Examination Questions for Obstetrics

1. The structure and functions of the fallopian tubes

Functions:
Transport sperm from uterus to the egg ( )
Provide conditions for fertilization ( )
Embryo development ( )
Structures:
10-12 cm, 4 parts (4 ): infundibulum with fimbriae, ampulla, isthmus, pars uterine
2. Principle therapy for bleeding in early postpartum period
Reasons:
Uterine atony/hypotony ( )
Coagulopathy ( )
Uterine rupture/soft tissues rupture ( )
Therapy:
<350ml external massage of uterine by Creed-Lazarevich followed by oxytocin
( - )
>400ml remove contents and massage by fist followed by oxytocin
( )
1000-1200ml surgery/hysterectomy
3. Methods of artificial previa in later periods. Indications and possible complications
Methods:
Excite uterine, intra and extra abdominal introduction of hypertonic solution and
prostaglandins followed by vaginal cesarean
( ,

)
Indications:
Disease of mother and disease of fetal ( )
Complications:
Hemorrhage ()
Infections ()
Infertility ()
4. Mechanism of labor at the back as occipital previa (head facing upwards)
1st moment flexion of head ( )
2nd moment internal rotation of head ( )
3rd moment supplementary flexion of head ( )

5. Fetal hypoxia and asphyxia, diagnosis, treatment, prophylactics

Definition:
Oxygen deficiency of fetal causing acidosis of fetal leading to accumulation of carbon
dioxide and fetal breaths through open glottis and aspirates mucus and blood.
( , ,

, )
Diagnosis: Examine fetal activity, heart rate, Doppler ultrasound
Disease of mother hemorrhage, coagulopathy, CVD, asthma, pneumonia
Disease of fetal infection, CVD, genetic
Pathology of uteroplacental
Pathology of respiratory tract
Treatment:
Oxygen therapy ()
Drugs antihypoxants, vasodilators, estrogens
Prophylactics:
Eliminate possible complications of pregnancy and provide effective treatments
(
)
6. Obstetric forceps. Indications. Methods of usage
Forcep:
Extract living full-term fetus in the head ( )
Structure:
Left handled and right handled each consisting a spoon, lock and handle
( )
Indications:
Maternal weakness ()
Fetal hypoxia/asphyxia
Methods:
Left handled on left side of maternal and vice versa. Lock the two parts and deliver the
baby. If front as occipital previa, extension followed by delivery. If back as occipital
previa, flexion and extention followed by delivery.
( .
. ,
. ,
)
7. High risk factors of Perinatal pathology (immediate before and after birth)
Maternal-fetal:
Malposition ( )
Breech presentation ( )
Placental anomaly ( )
Oligohydramnios
Premature birth ( )
Hemorrhage, rhesus factor incompatibility

8. Bleeding in early postpartum period. Etiology, clinical picture, treatments,

prophylactics, diagnosis
Reasons:
Uterine atony/hypotony ( )
Coagulopathy ( )
Uterine rupture/soft tissues rupture ( )
Clinical picture:
Anemia, hemorrhagic shock, gestosis (proteinuric hypertension), collapse (syncope)
Diagnosis:
Hypotension symptoms and uterus palpation (
)
Treatments:
<350ml external massage of uterine by Creed-Lazarevich followed by oxytocin
( - )
>400ml remove contents and massage by fist followed by oxytocin
( )
1000-1200ml surgery/hysterectomy
Prophylactics:
Introduction of oxytocin or misoprostol
9. Plodorazryshayuchie operations in Obstetrics
Plodorazrushayuschie surgery:
Surgery with the aim to reduce the size of the fetus to a value that permits its passage
through the birth canal
( ,
)
(1) Craniotomy
Indications:
Narrow pelvis, adverse previa and insertion head when the delivery is not possible
( , ,
)
(2) Embryotomy
Indication:
Transverse cross-fetal position ( )
(3) Cleidotomy
Indication:
Shoulder dystocia ( ) - anterior shoulder cannot pass below
Complications:
Uterine and soft tissues rupture ( )
Injuries of adjacent organs ( )

