abdominal part appeared, pain were followed with nausea and vomiting.
Objective findings: general condition is satisfactory, PR – 92 bpm, ABP – 120/70 mmHg,
Body temperature– 37.4˚C.
Abdomen is moderately tense, painful in palpation pain in lower part, especially to the left. Shotkin – Blumberg sign is positive.
VE: uterus is of normal size, movable and painless. Right adnexal area is not changed; to the left and behind the uterus the tumor like formation was palpated, sharply painful, 12x10cm in size. Discharges are mucous.
What is the diagnosis? What is the management?
typical problem № 24
Diagnosis: Torsion of ovarian cyst pedicle. Pelviperitonitis.
Management: Surgical intervention
TYPICAL PROBLEM 25
Patient D, aged 31, admitted to obstetrical department with active labor pains, which were started 8 hours ago, and expulsion of amniotic fluids, happened 4 hours ago. G1 P0.
Objective findings: there is hypertonus of the uterus,.
AC – 105cm
FH (SFH – 39cm
Fetal lie is longitudinal with cephalic presentation; the presenting part is above the first plane the pelvis. The lower abdominal part is painful in palpation in between contractions. Urination is laboured .Vasten’ symptom is positive, uterus contracts every 1-2min for 50-55sec, contractions are very painful. FHS up to 110bpm.
VE: cervix is dilated till 4cm, BOW is absent, fetal head is movable over the inlet plane. Discharges are bloody with amniotic fluid.
What is the diagnosis? What is the management?
typical problem № 25
Diagnosis: The 1st labor, at term; the 1st stage of labor. Simple flat pelvis. CPD. Incipient rupture of the uterus.
Management: Cesarean section.
Task on emergent situation
for state examination on obstetrics and gynecology № _1_
Pregnant woman E, aged 25 years old is admitted to Obstetrics department with active labour pains. Pregnancy is at term.
Objective findings: general condition is satisfactory, pulse rate 80 bpm, ABP – 150/100 mm Hg, edema of lower extremities and lower part of abdomen, proteinuria 0.66 g/L, Vision is not changed.
Abdominal circumference– 103 cm.Symphysis Fundal Height – 35 cm. External pelvic sizes – 26-29-31-21cm.Lie of fetus is longitudinal, presentation is cephalic, fetal head engaged to the pelvic inlet. Fetal heart sound is clear, rhythmic, at the rate of 140 bpm.
Labor pains rate|: duration 50 – 60 sec, interval 2-3 min, during 5 hours. Amniotic membranes are not ruptured (Amniotic fluid does not escape)
VE: vagina of primapara, uterus’ cervix dilation is 4 cm, amniotic membranes are not ruptured, the presenting part engaged to the pelvic inlet with smaller segment, saggittal suture is in the left oblique diameter, the posterior fontanelle turned to the right and anterior. Sacral promontory is not attainable.
What is the diagnosis? D 1st labor at term. It’s the 1st stage of labor, preeclampsia of mild degree
What is the management and treatment? Artificial amniotomy is recommended. Tt of preeclampsia is suggested. Prevention of fetal distress & maternal hemorrhage is necessary.
Task on emergent situation
for state examination on obstetrics and gynecology № _2_
Patient A., 28 years old, was referred to gynecologist because of delay of periods for 2 months. She suspects that she is pregnant.
In anamnesis: 2 years ago the acute salpingitis was registered; treatment was in out-patient department. The last menstruation was 9 weeks ago.
Objective findings: general condition is satisfactory. Pulse rate – 80 bpm, BP – 110/70 mm.Hg. Skin and the mucous are of normal color.
VE: cervix is cylindrical, normal in size and consistency, the external os is slit-like. The uterus is slightly enlarged, painless and freely movable in palpation; the discharges mucous.
CBC – without pathology. Urinealysis – no pathology. Transvaginal US reveals no ovum in the uterine cavity.
β-HCG is <2000MIU/mL
What is the diagnosis? Suspicious progressive ectopic pregnancy
What is the management? Regular checkup of β-HCG every 2 days is recommended. If x doubling, the diagnosis of progressive ectopic pregnancy will b proved. Then laparoscopic surgery is indicated 2 arrest the pregnancy & save the reproduction f(x).
Task on emergent situation
for state examination on obstetrics and gynecology № _3_
Patient F, 26 years old, is admitted to obstetrics department with full termed pregnancy, and labor pains, which started 8 hours ago. 2 hours ago amniotic fluid came out and after that contraction of uterus became weak. Anamnesis: G4 P1 0 2 1.
