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Preterm and post term pregnancy
1. A pregnant 25 years came to prenatal care with complains on amniotic membrane rupture. Labor pain is absent. Third pregnancy, the past two ended Illegal abortion in term of 22-24 weeks. Vaginal study: short cervix, cervical canal passes finger amniotic membrane is absent, fetal head presentation. Uterus enlarged to 20 weeks of pregnancy, painless. When it is nessesary to prevent a habitual abortion in this woman?
A. Prior to pregnancy
B. At 12-16 weeks of pregnancy
C. Not later than 20 weeks of pregnancy
D. In term miscarriages, which were previously
E. During the formation of placenta
2. The patient, 26 years old, entered the hospital complaining of abdominal pain and bloody discharge from sexual ways. Last menstruation 2 months ago. In the anamnesis 2 spontaneous miscarriages. In the cervical examination cyanosis, a symptom of "pupil" is negative. When vaginal study: external oss passes finger, uterus enlarged to 6-7 weeks pregnancy, soft consistency. What preliminary diagnosis?
A. Pregnancy 6-7 weeks. Threatened abortion
B. Pregnancy 6-7 weeks. Abortion, which began.
C. Abortion in the course.
D. Disturbances of menstrual cycle.
E. Ectopic pregnancy.
3. In the maternity department entered second pregnant woman, 24 years in the period 18-19 weeks in connection with istmico-cervical insufficiency. In the history 2 spontaneous abortions in the period 12 and 17 weeks. During vaginal examination: cervix is short to 1.5 cm, cervical channel passes 1 finger (2 cm). An amniotic bag is whole. Uterus enlarged to 18-19 weeks of pregnancy, in tone. What doctors tactics?
A. Observations
B. Put circular suture on the cervix with subsequent tocolytic therapy.
C. Prevention dystress-respiratory syndrome.
D. Electophoresis.
E. Magnesium therapy.
4. The patient, 26 years old, entered to the hospital complaining of abdominal pains. Last menstruation 2 months ago. In the history 2 spontaneous miscarriages. In speculum examination: cervix has bluish color, a symptom of "pupil" is negative. Vaginal examination: external os is closed, uterus increased to 7 weeks of pregnancy, soft consistency. Diagnosis?
A. Pregnancy 7 week. Threatened abortion
B. Pregnancy 7 week. Initiate abortion ..
C. Abortion in progress.
D. Disturbances of menstrual cycle.
E. Ectopic pregnancy.
5. In primapara 38 years, in 41-42 weeks., Complains to reduce fetal movements. Clinical and laboratory data indicate prolonged pregnancy. Estimated fetal weight of 4200 g, fetal heartbeat muffled 160 b / minute. According to amnioscopy – amniotic water is green. What tactics to accouchement?
A. hypoxia treatment
B. wait start self-patrimonial activity
C. Hold oxsitocin test
D. Labor activation
E. Ceserian section
6. In woman in term of 41-42 weeks of pregnancy labor lasted 6 hours. Contractions for 25 seconds. after 5-6 minutes. Fetal heartbeat arrhythmic 100-160 b. per minute, amniotic water is green. Cervix smoother opening 4 cm, suture sagitalis in the transverse dimensions of the inlet. What further tactics of labor?
A. Labor activation
B. Cesarean section
C. Overlay obstetric forceps
D. Vacuum extraction
E. hypoxia treatment
7.Woman 22 years old complains of great bloody discharge with clots and significant abdominal pain. Last menses was 3 months ago. During bimanual examination: in the vagina many bloody clots, cervix passes for one finger, in the cervix - elements of fertile eggs, uterus enlarged to 12 weeks of pregnancy, appendages not determined. What is the most likely diagnosis?
A. threatened abortion
B. Incomplete abortion
C. Abortion, which began
D. Abortion in progress
E. Complite abortion
8. A pregnant, 28 years in the period 42-43 weeks. She complaints of amniotic bag rupture, without labor activity. In history - menstrual irregular, infertility for 2 years. Fetal heartbeat muffled 170 b / min. In vaginal examination: cervix is 1.5 cm, softened, open to 2 cm, head presentation, pressed to the inlet, skull bones are dense, sutures are narrow and a fontanels it is difficult to determined. Amniotic water is colored with meconium. What preventive measures of this complication.