10. The pelvic floor. Structures and functions

The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the
coccygeus muscle. It separates the pelvic cavity above from the perineal region.
(
, coccygeus .
)
Structures:
The right and left levator ani lie almost horizontally in the floor of the pelvis. The levator
ani is usually considered in three parts: pubococcygeus, puborectalis, and iliococcygeus.
The pelvic floor has two hiatuses (gaps): Anteriorly urogenital hiatus through which
urethra and vagina pass through and posteriorly rectal hiatus through which anal canal
passes.
( .
, , : pubococcygeus,
puborectalis iliococcygeus. ():
, ,
, )
Functions:
Support for pelvic organs e.g the bladder, intestines, uterus (in females)
( , , , ( ))
Facilitates birth by resisting the descent of the presenting part, causing the fetus to rotate
forwards to navigate through the pelvic girdle.
( , , ,
)
11. Modern principles of intensive therapy in the late form of pregnancy toxicosis
Principles:
Affect CNS in neuro-protecting ( -)
Prevent vasospasm ( )
Normalize vascular permeability ( )
Improve blood flow ( )
Maintain the balance of electrolytes and metabolites (
)
Maintain homeostasis of coagulation ( )
Prevent fetal malnutrition and hypoxia/asphyxia
( / )
12. Indications and situation to use obstetric forceps
Forcep:
Extract living full-term fetus in the head ( )
Structure:
Left handled and right handled each consisting a spoon, lock and handle
( )
Indications:
Maternal weakness ()
Fetal hypoxia/asphyxia

13. Clinical course and management in the third stage of labor

Begins with the birth of fetus and ends with delivery of placenta
( )
Courses:
1. sudden gush of blood ( )
2. apparent lengthening of the umbilical cord ( )
3. elevation and contraction of the uterine fundus ( )
Management:
Uterine contractions result in cleavage of placenta between zona basalis and zona
spongiosum. Placenta separation can be encouraged by Brandt-Andrews maneuver (the
uterus is secured and controlled traction is applied to the cord) or Crede maneuver (the
cord is secured and uterus is elevated).
( Zona
. -
( ) Crede
( )
14. Pyelonephritis and pregnancy
6-7% of pregnancies
Etiology: gram-ve bacteria pseudomonas aeruginosa, proteus, staphylococcus
Stages:
I uncomplicated pyelonephritis
II chronic pyelonephritis
III pyelonephritis (with arterial hypertension, azotemia, etc.)
Clinical picture:
Temperature (38-40 degree Celsius)
Fever (), headache ( ), chills ()
Treatments:
Surgery:
Put in the stent during 25th to 26th week of pregnancy and remove the stent 4 to 5 days
after laboring
( 25- 26- 4
5 )
Medication:
Acute zeporin, no-spa, furagin, gemodez
Chronic cranberry juice ( )

15. Structure and functions of placenta, fetal membranes, umbilical cord. Amniotic
fluid, compositions and biological significance
Structures of placenta:
Placenta averages 22 cm in length and 22.5 cm width that weigh approximately 500
grams. It has a dark reddish-blue or crimson color. It connects to the fetus by an umbilical
cord of approximately 5560 cm in length, which contains two umbilical arteries and one
umbilical vein.
( 22 2-2,5 ,
500 . -- - .
55-60 ,
)
Functions of placenta:
Nutrition (), excretion (), immunity ()
Endocrine () Hcg, Hpl, estrogen, progesterone by chorionic villi
Functions of fetal membranes:
Metabolism - bone resorption, excretion, regulation of biochemical composition
( ,
)
Functions of umbilical cord:
Nutrition (), excretion ()
Contents of amniotic fluid:
Electrolytes, but by about the 12-14th week the liquid also contains proteins,
carbohydrates, lipids and phospholipids, and urea
(, 12-14 ,
, , )
Functions of amniotic fluid:
Protection (), movement of fetus ( ), metabolism
16. Uterine rupture. Etiology, classification, prophylactics
Etiology:
Narrowed pelvis ( )
Mismatch of the fetal head size ( )
Prolonged pregnancy ( )
Previous surgeries ( )
Inflammation ()
Classification (LS Persianinov):
I at the time of labor ( )
II pathology/trauma
III clinical course
IV Nature of rupture ( ) (partial/complete)
V Localization
Prophylactics:
Introduction of oxytocin or misoprostol
17. Obstetric forceps. Indications and situation
Same as Q6 & Q12

18. Clinical course and management in the first stage of labor

Interval between onset of labor and full cervical dilatation
( )

It is divided into latent phase (period between onset of labor and point of accelerated change) and
the active phase (great cervical dilation being around 3-4cm). Normal latent phase is <20 hours
in nullipara and <14 in multipara. In active phase, the cervix should dilate >1.2 cm in nullipara
and >1.5 cm in multipara. Maternal is brought into ward where the heartbeat of fetal is checked
every 15 minutes. Conditions of maternal are observed and vaginal examination is required.
Besides, discharged amniotic fluid is examined to determine the quantity, color and smell. If
everything is fine, mother is transferred to the delivery room.
( (
) ( 3-4).
<20 nullipara <14 multipara. ,
> 1,2 nullipara > 1,5 multipara.
, 15 .
. ,
, , .
, .)
19. Immunological incompatibility between fetus and mother
Rhesus factor incompatibility
If the mother is Rh negative (15%) and the baby is Rh positive (85%), the mother
produces antibodies (including IgG) against the Rhesus D antigen on her baby's red blood
cells. During this and subsequent pregnancies the IgG is able to pass through the placenta
into the fetus and if the level of it is sufficient, it will cause destruction of Rhesus D
positive fetal red blood cells leading to the development of Rh disease.
( - (15%)
(85%), ( IgG) - D
. IgG
,
D
Rh.