Objective findings: general condition is normal, the body T° is normal, the PR is 72 bpm, ABP is 115/70 mmHg. The results of external pelvimetry: 26-29-30-20 cm. Abdominal circumpherence (AC) – 106 cm. Fundal height (FH orSFH) – 32 cm. Lie of fetus is longitudinal, the presentation is cephalic, the fetal head station is +2 (the larger segment of the fetal head is engaged into the pelvic cavity); the fetal heart sounds are clear, rhythmic, the fetal heart rate is up to 140 bpm. Uterus contractions are regular: every 5 – 6 min, with 30 – 35 sec in durations, and weak.
VE: the dilatation of the cervix is up to 7 cm, the amniotic membranes are absent, the presenting part is the head, which is on the 1st plane of pelvis, the sagittal suture is in the right oblique diameter, the posterior fontanel turned to the left.
What is the diagnosis? 2nd labor at term; it’s 1st stage. Secondary weakness of labor pains is observed.
What is the management? Augmentation of labor wit oxytocin is recommended.
Task on emergent situation
for state examination on obstetrics and gynecology № _4_
Patient M., 40 years old, admitted to gynaecological department with complaints about yellow colored vaginal discharges.
Anamnesis: G 3 P 3 (3 pregnancies, 3 labors).
Specula examination: vaginal mucosa of hyperemic, there are whitish areas with clear contours on posterior lip of vaginal portion of the uterine cervix.
VE: cervix is cylindrical, uterine body is of normal sizes, appendages are not palpable, diacharges are yellow, foamy.
Vaginal smears’ microscopy: mixed flora and trichomonad defined in vaginal smears.
Colpocytology results: two areas stained white after the acetic acid wash (so called "acetowhite lesions") revealed on posterior cervical lip. The boundaries of these areas are distinct and clear.
What is the diagnosis? Cervical leukoplakia & Trichomonas colpitis
What is the management? Tt- Trichomonas colpitis is nessesary. Cervical biopsy 2 specify the diagnosis & further tt of cervical lesion
Task on emergent situation
for state examination on obstetrics and gynecology № _5_
The 22 years old patient was admitted to maternity hospital with full termed pregnancy and active labor pains, which started 8 hours ago. The reproductive history: G 1 P0 000.
Objective findings: general condition is satisfactory, ABP – 115/70 mmHg, PR is 80 bpm. The results of external pelvimetry: 22-25-27-18 cm. AC –98 cm. FH (SFH) - 28 cm.
Lie of fetus is longitudinal; presentation is cephalic, fetal head above the pelvic brim. Vasten’s sign is negative (-), fetal heart sounds are rhythmic, up to 140 bpm. Uterine contractions are regular, every 2 – 3 min, with 50– 60 sec in duration. Estimated Fetal Weight (EFW) is about 2800 grams.
Vaginal exam (VE): uterus’ cervix is dilated for 6 cm, Bag Of Waters (BOW) is not ruptured, the presenting part is the head of fetus and it is above the inlet, and the sagittal suture is in the right oblique diameter, the small fontanel is under the pubis and turned the left. The sacral promontory is reachable, the diagonal conjugate is 10 cm.
What is the diagnosis? 1st labor at term, it’s 1st stage of labor. Pelvis justo-minor is observed.
What is the management? Expectant management of labor is recommended.
Task on emergent situation
for state examination on obstetrics and gynecology № _6_
A 43-year-old woman complains of contact hemorrhages during the last 6 months.
Specula examination showed the following: cervix of the uterus is in the form of cauliflower.
Bimanual exam: cervix of the uterus is enlarged, restricted in mobility.
Schiller tests is positive.
What is the most probable diagnosis? Suspicion on cervical cancer
What is the management? Cervical biopsy, histological investigation of biopsy material, & management according 2 the final diagnosis r recommended.
Task on emergent situation
for state examination on obstetrics and gynecology № _7_
The patient aged 28 has addressed with gynecologist concerning pains in the lower abdomen, blood staining discharges form vagina, which have appeared 7 days after introduction of intrauterine device (IUD).
Menses since 14 years for 7 days in 30 days, plentiful; last year they became painful within last year, after the 3rd abortion.
Reproductive anamnesis: G 5 P2 0 3 (5 pregnancy: 2 labors at term, 0 premature labor, 3 artificial abortions). A follicular pseudo-erosion was registered in her previous anamnesis.
Objective findings: the uterus is a little bit more than norm, sensitive in palpation, appendages are not changed. Discharges are mucous-bloody.
What is the diagnosis? Endometritis
What is the proper management? Removal of IUD, anti-inflammatory therapy combined wit COCps is indicated.
Task on emergent situation
for state examination on obstetrics and gynecology № _8_
The 36 years old patient is admitted to maternity home with full term pregnancy, active labor pains which were started 6 hours ago. The reproductive anamnesis: G3 P2 0 0 2. There were no complications in previous confinements.
