8/13/2019 Obstetrical Cases

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READ THE FOLLOWING CLINICAL PRESENTATION AND

THEN ANSWER THE FOLLOWING QUESTIONS:

(1) A primigravida presented at 8 weeks amenorrhea with slight vaginal bleeding.

The vital signs were normal and stable. Abdominal and pelvic examination was

normal for the 8 weeks pregnancy. The cervix was closed and only few spots of dark

brown blood were detected.

a) What are the possibe !a"ses#

b) E$pai% i& there is a %ee' &or "r(e%t !areb) What i%*esti(atio%s to be or'ere'#

!) What are the possibe pro(%osti! e$pe!tatio%s#

(2) A !"year"old primigravida at term admitted as an emergency in early labor. #n

admission the $terine contractions were moderate in strength and one every !

min$tes. The fetal part at the f$nd$s of the $ter$s was hard% ro$nd and ballotable.

The $mbilical grip revealed the fetal back on the left side and the fetal limbs on the

right side. The first pelvic grip revealed irreg$lar b$lky parts above the pelvic brim.&on"engagement was confirmed on second pelvic grip. #n vaginal examination the

forewater was intact and b$lging% the cervix is cm dilated and the presenting part

high above the pelvic brim.

a) What is the &eta prese%tatio%#

b) What is the &eta positio%#!) Is there a roe &or "traso"%' at this sta(e#

') What is the roe o& tria o& *a(i%a 'ei*er+#

e) E$pai% +o"r see!tio% &or the best ,etho' o& 'ei*er+

() A 2'"year"old primigravida admitted as an emergency at ' weeks gestational

age with severe headache diff$se abdominal pain. he had no formal reg$larantenatal care. The blood press$re was 1' * 11.

a) What is the i,,e'iate ,a%a(e,e%t#

b) What are the possibe !o,pi!atio%s#

!) Is there a pa!e &or i,,e'iate 'ei*er+#') What is the !are (i*e% to the patie%t a&ter 'ei*er+#

(!) A 2"year"old gravida para 2% admitted at weeks pregnancy with s$dden

g$sh of fl$id per vagina. The obstetrical history was $nremarkable.

a) What are the possibe !a"ses#

b) -e%tio% the esse%tia 'ia(%osti! pro!e'"res

!) Dis!"ss the possibe i%es o& treat,e%t') -e%tio% the ris. &a!tors o& this !o%'itio%

8/13/2019 Obstetrical Cases

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(+) A 2,"year"old on her third pregnancy admitted as an emergency after a direct

bl$nt tra$ma to the abdomen. he was in a state of shock. The pregnancy was at 2

weeks gestational age and the $ter$s was extremely tender and hard. The fetal heart

so$nds were not heard. There was mild vaginal bleeding and the cervix was closed.

a) What is the ,ost probabe 'ia(%osis#

b) What are the i,,e'iate ,eas"res at the ,a%a(e,e%t#!) What is the *a"e o& the "traso"%'#

') Is there a pa!e &or !o%ti%"atio% o& the pre(%a%!+#

(') A "year"old primigravida presented at 12 weeks amenorrhea. he is

complaining of severe na$sea and vomiting. he vomits abo$t eight times per day

and has been $nable to keep down solid food or fl$ids for the past two days. The

medical and s$rgical histories were $nremarkable.

The physical examination revealed a well"developed healthy body. The height was

1'+ cm and the weight was '! kg% as she lost ! kg.% since beginning of the pregnancy.

-ital signs temperat$re /./ 0% blood press$re 1*'% p$lse , min$te% respiration

18 min$te. The oral m$co$s membrane appears dry. Abdomen normal bowelso$nds% soft% nontender% no masses or hepatomegaly. elvic examination was normal

for 12 weeks pregnancy. rinalysis 3 ketones and is negative for protein and

gl$cose.

a) What is the basi! e*a"atio% o& s"!h !ase#

b) What are the treat,e%t optio%s#

!) Is there a pa!e &or ter,i%atio% o& pre(%a%!+#') What are the possibe !o,pi!atio%s#

(/) A 1"year"old gravida para 2 patient 4$st had a vaginal delivery at !1 weeks

and ! days of gestation. A midline episiotomy is performed in anticipation of a

macrosomic infant. he has no known dr$g allergies and an $nremarkable familyhistory. 5er 2 prior pregnancies ended in normal spontaneo$s vaginal deliveries at

term witho$t notable complications.

$ddenly after vaginal delivery of a !.1 kg male% a large 6$antity of blood g$shes

from her vagina% and she contin$es to bleed prof$sely.

a) What is the &irst thi%( that sho"' be 'o%e#

b) What is the se/"e%!e o& steps that sho"' be 'o%e i% the ,a%a(e,e%t#b) What is the ,e'i!atio%s that !a% be or'ere'#

!) I& the patie%t0s he,orrha(e is "%respo%si*e to ,e'i!a ,a%a(e,e%t1 i% a''itio% to

i%&"si%( boo' pro'"!ts2 3hat are the s"r(i!a pro!e'"res to be per&or,e' !o%tro the

bee'i%( a%' preser*e &ertiit+#