Og Emerg 1 2

Situation task No 1
Patient, 16 years old. She consulted a doctor about acute pain in her abdomen that had
appeared while training in gym. Menstruation lasts 3-4 days every 28 days, painless,
regular since she was 13 years old. Lat menstruation was 2 weeks ago. She doesn’t
have sexual life. Through rectum: Body of womb (corpus uteri) corresponds to her age,
painless during palpation. Appendages on the left are not palpated, on the right of the
womb there is painful (algogenic) enlarged ovary in 4x4 cm is palpated. Serous
discharge.
1. Diagnostics of urgent state
2. Tactics determination and rendering of emergency medical aid.
Situation Task №1
1. TORSION OF CYST, Ovarian apoplexy.
2. Puncture of abdominal cavity through posterior vaginal fornix, after receiving blood –
laparotomy, resection of ovary, suture placation for hemostasis.
Situation task No 2
A woman, 20 years old, was taken to gynecology department. She complained of
cramp-like (spasmodic) pain in the lower part of (below) abdomen that had been lasting
for 2 days. Last menstruation was 2 months ago. Blood-smearing was observed within
the period of would-be menstruation. General state is satisfactory. Arterial blood
pressure (ABP) – 110-80 mm of mercury, pulse – 84 strokes/min. Abdomen is soft,
painful in lower parts. Womb is a bit larger than the norm is, appendages on the right
are enlarged up to 6-7 cm in diameter, they are painful during examination. Promptov’s
symptom is positive, posterior fornix hangs over slightly.
Situation Task №2
1. Ectopic pregnancy,The right-side tubal pregnancy.
2. hopitalisation.test for pregnancy,ultrasound,Puncture of abdominal cavity through
posterior vaginal fornix, after receiving blood – laparotomy, right-side tubectomy
Situation task No 3
Patient P., 20 years old. For the last two weeks she has lost 2 kg. There is acetone and
acetone bodies in her urine. Anamnesis: Menstruations since she was 12 years old,
every 30 days, moderate. Last menstruation was 6 weeks ago. It is her first pregnancy.
For the last 24 hours vomiting has taken place 19 times. Temperature – 37,4; P – 100
strokes/min., ABP –100/60 mm of mercury. Skin is pale with icteric tint. Palpatory acute
pain (tenderness) is defined (palpated) in the region of right hypochondrium.
Situation Task №3
1.6weeks of pregnancy,gestosis of pregnancy.
2. seduxen,droperidol,anti-emeti,iv infusion(colloid+crystalloid),parentral nutrition if not
successful=Therapeutic abortion.
.
.
Situation task No 4
A patient, 27 years old, complained of acute pain (below) in the lower part of abdomen.
Abortion was made a month ago. By the time of would-be menstruation there was no
bloody discharge, cramp-like (spasmodic) pain appeared. Vaginally: womb is enlarged
up to 12-13 weeks of pregnancy, tight and elastic, appendages are not defined
(palpated).
Situation Task №4
1. Trophoblastic disease
2. ultrasound,hematometria, RX=Antibiotic +Curettage of uterine cavity
Situation task No 5
A patient, 29 years old. Was taken to gynecology department. She complained of rise in
temperature, general weakness, pain (below) in the lower part of abdomen. Anamnesis:
she has had menstruations since she was 12 years old, that from the very beginning last
during 5 days, cycle – 26 days, medium painful, last menstruation took place 3 months
ago. A patient had 4 deliveries, two of them finished with normal deliveries and two –
with artificial abortions. Last abortion was made 8 days ago. She was discharged from
hospital the next day after abortion. Objectively: General state is satisfactory. P – 92
strokes/min., ABP– 120/80 mm of mercury. T- 38,2. Tongue is moist, slightly coated
white. Abdomen is soft, rather painful over pubis. There is profuse purulent discharge
from the cervical canal. PV: neck of womb is of cylindrical form, external fauces is
closed, body of the womb is a bit more than a norm is, of soft consistency, painful
during palpation. Appendages are not palpated.
Situation Task №5
1. Septic Postabortion metroendometritis.
2. U/S, Blood, urine Rx=Antibiotic therapy, anti-inflammatory therapy, infusion therapy,
disintoxication therapy, uterotonics. Ultrasound uterine cavity control.
Situation task No 6
A patient, 29 years old, complained of bleeding, cramp-like (spasmodic) pain in the
lower part of (below) abdomen. She has been on the books for 3 years because of
hysteromyoma. Menstruations are regular. Last menstruation began 3 days ago.
Vaginally: neck of womb (cervix uteri) is smoothed (flat). Myomatous node up to 5
weeks of pregnancy is seen from the cervical canal.
Situation Task №6
1. myoma of uterus (size 5weeks of pregnancy)
2. curettage of uterine cavity
Situation task No 7
A patient, 47 years old, was taken to gynecology department. She complained of
voluminous (profuse) bleeding and acute pain in the lower part of abdomen. Anamnesis:
she has had menstruations since she was 13 years old during 5-6 days, every 28 days,
painless but profuse. She had 2 deliveries, 2 abortions without complications. General
state is of medium severity. Skin is pale, P – 90 strokes/min., ABP– 100/60 mm of
mercury. PV: vagina of parous, neck of uterus is cylindrical, body of womb is enlarged
up to 15 weeks of pregnancy with multiple myomatous nodes, along posterior wall there
is a node in 4x6 cm on crus, very painful during palpation and displacement.
Situation Task №7
1. Myoma of uterus,15weeks. Necrosis of myomatous node. Hemorrhagic syndrome.
Posthemorrhagic anemia.
2. Surgical treatment, blood volume replacement
Situation task No 8
A patient, 39 years old, complained of acute pain in the lower part of abdomen,
vomiting, quickened urination. During examination: abdomen is rather (moderate)
swollen, Szczyotkin and Blumberg's sign is positive. P – 90 strokes/min., T – 38,
Vaginally: body of womb is not enlarged, firm, active, painless, on the left and ahead of
the womb tight and elastic mass (lump) in 6x9 cm is palpated. It is very painful while
displacing, appendages on the right are not defined (palpated).; mucous (mucilaginous)
discharge.
Situation Task №8
1. Left-side torsion if left uterine tube could cause pyosalpingo-oophoritis, pelviperitonitis.
2. Surgical treatment. Left-side salpingo-oophorectomy, drainage of abdominal cavity.
antibiotics and biopsy
Situation task No 9
A patient, 28 years old. She complained of acute pain in the lower part of abdomen that
is felt in anus. There was short loss of consciousness. Last menstruation took place 6
weeks ago. Anamnesis: she’s had menstruations since she was 12 years old during 3-4
days, moderate, painless. She had 2 deliveries, 1 abortion that was complicated with
oophoritis.
General state is satisfactory. P – 80 strokes/min., ABP– 105/60 mm of mercury. T- 36,5.
PV: vagina of parous, neck of uterus is cylindrical, body of womb is slightly enlarged,
soft by consistency, external fauces is closed. Painful mass in 4-5 cm is defined to the
right in the region of appendages, appendages to the left are not defined (palpated),
their region is painless. Discharge is poor, smearing.
Situation Task №9
1. The right-side tubal pregnancy(6 weeks), rupture of uterine tube.
2. Laparotomy, right-side tubectomy, blood volume replacement. antibiotics
Situation task No 10
A woman in childbirth, 20 years old, had attack of spasms during the second period of
term labor (partus matures) when fetal head was situated in the narrow part of pelvis
minor cavity.
Situation Task №10
1. Eclampsy (epilepsy-?).
2. Urgent delivery: high (cavitary, atypical) forceps delivery.
A patient F., 26 years old. She complained of voluminous (profuse) bloody discharge
from genital tracts and cramp-like pain in the lower part of abdomen. Last menstruation
took place 8 weeks ago. Out of anamnesis: She had 2 normal deliveries and one
spontaneous miscarriage (abortion). General state is satisfactory. P – 84 strokes/min.,
ABP– 110/70 mm of mercury, T – 36,2.PV: vagina of parous, neck of uterus is
cylindrical, external fauces is patulous for 1cm. Body of womb is enlarged up to 7-8
weeks of pregnancy, rather soft, sensitive during palpation. There is profuse bloody
discharge with grumes.
1. Abortion in progress at term of pregnancy 7-8 weeks.
2. Curettage of uterine cavity.
A pregnant woman, 25 years old, was taken for delivery. At home amniotic fluid was
poured out an hour ago. There is no birth activity. It is first pregnancy, first delivery at
term (partus matures). While examining: fetal lie is longitudinal, its head is defined at
the fundus of uterus; over the opening into small pelvis there is large, rather soft, not
balloting part. Vaginally: neck of womb is shortened up to 1cm, cervical canal is
patulous for 2cm out of which the pulsatile loop of cord is hanging down.
1. First delivery at term. Premature discharge of amniotic fluid. Pelvic presentation.
Prolapse of umbilical cord.
2. Urgent cesarean section in case of alive fetus.
A patient D., 28 years old, was taken to gynecology department for abortion, term of
pregnancy – 8-9 weeks. Gynecological state: womb is in anteflexion, body of womb
corresponds to 8-9 weeks of pregnancy, appendages are not defined (palpated). During
abortion under local anaesthesia curette No6 “fell in” the cavity of small pelvis. Woman
complains of severe pain in the lower part of abdomen. Skin is pale, ABP– 90/60 mm of
mercury, P – 90 strokes/min.
1. Uterine perforation during therapeutic abortion. Internal (intra-abdominal) hemorrhage.
2. Laparotomy, suture application.
A pregnant woman, 30 years old, was taken for delivery. Pregnancy – 4, delivery – 2 at
term, (partus maturus), there are 2 medical abortions in anamnesis. First delivery did
not have any complications, fetus weight – 3800,0. Medical abortions were complicated