Objective findings: general condition is satisfactory, ABP –120/80 mmHg, PR is 76 bpm. Abdomen is distended to transverse form. The results of external pelvimetry – 26-29-31-21 cm. AC – 110 cm. FH (SFH) – 28 cm.
On palpation of the right lateral side of the uterus the hard circular and balloted part of the fetus was detected. The presenting part of the fetus was not determined. FHS are clear; the rate is up to 136 bpm, detected on the right side near the umbilical area. Amniotic membranes are not ruptured. Contractions of the uterus are of moderate force, every 4 – 5 min, with 30-35 sec in duration.
VE: the cervical opening is 6 cm, BOW is not ruptured, presenting part is not determined. The sacral promontory is not reachable.
What is the diagnosis? 3rd labor at term; it’s 1st stage. Transverse lie of the fetus is observed.
What is the management? Cesarean sec is indicated.
Task on emergent situation
for state examination on obstetrics and gynecology № _9_
Patient O, aged 29, is admitted to gynaecologic department with complaints of increased body temperature, overall weakness, pain in the lower abdomen.Previous history: Menstrual function is from 12 years old, the duration of the menstrual cycle is 26 days the duration of flow is 5 days, and last menstruation was 3 months ago. The reproductive history: G 5 P2 0 2 2 (Patient had 4 pregnancies, 2 of them were finished with normal deliveries, 2-with artificial abortions). The last abortion was done 8 days ago; she was discharged from the hospital the next day after abortion.
Objective findings: general condition is satisfactory, PR is 92 bpm, ABP –120/80 mmHg. The body temperature is 38, 2; the tongue is moist with white coat; abdomen on palpation is soft and painful in the lower part.
Speculum examination: cervix of uterus is without any pathological changes, discharge is purulent and plentiful.
VE: cervix is of cylindrical form, the external os is closed, the uterus body is slightly increased according the norm, the consistency is soft, and uterus is painful in palpation. Uterine appendages are not palpable.
What is the diagnosis? Acute endometritis aft artificial abortion.
What is the management? Conservative tt endometritis is indicated.
Task on emergent situation
for state examination on obstetrics and gynecology № _10_
Pregnant woman O, 39 years old is admitted to obstetrical department with watery flow during 3 hours, and absence of labor pains.
Reproductive history: G6 P3 0 2 3 without any complication.
Objective findings: the general condition is satisfactory, the body temperature is 36,6°, the PS is 72 bpm, ABP –115/70mmHg. AC is 95 cm FH (SFH) - 36 cm. External pelvimetry results: 26-29-32-21.
Tonus of the uterus is normal, the lie of the fetus is longitudinal with cephalic presentation, and the station of the head is above the pelvic brim. FHS is clear and rhythmic- 136 bpm.
VE: cervix of the uterus is shortened to 1,5 cm, the cervical os opening is 2 cm, BOW is absent, the presenting part is the head located above the pelvic inlet. The sacral promontory is not palpable. Discharges are clear amniotic fluid.
What is the diagnosis? Full term pregnancy. Preterm rupture of BOW.
What is the management? Labor induction is indicated.
Task on emergent situation
for state examination on obstetrics and gynecology № _11_
Pregnant woman D, 35 years old is admitted to maternity home with term pregnancy and complaints of watery flow within 2 days. Labor pains are absent.
The reproductive history: G6 P3 0 2 3 No complications in her anamnesis
Objective findings: the general condition is of moderate severity, PR is 94 bpm, and the body temperature is 38°, ABP –110mmHg. Tonus of the uterus is normal, the fetal lie is longitudinal with cephalic presentation, the presenting part is above the pelvic inlet. FHS can’t be detected.
VE: cervix of the uterus is shortened to 1,5 cm, the os is dilated up to 2 cm, BOW is absent, the presenting part is the head of the fetus and it is situated above the pelvic inlet. Palpation of sutures and fontanels is not possible because cervix is opened to a very less extent. Vaginal discharge is purulent.
What is the diagnosis? Full term pregnancy, preterm rupture of BOW; chorioamnionitis; intrauterine fetal death.
What is the management? Antibacterial tt, augmentation of labor, craniotomy (in case of fully dilated cervix) is indicated.
Task on emergent situation
for state examination on obstetrics and gynecology № _12_
Patient Z, admitted to clinic with complaints of permanent pain in lower abdomen, irradiating to the loin, and increased body temperature up to 38°C.Anamnesis: Mensrual function started from age of 16. Menstrual cycle is regular; the last menstruation was 11 days ago, normal. She has sexual life for 26 years. No pregnancy in her history. More than once she was treated in the hospital concerning an inflammatory process in area of uterine appendages. Culdocentesis was done 2 times in her anamnesis and pus consistency was received.
