O. V. Bakun, I. R.

Nitsovich

CASE STORY

Chernivtsy 2011
 MINISTRY OF HEALTH OF UKRAINE

Bukovinean State Medical University

Department of Obstetrics and Gynecology with the Course of Infant and

Adolescent Gynecology

Head of Department:

Prof. Yuzko O.M

Teacher: Phd Bakun O.V

CASE STORY №

Curator:
student of ASHUTOSH
PADHY,GROUP-61 group 4TH
year studying
medical faculty № 3

Start of cure: « 9 » MARCH 2021 .

End of cure: « 15 » MARCH 2021
.
Case story defence: « » 20 .
Mark for case story written
Mark for case story defence
Total mark

2
 І. Personal information

Surname panigrahi
First name manisha
Patronymic: priyadarshini
Profession: Teacher
Place of occupation: NEW DELHI

Residence: NEW DELHI

Date of birth: « 24-07-1993 » . Age: 28 years.
Date of admission:« 9-03-2021 » 20 21 . 13 h 15
min. Date of discharge« 15» MARCH -2021. Suggested
diagnosis: disorder of menstual cycle

Admission diagnosis: DISORDER OF MENSTRURAL CYCLE

Clinical diagnosis: ECTOPIC PREGNANCY(DAMAGED FORM) ANEMIA 1ST DEGREE (5-6

WEEK)

Final diagnosis: ECTOPIC PREGNANCY(DAMAGED FORM) ANEMIA 1ST DEGREE (5-6

WEEK)

INFORMATION FROM DISPENSARY CARD

Date of the visit to female dispensary “ 9 ” MARCH 20 21 .
General state restless, looks pale, sweating dull
Complaints Lower Abdominal pain, shoulder tip pain Nausea, Vomiting, Vaginal bleeding,
Amenorrhea abdominal tenderness
Date of the last menstruation 26 jan 20 21 . Body temperature
38.5 °С, Pulse rate 90 per 1 min., АP= 130 / 90 мм mer. col.
Cutaneous integument and mucous membranes
NORMAL
Tongue_ DRY , moist (dry).
Abdomen soft (tense), unpainful, (painful in lower areas),
ABDOMINAL TENDERNESS IN LOWER REGION
Symptoms of peritoneum irritations present +VE
Pasternatsky’s symptom on both sides NOT PRESENT(-VE)
Vaginal discharge SCANTY BROWN WITH MUCOUS

Physiological excrements NONE

Bimanual examination REVEAL LOWER ABDOMINAL TENDERNESS,CERVICAL
EXITATION
 ADNEXAL MASS PRESENT

Indications: ADNEXAL MASS PRESENT

Laboratory analyses in female dispensary

General hematology Date: 9/03/21
Red blood cells (х 1012/l) 3.5 *10*12 L
Hemoglobin (g/l) 6.0 g\dl
Color index (globular value) 0.8
Reticulocytes (%) 0.5 %
Platelets (х 109 /l) 110 *10-9\ml
White blood cells (109/l): 13 *10-9\ml
Basophiles (%) <0.2 %
Eosinophiles (%) 2 %
Rod neutrophiles (%) 0.0 *10-3\ml
Polymorphonuclear neutrophiles (%) 60 *10-3\ml
Monocytes (%) 0.1 *10-3\ml
Lymphocytes (%) 1.0 *10-3\ml
Erythrocyte sedimentation rate ESR (mm/h) 62 mm\h
Hematocrit (%) 32 %

General urinalysis. Date:

Volume (ml)
Colour
Transparency
Protein
Density
Glucose
Acetone
Bile pigments
Urobilinogenum
Indication
Sediment
pH
Pavement epithelium (in the field of view)
Transitional epithelium (in the field of view)
Kidneys epithelium
Leucocytes (in the field of view)
Erythrocytes (in the field of view)

Blood coagulation parametres Date:

Prothrombin index %
Re-calcification time (sec)
Prothrombin test
Fibrinogen A (micromole/l)
Fibrinogen B
Plsama activity of fibrin lysis (min)
Plasma heparin tolerance (min)
Lee-Wite time (min)
 Blood clot retraction (%)

Clinical biochemistry Date:

Residual nitrogen (millimole/l)
Urea (millimole/l)
Creatinine (millimole/l)
Creatine (millimole/l)
Glucose (millimole/l)
Urea acid (millimole/l)
Total protein (g/l)

Vaginal smear Date:

Leucocytes (in the field of view)
Epithelium (in the field of view)
N.gonorrheae, Trichomonas vaginalis
Flora

Feces analysis on helmint’s eggs « » 20 .