with metroendometritis. While examining: fetal lie is longitudinal, its head presents,
pressed to the opening into small pelvis. Fetal heartbeats are distinct, rhythmical up to
140 stroke s/minute. Birth pangs occur every 1-2 minutes / 50-55 seconds, painful; they
have been lasting for 8 hours, amniotic fluid poured out 4 hours ago, light. abdominal
circumference – 105 cm, height of elevation of fundus of uterus- 42cm. She felt sharp
pain at the height of one of labor pains, weakness, sickness, cold sweat stood out, skin
is pale.
1. Hystopathologic hysterorrhexis. Big fetus.
2. Urgent laparotomy, hysterectomy with uterine tubes, blood volume replacement,
prophylaxis of DIC-syndrome
A patient A., 27 years old. She went to hospital with the complaints of delay
(suppression) of menstruation during 8 weeks. Profuse bloody discharge that stopped
abruptly after the birth of roundish form of dense formation. Pregnancy is longed-for
because 5 years of sterility is pointed in anamnesis. Time and again its treatment has
been undergone. PV: vagina of nullipara, neck of uterus is distinctly shortened, easily
patulous for 2 cm, body of womb is slightly enlarged. Appendages are not defined
(palpated), their region is painless. Discharge is bloody, moderate.
1. Incomplete spontaneous abortion.
2. Curettage of uterine cavity
A woman in childbirth, 25 years old. Pregnancy – 2, deliveries – 2, at term (partus
matures). Delivery finished 30 minutes ago with alive mature fetus. At this moment
bleeding began. There are no signs of removal of afterbirth (placenta). Hemorrhage
made 400,0 by the weight of the woman of 80 kg.
1. Anomaly /imcomplete of placental expulsion (false, incomplete).
2. Manual removal of afterbirth.
A patient was taken to gynecology department. She complained of acute pain in all
abdomen that had appeared after physical activity, sickness, vomiting. Skin is pale,
pulse – 96 strokes /min. During bimanual examination very painful formation of tight
and elastic consistency was palpated on the right of the womb. It took a great deal of
trouble because of muscle tension of anterior abdominal wall.
1. Ovarian apoplexy (Interruption of tubal pregnancy-?)
2. Laparotomy, suture application
A pregnant woman, 29 years old, was taken for delivery with regular labor activity, birth
pangs occur every 3-4 minutes / 35-40 seconds, amniotic fluid is intact, bloody
discharge with grumes. Pregnancy - 3, deliveries -1. Previous pregnancies finished with
medical abortions, without any complications. Fetal lie is longitudinal, its head presents
high over the opening into small pelvis. Vaginally: neck of womb (cervix uteri) is
smoothed (flat), cervical dilatation is up to 4-5cm, fetal bladder is intact. From behind
and on the left the edge of placenta is defined (palpated), there are grumes in vagina,
head is high over the opening into small pelvis, mobile.
1. Marginal placental presentation. Haemorrhage.
2. Amniotomy
A patient, 18 years old, was taken to gynecology department. She complained of acute
pain in the lower part of abdomen, sickness, vomiting, rapid pulse, deterioration of
general state. Aforesaid complaints appeared during physical activity. She has had
menstruation since she was 14 years old, every 28 days, last menstruation took place 2
weeks ago. During vagina examination: womb is of normal size, appendages on the
right are not defined (palpated), appendages on the left are impossible to palpate
because of sharp pain. Overhang of posterior fornix is marked.
1. Ovarian apoplexy.
2. Puncture of abdominal cavity through posterior vaginal fornix, after receiving blood
– laparotomy, suture plication.
Primigravida, 23 years old was taken to maternity hospital. She complained of
headache, pain in epigastric region, sickness, unclear sight. There was a fit of spasms
at home. Pregnancy – 1, term – 36 weeks. Examination detected: ABP –180/100 mm of
mercury, P – 90 strokes /min., protein in urine 5g/l, anasarca. Soon after being taken to
hospital fits of spasms began to recur one after another. Between spasms her
consciousness is black-out.
1. Pregnancy 36 weeks. eclampsia
2. Urgent delivery by cesarean section. Prolonged artificial lung ventilation, treatment for
gestosis in resuscitation department
A pregnant woman, 25 years old, was taken for delivery. Pregnancy - 2, deliveries -2.
Birth pains has been lasting for 4 hours. Amniotic fluid is intact. ABP –170/90 mm of
mercury, there is edema on lower extremities, protein in urine – 2g/l. Suddenly she began
complaining of pains in abdomen “causing to burst”. Woman turned pale. P – 110
strokes /min. Presentating (presentation) part and small parts of fetus are impossible to
palpate because of increased womb tonus and palpatory tenderness.
Fetal heartbeats are 100 strokes/min., muffled, arrhythmic. No bleeding.
Vaginally: opening of uterine fauces is 3-4 cm, fetal bladder is tense. Head presents.

