Task- 36 A 20-year-old primigravida with full term pregnancy presents in labor for 10 hours. She has strong uterine contractions 4 in 10 min, lasting 50 sec. FHR – 148/min. The patient is unable to pass urine for last two hours. On vaginal examination: the cervix is fully dilated, the fetal head is at -3 station, not descending for last 3 hours, there is poor application of presenting part on the cervix. 1. What is your primary diagnosis? 2. What is your plan of investigations? 3. What is appropriate management of the case? CASE № 65 White Philipinian woman, 41 years old at 10 weeks of pregnancy suffering from mild vaginal bleeding with headache and vertigo. On laboratory investigation: BP – 150/90mmHg, Pls – 86/min To – 36.7oC, β-hCG serum titer - 110,000 miu/ml External examination, we found that the size of uterus is going to 22weeks of pregnancy. During ultrasound examination we had a picture of “snow storm” pattern covering the atropic figure. 1. What is the primary diagnosis? 2. Medical appropriate management of the disease? 3. Surgical appropriate management of the disease? Task 28 A pregnant woman (primipara) went to maternity hospital on February 21. She complained of regular uterine contractions every 10-15 min, for 20-25 sec. On vaginal exam the cervix is centrally placed, shortened till 1,5 cm, thin, with cervical canal dilation till 3-4 cm; the fetal head at the station 0 well engaged, the posterior fontanel is near the symphysis, the anterior fontanel cannot be palpated. Her last menstrual period was on June 14. Total duration of her labor was 12 hours. 1. Calculate gestational age. 2. Make diagnosis. 3. How do we classification delivery by gestational age? Task 43 Primipara in labor 10 hours, rupture of amniotic sac 4 hours ago. Contractions regular, for 50 sec, every 1 min . The heartbeat of the fetus dull, arrhythmic beats 105- 110 in min. At vaginal examination: the opening of the cervix complete, head of the fetus in the pelvic floor, sagittal suture in exit plane, a small fontanel in the front from the symphysis. 1. What is your diagnosis? 2. What is your plan of investigations? 3. Tactic of management. Task 41 - Vivek Woman 41years old, primipara, was admitted to the maternity hospital with complaints of aching pain in the lower part of abdomen, dark brown discharge from vaginal; gestational age 25 weeks. In anamnesis - multiple myoma of the uterus, atypical form (localization of one of the nodes in the area of the isthmus). Pulse rate is 78 beats per min., blood pressure 110/70 mm Hg. In objective examination, the uterus size is increased to 26-27 weeks of pregnancy, with slight increase of tone, painless. Fetal heart tones are clear, rhythmic 140-142 beats per minute. External genitalia are normal, the threshold of the vagina is normal. When viewed in the speculum the vaginal mucosa cyanotic, clean, cervix cone-shaped net, external os round, half-open, from the cervical canal scarce dark brown discharge. Pelvic examination: length of cervix 3cm, superficially softened, the external os lets a finger in the anterior fornix, palpable nodes of myoma, size 3x4 cm. 1. Primary Diagnosis 2. What is your plan of investigations? 3. Plan of management. Task 56 A girl of 14 years turned to the gynecological hospital on duty complaining of profuse uterine bleeding. From the anamnesis it was found that the patient has profuse, with clots, irregular menstruation after 6-8 weeks for 8-10 days, painless during the year. Suffers from nosebleeds from an early childhood. Menarche is 13 years old. On examination: the skin is pale, pulse 82 beats per 1 minute, rhythmic, blood pressure 110/70 mm Hg, hemoglobin 90 g / L. The abdomen is soft, painless. Status genitalis: the external genitalia are developed correctly, female-type body hair, the hymen are intact. Per rectum: uterus of normal size, painless; ovaries on both sides are not enlarged. Discharges from the genital tract are bloody, plentiful. What is your primary diagnosis? What is your plan of investigations? What is the appropriate management? CASE № 46 Multigravida, 25 years old, admitted in the hospital with the prolapse of umbilical cord. Rupture of amniotic sac occur when patient was on the way to the hospital, contractions begun 5 hours ago. The third pregnancy proceeded without complication to full term. The first pregnancy 3 years ago was finished by normal urgent sorts, the child was healthy, second pregnancy - spontaneous abortion on the second month of pregnancy one year ago. The size of a pelvis: 26- 29-33-20. Longitudinal lie of fetus, left lateral position, breech presentation. Estimated weight of fetus - 3100,0±200,0. Auscultation of the fetal heart beat: 100 beats/minute, rhythmical. Vaginal examination: cervical dilatation full, without amniotic sac, in vagina can feel prolapsed pulsation of umbilical cord. Buttocks in the narrow part of pelvic cavity. 1. The Diagnosis. 2. The Plan of management. 3. What mistakes did the doctor do? Based on the obstetric knowledge algorithm (umbilical cord prolapse, breech presentation, full dilation), here is the structured analysis. Answer all the above tasks . Make sure you write the diagnosis with the correct formula. Also answer in an explanatory manner. Make sure you mention all possible questions that can be asked from the task at the end of answer of every task. Take References from books like Williams Gynecology and Obstetrics, DC dutta etc. Please write the correct detailed diagnosis.

Answer all the possible exam questions from all the cases .

Complete the answer the 14 question of last task. Task 46 . Regarding perinatal mortality in cord prolapse and factors affecting outcomes