KURSK STATE MEDICAL UNIVERSITY

FOREIGN STUDENT FACULTY

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 1
A 30 years female, gave birth to a baby boy several days ago complained on
tenderness on the right breast, fever and fatigue. Her temperature is 38.9C. During the
physical examination, the right breast was tender, brawny edema and erythema was
found on the skin surrounding the affected breast. Fluctuance and purulent nipple
discharge were noted.
Question
1. Give your Diagnosis.
2. Investigation for this patient.
3. Treatment.

Chief of Department, Professor G.A. Lazareva

 CASE № 1
A 30 years female, gave birth to a baby boy several days ago complained on
tenderness on the right breast, fever and fatigue. Her temperature is 38.9 C. During the
physical examination, the right breast was tender, brawny edema and erythema was
found on the skin surrounding the affected breast. Fluctuance and purulent nipple
discharge were noted.
Question
1. Give your Diagnosis.
2. Investigation for this patient.
3. Treatment.
Answer
1. Postpartum late period. Acute Purulent Mastitis complicated with breast
abscess.
2. Inspection & Palpation must be done and compare affected breast with the
healthy breast.
Full blood count – Leucocytosis is possible
Biochemical Test – C-reactive protein
Bacteriological Test – from discharge and from drainage
Antibiotic sensitivity test
Urine Test – To check for septical complication

3. Admission to the hospital

Incision and drainage of the breast
Infusion therapy
Antibiotic therapy – Local & Systemic
Anti-prolactin drug to stop lactation – Parlodel, Bromcriptine, Doxtinex
Immunocorrection
Anti-Histamine
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 2
A 35 years lady gravida 2 para 1, previously with natural delivery now is of 10-11
weeks of gestational age comes to emergency department with slight brownish discharge
and mild pain in lower abdomen. During speculum examination, it was revealed slight
brownish discharge from the cervix and opened cervix by 1cm. Ultrasound was done
with the observation of embryo cardiac heartbeat.
Question
1. Give diagnosis and its definition.
2. Investigation.
3. Treatment and advice to the patient.
4. Prognosis.

Chief of Department, Professor G.A. Lazareva

 CASE № 2
A 35 years lady gravida 2 para 1, previously with natural delivery now is of 10-11
weeks of gestational age comes to emergency department with slight brownish discharge
and mild pain in lower abdomen. During speculum examination, it was revealed slight
brownish discharge from the cervix and opened cervix by 1cm. Ultrasound was done
with the observation of embryo cardiac heartbeat.
Question
1. Give diagnosis and its definition.
2. Investigation.
3. Treatment and advice to the patient.
4. Prognosis.
Answer
1. Pregnancy 12-13 week. Threatened miscarriage.
It is a clinical entity where the process of miscarriage has started but has not
progressed to a state where recovery is impossible. Etiology can be due to hormonal or
uterine and endometrium factor, STD, endocrine insufficiency, multiple pregnancy.
2. Full blood count – Hemoglobin, Hematocrit, ABO and Rh grouping;
Biochemical test; Urine analysis for differential diagnosis of some kidney pathology.
Ultrasonography to check the viability of fetus, it is a single or multiple pregnancy
Level of serum progesterone – level of 25ng/ml or more indicate 95% chances of
viable pregnancy and level of serum chorionic gonadotrophin (hCG)
3. Bed rest for several days until bleeding or discharge stops, avoid coitus
Restriction heavy physical activity for at least 2 weeks
Pain relief if present
Repeat sonography in 3-4weeks time
4. The following events may occur: In 1/3 of cases, the pregnancy may
terminates as inevitable or missed miscarriage. In 2/3 of cases, the pregnancy may
continue beyond 28 weeks of gestational age but increased the risk to preterm labour,
placenta previa, IUGR of fetus and also fetal anomalies. Mother condition is satisfactory
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 3
A 31 year woman of East Asian ancestry, 24 week of pregnancy comes for her
regular checkup. She complained that recently she is always thirsty (polydipsia) and
frequently urinate at night. She losses some weight even with good appetite. She also
complained on dryness in the mouth. She noted this is the first time that she had the
symptoms. Before pregnancy, her body mass index was 30.5kg/m2.
Question
1. Give your primary diagnosis.
2. Tests you should perform to confirm diagnosis. Diagnostic criteria.
3. Risk factor of the diagnosis specific for this patient.
4. Effects on both mother and fetus.