Arterial blood pressure

Date Right arm (mm Hg) Left arm (mm Hg)

9-03-2021 140/90 130/90

Blood group B+VE(_), Rh-VE ,« » 20 .

Wasserman reaction (« » 20 ) ;
Australian antigen (« » 20 ) ;
HIV test « » 20 .

Consultation of specialists:GYNECOLOGIST
_

_
_

_
_

Ultrasound examination 9 20 21 :
MARCH
NO INTRA-UTERINE GESTATIONAL SAC,FREE FLUID IN ABDOMEN PRESENT

GYNECOLOGIST’S EXAMINATION AT ADMISSION

“ 9 ” MARCH 20 21 13h. 30 min.
Complaints ABDOMINAL PAIN,SHOULDER TIP PAIN,VAGINAL
BLEEDING,NAUSEA,ABDOMINAL TENDERNESS
 Anamnesis of the disease: Onset (acutely, gradually). The patient connects the disease with. Body
temperature, pain. Course of the disease. If she underwent any treatment before. What was her doctor’s diagnosis
according to the questions and documentation. The doctor’s diagnosis (according to the hospitalization).
A 28 YR OLD PATIENT FROM NEW DELHI COMPLAINING OF ACUTE ONSET OF LOWER ABDOMINAL PAIN
ASSOCIATED WITH A HISTORY OF VAGINAL BLEEDING FOR 2 WEEK.HER PAST OBSTETRIC HISTORY
INCLUDED NEGELECTED (PID) , FOLLOWED BY TREATMENT FOUR YEARS BACK. SHE WAS NOT TAKING
ANY MEDICATION OR CONTRACEPTION. UPON PRESENTATION, SHE COMPLAINED OF GENERALIZED
LOWER ABDOMINAL PAIN WHICH WAS OF A SUDDEN ONSET, CONTINUOUS, RADIATING, AND NOT
RELIEVED BY PAINKILLER . THE PAIN WAS ASSOCIATED WITH NAUSEA AND SYMPTOMS OF ANEMIA
SUCH AS DIZZINESS AND SHORTNESS OF BREATH, , THERE WAS HISTORY PELVIC INFLAMMATORY
DISEASE.

Life history: The diseases she suffered from in childhood and adult age. Gynecological diseases she suffered
from, when, the course, when and what treatment was used, results, last aggravation. Determine in detail the patients’
condition before and after cure. Operations (what and when were performed). The results of operations. Histological
examination data. What diagnosis was established? Parents’ diseases (including alcoholism, tuberculosis, syphilis,
nervous and mental diseases, failures of development).
Tuberculosis NONE , venereal diseases NONE , hepatitis NONE ,
rheumatism NONE , diabetes mellitus NONE .
CURRENTLY SHE WAS MEDICALLY FREE AND HER PAST OBSTERIC RECORD INCLUDED PELVIC
INFLAMMATORY DISEASES,FOLLOWED BY ANTIBIOTIC TREATMENT WHICH WAS PERFORMED 4-YEAR
AGO
SHE HAD NO ALLERGIES AND WAS NOT TAKING ANY MEDICATION OR CONTRACEPTION.UPON
PRESENTATION , SHE COMPLAINED OF GENERALIZED LOWER ABDOMINAL PAIN WHICH WAS OF A
SUDDEN ONSET, CONTINUOUS, RADIATING, AND NOT RELIEVED BY PAINKILLER . THE PAIN WAS
ASSOCIATED WITH NAUSEA AND SYMPTOMS OF ANEMIA SUCH AS DIZZINESS AND SHORTNESS OF
BREATH, ,

Gynecological history: 1. Menstrual function. The age of first menstrual period when periods became regular,
how many days, what is the interval between periods. The amount of blood discharge (are there clots). Pains before and
during periods. Onset, type, character, changes of menstrual cycle connected with the start of sexual life, labor,
abortions, inflammations. Date and character of last menstruation (if it wasn’t normal, characterize it)). Developmental
formula: Ax, Ma, Me, P.

when she was 14 yrs. old she had her first menstruation, regular, it was at first for 7 days but later the
next year it became to 5 days and regular. The interval between her periods was around 21 days . the first
3 days it was a heavy bleeding and the 4th day was normal bleeding and the last day was less than
normal. No problems with her menstruation. she used to have pain for first three days in her
menstruation. . Her menstrual cycle had always been regular with normal flow. There was no history of
otc or prescribed medication taken during the last menstrual cycle. There were no significant past
medical, surgical or gynaecological problems
 2. Sexual function. Onset of sexual life. Marriage: first, second. Methods of contraception. How long has she been using
methods? Whether there are pains during coitus? Sexual stimulation. Character of vaginal discharge after coitus. Last
coitus.