Objective findings: general condition is of moderate severity, PR is 104 bpm, rhythmic. The body temperature is 38°C. ABP –120/70mmHg.Abdomen is distended to moderate degree in the lower part, restrictes part involved in respiratory act, symmetrical. On palpation: pain in lower abdomen, positive Shotkin-Blumberg’ symptom revealed.
Speculum exam: uterus cervix without any pathological changes. The discharge is purulent. The external os is closed. The uterine body can not be palpated exactly, because of severe abdominal pain.
VE: the uterine body can not be palpated exactly, because of severe abdominal pain.
The left appendages of the uterus can’t be determined. To the right and behind the uterus tumor like formation measuring 12x7 cm was determined, restricted in movements and painful in palpation. On culdodentesis 20 ml of pus were obtained.
What is the diagnosis? Tubo-ovarian abcess; pelviperotonitis.
What is the management? Surgical intervention; removal of the left appendage; tt & drainage of the abd cavity; antibacterial & anti-inflammatory tt r indicated.
Task on emergent situation
for state examination on obstetrics and gynecology № _13_
Patient B, aged 36, referred to doctor of out-patients department with complaints of plenty menstruation. She has been registered to a gynecologist due to myoma, which was first revealed 6 years ago, at that time the uterus was enlarged to 6-7 weeks of pregnancy.
Last time she attended a doctor 6 months ago, at that time the uterus size was 10 weeks of pregnancy. Last menstruation began 10 days ago and continues up today.
Anamnesis: the menstruations from 10 years of age, regular. During the last year the menstrual flows are plenty, with 7-10 days duration. The sexual life from age 30.
The reproductive history: G2P0 0 2 0. Artificial abortions were done without any complication.
Objective findings: the general condition is satisfactory, PR is 76 bpm, ABP-120/80 mmHg. Abdomen is soft and painless in palpation.
VE: the vagina is narrow; the uterus enlarged up to 12 weeks of gestation, dense in consistency. Both adnexas are not enlarged. Discharges are plentiful and bloody.
What is the diagnosis? Myoma of the uterus, hemorrhagic syndrome.
What is the management? Diagnostic D & C (cervical canal & uterine cavity curttage), surgical intervention (hysterectomy) r indicated.
Task on emergent situation
for state examination on obstetrics and gynecology № _14_
Pregnant woman P aged 28, was admitted to maternity home with complaints of regular pains in lower abdomen during 12 hours. BOW was ruptured 2 hours ago.
The reproductive history: G2 P1 001 The previous labor was normal; with baby’ weight 2500 g.
Objective findings: the general condition is satisfactory, PR is 80 bpm, ABP-120/70 mmHg. AC – 100 cm. FH (SFH) – 38 cm. External pelvimetry: 26-26-30-18 cm.
The lie of the fetus is longitudinal with cephalic presentation, fetal head above the pelvic inlet. FUS 140 bpm, rhythmic. Uterine contractions are regular, every 3-4 min, with 40-45 sec. of duration, painful. Vasten’s symptom is positive.
VE: the cervical canal is fully dilated, BOW is absent. The fetal head is above the pelvic inlet. The sacral promontory is palpable, the diagonal conjugate is of 9cm.
What is the diagnosis? 2nd labor at term, the 2nd stage, rachitic flat pelvis, & cephalo-pelvic disproportion.
What is the management? Cesarean sec is indicated.
Task on emergent situation
for state examination on obstetrics and gynecology № _15_
A 24-year-old woman, gravida 1, para 1, is seeing you because every month since age 19 she has had severe lower pelvic pain during her periods. She says the pain is similar to labor pains and it interferes with her ability to concentrate at work and during leisure activities on the weekends. Her pain has also caused her to become extremely anxious and irritable. She has tried acetaminophen with little relief. She denies having a depressed mood or changes in sleep, energy, or eating patterns. Her past medical history is remarkable for mild asthma controlled with albuterol. She is sexually active, is in a monogamous relationship, and uses condoms for contraception. She has no known drug allergies but admits to drinking a few alcoholic beverages every day.
What is the most probable diagnosis? Dysmenorrhea (pain only during mens)
What is the management? Non-steroidal anti-inflammatory agents (ibuprofen), if that does not give relieve then give hormonal contraception (norgestimate plus ethinyl estrandiol) would b indicated.
Task on emergent situation
for state examination on obstetrics and gynecology № _16_
Expectant mother O, aged 30, was admitted to maternity home with active labor pains.
The reproductive history: G2 P1 0 0 1
Objective findings: the general condition is satisfactory, PR is 80 bpm, ABP-120/80 mmHg. AC – 105 cm. FH (SFH) – 42 cm.
