FORMATIVE ASSESMENT

Ques 1

A 26 year old para 2, delivered at term by a vacuum delivery 2 days back. At the morning rounds, she
complains of pain abdomen and pain at the vulva with excessive foul smelling blood stained
lochialdischarge, per vagina. There is difficulty in passing urine also.

Gen physical exam shows a temperature of 38.4 * C pulse is 100 per minute, the abdomen shows a
soft uterus at 20 weeks, tender. The vulva shows a normal episiotomy wound, foul smelling lochia
discharge with bleeding.

She is able to breast feed.

Ques 1 Give THREE (3) differential diagnosis of fever in this case ?

Ques 2 What investigations are required ? 3 invest

Ques 3 Give Three modalities of treatment for her condition.

Ques 2

A 19-year-old is admitted with pain abdomen and mild bleeding per vagina. She is at 8 weeks
gestation, pregnancy test done at home is positive. The bleeding is mild, pain is infrequent.
Occasional vomiting is present. Examination is within normal limits. PV exam is not done.

The USG abdomen shows a bulky uterus with intrauterine sac, no adnexal mass. The Foetal pole is
not seen.

1) What is your diagnosis ?

 Threatened miscarriage
2) Discuss the management of this case.
 Medical treatment usually not necessary
 Advise women to avoid strenuous activities and sexual intercourse
 If bleeding stops, follow up in antenatal clinic.
 If bleeding persists , Reassure if fetal heart activity is present ( >90% of cases will be
progressed satisfactorily)
 Hormone therapy : progesterone to support pregnancy

Mrs Kay is 25-year gravida 3 para 2, she has come with 10 weeks amenorrhoea. The pregnancy test
done at home was positive. She is very worried as she had her last delivery by a LSCS. The LSCS was
done as a planned procedure, a baby with weight of 4.2 kg. was delivered. The baby is in good
health. She mother and father have diabetes, on treatment.

On examination the BMI is 30, Uterus is not palpable per abdomen, per vaginal exam is not done. Hb
is 10 G%, blood group 0 RH D +ve, BP is 120 / 70 mmHg., no proteinuria.

Ques 1 What was the indication for the last LSCS ?

Ques 2 If you do an Ultrasound, what will you focus on?

Ques 3 What medical complication could have lead to the LSCS? What laboratory test can be done
and when to diagnose the condition?

Ques 4 Give THREE points to counsel her, so as to remove her fears during this pregnancy.

 The chances of a vaginal delivery needs to be explained.

 Diet control and exercises so as to control her blood sugar.
 Frequent visits to the clinic with the self monitoring of blood sugar reports.
 Start anti diabetic treatment as soon as it is indicated.
 Frequent foetal assessment.
 Plan to give her a vaginal delivery if the diabetes id under good control and the
weight of the baby is favourable.

Pn Siti is a 22-year-old primi gravida, at 34 weeks of amenorrhoea. The ante natal period has been
normal except for a feeling of tiredness and inability to do her routine work, she often has to take
leave from work.

Her las ante natal visit was 4 weeks back, when she was told that she has mild anemia.

Examination shows mild pallor, BP of 130/80 mm Hg., neck veins are full, she has mild pedal
oedema. The uterus is about 32 weeks size, foetal parts are felt, longtidinal lie with a vertex
presentation. The head is not engaged.

Q! what is the who classification

Q 2 what are the complicatiob of anmia with pregnancy

If the hb is 6 Gm what wull be your management,