____she was married at the age of 26 yrs. This was her first child at the age of 28.pain during coitus.
vaginal discharge was pinkish . She was sexually active and has been with the same partner using no other
form of contraception

3. Reproductory function. At what time after the onset of sexual life pregnancy occured? The course of each pregnancy
in particular. When was the last pregnancy and what was its termination? In case of long infertility determine the
reason. How many pregnancies were there and what was their termination (labor, abortion, extrauterine), what and
when was the last (labor, abortion, extrauterine). Complications of pregnancy. Diseases after labor or abortions.
Intervals between pregnancies. Infertility (primary or secondary).

There was no history of over-the-counter or prescribed medication taken during the last menstrual cycle.
There were no significant past medical, surgical or gynecological problems. Also no infertility,
complications with the patient. ______________________________________________________________________________

4. Secretory function. Character of vaginal discharge (colour, smell, consistency, amount), when appeared. What does
the patient connect her discharge with?

vaginal discharge is scanty or dark red colored. Secretions from vagina appear after pain, they are dark,
of poor amount,
 1. General physical examination: Body temperature, pulse rate, arterial blood pressure, weight, height,
obesity. Body constitution. Skeleton structure. Skin and visible mucous tunics (rash, yellowness, scars after operations,
colour of the skin and oth. Tongue. Teeth. Muscles. Condition of anterial abdominal cavity, activity. Patient’s position
(free or forced). Сardio-vascular system (heart area, auscultation data). Vein condition of lower extremities. Lungs
(lungs margins, auscultation data, roentgenoscopy and roentgenography data). Nasopharynx, tonsils and thyroid glands
condition. Gastro-intestinal tract condition (stomach, intestinel, liver). Kidneys and spleen condition. Urinary function
(frequencyof urination, sharp pains, bladder cystic pain and oth.). Clinical and biochemical laboratory data.
Height 160 см, weight 70 кg, body temperature 38.5 ºС. pulse rate 90per 1
min. АP(left arm)= 130 / 90 _ mm.Hg. АP(right arm)= 140 / 90 mm.Hg. Consciousness is
not disturbed (clouded, loss of consciousness). Patient’s position active (passive). General state RESTLESS__
. Body constitution RESTLESS,PALE ,SWEATING . Skin
and visible mucous tunics ,
their colour NORMAL _. Edema
Rash_ NONE _. Subcutaneous tissue NORMAL.........................Lymphatic
nodes NORMAL . Muscles WELL
DEVELOPED,NO LOSS OF STRENGTH . Face symmetric,
expression of the face____ PALLOR AND DULL________ _______ ____.Pilosis of
NONE type. Tongue DRY AND WHITE
.
Teeth HEALTHY N WHITE
. Tonsils NOT SEEN .
Thyroid gland is located in the base of the neck ,just below the adam
apple ,
palpated between the cricoid cartilage and the suprasternal notch

, which have normal consistency, painless, no indurations and

nodes. The gland looks like normal..............Thyroid gland is not increased (increased)
Breath system. Form of chest NORMAL . Varicosis on the chest visible
(invisible). Both halves of the chest normal , take part in respiration
synchronously. Auxilliary muscles take (don’t take) part in the act of respiration). Respiration rate
-
23 per one minute. No dyspnea. Breathing is rhythmical, of usual depth. Type of breathing
tachypnea .
Palpation of the chest along the ribs and intercostal spaces is (isn’t) painful. Symmetry of voice
trembling is the same (different).
Comparing percussion on the symmetrical sides percussion sound is
NORMAL .
Auscultation findings breathing.
Rales, crepitation, pleural sounds none .
Cardiovascular system. Findings on visual examination of heart
area NORMAL
. Visible pulsation in the neck and heart area isn’t
revealed (revealed). Heart apex pulsation is determined in__5TH_intercostal area 1.5 сm
more medial from MIDCLAVICULAR LINE
chest line. Epigastrium pulsation isn’t determined.
Apex heart auscultation: heart rhythm RHYTHYMIC , heart
sound NORMAL . Apex heart murmurs NONE , above
aorta Extracardial murmurs are absent.
Pulse on both arms rhythmical, __90___ per minute, FULL_______full (weak) pulse
and tension.Vascular wall is resistant and elastic. Arterial blood pressure on the left arm / mm.
Hg., on the right arm / mm. Hg.
Urinary flow system. Kidneys and bladder ___normal _ _______ ____ ___ ______
________________________________________, symptom by Pasternatsky ____none___________
__________________________________ ___ _______ ____ ___ _______ ____ _.
 Nervous system. Meningeal signs NONE . Weakening sensitivity
on extremities PRESENT
LOWER EXTREMITIES NUMBNESS,TINGLING SENSATION PRESENT ON SHOULDER