Signs and symptoms:

Fetal hepatosplenomegaly; newborn anemia, jaundice
Prophylactics:
Treating the mother during pregnancy or promptly (within 48 hours) after childbirth
( ( 48 )
)
Mother has an intramuscular injection of anti-Rh antibodies (Rho(D) Immune Globulin)
( -Rh (Rho (D)
)
20. Manual separation of placenta. Indications and techniques of operation
Insert hand into uterine cavity and remove the placenta.
( )
Indications:
Weakness of mother/Hypotonia of the uterus
Placenta adhaerens
Placenta accreta (villi into myometrium)
Placenta increta (invade into myometrium)
Placenta percreta (penetration into myometrium)
Techniques:
Placenta separation can be encouraged by Brandt-Andrews maneuver
(the uterus is secured and controlled traction is applied to the cord) or
Crede maneuver (the cord is secured and uterus is elevated)
( - (
) Crede (
)
21. Manual aid by Tsovyanov in breech presentation
The manual aid by Tsovyanov I in frank breech presentations.
The aim of the manual aid: to prepare the maternal ways to the delivery of the head and
shoulders and to keep the normal attitude of the fetus.
In the frank breech presentation the fetus extremities are flexed at the hips and extended
at the knees and thus the feet lie in close proximity to the head. The circumference of the
thorax with the crossing on it arms and legs are larger than circumference of the head and
the after-coming head deliveries easily.
The technique. The aid begins after the delivery of the buttocks. The obstetricians hands
are applied over the buttocks, the thumbs placed on the fetus sacrum and other fingers on
the legs. The doctor gently supports the legs to avoid its flexion. If the normal attitude of
the fetus is keeping the head deliveries easy.
The manual aid by Tsovyanov II in footling presentations.
The aim of the manual aid: To perform the footling presentation to the incomplete breech
and to prepare the maternal ways to the delivery of the head and shoulders.
The doctor covers the area of the vulva with the sterile napkin and puts up resistance to
the delivery of the feet. The feet are flexing and the footling presentation becomes
incomplete breech presentation. Than the delivery manage as in incomplete breech
presentation.

( Tsovyanov I .
:
.

, ,
.
, .
. .
, , .
, .
.
Tsovyanov II .
:
.

.
.
)
22. Infection due to abortion. Clinical picture, treatment
Spontaneous abortion causes development of septicemia due to infection of
endometrium, fallopian tubes, ovaries or pelvic peritoneum.
( -
, , )
Etiology:
Staphylococcus, chlamydia, Streptococcus
Types:
I Uncomplicated abort (only uterus) -
II Complicated abort (uterus and pelvic) -
III Septic abort -
Clinical picture:
I Fever, headache, chills, tachycardia, leukocytosis
II fever, chills, pain, leukocytosis, increased ESR
III fever, chills, intoxication, pale skin, yellow sclera, thrombophlebitis, pneumonia
Treatments:
I active remove infected ovum ( )
Wait and see postpone operation until symptoms subside
( , )
II & III
Antibiotics
Sulfonamides
Vitamins

23. Cesarean section. Indications, contraindications. Types of operations

C-section is the surgery to extract the fetus through incision on abdominal cavity.
(
)
Indications:
Absolute:
Relative:
Placenta previa
Breech presentation
Narrowed pelvis
Malposition of fetus
Large fetus
Uterine dysfunction
Tumor of pelvic organs
Fetal hypoxia
Preeclampsia
Post-term pregnancy
Contraindications:
Premature of fetus/Fetal death/Acute infection/Prolonged labor
Types:
Intraperitoneal c-section/Extraperitoneal c-section
24. The science of perinatology
The study of human life beginning from 28th week of pregnancy and including the first 7
days after birth.
( , 28- ,
7 )
Perinatal - from 22 completed weeks (154 days) of gestation (the time when birth weight
is normally 500 g) to 7 completed days after birth
( 22 (154 ) (
, , 500 ) 7 )
Prenatal/antepartum - period between the 24th/26th week of gestational age until birth
( 24/26 )
Postnatal/postpartum - period beginning immediately after the birth of a child and
extending for about six weeks
(,
)
25. Hydrops pregnancy. Clinical picture, diagnostics, treatment, prophylactics
Edema as early signs of toxicity of the second half of pregnancy.
(, )
Stages:
I edema of lower extremities
II edema of lower extremities, lower abdomen and lumbosacral
III edema involving upper extremities
IV Anasarca
Clinical picture:
Swelling, skin normal color (If severe shortness of breath, fatigue, tachycardia)
Treatments:
Limit intakes of salt (2-3g/day)/Limit intakes of fluid (<800ml/day)/Vit. B/C
Prophylactics:
Diet/hygienic regime