Chief of Department, Professor G.A. Lazareva

 CASE № 3
A 31 year woman of East Asian ancestry, 24 week of pregnancy comes for her
regular checkup. She complained that recently she is always thirsty (polydipsia) and
frequently urinate at night. She losses some weight even with good appetite. She also
complained on dryness in the mouth. She noted this is the first time that she had the
symptoms. Before pregnancy, her body mass index was 30.5kg/m2.
Question
1. Give your primary diagnosis.
2. Tests you should perform to confirm diagnosis. Diagnostic criteria.
3. Risk factor of the diagnosis specific for this patient.
4. Effects on both mother and fetus.
Answer
1. Pregnancy 24-25 week. Gestational Diabetes Melitus.
However it can be differentiated with cancer, Helminthes, Hyperemesis Gravidum
2.
i. Fasting Glucose Test +ve if >126mmol/dL
ii. Random Plasma Glucose Test (RPGT) < 200mg/dL is normal
If Increase twice, abnormal result
iii. Glucose challenge Test
Drink sugary drink of 150g, check blood after 1 hour.
Abnormal result is >140
iv. Oral Glucose tolerance test
Diagnosis Criteria:
i. Symptoms of Diabetes Melitus
Plasma glucose >200mg/dL or 11.1mol/L
ii. Fasting Plasma Glucose ≥126mg/dL or 7.4mmol/L
iii. Glucose Tolerance Test
Plasma Glucose (after 1-2hour) ≥200mg/dL or 11.1mmol/L after 75g sugary
drink.
3. Age over 30 year, Obesity, Ethnic group

4. Maternal
i. During pregnancy:
Spontaneous Abortion
Infection
Increase incidence of Pre-eclampsia
Maternal distress
Diabetic retinopathy, nephropathy
Ketoacidosis

ii. During Labour

Prolonged labour
Shoulder dystocia
Birth Canal injuries

iii. Postpartum hemorrhage and sepsis

Lactation Failure
Fetal
Congenital disorder
Polyhydramnios
Neonatal hypoglycemia
Neonatal distress syndrome
Birth Injuries
Baby may develop childhood obesity and diabetes
Perinatal mortality
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 4
A 29 years woman of gravida 2 para 1, 6-7 weeks gestational age, comes to
emergency department with bleeding and pain in lower abdomen. Previous pregnancy
was natural vaginal delivery. Ultrasound was done with the cervix is shorter by 2cm and
opening 1cm. The ultrasound of the embryo was without the cardiac heartbeat.
Question
1. Give your diagnosis. Explain.
2. Investigation.
3. Treatment.

Chief of Department, Professor G.A. Lazareva

 CASE № 4
A 29 years woman of gravida 2 para 1, 6-7 weeks gestational age, comes to
emergency department with bleeding and pain in lower abdomen. Previous pregnancy
was natural vaginal delivery. Ultrasound was done with the cervix is shorter by 2cm and
opening 1cm. The ultrasound of the embryo was without the cardiac heartbeat.
Question
1. Give your diagnosis. Explain.
2. Investigation.
3. Treatment.

Answer
1. Spontaneous Abortion
Bleeding per vagina, no embryo cardiac heartbeat during ultrasound.

2. Full blood count – Hemoglobin, Hematocrit, ABO and Rh grouping,

Leucocytosis.
Urine analysis for differential diagnosis of some kidney pathology.
Biochemical test
Ultrasonography to check the viability, however in this case it is the death of
embryo.

3. Aim of Treatment is:

i. To accelerate the process of expulsion
ii. To maintain asepsis (prevent infection)
If excessive bleeding, stop it by administering methergin 0.2 mg.
Correction of blood loss through intravenous fluid therapy
Active Treatment:
Dilation and evacuation then followed by curettage of uterine cavity by blunt
curette under general anesthesia.
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 5
A 17-year-old Arabian girl is admitted on 1 August 2013 to the labour ward
because of a severe headache and stomach-ache. This is her first pregnancy. During
examination her fundal height is 37cm, and she feels fetal kicking is on 4 April 2013.
The blood pressure is 164/106 mm Hg, 160/100 mmHg. She has anasarca.
INVESTIGATIONS
Haemoglobin 11.6 g/dL
White cell count 5 x109
Platelets 126 x 109
Urinalysis: 1g/l in urine in 24 hours
Ultrasound: cervix is close; fetus heart rate is 120 beats per minute

Question
1. What is the diagnosis?
2. How would you manage this patient?
3. Possible maternal complication?
4. Possible fetal complication?