9. Patient R., 20, entered in the gynecological department with complaints of pain below abdomen, in the lumbar region, bloody discharge from sexual ways. Last menstruation 2 months ago. Bimanual study: cervix length 2.5 cm, soft, cyanosis External os passes fingertip. Uterine body has oval form, soft consistency corresponds to 7 weeks of pregnancy. Vaults are free, painless. Bloody discharges are insignificant. What is the most likely diagnosis?
A. Threatened abortion
B. Incipient abortion
C. Abortion in progress
D. Leyomioma of uterus
E. Ectopic pregnancy
10 V. patient, 23 years old, entered the gynecological department with complaints of low abdominal pain, abundant bloody discharges of sexual ways. Last menstruation 2 months ago. Bimanualne investigation: cervix length of 2 cm, cervical canal passes 1 finger. The body of the uterus enlarged to 6 weeks of pregnancy. Bloody discharges are abundant. What is the most likely diagnosis?
A. Threatened abortion
B. Abortion in progress
C. Incipient abortion
D. Incomplete abortion
E. Full abortion
11 Woman, 36 years, addressed in the Women's Consulting with complaints on menses delay for 4 weeks, irregular bloody discharges with bubbles. When ultrasound: uterus corresponds to 20 weeks pregnancy, the fetus is not defined. During USE in uterus cavity was find a lot of cysts. What is the diagnosis most?
A. Threatened abortion
B. Missed abortion
C. incomplete abortion
D. Hydatidiform mole
E. Horionamnionitis
12. Woman 25 years old, complaining of aching pain in the bottom of the stomach and waist. Term pregnancy 9-10 weeks. In the history of artificial abortion 2. When vaginal investigation: cervix length of 3cm, the cervical channel closed, uterus increased to the term of pregnancy, the discharges are mucous, poor. What is the most likely diagnosis?
A. Threaten abortion
B. Spontaneous abortion, which began
C. missed abortion
D. Hydatidiform mole
E abortion in progress
13. Woman 29 років appealed to women's consultation with complaints of pain below the stomach, blood discharge. Diagnosed 7-8 weeks of pregnancy, In anamnesis 1 artificial abortion in time 9 weeks. During the abortion had difficulty with cervical dilatation. Two pregnancies following spontaneous abortion in weeks 20-21. Rh - negative blood type without RH-antibodies. What is the most possible cause of miscarriage in this case?
A. Genetic Pathology
B. Istmyco-cervical insufficiency
C. Rh-conflict
D. Metroendometryt
E. Adreno-genital syndrome
14.Pregnant, 28 years. Term of pregnancy 6-7 weeks. Fourth pregnancy, previous spontaneous abortion ended in time 20-21 weeks. Examined outside of pregnancy. Istmico-cervical insufficiency was determined. What is the best time overlay seam on the cervix?
A.6 - 8 weeks
B.10 - 12 weeks
C 14 - 16 weeks
D 18 - 20 weeks
E 20 - 22 weeks
15. V., 27, entered the hospital. In history - 2 miscarriages. It was found 14 weeks of pregnancy, cervix is short, os passes for fingertip. Diagnosis: istmiko-cervical insufficiency. Tactics doctor:
A. bed rest with the sedative drugs
B. put a circular suture of the cervix.
C. Administration uterotonics drugs.
D. Perform a hormonal treatment.
E. Make amniocentesis and interrupt pregnancy
16. In department was admitted 24 years woman, 18-19 weeks of pregnancy. During ultrasound examination istmyco-cervical insufficiency was detacted. In the history 2 spontaneous abortions in 12 and 17 weeks. During vaginal investigation: cervix is shortened to 1.5 cm, cervical channel passes for 1 finger (2cmUterus enlarged to 18 19 weeks of pregnancy in normoton. Cervix without pathological changes. What further tactics?
A. Conduct prevention dystress-respiratory syndrome
B. Monitoring.
C. Imposition of a circular seam of the cervix with subsequent tokolitycs therapy.
D. Conduct reflexotherapy.
E. Conduct electrophoresis with magnesium.
17.Pregnant woman with term of pregnancy 10 weeks. Patient has chronic glomerulonephritis, chronic renal failure, stage III. What doctors tactics?