26. Breech presentation. Mechanism of labor

Mechanism:
I moment the internal breech rotation ( ). The breech
rotates and the fetal intertrochanteric diameter from one of oblique size of the pelvic inlet
to anteteroposterior size of the pelvic outlet.
II moment the lateral flexion of the body ( ). The anterior
hip is stemmed against the pubic arc. By lateral flexion of the fetal body the posterior hip
is forced over the anterior margin of the perineum. Then anterior hip is born.
III moment the internal shoulders rotation (
). After the birth of the breech, there is the slight
external rotation as a result of the descends and rotations of the shoulders. The shoulders
rotates on the pelvic floor and diameter biacromialis occupies anteroposterior diameter of
the pelvic outlet.
IV moment the lateral flexion the body in the thoraco-brachial part (
- ). The shoulders are born.
V moment the internal rotation of the head ( ). The
rotation begins when the fetal head descends from the plane of greatest pelvic dimensions
to the least pelvic dimensions (midpelvis). The rotation is complete when the head
reaches the pelvic floor, the sagittal suture is in the anteroposterior diameter of the pelvic
outlet and the small fontanel is under the symphysis.
VI moment the flexion of the fetal head ( ). The head fixes with its
fossa suboccipitalis to the inferior margin of symphysis pubis and flexes. The face,
forehead, vertex, and occiput are born.
27. Narrowed pelvis (page. 127)
Cross-parameters of pelvis:
Distantia spinarum (25-26 cm)
Distantia cristarum (28-29 cm)
Distantia trochanterica (31-32 cm)
Conjuta externa (21-22 cm)
Types:
Decreased dimension of female pelvis ( )
Size mismatch of pelvis and fetus ( )
Reasons:
Osteomalacia
scoliosis/kyphosis
Tuberculosis
poliomyelitis
Bone tumors
spondylolisthesis
Diagnosis: ultrasound/pelvic exam
Complications:
Fetal hypoxia
Gestoz
Shoulder dystocia
Treatment:
1st pregnancy C-section
2nd pregnancy check on 30th week
if scar >4 cm, C-section; if <4cm, natural delivery

28. Treatments of Istmocervical incompetence (Incompetncia istmocervical)

IIC is the inability of the cervix to maintain a pregnancy due to anatomic or functional
defects.
( ,
.)
Treatments:
Surgery - cerclage before the 13th week of pregnancy
(technique that reinforces the cervical muscle by placing sutures above the opening of
the cervix to narrow the cervical canal)
Drugs - inhibin, Dactil
Goja, Meyer rings (pessaries)
29. The physiological birth, reasons of the onset of labor
The beginning of labor is considered:
(a) Regular contractions of uterus every 10-15 minutes
(b) Smoothing of cervix and uterine mouth opening
(c) Discharged of mucus stained with blood ( )
Preterm birth before 28th week ( )
Urgent birth 28th 41st week ( )
Late birth after 41th week ( )
Three periods:
Opening of cervix (nullipara 10-11 hours; multipara 6-7 hours)
Period of expulsion (nullipara 1-2 hours; multipara 15min-1 hour)
Sequence period - <30 minutes separation of placenta and membranes
30. Chronic hypoxia and hypotrophy of fetus. Diagnostics and treatments
Definition:
Oxygen deficiency of fetal causing acidosis of fetal leading to accumulation of carbon
dioxide and fetal breaths through open glottis and aspirates mucus and blood.
( , ,

, )
Diagnosis: Examine fetal activity, heart rate, Doppler ultrasound
Disease of mother hemorrhage, coagulopathy, CVD, asthma, pneumonia
Disease of fetal infection, CVD, genetic
Pathology of uteroplacental
Pathology of respiratory tract
Treatment:
Oxygen therapy ()
Drugs antihypoxants, vasodilators, estrogens
Prophylactics:
Eliminate possible complications of pregnancy and provide effective treatments
(
)