Form and dimensions of the abdomen. Sensitivity, symptoms of peritoneal irritation. Palpation data
(determining tumors, infiltrates, tender points). Percussion data (meteorism, ascites, muffled sound and oth.). Character
of scars, their localization on anterior abdomen wall.
Abdomen bypalpation ABDOMINAL TENDERNESS

Symptoms ofperitoneal irritations are negative (positive, extremelypositive). POSITIVE

Liver NONE , spleen NONE .
Pasternatskysymptom isnegative onboth sides (positive both sides, onthe right, on theleft)
NEGATIVE
Physiological excretions NONE .
2. Special study:
Examination and palpation mammary glands. Shape and dimensions, presence of tumor, infiltrates, tender
points.
Mammary glands BREST FULLNESS ,PRESENCE OF TUMOR-NONE

Gynecological status: data of external genitals examinations (developmental stage, general appearance, type of
pilosis of external genitals, developmental pathology, changes connected with age, intertrigoes, ulcers, tumors,
deformations) . State of perineum posterior commissural (scars after ruptures), ptosis and prolapsus of vaginal walls.
The state of external orifice of urinary canal, paraurethrical glands, excretory ducts, Bartholin’s glands,
entrance into vagina. Data of vaginal examination and uterine cervix examination by specula (dimensions and shape of
uterine cervix, external ostium, character of discharge from uterine cervix canal, colour of mucous membranes,
erosions, polyps, ulcers, malignant growth of mucous membrane, ruptures and oth.).
External genitals are developed normally(abnormally) NORMALLY

Hairiness according to the female (male, mixed) type FEMALE

Posterior commissure NORMAL

The condition of urethra, Bartholin’s glands, introitus into the vagina INFLAMED

Specula examination. Vagina

Uterine cervix is conical, cylindrical CONICAL

External ostium OPEN

Bimanual vaginal examination: The shape, softness and size of the vagina. The condition of vaginal vaults.
The condition of the urethra and rectum. The size, shape and consistency of the uterine cervix. The ratio of the cervix to
the body of the womb (anteflexio, retroflexio, anteversio, retroversion, retroposition and oth.). The state, size and shape
of the uterine body (consistency). The condition of the uterine appandages (size, tenderness, tumors, oth.). The
condition of the parametrium. The mobility of the uterus and tumors. Localization of the appendage tumors in relation
to the uterus. If there are tumors, the size, consistency, character of the surface, mobility, relation to the pelvic walls,
filling of the small and large pelvises cavities are to be determined.
The vagina of an onparous (parous) woman, narrow (broad) NARROW ,
APPEAR PALE
The urethra and rectum _

The uterine cervix SLIGHTLY SOFT

The ostium takes 1 a finger, (сlosed).
The uterus in anteflexio (retroflexio), isn’t deviated (is deviated to the right, left); the size is normal (decreased,
,increased up to
5-6 we ks of pregnancy); the shape isn’t changed (is changed due to fibromatous nodes which are
located

the consistencyis normal (soft, dense), the mobilityis normal (excessive, limited).
The appendages are visible (invisible): onthe right

On the left

Thevaults are loose (deep, suspended).

The discharge

Instrumentalmethodsofexamination. Uterine probing, metrosalpingography, colposcopy, basal temperature and oth.