Chief of Department, Professor G.A. Lazareva

 CASE № 5
A 17-year-old Arabian girl is admitted on 1 August 2013 to the labour ward
because of a severe headache and stomach-ache. This is her first pregnancy. During
examination her fundal height is 37cm, and she feels fetal kicking is on 4 April 2013.
The blood pressure is 164/106 mm Hg, 160/100 mmHg. She has anasarca.
INVESTIGATIONS
Haemoglobin 11.6 g/dL
White cell count 5 x109
Platelets 126 x 109
Urinalysis: 1g/l in urine in 24 hours
Ultrasound: cervix is close; fetus heart rate is 120 beats per minute

Question
1. What is the diagnosis?
2. How would you manage this patient?
3. Possible maternal complication?
4. Possible fetal complication?

Answer
1. Pregnancy G1 P1, 37 week gestational age, Preeclampsia severe stage

2. Pregnancy termination. Prepare patient for c- section. Prepare adequate analgesia,

administered magnesium sulphate, check placenta condition. For emergency case we can use
sublingual antihypertensive drug eg: nifedipine

3. Maternal complication: injuries, aspiration, pulmonary edema, pneumonia, hepatic necrosis,

disturb vision, thrombocytopenia, postpartum shock, anuria.

4. Fetal complication: termination of pregnancy, fetoplacental insufficiency, perinatal mortality

 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 6
A Jamaican woman admitted to the maternity hospital on 1/11/2013 with fundal
height 39cm. Her last menstrual cycle is 1 February 2013 week’s complains with vaginal
bleeding for 3 days with local right side pain. Her blood pressure is 155/85mmHg.
Examination:
Biophysical profile is 6 balls,
Ultrasound shown cervix is 2 cm in size closed T- variant, placenta is at the low
line 2-3cm.

Question
1. What is the diagnosis?
2. How should this woman be managed?

Chief of Department, Professor G.A. Lazareva

 CASE № 6
A Jamaican woman admitted to the maternity hospital on 1/11/2013 with fundal
height 39 cm. Her last menstrual cycle is 1 February 2013 week’s complains with
vaginal bleeding for 3 days with local right side pain. Her blood pressure is
155/85mmHg.
Examination:
Biophysical profile is 6 balls,
Ultrasound shown cervix is 2 cm in size closed T- variant, placenta is at the low
line 2-3cm.

Question
1. What is the diagnosis?
2. How should this woman be managed?

Answer
1. Pregnancy 39 week gestational age, placenta abruption, preeclampsia.

2. Pregnancy termination. Prepare patient for c- section. Prepare adequate analgesia,

administered magnesium sulphate, check placenta condition. For emergency case we can use
sublingual antihypertensive drug eg: nifedipine.
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 7
A 27-year-old Australian woman attends the emergency department with brown
vaginal bleeding and abdominal pain. She noticed the bleeding 2 days previously and it
is dark red but not heavy. The abdominal discomfort is suprapubic and crampy, more on
the right-hand side. Her last menstrual period commenced 6 weeks ago. She has never
been pregnant.
Examination
Human chorionic gonothrophin level = 3610 mIU/mL
Transvaginal ultrasound scan is shown present egg outside of the uterine cavity

Question
1. What is the diagnosis?
2. How would you investigate and manage this patient?

Chief of Department, Professor G.A. Lazareva

 CASE № 7
A 27-year-old Australian woman attends the emergency department with brown
vaginal bleeding and abdominal pain. She noticed the bleeding 2 days previously and it
is dark red but not heavy. The abdominal discomfort is suprapubic and crampy, more on
the right-hand side. Her last menstrual period commenced 6 weeks ago. She has never
been pregnant.
Examination
Human chorionic gonothrophin level = 3610 mIU/mL
Transvaginal ultrasound scan is shown present egg outside of the uterine cavity

Question
1. What is the diagnosis?
2. How would you investigate and manage this patient?

Answer
1. Pregnancy 6 weeks gestational age, ectopic pregnancy.

2. General ectopic pregnancy management options are:

Laparoscopy, laparoscopy depend s on degree of bleeding.
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 8
A 21 years old pregnant female with height 171 cm, weight 67 kg, abdominal
circumference of 95cm, height of the uterus above the pubis is 36 cm.

Question
1. Calculate the estimated birth weight of the fetus of this lady using all
possible methods.

Chief of Department, Professor G.A. Lazareva

 CASE № 8
A 21 years old pregnant female with height 171 cm, weight 67 kg, abdominal
circumference of 95cm, height of the uterus above the pubis is 36 cm.