ANWER
1)2ND delivery at term – 1st stage of delivery. Moderate pre –eclampsia.
Premature detachment of placenta , intrauterine fetal hypoxia
2)aminiotomy -section lower segment
A pregnant woman, 30 years old, was taken to hospital. She complained of profuse
bloody discharge with grumes that suddenly appeared. No labor activity. Pregnancy - 3,
deliveries -3. Time of pregnancy – 36 weeks.
Objective observation: skin is pale, ABP –100/60 mm of mercury, P – 100 strokes /min.
Fetal lie is longitudinal, its head presents over the opening into small pelvis. Fetal
heartbeats are120 strokes/min., rhythmic.
Vaginally: neck is shortened, cervical canal is patulous for a finger, sponge tissue is
defined (palpated) behind internal fauces, bleeding became stronger.

ANSWER
1)Pregnancy 36 weeks . placental presentation. Hemorrhage
2)urgent c-section
A patient, 48 years old, was taken to gynecology department. She complained of
voluminous (profuse) bleeding with clots from genital tracts after menstruation delay for
3 months.
In anamnesis: She had 2 deliveries, 1 abortion without complications. Cycle has been
disturbed for the last 2 years.
Vaginally and in speculum there is no pathology.

ANSWER
1)Climateric bleeding
2) curettage of uterine cavity , hormonotherapy
A patient, 25 years old. She complained of delay of menstruation for 3 weeks. Once at
home she fainted. ABP– 90/50 mm of mercury, P –100 strokes/min., skin is pale.
Vaginally: womb is slightly enlarged, appendages to the left are not defined (palpated), to
the right they are enlarged up to 6x5 cm, painful during palpation.
ANSWER
1)right-sided interrupted tubal pregnancy. Hemorrhagic shock- 1 degree
Puncture of post fornix
Blood is seen
Right sided tubectomy
Blood replacement
A patient, 25 years old. She complained of pain in left iliac region, giddiness. Pains
appeared after sexual contact. Last menstruation is in time. Objectively: skin is pink and
pale. ABP– 105/60 mm of mercury, P –90 strokes/min.
Vaginally: womb is not enlarged, enlarged up to 5x4 cm appendages to the left are
palpated, they are painful. Puncture of posterior fornix was made: 20,0 incoagulable
blood was obtained.

ANSWER
1)left sided ovarian apoplexy
Laparotomy,suture,blood replacement
A patient, 27 years old. She complained of sharp pain in the region of large genital lip,
rise in temperature up to 38,9.
During examination: tumor-like mass is palpated in the region of Bartholin’s gland, very
painful, skin is hyperemic. Fluctuation is defined (palpated).

ANSWER
1)abcess of bartholin’s gland
Puncture,drainage,antibiotics
A patient, 26 years old, complained of cramp-like (spasmodic) pains in the lower part of
abdomen after 2 week of menstruation delay, bloody discharge from genital tracts.
Curettage of uterine cavity was made, fetal egg in womb was not revealed.
Cytohistology: decidual tissue without chorionic villi.