Examination of girls. Virgo. Per rectum

Provisional diagnosis. Differential diagnosis. Treatment. It is necessary to describe a disease with a similar
clinical presentation. On the basis of considerations, data and clinical course of the disease (as well as laboratory tests) a
clinical diagnosis should be made. Therapeutic methods are to be described and the methods for treatment this very
diseases should be grounded. If the patient have an operation, its indication should be grounded, a detailed protocol of
the operation is to be submitted as well as the description of the preparations and the data of histological tests.
Diagnosis: ECTOPIC PREGNANCY DAMAGED FORM ANEMIC STAGE-1(5-6WEEK)

Recommended treatment: LAPROTOMY

Differential diagnosis: ACUTE SALPINGITIS,UTERINE ABORTION

 Laboratory analyses in gynecological department
General hematology Date:
Red blood cells (х 1012/l)
Hemoglobin (g/l)
Color index (globular value)
Reticulocytes (%)
Platelets (х 109 /l)
White blood cells (109/l):
Basophiles (%)
Eosinophiles (%)
Rod neutrophiles (%)
Polymorphonuclear neutrophiles (%)
Monocytes (%)
Lymphocytes (%)
Erythrocyte sedimentation rate ESR (mm/h)
Hematocrit (%)

General urinalysis. Date:

Volume (ml)
Colour
Transparency
Protein
Density
Glucose
Acetone
Bile pigments
Urobilinogenum
Indication 1865 mIU/mL. mIU/mL
Sediment
pH
Pavement epithelium (in the field of view)
Transitional epithelium (in the field of view)
Kidneys epithelium
Leucocytes (in the field of view)
Erythrocytes (in the field of view)

Blood coagulation parametres Date:

Prothrombin index %
Re-calcification time (sec)
Prothrombin test
Fibrinogen A (micromole/l)
Fibrinogen B
Plsama activity of fibrin lysis (min)
Plasma heparin tolerance (min)
Lee-Wite time (min)
Blood clot retraction (%)

Clinical biochemistry Date:

Residual nitrogen (millimole/l)
Urea (millimole/l)
Creatinine (millimole/l)
Creatine (millimole/l)
Glucose (millimole/l)
Urea acid (millimole/l)
Total protein (g/l)

Vaginal smear Date:

Leucocytes (in the field of view)
Epithelium (in the field of view)
N.gonorrheae, Trichomonas vaginalis
Flora

Blood group (_), Rh ,« » 20 .

Ultrasound examination « » 20 :
_
_

PROTOCOLS OF OPERATIONS

Card of the patient’s agree

S.N.P. MANISHA PRIYADARSHINI PANIGRAHI , Сase report №
Diagnosis ECTOPIC PREGNANCY DAMAGED FORM 5-6 WEEK ANEMIC STAGE -1

Recommended treatment: conservative (surgery – the name of the operation) LAPROTOMY

Anesthesia – given/not given; transfusion of blood and its components – yes/no;; participation in
experimental programmes – yes (no); other GIVEN, YES
NO
 Information available to a patient:
 diagnosis: Alternatives to the proposed are possible
 the essence and target of the proposed treatment • the prognosis in case of a refusal to undergo
• the risk and consequences of the proposed treatment therapy
 other information
The patient confirms what was explained to her in a simple form: about the condition of her
health, the target of the proposed examination and therapy, prognosis of a possible development of
the disease, a possibility of unforeseen complications in the consequence of general anesthesia or
local anesthesia, connected with physiologicofunctional peculiarities or age structure of the
patient’s organism, endangering her health and life.
If there are some special anatomical features or the disease was neglected, the desired result
may not be achieved.
The patient is to give a complete and objective information about the state of her health,
including the data about severe concomitant diseases, surgery she had, hepatitis, venereal diseases,
HIV-infection, and so on
The patient agrees that unfulfilment of the doctor’s recommendations decreases the quality
of therapy and may lead to undesired consequences and gives her consent to fulfil the doctor’s
prescriptions, to keep accurately to the recommended therapeutic regime and timetable of the
hospital. The patient’s refusal to undergo therapy.

Signitures: Patient Doctor Data 20 year.

Preoperative epicrisis
“ ” 20 year
S.N.P. Age years old.
Blood group,Rh: Hepatitis: yes, no ( year)
Diagnosis:

Peculiarities of the anamnesis:

Histological test of the curettage:

Extragenital pathology

Deviation from the norm in laboratory indeces, consultations

Allergiologic anamnesis
Sensitivity test to antibiotics
Culture for flora and sensitivity to antibiotics

The volume of surgery is expected to be

13
The degree of the surgical risk
The date of the operation ” ” 20 year. Surgical team

Date 20 year. o’clock minute.