Question
1. Calculate the estimated birth weight of the fetus of this lady using all possible
methods.
Answer
Jordan I.F
FW = AC * F = 95 * 36 = 3,420 g = 3.4kg

Yakubova Z.N
FW = AC + F * 100
4
=95 + 36 * 100
4
= 3,275 g = 3.3kg

Lankovits A.V
FW = (AC + F + WH + WW) * 10 = (95 + 36 + 171 + 67) * 10 = 3,690g = 3.7kg
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 9
A 24 years old woman was admitted in the hospital in 1 st stage of labour. During
vaginal examination, it was found that, in the pelvic outlet the chin was rotated to the
sacrum and conductor point was the mentum.
Question
1. What type of head presentation is present here?
2. What is the diameter and circumference?
3. What method of delivery would you advice?

Chief of Department, Professor G.A. Lazareva

 CASE № 9
A 24 years old woman was admitted in the hospital in 1st stage of labour. During
vaginal examination, it was found that, in the pelvic outlet the chin was rotated to the
sacrum and conductor point was the mentum.
Question
1. What type of head presentation is present here?
2. What is the diameter and circumference?
3. What method of delivery would you advice?

Answer
1. Face posterior presentation
2. Hyobregmatic/vertical/submentobregmatic 9.5cm, circumference is 32 cm.
3. Cesarian section.
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 10
A 35 years old patient who is breastfeeding and had a history of thromboembolism
comes to you as a medical practitioner for an advice on the safest method of
contraception for her.

Question
1. What method would you advice?
2. What are the contraindications of this method?

Chief of Department, Professor G.A. Lazareva

 CASE № 10
A 35 years old patient who is breast feeding and had a history of
thromboembolism comes to you as a medical practitioner for an advice on the safest
method of contraception for her.

Question
1. What method would you advice?
2. What are the contraindications of this method?

Answer
1. The use of only progesterone pill.

2. Contraindications of this method are:

- Pregnancy
- Unexplained vaginal bleeding
- Recent breast cancer
- Arterial disease
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 11
A 25 year old woman with first pregnancy has a height of 173 cm and a weight of
68 kg. After examination, it was found that the height of the fundus is midway between
the umbilicus and the pubic symphysis.

Question
1. Determine what week of pregnancy.
2. Determine the body-mass index of the woman.
3. Define the terms Gravidity and Parity and state the gravidity and parity of
the woman.

Chief of Department, Professor G.A. Lazareva

 CASE № 11
A 25 year old woman with first pregnancy has a height of 173 cm and a weight of
68 kg. After examination, it was found that the height of the fundus is midway between
the umbilicus and the pubic symphysis.

Question
1. Determine what week of pregnancy.
2. Determine the body-mass index of the woman.
3. Define the terms Gravidity and Parity and state the gravidity and parity of the
woman.

Answer
1. The woman is 16 weeks pregnant

2. 68kg/(1.73m)2 = 22.7. The woman has a normal BMI (18.5-24.9).

3. Gravida: a pregnant state both past and present, irrespective of the period of
gestation. The woman is a Primigravida.
Parity: a state of previous pregnancy beyond the period of viability. The woman is
a nullipara.
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 12
A 23 year old woman was admitted to the hospital, after examination, it was
found that the height of her symphysis pubis was 4 cm.

Question
1. Calculate the true conjugate, if the diagonal conjugate is 13 cm.

Chief of Department, Professor G.A. Lazareva

 CASE № 12
A 23 year old woman was admitted to the hospital, after examination, it was
found that the height of her symphysis pubis was 4 cm.

Question
1. Calculate the true conjugate, if the diagonal conjugate is 13 cm.

Answer
CV= DC - 2.0 = 13 cm - 2.0 cm = 11cm
Where CV = conjugate vera (true conjugate)
DC= Diagonal conjugate
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
CASE № 13
A woman 25 years old and 39 weeks pregnant was being observed by an
obstetrician. During Leopold’s maneuver, the doctor found that the back of the fetus was
facing the right anterior part of the uterine wall. 2 days later, the woman went into labor
and during delivery, the sagital suture of the fetus was in the oblique diameter and the
anterior fontanel was near the symphysis.

Question
1. Determine the lie, presentation, position of the fetus, and diameter and of the
head (size and circumference).

Chief of Department, Professor G.A. Lazareva

 CASE № 13
A woman 25 years old and 39 weeks pregnant was being observed by an
obstetrician. During Leopold’s maneuver, the doctor found that the back of the fetus was
facing the right anterior part of the uterine wall. 2 days later, the woman went into labor
and during delivery, the sagital suture of the fetus was in the oblique diameter and the
anterior fontanel was near the symphysis.
Question
1. Determine the lie, presentation, position of the fetus, and diameter and of the
head (size and circumference).

Answer
Lie longitudinal
Presentation cephalic
Position right anterior
Diameter occipito-bregmatic (9.5 cm, circumference 32 cm).
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 14
A 26 year old woman came to the hospital for advice on what method of
contraceptive she should adopt. The woman has a constant sexual partner and was
currently on her period, and 8 months ago she had just had a baby. The doctor
recommended the use of Cu T380A.
Question
1. State the advantages, disadvantages, and contraindications for this method.