ANSWER
1)ectopic pregnancy
U/S ,surgery
A pregnant woman, 22 years old. Pregnancy – 1, full-term. She’s had headache, ear noise
(tinnitus), stuffiness in nose for 2 days. Fetal lie is longitudinal, pelvic extremity presents.
Fetal heartbeats are distinct, up to 140 strokes/min., rhythmic. Birth pangs occur every 5-
6 minutes / 30-35 seconds. A fit of cramps began at the attempt of internal examination.

ANSWER
1)1ST delivery at term . ecclampsia
Urgent c-section
A pregnant woman, 24 years old, was taken for delivery. Pregnancy – 1, full-term. Birth
pangs occur every 2-3 minutes / 50-55 seconds, painful; parturient woman behaves
uneasily. abdominal circumference – 102 cm, height of elevation of fundus of uterus-
39cm. Pelvis size: 24-24-30-17. Examination showed: womb is of wrong form,
hourglass-like, very painful during palpation, head presents, pressed to the opening into
small pelvis. Fetal heartbeats are 160 strokes/minute, fetal bladder is intact.
Vaginally: cervix of the uterus is shortened, edematic, opening is 2 cm, head is pressed.
Arrow-shaped suture in transverse incision is closer to pubis. Small fontanel is on the left,
large one is on the right. Amniotic fluid is intact. Diagonal conjugate is 10 cm.

ANSWER
1)1st delivery. 1st stage of labour . big fetus- flat rachitic pelvis. Threatened hysterorrhesis.
Fetal hypoxia
A pregnant woman, 23 years old, was taken to hospital with complaints of bloody
discharge from genital tracts and acute pains in the lower part of abdomen. Pregnancy –
1. Term of pregnancy – 36 weeks. During pregnancy she put on the weight 16 kg.
General state is grave, skin is pale, ABP –90/60 mm of mercury, P – 100 strokes /min.
Womb is tense, painful, of wrong form, parts of fetus are not determined because of the
tension of walls of the womb. Fetal heartbeats are failed to hear.
Vaginally: there is cervix of the uterus, canal is patulous for one finger, fetal bladder is
tense, tissue of placenta is not defined.

ANSWER
1) Pregnancy 36 weeks. Premature detachment of placenta. Intrauterine fetal
death. Hemorrhagic shock
A pregnant woman, 26 years old, was taken for delivery with regular labor activity.
Amniotic fluid poured out 2 hours ago at home. Second delivery, at term (partus
maturus). Fetal lie is transversal, head is on the left, pelvic extremity (end) is on the right.
Fetal heartbeats are distinct, rhythmical up to 120 strokes/minute.
While vaginal examining: a hand is hanging down into vagina, opening of uterine fauces
is full,
light amniotic fluid is running.

ANSWER
1)2ND delivery at term . 2nd stage of delivery. Transverse lie. Prolapse of hand of
fetus
c-section
A pregnant woman, 28 years old, was taken with complaints of weak birth pangs every 8-
10 minutes / 20 seconds. Pregnancy – 3, delivery – 3rd at term (partus maturus). First
pregnancy finished with transformation, the second one – with Cesarean section
(operation). abdominal circumference – 98 cm, height of elevation of fundus of uterus-
36cm. Fetal lie is longitudinal, head presents high over the opening into small pelvis.
Pelvis size: 23-26-29-17. After one of the pangs acute pain appeared in abdomen, cold
sweat, small rapid pulse,
adynamy. Womb’s form has changed – to the left of medial line there is rounded body of
the womb, to the right there is fetus.

ANSWER
1)3rd delivery. Uterine scar rupture
Urgent laparatomy, hysterectomy, blood replacement
A patient, 28 years old was taken with complains of acute pain in the lower part of
abdomen that is felt in anus. She lost consciousness. In anamnesis: there are 2 deliveries,
2 medical abortions.
Last menstruation took place 6 weeks ago. General state is satisfactory. P – 90
strokes/min., ABP– 105/60 mm of mercury.
Vaginally: womb is slightly enlarged. Over right fornix there are enlarged and painful
appendages. They are badly bordered because of tension and painfulness of posterior
fornix. Discharge is dark, bloody and poor.

ANSWER
1)Right sided tubal pregnancy-rupture. Intra-abdominal hemorrhage
Laparatomy,tubectomy
A woman, 34 years old, complained of profuse bloody discharge with grumes. She is on
the books because of cervical erosion. She hasn’t consulted a doctor for 15 years. She has
had sexual life since 20 years old. There were no pregnancies. She didn’t preserve. While
examining in speculum: on the neck of uterus there are a great number of cups bleeding
profusely.