In palpation: 2 fetuses wee determined, both with longitudinal lie. The 1st fetus is in cephalic presentation, the 2nd fetus is in breech presentation. The first fetus was born in satisfactory condition with Apgar score 8-9, 30 minutes after admitting to maternity home, with 3000 g of body weight.
VE: cervix is fully dilated; BOW of the 2nd fetus is not ruptured.The presenting part of the 2nd baby is above the pelvic inlet. The sacral promontory is not palpable.
What is the diagnosis? 2nd labor at term; 2nd stage; twins; breech presentation of 2nd fetus
What is the management? Artificial amnitomy; management of labor by Tsovianov 1 is indicated
Task on emergent situation
for state examination on obstetrics and gynecology № _17_
Patient H aged 32 years referred to a gynecologist with complaints of pain and bleeding in area of postoperative scar on the days of menstruation.
Anamnesis: Menstruation for 13 years, regular. For the past 4 years menstruations were plentiful, prolonged and painful. Sexual life for 22 years. G5 P2 0 3 2. Confinements and abortions were not complicated.
Objective findings: the general condition is satisfactory; PR is 80 bpm, ABP-120/80 mmHg. On palpation of the scar the dense and painful nodes were detected, the skin above nodes is dark blue in color. Abdomen is soft, moderately painful to the right side.
VE: Uterus is of normal size, dense and painless. Left adnexa is not determined. To the right and behind of uterus the mass 7x8 cm in size, painful and fixed, was detected.
Cervical discharge is mucous.
What is the diagnosis? Endometriosis of a postoperative scar, external endometriosis of genitals; endometrioid cyst of right ovary.
What is the management? Surgical intervention would b indicated
Task on emergent situation
for state examination on obstetrics and gynecology № _18_
Pregnant woman G aged 21 was admitted to maternity home with regular uterine contractions which were started 18 hours ago. The fore waters were expulsed 2 hours ago. G1 P0 00 0
Obgective findings: the general condition is satisfactory, PR 74 bpm, ABP-115/70 mmHg. Fetal lie is longitudinal with cephalic presentation, the fetal head engaged to the inlet. FHS are 110 bpm. Labor pains every 2-3 min for 50-60 sec.
VE: the cervix is fully dilated, BOW is absent, and head station is 5 (the head is on the 4th plain of anatomical outlet, sagittal suture in anteroposterior diameter, the small fontanel is under the pubis. The perineum is of 9 cm in height.
What is the diagnosis? 1st labor at term; 2nd stage intrauterine fetal distress; & the high perineum
What is the management? Median episitomy & outlet forceps delivery would b indicated
Task on emergent situation
for state examination on obstetrics and gynecology № _19_
Patient H aged 32 referred to gynecologist with complaints of absence of menstruation during 8 weeks.
Anamnesis: Menstruations from age14, regular. Sexual life regular, from age 24.
G4 P2 0 1 Confinements and artificial abortion were without any complication.
Last week patient complained of dull pain in lover abdominal region. Bloody discharge was absent.
VE: the vaginal walls are cyanotic. The uterus is round in form, painful, enlarged up to 10 – 11 weeks of gestation, both appendages are enlarged.
Discharge is whitish and moderate.
UE: The “snow storm” is detected.
What is the diagnosis? Hydatidiform mole
What is the management? Removal of the mole by D & C; check up of hCG; chemotherapy according 2 the levels of hCG would b indicated.
Task on emergent situation
for state examination on obstetrics and gynecology № _20_
Patient A aged 27 referred to gynecologist with complains of general weakness, dyspnea, palpitation, cough and bloody discharge from vagina within last week.
Anamnesis: Menstruation from age 14, regular. Sexual life from age 20, regular.
Three months ago spontaneous abortion at term 6-7 weeks was happened, curettage of uterine cavity was made, after which she had bloddy discharge during 2 weeks. One week after curettage of uterine cavity dyspnea and cough were onset.
Objective findings: the general condition of patient is of moderate severity. PR is 98 bpm, ABP is 100/70 mm of Hg. Blood test: Hb 47g/L ESR: 47mm/h
Speculum exam: there is a node 4x6 cm in size which is located to the right in vaginal entrance. The uterus cervix is not visible because of node.
VE: Uterus enlarged for 14 weeks of gestation, its surface is tuberous. Adnexas on both sides are not palpable. Discharge is dark-bloddy in color.
X-ray of lung: Lung’ metastasis detected. hCG test is 50.000 IU/L
What is the diagnosis? Chorioepithelioma & anemia
What is the management? Chemotherapy would b indicated
Task on emergent situation
for state examination on obstetrics and gynecology № _21_
Patient E aged 29 admitted to maternity home with active labor pains, continued for 5 hours. Amniotic fluids are not expulsed.
