Solve the following tasks... make sure you use obgyn books like Williams Gynecology and Obstetrics and DC dutta as your bases of information.. proper medical books . Answer these like you are a md ms obgyn. Detailed answers with explanations. CASE № 1 Patient 22 years old, primapara, three days ago she had normal labor, weight of new born - 3,5kg, breast are soft, lactation is normal; fundus of uterus is 10 cm above pubis, uterus is hard, temperature – 36.6о С. Discharge from vagina is red; perineum is normal 1. Primary diagnose? 2. Classification of lochia. 3. Differentiation between milk and colostrums by constitution. CASE № 2 A young 12 year old girl who has attained menarche (first menstruation) 6 months back comes with bleeding coming on every 15 days. The flow is not heavy, but it is bothersome and the girl is not able to concentrate in her studies. 1. Does it need medical intervention? 2. If the same girl comes with heavy bleeding, what could be the reason? 3. If a woman in the reproductive age group comes with heavy bleeding what could be the reason? CASE № 3 A 20 years old primipara patient presents at 32 weeks of gestation with complaints of lower abdominal pain and leaking of clear amniotic fluid from vagina. On objective examination: Ps – 80, BP – 110/70 mm Hg, T – 36.7. Uterus is enlarged up to 32 weeks, soft and non-tender. Lie of the fetus – longitudinal, cephalic presentation. FHR – 144 bpm. On vaginal examination: Position of the cervix – posterior, lenth – 3cm, consistency – firm, external os admits tip of finger, internal os is closed, presenting part is non-engaged; leaking of clear amniotic fluid is present. 1. What is your primary diagnosis? 2. Estimate cervical maturity by Bishop score 3. What is your plan of investigations? 4. What is the appropriate management? CASE № 4 Patient 20 years old, primipara, three days ago, was a normal delivery. Fetal weight - 3,5 kg. The breasts are soft, lactation. Fundal height - 10 cm above the womb, the uterus is dense. Body temperature - 36.6 ° C. Vaginal discharge - bloody, perineum in a satisfactory condition. The stools was unremarkable. Gases passed out. Urination is free, painless and adequate. 1. The preliminary diagnosis. 1. The preliminary diagnosis. 2. What do doctors call a woman during pregnancy, delivery and the postpartum period? 3. Classification of post-partum period. 4. What is lochia, their classification? 5. What is different between colostrum and milk? CASE №5 A G5P4 patient presents with complaints of painless vaginal bleeding at 37 weeks of gestation, appreciates fetal movements well. On examination: Ps – 100, BP – 120/70 mm Hg. Uterus is soft ad non-tender. Presentation is cephalic, fetal head is high above the pelvic brim. FHS – 150/min. 1. What is your primary diagnosis? 2. What is your plan of investigations? 3. Management? CASE № 6 A pregnant woman has following sizes of pelvis: Distancia interspinarum – 26 cm, Distancia intercristarum – 28 cm, Distancia intertrochanterica – 32 cm, Conjugata externa – 20.5 cm, Wrist circumference – 14 cm. 1. Has this woman normal sizes of pelvis? 2. What is the conjugata vera for this pregnant woman? 3. What are the methods used for estimate true conjugate (4 methods)? CASE № 7 The Woman, 27 years old, came to the Consultation with complaints to impossibility to be pregnant during last 2 years. She is married from 22 years old. First 3 years of married life she used condoms and oral pills, but 2 years ago she finished to do it without effect. She has normal menstrual cycle - it came when she was 12 years old, length is 28 days, length of the menstruation 3-5 days and volume of blood loss about 80-100 ml. She never was pregnant before. 1. What is your diagnosis? 2. Describe all reasons which could present at that disorder. 3. Describe tactic of medicine investigation. CASE № 8 Patient 20 years old, nullipara, has 39 weeks of pregnancy; by Leopold maneuvers – cephalic presentation; cardiac tone of fetus 136-138 per minute; abdominal circumference 99 cm, fundus length is 38 cm. Vaginal examination – cervix in the middle of pelvis, length 1, 5 cm, soft, external os goes to 1 finger, nose and lips of fetus are palpated. 1. Primary diagnose? 2. Plan of delivery. 3. What complications may be? CASE № 9 Primipara woman 20 years old was send to the labor room with a full-term pregnancy in a state of sopor. At home and on the road was three attack of eclampsia. BP 180/100. Labor after 2-3 minutes. The opening of the cervix is complete, head into the pelvic cavity. Fetus is medium size. Fetal heartbeat muffled, 160 bpm. 1. Diagnosis. 2. Plan for the management of labor. 3. List the sequence of events to help the mother in this case. 4. List the major clinical manifestations of an attack of eclampsia according to stages. 5. Condition and indications for forceps. 6. Show on the phantom method to operate forceps. CASE №10 A 19-year-old primigravida at 37th week of gestation presents with lower abdominal pain, vaginal bleeding, weakness and giddiness. On examination: Ps – 100, BP – 100/60 mm Hg. Uterus is firm and tender. FHR – 90, weak. 1. What is your primary diagnosis? 2. What is your plan of investigations? 3. Management?