ANSWER
1)Carcinoma of cervix, hemorrhage
Vaginal tamponade, hemostatic therapy, vartgeim’s surgery, blood replacement
A patient, 29 years old, complained of acute pain in the lower part of abdomen after
physical activity. She is on the books because of cyst of left ovary.
Examination showed: tension of anterior abdominal wall, Blumberg's sign is positive.
Vaginally: body of womb is of normal size, appendages on the right are not enlarged,
tumor-like mass in 7x9 cm on the left is defined, very painful during palpation.

ANSWER
1) Left sided ovarian cyst rupture
2) Puncture post fornix, laparatomy,cystectomy
Emergency task №36.

Patient 57 years old address to gynecologist with complains of acute pains are progresses
in the low parts of abdomen, body temperature increase up to 38.0º С, general weakness.
In anamnesis: was registered on the gynecologist’s books due to hysteromyoma. Did not
address to doctor last 3 years.
Objectively: tongue is clear, dry, abdomen is a little tympanitic, painful in palpation in
low regions of abdomen. Peritoneal symptoms are positive.
Per vaginum: uterine corpus is enlarged to 11-12 weeks of pregnancy due to plural nodes
of myoma, sharply painful in palpation and movement. Both side appendages are not
palpable.
Formulate the diagnosis of urgent state.
Determine the tactics of first aid.
ANSWER
1)Torsion and necrosis of pedicle with myomatous node, pelvicoperitonitis
2)urgent laparatomy, myomectomy and hystectomy, antibiotics and hemotransfusion.

Woman E. in conferment, 23 years old, was hospitalized for delivery with good labor
activity. Delivery – 1st, pregnancy – 3rd. Previous pregnancies were interrupted by
therapeutic abortion without complications.
Hemodynamics is stable. Body height – 148 cm, circumference of abdomen – 100 cm,
uterine fundus high – 37 cm. Sizes of pelvis: 22-25-28-17 cm.
Labor pains are present during 5 hours, regular, intensive. Amniotic fluid has discharged
3 hours ago.
Complains of pain in low part of abdomen between labor pains.
Position of fetus is longitudinal, presenting head is crowded to pelvic inlet.
Fetal heart rate is muted, rhythmic, 110 per minute.
Per vaginum: cervix is 2 cm dilated, is smoothed not completely, dense, low-elastic.
Presenting head push itself off. Light amniotic waters leak. Promontory is palpable.
ANSWER
1)Cephalopelvis disproportion
2) urgent c-section

Woman D. in conferment was hospitalized with active labor activity.
Delivery – 2nd, pregnancy – 2nd. First delivery - without complications.
Hemodynamics is stable. Birth pains in 45-50’’, intervals – 3-4 minutes, strong. Labor
activity is present during 6 hours. Amniotic fluid has discharged during hospitalization.
Position of fetus is longitudinal, breech presentation. Fetal heart rate is 140 per minute,
clear, rhythmic.
Per vaginum: cervical dilatation is complete. Amniotic sac is absent. There is a leg of
fetus and pulsing loop of umbilical cord inside the vagina. Buttocks are compressed to
pelvic inlet.
ANSWER
1)2nd pregnancy at term , 2nd stage of labour, breeh presentation umbilical ord prolapsed
Urgent c-section

Woman K. in conferment, 35 years old. Was hospitalized to maternity home with active
labor activity during 10 hours. Amniotic fluid has discharged 2 hours ago.
Delivery – 5th, pregnancy – 9th. Circumference of abdomen – 105 cm, uterine fundus high
– 39 cm.
Position of fetus is longitudinal, presenting head is crowded to pelvic inlet.
During one of labor pains acute pain in the abdomen, cold sweat, rapid pulse have come.
Objectively: skin is pale, weak pulse – 98 per minute. Tympanitic abdomen, peritoneal
symptoms are positive and full-blown.
ANSWER
1)10th pregnancy 5th delivery 1st stage of labour (hysterorrhesis +peritonitis)
2. Urgent laparotomy, c-section, antibiotics,hysterectomy with uterine tubes, blood
volume replacement, prophylaxis of DIC-syndrome
Woman in conferment, 28 years old, was hospitalized to maternity home for delivery.
Delivery – 1st, pregnancy – 1st, mature.
Birth activity is present during 8 hours. Amniotic fluid has discharged 6 hours ago at
home.
Objectively: general status of the woman is good, pulse rate – 72 per minute, blood
pressure – 120/70 mm.Hg. Sizes of pelvis: 25-27-30-19 cm.
Position of fetus is transverse. Head is on the left, pelvic part of fetus is on the right.
Presenting part is absent. Fetal heart rate is not auscultated.
Per vaginum: cervical dilatation is complete. Amniotic sac is absent. Shoulder of the fetus
is determined inside the pelvic inlet. Promontory is not palpable.
ANSWER
1)1ST Pregnancy at term . 1st stage of labour . transverse lie of fetus , premature rupture of
amniotic sac. Intrauterine fetal death
2)cephalotomy & dilatation and curettage