31. Surgical method to stop the bleeding during early postpartum period
Surgery indication: blood loss 1000-1200 ml
Before surgery, a manual examination of uterus is performed and massages the uterus by
fist. If continues bleeding, surgery is performed.
After opening the abdominal cavity, catgut ligature is applied to the uterine and ovarian
vessels on both sides. If the bleeding does not stop, hysterectomy/amputation is
performed.
( ,
. - , .
,
. , /
)
32. Questionable, Probable and Reliable signs of pregnancy
Questionable signs:
Dyspepsia, nausea, vomiting (, )
PICA ( )
Metabolism
Probable signs:
No menstruation ( )
Breast engorgement ( )
Reliable signs:
Palpable parts of fetus
Fetal movements ( )
Fetal heartbeat
33. Methods of assessment of feto-placental system
Ultrasound
Echocardiography
Cardiotocography study of frequency of heartbeat
Doppler ultrasound study of hemodynamic circulation
Dopplerometria study of placental blood flow
Hemostasiogram
34. Featured course and managements in multiple-fetal pregnancies
Doctor should closely monitor the situations of both mother and fetuses. After the birth of
first fetus, immediately start the intravenous dripping of oxytocin in 5% glucose solution
to accelerate the birth of the second fetus. In the postpartum period, the conditions of
mother and fetuses need to be observed.
( , .
,
5% , .
, )

35. Concepts of neurohumoral regulation in menstrual cycle

Estrogen secreted by mature ovarian follicles and is important in the maturation of
secondary sex characteristics
Progesterone controls the secretory phase of menstrual cycle
CNS ----HYPOTHALAMUS RELEASES ---- GnRF (FSHRH & LHRH) --- CAUSES
ANTERIOR PITUITARY TO RELEASE FSH & LH ---- STILMULATES GONADS
TO SECRETE HORMONES (ESTROGEN & PROGESTERONE)
36. Couse of pregnancy and laboring in narrow pelvis
Cross-parameters of pelvis:
Distantia spinarum (25-26 cm)
Distantia cristarum (28-29 cm)
Distantia trochanterica (31-32 cm)
Conjuta externa (21-22 cm)
Types:
Decreased dimension of female pelvis ( )
Size mismatch of pelvis and fetus ( )
Reasons:
Osteomalacia
scoliosis/kyphosis
Tuberculosis
poliomyelitis
Bone tumors
spondylolisthesis
Diagnosis: ultrasound/pelvic exam
Complications:
Fetal hypoxia/Gestoz/Shoulder dystocia
Treatment:
1st pregnancy C-section
2nd pregnancy check on 30th week (if scar >4 cm, C-section; if <4cm, natural delivery)
37. Trauma of perineum. Etiology, clinical picture, classification, treatment and
prophylactics
Etiology:
Overstretching of perineum ( )
Improper laboring ( )
Clinical picture:
Cyanosis
Edema
Pale perineum ( )
Classification:
I rupture of perineum
II rupture of perineum and pelvic floor muscles
III rupture of perineum, muscles and rectal sphincter/rectum
Treatment:
Surgery suturing ( )
Prophylactic:
Prevent trauma

38. Bony pelvis. Plane and size of small pelvis. Axis

3 parts: pelvic inlet, pelvic outlet, pelvic floor
Pelvic inlet:
Front pubis symphysis
Lateral/medial upper margine of pubic bone/linea ileopectinealis/ala sacralis
Back promontory of sacrum
Transverse diameter 13.5cm; anterior-posterior diameter 11cm; mid-pelvis 12cm
Pelvic outlet:
Front lower margin of pubis symphysis
Lateral/medial ischial tuberosity/sacrotuberous ligament
Back last piece of sacrum
Transverse 11cm; anterior-posterior 13.5cm
Pelvic floor:
The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the
coccygeus muscle. It separates the pelvic cavity above from the perineal region.
The right and left levator ani lie almost horizontally in the floor of the pelvis. The levator
ani is usually considered in three parts: pubococcygeus, puborectalis, and iliococcygeus.
The pelvic floor has two hiatuses (gaps): Anteriorly urogenital hiatus through which
urethra and vagina pass through and posteriorly rectal hiatus through which anal canal
passes.
39. Indications for early delivery and methods of delivery in forms of late toxicity
Indication:
Preeclampsia
Eclampsia
Nephropathy
Neuropathy
Methods:
Vaginal caesarean/c-section
40. Extraction of fetus through inguinal fold. Indication, situation, operation technique
Indications:
Size mismatch of fetus and pelvis
When c-section is not possible
Technique:
Manual:
Introduce both index fingers into inguinal folds. Then, capture the pelvic end of the fetus
and try to bring under the lower edge of pubic symphysis.
( .
symphisis)
Instrumental:
The fetus is extracted by using a loop or a hook.
( )
41. Mechanism of labor at the back as occipital previa (head facing upwards)
Same as Q4