CASE №11 In primigravida women, whose pregnancy proceeded with moderate preeclampsia, during labor arise stomach pain, weakness, dizziness, bleeding from the genital tract. Pulse increased to 100 bpm, blood pressure 100/60 mmHg. The uterus is tense, painful on palpation, more on the right, between labor attempts not relaxed. The fetal head in the pelvic cavity. Fetal heart rate - about 100 bpm. Vaginal examination: a complete opening of the cervix, the amniotic sac is not present, the fetal head in the narrowest part of the pelvis, a small fontanelle at the left womb, located below the big one. 1. Make a preliminary diagnosis. 2. What are the main etiological cause of this disease? 3. Further management plan. 4. Is it possible in this case, the use of forceps instead of vacuum? CASE № 12 White women 26 years old, primapara, came to the maternity home in the 25 of April 2010, first day of last menstrual cycle was 18 of July 2009, and first movement of fetus was 12 of December 2009; abdominal circumference 101 cm, height of uterus 35 cm. 1. How many weeks of pregnancy of this patient, and the expected day of labor. 2. Calculate the fetal weight. 3. Stages of labor? CASE № 13 Multipara woman in the second stage of labor with mixed breech presentation of fetus, marked decrease in the fetal heart rate up to 100 beats / min and decrease of the heart sounds. At vaginal examination, cervix is not noted, buttocks and feet of the fetus are in the pelvic cavity, prolapse of umbilical cord found. 1. Diagnosis. 2. Plan for the conduction of labor. 3. What are the mistakes? 4. Is it possible to give birth to a living fetus with umbilical cord prolapsed by vaginal delivery: a) in the cephalic presentation, and b) for breech presentation? 5. What kind of aid should be provided to women in the II stage of labor when there is prolapse of umbilical cord: a) cephalic presentation, and b) in breech presentation? 6. At 34 weeks revealed breech presentation of fetus, further tactics of doctor of women consultation clinic. CASE № 14 Patient 18 years old has complains – amenorrhea about 9 weeks, nausea and vomiting. By vaginal examination uterus is soft and enlarged to 7-8 weeks. 1. Primary diagnose? 2. Which examinations you need to confirm you diagnose? 3. Classification of symptoms of pregnancy? CASE №15 A 20-year-old G1 patient at 40th week of gestation presents with mild labor pain since last 20 hours. The pain is located in lower abdomen, intensity and duration of pain remains unchanged. Vaginal discharge is absent. On vaginal examination: the cervix is uneffaced, 3cm in lenth, external os admits tip of finger. 1. What is your primary diagnosis? 2. What is the appropriate management? CASE № 16 A pregnant woman was admitted into the hospital 6 hour’s after the beginning of uterine contractions. The amniotic sac was not ruptured. Term pregnancy 5, delivery 5. All previous pregnancies and deliveries proceeded without complications. The size of the pelvis is normal. Through palpation of the abdominal wall, the head of the fetus is felt on the right side, transverse lie of the fetus is felt. Heart beat of the fetus is clear at level umbilicus 136 beats/minutes, rhythmical. 30 minutes after admission, the amniotic sac ruptured. In vaginal examination: cervix dilation was 6cm, without presence of amniotic sac, presenting part is not determined. The head is not reached, bone deformations are not present. 1. Diagnosis 2. Plan of management 3. What methods of delivery are possible at transverse position of a fetus? CASE № 17 White women 32 years old, primapara, 27 weeks of pregnancy; by physical examination uterus vertex, cephalic presentation, fetal heart rate 136-138 per minute . During auscultation was found systolic murmurs, Pls – 78 per minute, BP 110/70 mm Hg. Gestational body weight 9 kg. During ultrasound examination of kidneys was found mild hydronephrosis. Laboratory analysis: Er - 3,6x1012 Hb – 108g/l, Ht – 39%, Leukocyte – 7,3x10 9, Thrombocyte – 240x10 9. 1. Primary diagnose. 2. Physiological changes during pregnancy. 3. Due to what the increased body weight during pregnancy, can be explained? CASE №18 A 27-year-old G1P1 patient presents on the 2nd postpartum day after unremarkable spontaneous delivery with complaints of lower abdominal pain, high fever, and weakness. On examination: T – 38.4*C, PS – 100, BP – 110/70 mm Hg, both breasts are soft, there is lower abdominal tenderness and foul smell lochia. 1. What is your primary diagnosis? 2. Make plan of investigations? 3. Management. CASE №19 A 20-year-old primigravida with full term pregnancy was admitted because labor onset. Pelvimetry: 22 – 24 – 27 – 15, wrist index – 14cm. Estimated fetal weight – 3.5 kg. 1. What is your primary diagnosis? 2. Select delivery mode. CASE № 20 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. Tactic of management. Do the same for these