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 possible causes?
b) Explain if there is a need for urgent care.
b) What investigations to be ordered?
c) What are the possible prognostic expectations?

(2) A 34-year-old primigravida at term admitted as an emergency in early labor. On

admission the uterine contractions were moderate in strength and one every 4
minutes. The fetal part at the fundus of the uterus was hard, round and ballotable.
The umbilical grip revealed the fetal back on the left side and the fetal limbs on the
right side. The first pelvic grip revealed irregular bulky parts above the pelvic brim.
Non-engagement was confirmed on second pelvic grip. On vaginal examination the
forewater was intact and bulging, the cervix is 3 cm dilated and the presenting part
high above the pelvic brim.
a) What is the fetal presentation?
b) What is the fetal position?
c) Is there a role for ultrasound at this stage?
d) What is the role of trial of vaginal delivery?
e) Explain your selection for the best method of delivery.

(3) A 26-year-old primigravida admitted as an emergency at 36 weeks gestational

age with severe headache diffuse abdominal pain. She had no formal regular
antenatal care. The blood pressure was 160 / 110.
a) What is the immediate management?
b) What are the possible complications?
c) Is there a place for immediate delivery?
d) What is the care given to the patient after delivery?

(4) A 32-year-old gravida 3 para 2, admitted at 30 weeks pregnancy with sudden

gush of fluid per vagina. The obstetrical history was unremarkable.
a) What are the possible causes?
b) Mention the essential diagnostic procedures.
c) Discuss the possible lines of treatment.
d) Mention the risk factors of this condition.
(5) A 29-year-old on her third pregnancy admitted as an emergency after a direct
blunt trauma to the abdomen. She was in a state of shock. The pregnancy was at 32
weeks gestational age and the uterus was extremely tender and hard. The fetal heart
sounds were not heard. There was mild vaginal bleeding and the cervix was closed.
a) What is the most probable diagnosis?
b) What are the immediate measures at the management?
c) What is the value of the ultrasound?
d) Is there a place for continuation of the pregnancy?

(6) A 30-year-old primigravida presented at 12 weeks amenorrhea. She is

complaining of severe nausea and vomiting. She vomits about eight times per day
and has been unable to keep down solid food or fluids for the past two days. The
medical and surgical histories were unremarkable.
The physical examination revealed a well-developed healthy body. The height was
165 cm and the weight was 64 kg, as she lost 4 kg., since beginning of the pregnancy.
Vital signs: temperature 37.7 ◦, blood pressure 100/60, pulse: 90 minute, respiration:
18 minute. The oral mucous membrane appears dry. Abdomen: normal bowel
sounds, soft, nontender, no masses or hepatomegaly. Pelvic examination was normal
for 12 weeks pregnancy. Urinalysis: 3 + ketones and is negative for protein and
glucose.
a) What is the basic evaluation of such case?
b) What are the treatment options?
c) Is there a place for termination of pregnancy?
d) What are the possible complications?

(7) A 31-year-old gravida 3 para 2 patient just had a vaginal delivery at 41 weeks
and 4 days of gestation. A midline episiotomy is performed in anticipation of a
macrosomic infant. She has no known drug allergies and an unremarkable family
history. Her 2 prior pregnancies ended in normal spontaneous vaginal deliveries at
term without notable complications.
Suddenly after vaginal delivery of a 4.100 kg male, a large quantity of blood gushes
from her vagina, and she continues to bleed profusely.
a) What is the first thing that should be done?
b) What is the sequence of steps that should be done in the management?
b) What is the medications that can be ordered?
c) If the patient’s hemorrhage is unresponsive to medical management; in addition to
infusing blood products, what are the surgical procedures to be performed control the
bleeding and preserve fertility?