Chief of Department, Professor G.A. Lazareva

 CASE № 14
A 26 year old woman came to the hospital for advice on what method of
contraceptive she should adopt. The woman has a constant sexual partner and was
currently on her period, and 8 months ago she had just had a baby. The doctor
recommended the use of Cu T380A.
Question
1. State the advantages, disadvantages, and contraindications for this method.

Answer
Advantages:
1. Highly effective, with failure rate of only 2%
2. No systemic side effects
3. Doesn’t interrupt sexual activity
4. Suitable for breast feeding women
5. Effective during long time

Disadvantages:
1. Risk of pelvic infections
2. Increase ectopic pregnancy
3. Uterine perforation
4. No STD protection
5. Insertion involves a trained clinician

Contraindications:
1. Pregnancy
2. Acute cervicitis
3. STD
4. Congenital malformation of the uterus
5. Suspected uterine malignancy
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 15
A woman came to the hospital on the 6-th of July 2013 for medical examination.
The first day of her last menstrual period was on the 28-th of May 2013. Her menstrual
cycle is 28 days with a normal menstrual flow duration of 6 days. She has regular
menstrual cycle.
Question
1. When is the day of ovulation
2. Calculate her expected date of delivery, EDD according to Negel’s rule.

Chief of Department, Professor G.A. Lazareva

 CASE № 15
A woman came to the hospital on the 6-th of July 2013 for medical examination.
The first day of her last menstrual period was on the 28-th of May 2013. Her menstrual
cycle is 28 days with a normal menstrual flow duration of 6 days. She has regular
menstrual cycle.
Question
1. When is the day of ovulation
2. Calculate her expected date of delivery, EDD according to Negel’s rule.

Answer
1. Her next period is expected to be on the 25th of June.
Ovulation date is calculated by subtracting 14-16 days from the date of the next
period. Hence, her ovulation date is on the 11-th of June. She is now 18 weeks pregnant
in her 2-nd trimester of pregnancy.
Estimated delivery date according to ovulation day = 40 weeks after her ovulation
date = date of ovulation +38 weeks = 18-th of March 2014

2. Estimated delivery date according to Negel’s rule = 1st day of last menstrual
period – 3 months + 7 days = 28th of May – 3 months + 7 days = 28th of February + 7
days = 7th of March 2014.
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 16
A woman came to the hospital on the 6-th of July 2013 for medical examination.
Her pelvic inlet was measured. Her lateral conjugate was 12 cm.
Question
1. Calculate conjugata vera from the lateral conjugate ratio. Is it normal?
2. Define conjugata vera.
3. How is lateral conjugate measured?

Chief of Department, Professor G.A. Lazareva

 CASE № 16
A woman came to the hospital on the 6-th of July 2013 for medical examination.
Her pelvic inlet was measured. Her lateral conjugate was 12 cm.
Question
1. Calculate conjugata vera from the lateral conjugate ratio. Is it normal?
2. Define conjugata vera.
3. How is lateral conjugate measured?

Answer
1. The normal ratio of lateral conjugate is 14-15cm. Her lateral conjugate is <14
cm, hence conjugate vera is <11cm. It is not normal.

2. Conjugata vera is the distance between the promontory of the sacrum and the
upper margin of the symphysis.

3. Lateral conjugate is measured using the distance between the anterior superior
iliac spine and posterior superior iliac spine.
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 17
A woman was admitted to the hospital on her 40 th week of pregnancy. During
labor, the sagital suture was placed in the anterior-posterior diameter of the pelvic outlet
and the hair line was fixed under the pubis and the sub-occipital fossa at the coccyx.
Question
1. What is the type of head presentation?
2 .What kind of diameter is this?
3. What are the values of the diameter and circumference.

Chief of Department, Professor G.A. Lazareva

 CASE № 17
A woman was admitted to the hospital on her 40 th week of pregnancy. During
labor, the sagital suture was placed in the anterior-posterior diameter of the pelvic outlet
and the hair line was fixed under the pubis and the sub-occipital fossa at the coccyx.

Question
1. What is the type of head presentation?
2 .What kind of diameter is this?
3. What are the values of the diameter and circumference.

Answer
1. It is occipito-posterior presentation.
2. Sub-occipito-frontal diameter.
3. Diameter is 10 cm, the circumference is 33cm.
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 18
A woman came to hospital on June 2- nd and complained that she got her 1-st day
of last menstrual period was on April 15-th. Her menstrual cycle was regular.
Question
1. Calculate the expected day of delivery of the woman?