Protocol of the operation: SCRAPING OUT DIAGNOSTIC CURETTAGE OF THE
CERVICAL CANAL AND WALLS OF THE UTERINE CAVITY
Anesthesia: intravenous narcosis, local anesthesia
Course of the operation: after the cleansing preparation of the external genitals and
vagina _, in aseptic conditions the uterine cervix is bare in specula, fixed with
bullet forceps by the anterior lip. Uterine probing. The length of the uterine cavity along the
probe сm. The cervical canal is dilated up to № with the Gegar’s dilator. Curettage of the
cervical canal was performed by a curette № . The
curettage was sent to a histological test. Curettage of the
uterine walls was performed with a curette № . The walls are smooth, tuberous, dense, soft.
The cavity of the uterus isn’t deformed (is deformed due to)

Сurettage has been

sent to a histological test. Bloody discharge decreased (didn’t decrease, continue)
The bullet forceps has been taken away. The uterine cervix is treated

Diagnosis:

Recommended:

The surgery was performed by:

Date 20 year. o’clock min

Protocol of the operation: LAPAROTOMY AFTER PFANNENSHTIEL (or lower midline).

SUPRAVAGINAL UTERINE AMPUTATION (with right, left appandages, without
appandages).
Date 9-03 20 21 year. Started 16.00HR Ended 20.00HR Duration 4HR
№ case report In the condition of asepsis and antisepsis after a
corresponding treatment of the surgical field
under anesthesia the opening of the anterior abdominal wall was performed layer-by-layer. At the
revision of the organs of the small pelvis there was distinguished: the uterus is located
EXTRATUBAL , its sizes are SMALL (enlarged as if 5-6 weeks of pregnancy due to
the miomatous nodes located

х mm. The appandages: right (without special features)-

 , left appendages (without special features)

).
Taking into account the woman’s age of –28 years, appearance of the above-mentioned
symptomatology, the presence
of
it has
been decided to perform a supravaginal amputation of the uterus with (without) (right, left)
appandages.
The uterus is pulled into the wound and clenched with Muzo’s forceps, bullet forceps,
fixed with a corkscrew), the abdominal cavity is . Round ligaments of the uterus, proper ligaments
of the ovaries and uterine ends of the tubes on both sides (infundibulo-pelvical ligaments) (on the
right, on the left) are clenched with Kocher’s forceps. The formation is dissected, ligated. Cut and
bluntly (together with the urinary bladder) displaced downwards to pl. vesico uterina. Vascular
fascicles are clenched with Kocher’s forceps on both sides. The formation is dissected, ligated. The
uterus is cut off 0,5 cm above the external ostium. The stump is cleansed with spirit and stitched
with a continuous decson suture. Control of hemostasis - complete. Peritonization – at the expense
of pl. vesico-uterina and layers of broad ligaments of the uterus (wasn’t made). Toilet of the
abdominal cavity. Calculation of serviettes and in instruments – everything is present. Anterior
abdominal wall is saturated tightly layer-by-layer. On the skin suture.
Aseptic dressing. During the operation through an indwelling catheter there was excreted ml
of straw-yellow transparent urine. Total blood loss ml.
Macropreparation:

Diagnosis after the operation:

Protocol of the operation: OVARIAN CYST RESECTION

Date 20 year. StartedEnded Duration № case report
In the conditions of asepsis and antisepsis, after treatment of the operative field, under
anesthesia, with the access_
anterior abdominal wall was opened layer-by-layer. At the revision of the small pelvis organs there
appeared: the uterus , its sizes , uterine
appendages

.
Some sites for biopsy in doubtful tissues of upper abdominal cavity and paraaortal lymphonodes must be taken
and sent for urgent pathomorphological test.
Cyst resection of ovary was decided to perform.
The uterus is displaced forward with the aid of a suture-holder or uplifter, applied to the
fundus of the uterus. The ovary is fixed by means of the application of a special forceps-keeper to
the suspensory ligament. A capsule of the ovary is cut with a scalpel at the base of the cyst.
After the dissection of the ovarian capsule with a scalpel the surgeon with the aid of a thin
clamp and narrow scissors separates the tissues between the cyst and the capsule.
The edges of the ovarian capsule are supported with clamps. The severed separated part of
the cyst is raised a little, and the part which stayed is being cut from the ovary with the aid of