A. Conduct a full clinical and laboratory examination and nurture pregnancy
B. Abort for medical indications
C. Watch for pregnancy
D. Watch for pregnancy, to conduct intensive care
E. Inspect in specialized clinic
18. In primipara 38 years, in 41-42 weeks., Complains to reduce fetal movements. Clinical and laboratory data indicate prolonged pregnancy. Estimated fetal weight of 4200 g, fetal heartbeat muffled 160 strokes per minute. According amnioscopy – water is green. What tactics to accouchement?
A. wait early self-patrimonial activity
B. Conduct oxsitocyn test
C. Labor activation
D. Treatment of fetal hypoxia
E. Cesarean section
19. 22 years old patient complains of bloody discharges with clots from vagina, and significant abdominal pain in low abdominal. Last menses 3 months ago. Bimanual examination: in vagina clots of blood, cervix passes one finger, in the cervical canal - elements of fertile ovum, uterus enlarged to 12 weeks of pregnancy, appendages not determined. What is the most likely diagnosis?
A. threatened abortion
B. Incomplete abortion
C. Abortion incipient
D. Abortion in progress
E. Full abortion
20. In the department of pathology of pregnant came women 20 years with complaints of pain below the abdomen. OBJECTIVE: belly has oval form by a pregnant uterus, which corresponds to 30 weeks of pregnancy. Uterus during palpation comes in tone, longitudinal fetal position, head above the entrance in the small pelvis, low heartbeat clear, rhythmic 140 bits in minute. Diagnosis - the threat of premature birth. Your tactics?
A. Start tocolitycs therapy, prevention fetal-distress syndrome
B. Start labor stimulation
C. Transfer for labor
D. Start tocolitycs therapy
E. Caesar roses fence
Situational tasks
1.Pregnant 27 years in the period of 17 weeks entered to the hospital for treatment. In history - two spontaneous abortions. During bimanual examination: uterus enlarged to 17 weeks of pregnancy, cervix is shortened, os passes finger.
Diagnosis? What doctors tactics?
2. Woman 40 years, with first pregnancy and sterility in anamnesis comes to maternity house. She has 42 - 43 weeks. Labor activity is weak. Longitudinal fetal position, I position, anterior view. Fetal head enters to the small pelvis. Fetal heartbeat 140 UD / min, rhythmic, muffled. Opening the cervix 4sm. Data amnioskopiyi: greenish color of water. Thick skull bones, sutures and small fontanel reduced in size
.
Diagnosis? Tactics doctor?
3. Pregnant complaints of amniotic bag rupture. Second pregnancy. The first ended in late spontaneous abortion. The term of the pregnancy - 32 weeks. Abdomen uniformly increased by a pregnant uterus, its precise contours. Uterine fundus - midway between the navel and xiphoid process. Rhythmic heartbeat of the fetus, 140 b / min. Vaginal investigation: cervix is not smooth cylindrical, external os is closed, presentation part - head, high above the entrance to the small pelvis. Vaginal discharges - light amniotic water.
Diagnosis? Tactics doctor?
4. A pregnant 26 years, first birth enter in department two weeks after term of delivery. Pelvic size 26 - 29 - 32 - 21sm. Fetal lies longitudinal heard presentation, head pressed to enter the small pelvis. Amniotic bag is full. Abdominal circumference - 100sm, standing height of the bottom of the uterus - 38sm. Fetal heartbeat clear, rhythmic, 136 UD / min
Diagnosis? Tactics doctor?
5. Childbirth 32 year. Labor is first, at 43 weeks of pregnancy. Labor is continuing eight hours. Amniotic bag rapter an hour ago. Three hours ago, oxitocyn was administrated. Contractions are weak, irregular. Pelvis 25 - 28 - 31 - 20cm. Longitudinal fetal situation, the heard presentation, head pressed to enter the small pelvis. Fetal heartbeat clear, rhythmic, 140 UD / min. Abdominal circumference - 110sm, standing height of the uterus - 40cm. When vaginal study: set that cervix is shortened, passes one finger (2cm).