Anamnesis: G5 P2 0 2 2. No complication in labor and abortions. Now she has multiple pregnancy (twins).
Objective findings: General condition is satisfactory, PR 76 bpm, ABP 110/70 mmHg
AC - 106cm. FH (SFH) - 43 cm
Labor pains character: every 2 min, with 50 sec of duration. In 10 min the 1st new born delivered with body weight of 2900 g and satisfactory general condition.
External palpation of uterus: thehead of 2nd fetus is on right side, breech is to the left; fetal heart sound 136 bpm, clear and rhythmic.
VE: Fully dilated uterine os, BOW of the 2nd fetus is not ruptured, the presenting part is not determined.
What is the diagnosis? 3rd labor at term; it’s 2nd stage; twins; transverse lie of the 2nd fetus.
What is the management? Amniotomy, internal version of the fetus would b indicated
Task on emergent situation
for state examination on obstetrics and gynecology № _22_
Primipara J aged 31 was admitted to obstetrics department with pregnancy at term and active labor pain, which were started 4 hours ago. BOW was ruptured together with starting of uterine contractions
Objective findings: general condition is satisfactory. PR 72 bpm, ABP is 110/70 mm of Hg. The body temperature is 36.6ºC. AC is 102cm. FH (SFH) is 33cm. External pelvic sizes are 27-27-32-19cm.
The fetal lie is longitudinal with cephalic presentation; the head of the fetus is above the inlet. FHS100 bpm, arrhythmic, dull. Labor pains: every 4-5 min , the duration is 30 sec.
VE: cervix is opened till 5cm, BOW is absent. The presenting part is the head, located abovethe pelvic inlet. The loops of pulsated umbilical cord are detected in vaginal. Discharge is light amniotic fluid. The diagonal conjugate is of 10cm
What is the diagnosis? 1st labor at term; it’s 1st stage of labor; flat rachitic pelvis; intrauterine fetal hypoxia; delivery of umbilical cord loops
What is the management? Immediate c-sec
Task on emergent situation
for state examination on obstetrics and gynecology № _23_
Patient B aged 60, admitted to gynecological department with complains of pain in left inguinal region and left thight, especially at nighttime. Pain is of acute character, micturation is painful and defecation too. There are blood inclusions in urine and feces. Patient didn’t consulted to doctor for more than a year.Objective findings: general condition is of moderate severity, PR 90 bpm, ABP 90/60 mm Hg. Body temperature is 37.2ºC. Patient is cachexic, in abdominal palpation hard tumour with irregular border, fixed and tubourous, was find in hypogastric area.
Speculum exam: there is a crateriform formation with necrotic coat in place of cervix.
Discharge like a meat slops.
VE: 2/3 of vaginal wall are edematous. Tumor conglomerate, hard in consistency, is palpated in the pelvic cavity; spread to the pelvic wall on both sides, fixed, slightly painful in palpation.
Rectal exam: the mucous membrane of the rectum is fixed. There is an infilteration in parametrial space on both sides which is spread to the pelvic wall.
What is the diagnosis? Cancer of uterine cervix, III-IV degree
What is the management? Multisystem tt
Task on emergent situation
for state examination on obstetrics and gynecology № _24_
Patient B, aged 53, was admitted in gynecological department with complains of bloody discharge from vagina.
Anamnestic data: no hereditary report, menopause during 3 years.
In previous history there were 4 pregnancies. No gynecological disease in previous history. During the last 3 months there are periodic bloddy discharges from vagina.
VE: Cervix is of cylindrical form, the external os is closed, the uterus body is not enlarged, uterus is freely movable and painless, adnexas are not determined.
Histological examination of maternal taken from curettage of uterine mucosa: multiple polyps in without any sign of malignancies.
What is the diagnosis? Endometrial polyposis
What is the management? Hormonal tt
Task on emergent situation
for state examination on obstetrics and gynecology № _25_
A 14-year-old girl reports excessive menstrual bleeding during 9 days. She experienced menarche at age 13. Her menstrual cycle is not regular; often she has delay of menstruation for 2-3 weeks whereupon bleeding occurs. She is not sexually active. Her serum pregnancy test is negative.
Oblective findings: general condition is satisfactory, PR- 80 bpm, skin is pale. ABP – 110/60 mm Hg.
External examination: external genitals are hypoplastic. Hymen is intact.
Rectal exam: body of the uterus is normal, mobile and painless. Appendages are not palpable. Discharges are bloody.
What is the diagnosis? Dysfunctional uterine bleeding (at juvenile age)
What is the management? NSAIDs; CCOCPs; antianemic tt.