42. Postpartum metroendometritis. Clinical picture, diagnostics and treatments

Clinical picture:
Increased temperature (38-39 degree Celsius)
Weakness
Chills
Tachycardia
Leukocytosis
Diagnostics: ultrasound/hysteroscopy
Treatments:
Oxacillin/methicillin (4g/day) - penicillins
Zeporin/kefzol/zefamizin (4g/day) - cephalosporins
Kanamycin (0.5g 4times/day) - aminoglycosides
Gentamycin (40mg 2 times/day) - aminoglycosides
(Usual combination: zeporin+oxacillin/ampicillin+gentamycin/levomizetin+lincomycin)
43. Mechanism of labor at the front as occipital previa (head facing downwards)
1st moment flexion of head ( )
2nd moment internal rotation of head ( )
3rd moment extension of the head ( )
4th moment external rotation of the head ( )
Birth of anterior shoulder ( anterior)
Birth of posterior shoulder ( posterior)
44. Therapy of postpartum septical diseases
Diseases including:
Chorioamnionitis (0.78%)
Metroendometritis
Mastitis
Obstetric peritonitis (0.3-1.5%)
Therapies:
Oxacillin/methicillin (4g/day) - penicillins
Zeporin/kefzol/zefamizin (4g/day) - cephalosporins
Kanamycin (0.5g 4times/day) - aminoglycosides
Gentamycin (40mg 2 times/day) - aminoglycosides
(Usual combination: zeporin+oxacillin/ampicillin+gentamycin/levomizetin+lincomycin)
Septicemia/septicocemia
Therapy:
Antibioticotherapy
Combinations of sulfonamides+antiseptical preparatus
(furazolidon/solafur/furazolin)
Septic shock (3-5%)
Therapy:
Zefotaksin/zefuroksin
Meronem/Metronidazole/clindamycin/diflukan/immunoglobulin

45. Suspensory, supporting, fixing apparatus of uterus

Suspensory ligaments:
Round ligament of uterus - maintenance of the anteflexion of the uterus during pregnancy
( )
Broad ligament of uterus 3 parts: mesometrium, mesosalpinx, mesovarium
maintaining the uterus in its position
( )
Ovarian ligament - connects the ovary to the lateral surface of the uterus
( )
Suspensory ligament of ovary (infundibulopelvic ligament)
connects the ovary to the wall of the pelvis
( )
Supporting ligaments:
Uterosacral ligament posterior cervix
Cardinal ligament side of cervix
Pubocervical ligament side of cervix
Fixing apparatus:
Anterior to the bladder and symphysis
Posterior to the sacrum and rectum
46. Blood supply of internal genital organs
Main aorta, system of common and internal iliac arteries
Uterus is supplied by uterine artery
Uterine artery is divided into branches and supply upper part of vagina and adjacent part
of bladder.
The ascending branch of uterine artery approaches fallopian tube and is divided into tubal
artery and ovarian artery.
Ovaries are supplied by ovarian artery.
Venus outflow: venous plexus around bladder, between uterus and ovaries.
(

.

.
.
: ,
)
47. Partial placenta praevia. Clinical picture, diagnostic, obstetric tactics
Definition;
Implantation of the placenta in the uterus, causing it alongside or in frontof the fetal
presenting part
( , frontof
)

Etiology: multipara, maternal age

Grades:
I Low implantation (into lower segment)
II Marginal (almost covering cervical os)
III Partial/Incomplete (partially cover cervical os)
IV Central/Complete (completely cover)
Clinical picture:
Painless bleeding
Diagnosis:
Ultrasound/abdomen examination (soft, non-tender)
Tactics:
Pregnancy <37 weeks conservative treatment (hospitalization, cross-matched blood)
Pregnancy >37weeks surgery, c-section
48. Basic reasons istmocervical incompetencia
IIC is the inability of the cervix to maintain a pregnancy due to anatomic or functional
defects.
( ,
.)
Treatments:
Surgery - cerclage before the 13th week of pregnancy
(technique that reinforces the cervical muscle by placing sutures above the
opening of
the cervix to narrow the cervical canal)
Drugs - inhibin, Dactil
Goja, Meyer rings (pessaries)
Etiology:
Anatomical Traumatic injuries of cervix
Functional infantilism, hypoplasia, malformation of uterus, hyperandrogenism
49. Eclampsia. Clinical picture, diagnostic, treatment, prophylactic
Definition:
Eclampsia is the onset of seizures (convulsions) in a woman with pre-eclampsia
( ()
)
4 periods:
I Preconvulsive period (twitching of facial muscles)
II Period of tonic spasms (face turning blue)
III Period of clonic spasms (seizures of muscles of extremities & trunk; biting tongue)
IV Period of cessation (cessation of convulsive seizures)
Clinical picture:
Hypertension
Proteinuria
Nausea, vomiting, headache
Diagnosis:
CBC, renal function test, liver function test, ultrasound