Chief of Department, Professor G.A. Lazareva

 CASE № 18
A woman came to hospital on June 2- nd and complained that she got her 1-st day
of last menstrual period was on April 15-th. Her menstrual cycle was regular.
Question
1. Calculate the expected day of delivery of the woman?

Answer
EDD = 1 st day of LMP+9 months+7days =January 22-nd
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 19
A woman came to hospital on May 1-st and she complained that her 1-st day of
the last menstrual period was March 3-rd. Her menstrual cycle was regular, and the
length of menstrual period is 30 days.
Question
1. Calculate the expected day of delivery of the woman?

Chief of Department, Professor G.A. Lazareva

 CASE № 19
A woman came to hospital on May 1-st and she complained that her 1-st day of
the last menstrual period was March 3-rd. Her menstrual cycle was regular, and the
length of menstrual period is 30 days.
Question
1. Calculate the expected day of delivery of the woman?

Answer
EDD according to Negels = 1 st day of LMP-3months+7 days+1 year = 10-th of
December
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 20
A 25 years old woman admitted to hospital in 1-st stage of labour it was found
that, in pelvic inlet frontal suture in transverse diameter in synclitism. In pelvic outlet
frontal suture in the anterior posterior diameter, and the denominator was middle of the
forehead.
Question
1. What is the type of head presentation?
2. What is the diameter and the circumference?

Chief of Department, Professor G.A. Lazareva

 CASE № 20
A 25 years old woman admitted to hospital in 1-st stage of labour it was found
that, in pelvic inlet frontal suture in transverse diameter in synclitism. In pelvic outlet
frontal suture in the anterior posterior diameter, and the denominator was middle of the
forehead.
Question
1. What is the type of head presentation?
2. What is the diameter and the circumference?

Answer
1. Brow
2. Occipito-mental 13-13.5 cm, 38-40 cm
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 21
A woman primipara in her 2nd trimester of pregnancy visited the hospital on the
28th of September, 2013 for medical examination. The first day of her last menstrual
period was on the 14th of April, 2013 and it lasted for 5 days. She has a regular
menstrual cycle of 28 days. The first fetal movement was felt on the 20 th week of
pregnancy.
Question
1. Calculate her Expected Date of Delivery according to fetal movement.
2. What is the Expected Date of Delivery according to Naegele’s rule?

Chief of Department, Professor G.A. Lazareva

 CASE № 21
A woman primipara in her 2nd trimester of pregnancy visited the hospital on the
28th of September, 2013 for medical examination. The first day of her last menstrual
period was on the 14th of April, 2013 and it lasted for 5 days. She has a regular
menstrual cycle of 28 days. The first fetal movement was felt on the 20 th week of
pregnancy.
Question
1. Calculate her Expected Date of Delivery according to fetal movement.
2. What is the Expected Date of Delivery according to Naegele’s rule?

Answer
1. According to Fetal movement
If the 1st day of last menstrual period was on the 14 th of April, ovulation probably
occurred on the 28th of April. Therefore, the 20th week was on the 15th of September,
2013 (first fetal movement).
Expected Date of Delivery= Date of first fetal movement + 20 weeks
EDD = 20 weeks + 20 weeks = 2nd of February, 2014.

2. According to Naegele’s rule

Expected Date of Delivery = (1st day of last menstrual period – 3 months + 7
days) + 1 year.
1st day of last menstrual period = 14th April (4), 2013
4-3 = 1(January).
January, 14 + 7 days + 1 year = 21st of January, 2014.
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 22
A woman in her 1st trimester of pregnancy visited the hospital on the 20 th of
September, 2013 for medical examination. Her pelvis was measured and her Conugata
externa was 20 cm, wrist index was 14.5 cm.
Question
1. Calculate Congugata vera by Conugata externa, is it normal?
2. Define Congugata vera.
3. How is Congugata externa measured?

Chief of Department, Professor G.A. Lazareva

 CASE № 22
A woman in her 1st trimester of pregnancy visited the hospital on the 20 th of
September, 2013 for medical examination. Her pelvis was measured and her Conugata
externa was 20 cm, wrist index was 14.5 cm.
Question
1. Calculate Congugata vera by Conugata externa, is it normal?
2. Define Congugata vera.
3. How is Congugata externa measured?

Answer
1. Congugata vera= Conugata externa - 8cm (if wrist index<14cm)
Congugata externa -9cm (if wrist index is 14cm-15cm)
Congugata externa-10 cm (if wrist index >15cm)
In this case, Wrist index=15cm
Congugata externa= 20cm therefore, Congugata vera= 20-9 = 11cm.
The normal value is 11cm, therefore it is normal.