Task on emergent situation
for state examination on obstetrics and gynecology № _26_
A 18-year-old woman applied to gynecologist with complaints of the pain in the lower part of the abdomen, fever up to 37,5°C, considerable mucopurulent discharges from the genital tract, colic by urinating.
After specula and vagina exam the results are the following: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful, ovaries are painful, thickened, free.
Bacterioscopy test showed diplococcus.
What diagnosis is the most probable?
What is the treatment?
Task on emergent situation
for state examination on obstetrics and gynecology № _27_
A 27-year-old nulliparous woman presents to the emergency room reporting hemoptysis. She has no medical history other than a pregnancy 3 months ago that resulted in spontaneous abortion. She also has had intermittent vaginal spotting since the miscarriage.
Her BP = 110/70 and P = 88. Significant labs are hemoglobin = 9.6 mg/dL and quantitative ОІ-hCG = 35,000 mIU/mL.
Her chest radiograph shows several masses in the right middle lobe.
What is the probable diagnosis?
What is the management ?
Task on emergent situation
for state examination on obstetrics and gynecology № _28_
A 34-year-old woman, gravida 0, has been trying to get pregnant for the last 3 years and has been unsuccessful.
Her history is also significant for pelvic pain for several years and deep dyspareunia.
On pelvic examination, one can palpate a nodular, tender uterosacral ligament, a retroverted but normal-sized uterus, and a right adnexal mass. A recent pelvic ultrasound reveals a 6-cm right complex ovarian mass.
Her CA-125 is elevated.
What is the probable diagnosis?
What is the management?
Task on emergent situation
for state examination on obstetrics and gynecology № _29_
A 24-year-old woman, gravida 1, para 1, is seeing you because every month since age 19 she has had severe lower pelvic pain during her periods. She says the pain is similar to labor pains and it interferes with her ability to concentrate at work and during leisure activities on the weekends. Her pain has also caused her to become extremely anxious and irritable.
She has tried acetaminophen with little relief. She denies having a depressed mood or changes in sleep, energy, or eating patterns. Her past medical history is remarkable for mild asthma controlled with albuterol.
She is sexually active, is in a monogamous relationship, and uses condoms for contraception. She has no known drug allergies but admits to drinking a few alcoholic beverages every day.
What is the probable diagnosis?
What is the management?
Task on emergent situation
for state examination on obstetrics and gynecology № _30_
The patient aged 38 years, was observed concerning a uterus myoma during 5 years. The tumor size corresponded to 9-10 weeks of pregnancy. She address gynecologist because of complains about plentiful prolong menstruations.
Clinical findings: the patient at the fifth day of periods, skin is pale, discharges are plentiful.
The level hemoglobin is decreases to 80 g/L.
What is the diagnosis?
What is the management?
Task on emergent situation
for state examination on obstetrics and gynecology № _31_
There are an infertility, bilaterial adnexitis with frequent exacerbations in the anamnesis of a 32 years old patient. She admitted into the hospital with high temperature and pains in abdomen.
In inspection: the abdomen is tympanitic, swollen, painful in palpation, the Shetkin-Blumberg symptom is positive. The tongue is dryish, pulse rate is 120 bpm.
In bimanual exam: the cervix is displaced and sharply painful in palpation, the ueterus body and adnexa are not palpable because of morbidity. The posterior vaginal fornix is flattened and painful.
What is the probable diagnosis?
What is the management?
Task on emergent situation
for state examination on obstetrics and gynecology № _32_
A 25-year-old woman complains of absence of menses during 3 months, nausea.
On vaginal examination: vulval and vaginal mucosa is bluish, uterine corpus is enlarged, uterine fundus is 3 cm above symphysis pubis. Uterus is soft, and becomes dense upon palpation. Adnexa are not identified. Discharge is mucous.
What is the most probable diagnosis?
What is the management?
Task on emergent situation
for state examination on obstetrics and gynecology № _33_
A 18-year-old woman applied to gynecologist with complaints of the pain in the lower part of the abdomen, fever up to 37,5°C, considerable mucopurulent discharges from the genital tract, colic by urinating.
After specula and vagina exam the results are the following: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful; ovaries are painful, thickened, and free.
Bacterioscopy test showed diplococcus.
What diagnosis is the most probable?
What is the management?
Task on emergent situation
for state examination on obstetrics and gynecology № _34_
The patient aged 28 has addressed with ginecologist concerning pains in the lower abdomen, blood staining discharges form vagina, which have appeared 7 days after introduction of intrauterine device (IUD).
Menses since 14 years for 7 days in 30 days, plentiful; last year they became painful within last year, after the 3rd abortion.