Treatments:
Magnesium sulphate (prevent further convulsion)
Hydralazine/labetalol (blood pressure control)
Promptly delivery
Monitor onset of multi-organ failure
Prophylactics:
Nutrition/Hygiene
Monitoring maternal-fetal condition
50. Perineotomy/Episiotomy and perineorrhaphy/Perineoplasty. Indications, techniques
Indications for perineotomy:
Shoulder dystocia
Large fetus
Perineal muscle rigidity
Techniques:
Medio-lateral: The incision is made diagonally in a straight line which runs about 2.5 cm
(1 in) away from the anus
Median: The incision is made along the midline for 2.5 cm (1 in)
Lateral: The incision starts from about 1 cm (0.4 in) away from the centre
J-shaped: The incision begins in the centre of the fourchette and is directed posteriorly
along the midline for about 1.5 centimetres (0.59 in) and then directed downwards and
outwards along the 5 or 7 o'clock position
Indications for perineoplasty:
Damage/defect/deform of perineum
Technique:
There are two variants of the perineoplasty procedure: the first, to tighten the perineal
muscles and the vagina; the second, to loosen the perineal muscles
( : -,
;-, )
51. High risk factors of Perinatal pathology (immediate before and after birth)
Maternal-fetal:
Malposition ( )
Breech presentation ( )
Placental anomaly ( )
Oligohydramnios
Premature birth ( )
Hemorrhage, rhesus factor incompatibility

52. Anatomical narrowed pelvis. Classification by forms and stages

Reason: size mismatch of pelvis and fetus
Classification by forms:
1. poperechnosuzhenny (45.2%)
Stage I 11.5 12.5 cm
Stage II 10.5-11.5 cm
Stage III 10.5 cm
2. Flat plain (13.6%)
Ploskoranitichesky (6.5%)
Reduced pelvis (21.8%)
Obscheravnomernosuzhenny (8.5%)
Classification by stages of true conjugate diameter narrowing (from p.sym. to promon.):
Stage I 9-11 cm
Stage II 7.5-8.9 cm
Stage III - 6.5-7.4 cm
Stage IV - <6 cm
53. Rupture of cervix. Etiology, treatment, prophylactic, clinical picture
Etiology:
Narrowed pelvis ( )
Mismatch of the fetal head size ( )
Prolonged pregnancy ( )
Previous surgeries ( )
Inflammation ()
Classification:
I rupture one or two sides <2 cm
II >2 cm not but not reaching vagina vault
III >2 cm reaching vagina vault
Clinical picture: bleeding
Treatment:
Catgut suture of cervix
Prophylactics:
Introduction of oxytocin or misoprostol
54. The clinical course and management of physiological postpartum period
Prevention of suppurative-septic diseases in maternal and fetal
( - )
Examination and observation of uterus, mammary glands
( , )
Good hygiene and balance diet
( )
Ultrasound of uterus
( )

55. Hemorrhagic shock in obstetric clinic. Principles of treatment

Blood loss >1% of total body weight ( than1% )
Clinical picture:
Hypothermia/Tachycardia/Cyanosis/Weaken pulse
Treatments:
<350ml external massage of uterine by Creed-Lazarevich followed by oxytocin
( - )
>400ml remove contents and massage by fist followed by oxytocin
( )
1000-1200ml surgery/hysterectomy
56. Indications to amniotomy
Definition:
Artificial rupture of membranes. ( )
Indications:
When internal fetal or uterine monitoring is needed ( )
For induction of labor ( )
For augmentation of labor ( )
Contraindications:
Known or suspected vasa previa
Any contraindications to vaginal delivery
Unengaged presenting part
57. The structure and functions of ovaries
Structure: Width 2 cm, length 4 cm, thick 1 cm
Ovarian ligament - connects the ovary to the lateral surface of the uterus
( )
Suspensory ligament of ovary (infundibulopelvic ligament)
connects the ovary to the wall of the pelvis
( )
Functions:
Follicular growth and maturation of egg
( )
Produce sex hormones (estrogen, progesterone, androgen)
58. Perineotomy/Episiotomy. Indications and techniques
Indications for perineotomy:
Shoulder dystocia/Large fetus/Perineal muscle rigidity
Techniques:
Medio-lateral: The incision is made diagonally in a straight line which runs about 2.5 cm
(1 in) away from the anus
Median: The incision is made along the midline for 2.5 cm (1 in)
Lateral: The incision starts from about 1 cm (0.4 in) away from the centre
J-shaped: The incision begins in the centre of the fourchette and is directed posteriorly
along the midline for about 1.5 centimetres (0.59 in) and then directed downwards and
outwards along the 5 or 7 o'clock position

