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 possib e !a"ses# b) E$p ai% i& there is a %ee' &or "r(e%t !are) b) What i%*esti(atio%s to be or'ere'# !) What are the possib e pro(%osti! e$pe!tatio%s# (2) A !"year"old primigravida at term admitted as an emergency in early labor. #n admission the $terine contractions were moderate in strength and one every ! min$tes. The fetal part at the f$nd$s of the $ter$s was hard% ro$nd and ballotable. The $mbilical grip revealed the fetal back on the left side and the fetal limbs on the right side. The first pelvic grip revealed irreg$lar b$lky parts above the pelvic brim. &on"engagement was confirmed on second pelvic grip. #n vaginal examination the forewater was intact and b$lging% the cervix is cm dilated and the presenting part high above the pelvic brim. a) What is the &eta prese%tatio%# b) What is the &eta positio%# !) Is there a ro e &or " traso"%' at this sta(e# ') What is the ro e o& tria o& *a(i%a 'e i*er+# e) E$p ai% +o"r se e!tio% &or the best ,etho' o& 'e i*er+) ( ) A 2'"year"old primigravida admitted as an emergency at ' weeks gestational age with severe headache diff$se abdominal pain. (he had no formal reg$lar antenatal care. The blood press$re was 1') * 11). a) What is the i,,e'iate ,a%a(e,e%t# b) What are the possib e !o,p i!atio%s# !) Is there a p a!e &or i,,e'iate 'e i*er+# ') What is the !are (i*e% to the patie%t a&ter 'e i*er+# (!) A 2"year"old gravida para 2% admitted at ) weeks pregnancy with s$dden g$sh of fl$id per vagina. The obstetrical history was $nremarkable. a) What are the possib e !a"ses# b) -e%tio% the esse%tia 'ia(%osti! pro!e'"res) !) Dis!"ss the possib e i%es o& treat,e%t) ') -e%tio% the ris. &a!tors o& this !o%'itio%)

(+) A 2,"year"old on her third pregnancy admitted as an emergency after a direct bl$nt tra$ma to the abdomen. (he was in a state of shock. The pregnancy was at 2 weeks gestational age and the $ter$s was extremely tender and hard. The fetal heart so$nds were not heard. There was mild vaginal bleeding and the cervix was closed. a) What is the ,ost probab e 'ia(%osis# b) What are the i,,e'iate ,eas"res at the ,a%a(e,e%t# !) What is the *a "e o& the " traso"%'# ') Is there a p a!e &or !o%ti%"atio% o& the pre(%a%!+# (') A )"year"old primigravida presented at 12 weeks amenorrhea. (he is complaining of severe na$sea and vomiting. (he vomits abo$t eight times per day and has been $nable to keep down solid food or fl$ids for the past two days. The medical and s$rgical histories were $nremarkable. The physical examination revealed a well"developed healthy body. The height was 1'+ cm and the weight was '! kg% as she lost ! kg.% since beginning of the pregnancy. -ital signs. temperat$re /./ 0% blood press$re 1))*')% p$lse. ,) min$te% respiration. 18 min$te. The oral m$co$s membrane appears dry. Abdomen. normal bowel so$nds% soft% nontender% no masses or hepatomegaly. 1elvic examination was normal for 12 weeks pregnancy. 2rinalysis. 3 ketones and is negative for protein and gl$cose. a) What is the basi! e*a "atio% o& s"!h !ase# b) What are the treat,e%t optio%s# !) Is there a p a!e &or ter,i%atio% o& pre(%a%!+# ') What are the possib e !o,p i!atio%s# (/) A 1"year"old gravida para 2 patient 4$st had a vaginal delivery at !1 weeks and ! days of gestation. A midline episiotomy is performed in anticipation of a macrosomic infant. (he has no known dr$g allergies and an $nremarkable family history. 5er 2 prior pregnancies ended in normal spontaneo$s vaginal deliveries at term witho$t notable complications. ($ddenly after vaginal delivery of a !.1)) kg male% a large 6$antity of blood g$shes from her vagina% and she contin$es to bleed prof$sely. a) What is the &irst thi%( that sho" ' be 'o%e# b) What is the se/"e%!e o& steps that sho" ' be 'o%e i% the ,a%a(e,e%t# b) What is the ,e'i!atio%s that !a% be or'ere'# !) I& the patie%t0s he,orrha(e is "%respo%si*e to ,e'i!a ,a%a(e,e%t1 i% a''itio% to i%&"si%( b oo' pro'"!ts2 3hat are the s"r(i!a pro!e'"res to be per&or,e' !o%tro the b ee'i%( a%' preser*e &erti it+#