2. Congugata vera is the distance between promontory of the sacrum and the
upper margin of symphysis.
3. Congugata externa is measured with the patient in a lateral position, from the
symphysis to projection of the upper part of sacrum or upper part of the rhombus.
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 23
A woman was admitted into the hospital on the 30 th of September, 2013 which
was the 40th week of her pregnancy and her expected day of delivery. During the 2nd
stage of labour, the frontal suture of the fetus was in the anterior-posterior diameter of
the pelvic outlet. The maxilla emerged first at the lower border of the pubis, and the
occipital protuberance was fixed at the tip of the coccyx.
Question
1. What was the fetal presentation?
2. What is the name of this diameter and its definition?
3. What are the values of the diameter and circumference?

Chief of Department, Professor G.A. Lazareva

 CASE № 23
A woman was admitted into the hospital on the 30 th of September, 2013 which
was the 40th week of her pregnancy and her expected day of delivery. During the 2 nd
stage of labour, the frontal suture of the fetus was in the anterior-posterior diameter of
the pelvic outlet. The maxilla emerged first at the lower border of the pubis, and the
occipital protuberance was fixed at the tip of the coccyx.
Question
1. What was the fetal presentation?
2. What is the name of this diameter and its definition?
3. What are the values of the diameter and circumference?

Answer
1. Brow presentation.
2. Occipito-mental diameter: the diameter from the external occipital
protuberance to the chin.
3. The diameter= 13-13.5cm; the circumference= 38-40cm.
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 24
A woman who is 34 years old came to the hospital for advice on contraception.
She has a stable partner, an active sexual life, a regular menstrual cycle but complained
of dysmenorrhea and she does not smoke. Genetic screening for thromboembolism was
carried out on her and she has no risk of thromboembolism or any other disease.
Question
1. What method of contraception would you recommend for her?
2. What are the advantages of this method to the patient?
3. List some other advantages of this method.
4. What are the disadvantages of this method?
5. What are the contraindications for this method of contraception?

Chief of Department, Professor G.A. Lazareva

 CASE № 24
A woman who is 34 years old came to the hospital for advice on contraception.
She has a stable partner, an active sexual life, a regular menstrual cycle but complained
of dysmenorrhea and she does not smoke. Genetic screening for thromboembolism was
carried out on her and she has no risk of thromboembolism or any other disease.
Question
1. What method of contraception would you recommend for her?
2. What are the advantages of this method to the patient?
3. List some other advantages of this method.
4. What are the disadvantages of this method?
5. What are the contraindications for this method of contraception?
Answer
1. Combined oral contraceptive pills.
2. It will help to treat dysmenorrhea in the patient and also avoid the
possibility of her having children without interfering in her sexual life.
3. The pills can sometimes improve conditions such as premenstrual
syndrome, acne, reduce symptoms of endometriosis and polycystic ovary syndrome, and
decrease the risk of anemia. It also reduces lifetime risk of ovarian cancer, endometrial
cancer and colorectal cancer.
4. Mistakes may be made by the user due to inconsistency will affect its
effectiveness. It can cause temporary side effects at first, such as headaches, nausea,
breast tenderness and mood. It can increase blood pressure.
5. Women who are smokers
Women who have genetic predisposition to thromboembolism
Pregnancy
Women with severe obesity and hypercholesterolemia
Women with liver tumors, hepatic adenoma or severe cirrhosis of the liver, and
for those with known or suspected breast cancer
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 25
A sexually active 23 year old woman with regular menstrual cycle have stopped
having her menstrual cycle for 4 months. She realized some changes in her body. She
has increase in bodyweight and easily tired. She started to have hyperventilation about a
month before. She notices a dark midline on her lower abdomen.
Question
1. What problem is the woman having?
2. Why is she having hyperventilation?
3. What causes the appearance of the dark midline on her lower abdomen?

Chief of Department, Professor G.A. Lazareva

 CASE № 25
A sexually active 23 year old woman with regular menstrual cycle have stopped
having her menstrual cycle for 4 months. She realized some changes in her body. She
have increase in bodyweight and easily tired. She started to have hyperventilation about
a month before. She notice a dark midline on her lower abdomen.
Question
1. What problem is the woman having?
2. Why is she having hyperventilation?
3. What causes the appearance of the dark midline on her lower abdomen?