15
scissors. Clamping and punctuate electrocoagulation is used for hemostasis of the bed which is
bleeding.
Beginning from the upper pole where the first node finishes, hemostatic continuous mattress
suture is stitched with a synthetic absorptive thread 3/0.
With the same thread in the opposite direction, from the lower pole to the edges of the
ovaries, a continuous Connell’s suture is stitched.
Toilet of the abdominal cavity. Calculation of serviettes and in instruments – everything is
present. Anterior abdominal wall is saturated tightly layer-by-layer. On the skin
suture. Aseptic dressing. During the operation through an indwelling
catheter there was excreted ml of straw-yellow transparent urine. Total blood loss ml.
Macropreparation:

Diagnosis after the operation:

OTHER OPERATIONS (manipulations):

Protocol of the operation:
Date 20 year. Started Ended Duration № case report
 Appointment for pathologo-histological examination
Date and time of the appointment “ ” 20 year
Department: Case report №
S.N.P.of the patient Sex Age .
Address
Date and kind of the
operation

Material which was sent for analysis (fixed: 5-10% of formalin, (spirit):

Clinical diagnosis:

The date of taking the material “ “ 20 year

The doctor’s surname
DIARIES FOR RECORDING THE COURSE OF THE DISEASE
Everyday the temperature, pulse rate, arterial pressure, general state, appetite, functions of the intestine, diuresis,
character of the vaginal discharge and other changes during a day are recorded. Indications, regimen, diet. Medical
preparations were prescribed in the form of prescriptions

“ ” 20 year. General state

Complaints
Body temperature _°С, Pulse rate per 1 min., АP= / mm.merc.column.
Cutaneous integuments and visible mucous membranes
The tongue
, humid (dry).
The abdomen (tense), painless, (painful in lower parts),

Symptoms of peritoneal irritation

Pasternatsky’s symptom on both sides
Vaginal discharge
Physiological excrements
Appointments

“ ” 20 year. General state

Complaints
Body temperature _°С, Pulse rate per 1 min., АP= / mm.merc.column.
Cutaneous integuments and visible mucous membranes
The tongue , humid (dry).
The abdomen (tense), painless, (painful in lower parts),

Symptoms of peritoneal irritation

Pasternatsky’s symptom on both sides
Vaginal discharge
Physiological excrements
Appointments

“ ” 20 year. General state

Complaints
Body temperature _°С, Pulse rate per 1 min., АP= / mm.merc.column.
Cutaneous integuments and visible mucous membranes
The tongue
, humid (dry).
The abdomen (tense), painless, (painful in lower parts),

Symptoms of peritoneal irritation

Pasternatsky’s symptom on both sides
Vaginal discharge
Physiological excrements
Appointments

“ ” 20 year. General state

Complaints
Body temperature _°С, Pulse rate per 1 min., АP= / mm.merc.column.
Cutaneous integuments and visible mucous membranes
The tongue
, humid (dry).
The abdomen (tense), painless, (painful in lower parts),

Symptoms of peritoneal irritation

Pasternatsky’s symptom on both sides
Vaginal discharge
Physiological excrements
Appointments

“ ” 20 year. General state

Complaints
Body temperature _°С, Pulse rate per 1 min., АP= / mm.merc.column.
Cutaneous integuments and visible mucous membranes
The tongue
, humid (dry).
The abdomen (tense), painless, (painful in lower parts),

Symptoms of peritoneal irritation

Pasternatsky’s symptom on both sides
Vaginal discharge
Physiological excrements
Appointments

“ ” 20 year. General state

Complaints
Body temperature _°С, Pulse rate per 1 min., АP= / mm.merc.column.
Cutaneous integuments and visible mucous membranes
The tongue
, humid (dry).
The abdomen (tense), painless, (painful in lower parts),

Symptoms of peritoneal irritation

Pasternatsky’s symptom on both sides
Vaginal discharge
Physiological excrements
Appointments

“ ” 20 year. General state

Complaints
Body temperature _°С, Pulse rate per 1 min., АP= / mm.merc.column.
Cutaneous integuments and visible mucous membranes
The tongue
, humid (dry).
The abdomen (tense), painless, (painful in lower parts),

Symptoms of peritoneal irritation

Pasternatsky’s symptom on both sides
Vaginal discharge
Physiological excrements
Appointments

“ ” 20 year. General state

Complaints
Body temperature _°С, Pulse rate per 1 min., АP= / mm.merc.column.
Cutaneous integuments and visible mucous membranes
The tongue
, humid (dry).
The abdomen (tense), painless, (painful in lower parts),
Symptoms of peritoneal irritation
Pasternatsky’s symptom on both sides
Vaginal discharge
Physiological excrements
Appointments