Reproductive anamnesis: G 5 P2 0 3 (5 pregnancy: 2 labors at term, 0 premature labor, 3 artificial abortions). A follicular pseudo-erosion was registered in her previous anamnesis.
Objective findings: the uterus is a little bit more than norm, sensitive in palpation, appendages are not changed. Discharges are mucous-bloody.
What is the diagnosis?
What is the proper management?
Task on emergent situation
for state examination on obstetrics and gynecology № _35_
A 50-year-old woman, gravida 3, para 2, spontaneous abortions 1, presents to you reporting abnormal vaginal bleeding.
Her menstrual cycles used to occur regularly every 30 days and lasted 3 to 4 days. She now has periods every 15 to 22 days and they last for 6 to 7 days for the last 6 months. She denies any past medical or surgical history. Review of systems is negative and she specifically denies light -headedness. Her speculum examination is unremarkable. The bimanual examination reveals a slightly enlarged, regular contour, anteverted uterus that is nontender to palpation.
What is the probable diagnosis?
What is the managements to prove the diagnosis?
Task on emergent situation
for state examination on obstetrics and gynecology № _36_
An 18-year-old nulligravid girl presents to the emergency department by ambulance because she passed out on the floor of her house and is covered in blood. She is now conscious. She has been bleeding off and on for the past 5 months. Her ABP = 98/48, P = 120, RR = 16, and T = 36.C
Her speculum examination reveals blood trickling from the cervical os. There are no lesions in the vagina or cervix. The bimanual examination is unremarkable. Pelvic ultrasound is also unremarkable. Serum human chorionic gonadotropin (hCG) is negative, and her hemoglobin is 7 g/dL.
What is the probable diagnosis?
What is the management to ensure the diagnosis?
Task on emergent situation
for state examination on obstetrics and gynecology № _37_
Pregnant women (multigravidae) A,36 years old is admitted to maternity home with active labour pain which started 6 hours back. Pregnancy is mature. This is her 3 rd pregnancy.First 2 pregnanciescompleted with normal deliveries.
OBJECTIVES: condition is satisfactory,AP –120/80 mmHg,pulse 76 beats/min.Abdomen is distendedto transverse form.Measurement of pelvis – 26-29-31-21 cm.Circumference of abdomen – 110 cm.Height of fundus of uterus – 28 cm.
On palpation of the right lateral side of the uterus – we find hard circular and balloted part of the fetus.Presenting part of the fetus is not determined. Fetal heart sound till 136 beats/min is heard and clear on the right side near the umbilical area. Amniotic membrane is not ruptured. Contraction of uterus is of moderate force, through 4 – 5 min continues for 30-35 sec.
VAGINAL EXAMINATION: Multiparae vagina,opening of cervix till 6 cm,fetal membrane is not ruptured, presenting part is not determined.Promontorium of sacrum is not palpable.
What is the diagnosis?
What is the management?
Task on emergent situation
for state examination on obstetrics and gynecology № _38_
A 19-year-old woman, whose last menstrual period (LMP) was 32 days ago and who is sexually active, presents to the emergency department reporting a 5-day history of lower abdominal pain. Her vitals are as follows: T = 38°C, BP = 110/75, P = 80, R = 16.
Speculum examination reveals purulent exudate at the cervical os, and there is cervical motion tenderness. Bimanual examination is unremarkable for masses but produces severe discomfort.
Her quantitative serum hCG =150 mIU/mL. Urinalysis is normal. Her WBC count is 14,000. An office ultrasound shows a normal-sized, normal-striped uterus and no adnexal masses.
What is the probable diagnosis?
What is the management?
Task on emergent situation
for state examination on obstetrics and gynecology № _39_
Patient B, aged 36, referred to doctor of out-patients department with complaints of plenty menstruation. She has been registered to a gynecologist due to myoma, which was first revealed 6 years ago, at that time the uterus was enlarged to 6-7 weeks of pregnancy.
Last time she attended a doctor 6 months ago, at that time the uterus size was 10 weeks of pregnancy. Last menstruation began 10 days ago and continues up today.
VE: the vagina is normal; the uterus enlarged up to 10 weeks of gestation, dense in consistency. Both adnexas are not enlarged. Discharges are plentiful and bloody.
What is the diagnosis?
What is the management?
Task on emergent situation
for state examination on obstetrics and gynecology № _40_
Patient H aged 32 years referred to a gynecologist with complaints of pain and bleeding in area of postoperative scar on the days of menstruation.
Objective findings: On palpation of the scar the dense and painful nodes were detected, the skin above nodes is dark blue in color.
VE: Uterus is of normal size, dense and painless. Uterine appendages are not determined. Cervical discharge is mucous.
What is the probable diagnosis?
What is the management?
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