Answer
1. The woman is pregnant.
2. As the pregnancy progresses and the uterus expands to accommodate the
growing fetus, the top of the uterus moves upward and pushes the diaphragm up. This
puts pressure on the lungs and causes shortness of breath. Apart from that, progesterone
make the respiratory center of the brain more sensitive to carbon dioxide, causing a
pregnant woman to breathe more frequently.
3. The dark midline is called linea nigra which is common in pregnant woman
which appear due to increasing of cortisol level.
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 26
A 26 years old woman was admitted into the hospital. After some obstetrical
examinations, it was determined that the height of her symphysis pubis was 3.8 cm.
Calculate her true conjugate, if her diagonal conjugate is 13cm.

Chief of Department, Professor G.A. Lazareva

 CASE № 26
A 26 years old woman was admitted into the hospital. After some obstetrical
examinations, it was determined that the height of her symphysis pubis was 3.8 cm.
Calculate her true conjugate, if her diagonal conjugate is 13cm.

Answer

CV = DC – 1.5 cm
CV = 13 cm – 1.5 cm = 11.5 cm

Where CV = conjugate vera ( true conjugate )

DC = diagonal conjugate.
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 27

A 25 years old woman came to the hospital to seek professional advice on what method
of contraception to use. She reported of having a stable sexual partner, an active sexual
life and frequent dysmenorrhoea (menstrual pains).

Question
1. What method of contraception is most appropriate for this situation, and why?
2. What are the contra-indications to this method?

Chief of Department, Professor G.A. Lazareva

 CASE № 27

A 25 years old woman came to the hospital to seek professional advice on what method
of contraception to use. She reported of having a stable sexual partner, an active sexual
life. She has acne and irregular menses.

Question
1. What method of contraception is most appropriate for this situation, and why?
2. What are the contra-indications to this method?

Answer
1. Combined contraceptives is most appropriate because it provides effective
contraception, and can be used to improve acne and regulate menses.

2. Contra-indications to Combined Oral Contraceptives.

Oral contraceptives should not be used in women with any of the following conditions:
– Thrombophlebitis or thromboembolic disorders
– A past history of deep-vein thrombophlebitis or thromboembolic disorders
– Cerebrovascular or coronary-artery disease
– Known or suspected breast carcinoma
– Endometrial carcinoma or other known or suspected estrogen-dependent neoplasia
– Undiagnosed abnormal genital bleeding
– Cholestatic jaundice of pregnancy or jaundice with prior pill use
– Hepatic adenomas or carcinomas
– Known or suspected pregnancy.
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 28
A woman, 27 years of age, in her late trimester was examined by an obstetrician in the
hospital 3 days before delivery. During Leopold maneuver, the doctor found that the
back of the fetus was directly facing the anterior part of the uterine wall. She had a
normal delivery, and at the end of internal rotation in the pelvic outlet, the posterior
fontanelle of the fetal head appeared.

Question
1. Determine the type of lie, presentation, position, diameter of the fetus.

Chief of Department, Professor G.A. Lazareva

 CASE № 28
A woman, 27 years of age, in her late trimester was examined by an obstetrician in the
hospital 3 days before delivery. During Leopold maneuver, the doctor found that the
back of the fetus was directly facing the anterior part of the uterine wall. She had a
normal delivery, and at the end of internal rotation in the pelvic outlet, the posterior
fontanelle of the fetal head appeared.

Question
1. Determine the type of lie, presentation, position, diameter of the fetus.

Answer
Lie = longitudinal
Presentation = cephalic.
Position = direct anterior.
Diameter = sub occipital bregmatic (size 9.5cm; circumference 32cm).
 KURSK STATE MEDICAL UNIVERSITY
FOREIGN STUDENT FACULTY
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CASE № 29
A 37 years old woman, multipara, in her 2nd trimester of pregnancy, who works at
chemical factory, visited her doctor during her antenatal schedule and expressed over
possible complications of her present pregnancy after a previous miscarriage 18 months
ago.

Question
1. What other information is required for further evaluation?
2. What kind of medical screening is required for the patient?
3. Which diagnostic invasive procedures can be recommended?

Chief of Department, Professor G.A. Lazareva

 CASE № 29
A 37 years old woman, multipara, in her 2nd trimester of pregnancy, who works at
chemical factory, visited her doctor during her antenatal schedule and expressed over
possible complications of her present pregnancy after a previous miscarriage 18 months
ago.

Question
1. What other information is required for further evaluation?
2. What kind of medical screening is required for the patient?
3. Which diagnostic invasive procedures can be recommended?

Answer
1. Information of past medical history, family history such as presence of genetic
disorders. Information of social status and teratogenic agents at her of work.

2. Genetic screening, Ultrasound.

3. Placentocentesis, choriocentesis, amniocentesis, cordocentesis.