“ ” 20 year. General state

Complaints
Body temperature _°С, Pulse rate per 1 min., АP= / mm.merc.column.
Cutaneous integuments and visible mucous membranes
The tongue
, humid (dry).
The abdomen (tense), painless, (painful in lower parts),

Symptoms of peritoneal irritation

Pasternatsky’s symptom on both sides
Vaginal discharge
Physiological excrements
Appointments

“ ” 20 year. General state

Complaints
Body temperature _°С, Pulse rate per 1 min., АP= / mm.merc.column.
Cutaneous integuments and visible mucous membranes
The tongue
, humid (dry).
The abdomen (tense), painless, (painful in lower parts),

Symptoms of peritoneal irritation

Pasternatsky’s symptom on both sides
Vaginal discharge
Physiological excrements
Appointments

STAGE EPICRISIS (is written every ten days)

Patient , born in the year

Examined:

Consulted:
Underwent treatment:

Diagnosis:

Recommended:

EXAMINATION TOGETHER WITH THE HEAD OF THE DEPARTMENT (docent, head

of the department)
“ ” 20 year. General state. .
Complaints .
Cutaneous integuments and visible mucous
membranes .
Heart tones . Pulse rate per 1 min., satisfactory character.
АP= / mm.merc.column. In the lungs respiration. The tongue .
The abdomen .
Symptoms of peritoneal irritation. .
Pasternatsky’s symptom on both sides

The liver and spleen .

Physiological excrements .
Other

St. Gynaecologicus
External organs are developed , Hair-covering _
type. The vagina . The cervix of the uterus in
the specula , external
ostium . The uterus
.
Appendages on the right
,
On the left
.
Vaults . Discharge .
Other

Diagnosis:

Recommendations:
 EPICRISIS
“ ” 20 year.
Patient .
Was admitted to the gynecological department of the maternity home (hospital)
“ ” 20__year. According to the direction
With the diagnosis

The examination was made:

The treatment was performed:

The patient in a satisfactory condition was discharged from the hospital for further supervision by
the district gynecologist.
Recommended: 1.
2.
3.
4.

EXTRACT FROM THE CASE REPORT

S.N.P. Age .
Address
Place of
employment
Diagnosis

Date of admittance to the hospital 20 year.

Date of discharge from the hospital 20 year.
Was admitted with the complaints

Was examined by a professor, docent, medical director, head doctor, head of the department
Examination was made. RW from - negative, blood group ,
General hematology: Red blood cells , Hemoglobin , leucocytes formula: е- ,
r.n.- , p.n- , lymphoc.- , mon- , ESR- .from 20 year.
Clinical biochemistry: _ 20 year. Bilirubin . Urea , Creatinine , Total
protein .
Blood coagulation parametres from 20 year. Ht , Prothrombin index , Re-
calcification time , Fibrinogen A ,В .
General urinalysis from _ 20 year. Density , Transparency Protein ,
Glucose , Leucocyt. , Erythr. , Urats .
Urinalysis by Nechiporenko from 20 year. Leucocyt. , Erythtocyt.
,
Urinalysis by Zymnitsky from 20 year. Protein
Vaginal smear from 20 year
Roentgenology from 20 year
Feces analysis on helmint’s eggs « » 20 .
Was performed (Diagnostic curettage, оperation)

At the revision of the organs of the abdominal cavity there was distinguished:
The uterus has the size сm, shape
colour;

Left ovary has the size Right ovary has the size ,
shape, shape
Cyst Cyst
Left tube is visible totally /partially, Right tube is visible totally /partially,
of colour of colour,
of size of size
fimbria are preserved/preserved partially/ fimbria are preserved/preserved partially/
occlusion occlusion

PERFORMED:
_

Underwent treatment:

RECOMMENDED:
1
2
3
4
 TEMPERATURE LIST
Date
Day after the operation
Day in the hospital 1 2 3 4 5 6 7 8 9 10
Pulse АP Temp. m e m e m e m e m e m e m e m e m e m e

120 175 39°С

90 125 38°С
▲

80 10 37°С
0
▄ ☻

70 75 ▼ 36°С

60 50 35°С

Respiration
Physiol. excrements
Temperature is marked with red points (being united into a line), AP – blue triangles,
pulse – green squares
 LIST OF APPOINTMENTS
Date
Day after the operation
Day in the hospital 1 2 3 4 5 6 7 8 9 10
d n d n d n d n d n d n d n d n d n d n
 WRITE DOWN PRESCRIPTIONS FOR THE MEDICINES USED IN THE
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