Woman in conferment, 24 years old. Was hospitalized to maternity home with good labor
activity. Pregnancy – 3rd, delivery – 3rd. First delivery was ended by embryotomy, second
delivery – by operation of cesarean section.
Circumference of abdomen – 105 cm, uterine fundus high – 37 cm. Sizes of pelvis: 23-
26-29-17 cm.
Position of fetus is longitudinal, presenting head is movable above the pelvic inlet.
Fetal heart rate is 140 per minute, clear, rhythmic. Birth pains in 45-50’’, intervals – 2-3
minutes. Amniotic sac is whole.
Per vaginum: cervix is smoothed, cervical dilatation is 5 cm. Presenting head push itself
off. Amniotic sac is whole. Promontory is palpable. Diagonal conjugate is 11 cm long.
During one of labor pains acute pain in the abdomen, cold sweat, rapid pulse have come.
Shape of uterus has changed: in the left of centerline – roundish corpus of uterus, in the
right – fetus.
ANSWER
1)3rd pregnancy at term 3rd delivery 1 stage of labour flat rachitis pelvis, rupture of uterine
scar
2)urgent laparatomy, c-setion, blood replacement, hemostatic therapy ,antibiotics

Woman in conferment, 28 years old. Was hospitalized with mature pregnancy and good
labor activity.
Pregnancy – 5th, delivery – 3rd, there are two therapeutical abortions without
complications in anamnesis. Labor pains continue during 12 hours, waterless period – 6
hours.
General status of the woman is good, Body temperature is 37,5°С, pulse rate – 94 per
minute, rhythmic.
Position of fetus is longitudinal, presenting part is not palpated. Fetal heartbeats are not
auscultated.
Per vaginum: cervical dilation is complete, there is a hand and not-pulsing loop of cord
inside the vagina.
ANSWER
1)interuterine death
2)craniotomy & evacuation
Patient, 26 years old. Was hospitalized to gynecological department with complains of
profuse bleeding with grumes from genitals. Woman considers herself pregnant, last
menstruation was 8 weeks ago.
General status of patient is good. Body temperature is normal, pulse rate – 78 per minute,
rhythmic.
Per vaginum: non-parous, narrow vagina. Cervical canal is passable for 2 cm, corpus of
uterus is enlarged to 6-7 weeks of pregnancy. Discharges are profuse, bloody with
grumes.
ANSWER
1)Abortion in progress 7-8weeks , hemorrhage
2)dilatation &curettage,hemotransfusion

Woman in conferment, 29 years old. The third delivery continues 7 hours.
Complains of bloody discharges with grumes.
General status of patient is good. Skin and visible mucous tunics have usual color. Body
temperature is normal. Blood pressure – 100/70 mm.Hg., pulse rate – to 94 per minute,
rhythmic.
Position of fetus is longitudinal, presented head is situated high above the pelvic inlet.
Fetal heart rate is 134 per minute, clear, rhythmic.
Per vaginum: cervix is dilated to 5 cm. In the right-posterior side placental tissue is
determined. Amniotic sac is whole. Head is high above the pelvic inlet. There are grumes
in vagina.
ANSWER
1)marginal placenta previa, 3rd delivery at term,1st stage
2)aminotomy & c-section

Pregnant woman K., 23 years old, was hospitalized into maternity home for delivery. The
first mature pregnancy. Blood pressure arise up to 140/100 mm.Hg. repeatedly during the
pregnancy, woman did not ask for help. She visited the maternity welfare centre
infrequently.
Complains of head ache, stuffiness in nose, blurred vision, pain in epigastric region.
Objectively: body temperature is normal, pulse rate – 90 per minute, blood pressure –
180/110 mm.Hg., edema of legs and anterior abdominal wall. Urine protein – 6 g/l.
Attack of convulsions happened at home.
Position of fetus is longitudinal, cephalic presentation, fetal heart rate is 100 per minute,
muted.
ANSWER
1. Eclampsia at term of pregnancy, intrauterine fetal hypoxia
2. general tactics,Urgent c-section ,artificiallung ventilation anti-convulsive

Pregnant woman C. was hospitalized for delivery with mature pregnancy. Labor activity
is absent. Pregnancy is the first.
Woman complains of head ache, sickness, “scales in front of her eyes”, there were one
vomiting at home.
Objectively: General status of patient is moderate, Blood pressure – 170/110 mm.Hg.,
urine protein – 3 g/l, edema of legs and anterior abdominal wall.
Presenting part is not palpated, head of fetus is on the right, back is on the left, fetal
heartbeats are auscultated on the level of navel, dull, to 130 per minute, rhythmical.
Attack of convulsions has started 20 minutes after admission.
ANSWER
1. Eclampsia at term of pregnancy
2. general tactics, anti-convulsive, Urgent c-section ,artificial lung ventilation

Patient A., 28 years old, was hospitalized into gynecological department with complains
of profuse bloody discharges with grumes.
Last menstruation was 2.5 months ago. Woman is registered on the books with
pregnancy, pregnancy is desired. She thinks her condition has the cause in psycho-
emotional stress.
Objectively: general status of patient is good. Pulse rate – 120 per minute, blood pressure
– 90/60 mm.Hg. Skin and mucous tunics have usual color.
Per vaginum: cervix is shortened up to 1.5 cm, cervical canal is opened, embryo is
situated there. Uterus is enlarged up to 4-5 weeks of pregnancy, discharges are bloody,
profuse, with grumes.
ANSWER
1)Abortion in progress(4-5th week)
2)d&c

Patient B., 35 years old. Was hospitalized with complains of bloody discharges from
genital tracts after coitus.
In anamnesis: menstruations since 11 years, every 28 days, moderate. There were one
pregnancy was ended by therapeutic abortion without complications.
Per speculum: there is a cup (crater) on the cervix, which bleeds profusely. Uterus has
normal sizes, appendages are not palpated.
After the doctor’s manual examination profuse bleeding has started.
ANSWER
1)carcinoma of cervix(hemorrhage)
2)vaginal tamponade ,hemostatic therapy,vartgeim’s surgery, blood replacement.

Patient N., 25 years old. Complains of low abdominal pains, nausea, vomiting.
Therapeutic abortion in term 3 weeks of pregnancy was done day before.
Objectively: general condition is severe, pulse rate – 120 per minute, body temperature –
37.5°C, Blood pressure – 90/60 mm.Hg., skin is pale. Abdomen is tensed, peritoneal
signs are positive. Dullness on percussion in low regions of abdomen is revealed.
Per vaginum: cervix is passable for 2 cm, uterus is enlarged up to 7-8 weeks of
pregnancy, soft, painful, fornicis of vagina are tensed, painful. Discharges are bloody,
moderate.
ANSWER
1. Septic Postabortion metroendometritis.
2. U/S, Blood, urine Rx=Antibiotic therapy, anti-inflammatory therapy, infusion therapy,
disintoxication therapy, uterotonics. Ultrasound uterine cavity control.

A girl, 12 years old, complains of spastic pain 4-5 days every week in the course of half a
year. During admission to hospital: severe pain in is resistant to analgesics.
In examination of external genitals: there are protrusion between leafs of small lips of
pudendum throw what the violet fluid is seen.
The foramen of hymen is absent.
ANSWER
1)imperforate hymen or aresia of hymen
Urgent incision with evacuation of contents

Og Emerg 1 2

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Situation task No 1

1. Diagnostics of urgent state

1. Diagnostics of urgent state

1. Diagnostics of urgent state

1. Diagnostics of urgent state

1. Diagnostics of urgent state

1. Diagnostics of urgent state

1. Diagnostics of urgent state

1. Diagnostics of urgent state

1. Diagnostics of urgent state

1. Diagnostics of urgent state

1. Diagnostics of urgent state

1. Diagnostics of urgent state

1. Diagnostics of urgent state

1. Diagnostics of urgent state

Emergency task №36.

Emergency task №37.

Emergency task №38.

Emergency task №39.

Emergency task №41.

Emergency task №42.

Emergency task №44.

Emergency task №45.

Emergency task №46.

Emergency task №47.

Emergency task №48.

Emergency task №49.

Emergency task №50.

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