59. Diagnostic of early pregnancy

Questionable signs:
Dyspepsia, nausea, vomiting (, )
PICA ( )
Metabolism
Probable signs:
No menstruation ( )
Breast engorgement ( )
Reliable signs:
Palpable parts of fetus
Fetal movements ( )
Fetal heartbeat
Diagnostics:
1st trimester (until 12th week) perform screening test to find disturbance
2nd trimester (13th 28th week) to find alpha-fetoprotein
3rd trimester (29th 40th week) perform 7 tests for 3 times:
I syphilis/Hep B or C
II Hormonal
III CBC
IV Biochemistry (glucose, AST/ALT)
V Urine analysis
VI Blood group, rhesus factor
VII Coagulogram
60. Peculiarities of birth in patient with severe preeclampsia
Early delivery:
Eclampsia/Preeclampsia
Neuropathy/Nephropathy
Presence of chronic fetal hypoxia (<34-35 weeks pregnancy)
Presence of severe hypertension/convulsion use perineotomy/episiotomy/forcep deliver
dead fetus plodorazrushayushie operations (craniotomy/embryotomy/cleidotomy)
61. Preoperative and postoperative management after cesarean section
Preoperative:
Empty stomach before surgery
If full stomach, use tube emptying
Cleansing enema/soapsuds to cleanse bowel and relieve constipation
Give 3 ml sodium citrate to prevent acid regurgitation
Provide anesthesia before surgery (epidural, spinal, spino-epidural)
Postoperative:
Monitoring and examination of maternal (pulse/BP/urine output/skin color)
Fluid therapy (1500-2000 ml)
Non-narcotic pain reliever
Good hygiene and balance diet

62. Complete placenta praevia. Clinical picture, diagnostic, obstetric tactics

Definition;
Implantation of the placenta in the uterus, causing it alongside or in frontof the fetal
presenting part
( , frontof
)
Etiology: multipara, maternal age
Grades:
I Low implantation (into lower segment)
II Marginal (almost covering cervical os)
III Partial/Incomplete (partially cover cervical os)
IV Central/Complete (completely cover)
Clinical picture:
Painless bleeding
Diagnosis:
Ultrasound/abdomen examination (soft, non-tender)
Tactics:
Pregnancy <37 weeks conservative treatment (hospitalization, cross-matched blood)
Pregnancy >37weeks surgery, c-section
63. Lactation mastitis/ Etiology, clinical picture, diagnostic, treatment, prophylactic
Etiology: staphylococcus
Types:
I Serous
II Infiltrative
III Purulent:
a) infitrative-suppurative
b) Abscess
c) Fragment nous/purulent-necrotic
d) Gangrenous
Clinical picture:
Increased temperature (38-38.5 degree Celsius)
Weakness
Chills
Tachycardia
Leukocytosis
Diagnostics: ultrasound/hysteroscopy
Treatments:
Oxacillin/methicillin (4g/day) - penicillins
Zeporin/kefzol/zefamizin (4g/day) - cephalosporins
Kanamycin (0.5g 4times/day) - aminoglycosides
Gentamycin (40mg 2 times/day) - aminoglycosides
(Usual combination: zeporin+oxacillin/ampicillin+gentamycin/levomizetin+lincomycin)
Prophylactics:
Antistaphylococcal gamma-globulin
Antistaphylococcal plasma

64. Anesthetics in obstetric operations

Anesthesia in normal delivery:
Epidural/Spinal/Spino-epidural
Anesthesia in forceps delivery:
General anesthesia
Anesthesia in vacuum/ventouse delivery: (using aid of vacuum device)
Inhalation of nitric oxide and oxygen (2:1); simultaneous I/V of antispasmodic agents
Anesthesia in pelvic end delivery:
Before surgery, I/V antispasmodic agents. General anesthesia/ I/V Kalipsol or Ketamine
65. The structure and functions of uterus
Structure:
7.6 cm long, 4.5 cm broad (side to side) and 3.0 cm thick (anteroposterior).An adult
uterus weighs about 60 grams.
Four segments: The fundus, corpus, cervix and the internal os
3 layers: Endometrium, myometrium, perimetrium
Functions: Implantation of fertilized ovum to endometrium
( )
Embryo development ( )
66. Viral diseases in pregnancy
Rubella (rubella virus):
Ask pregnant woman about past history/family history and perform test. If Ig G = past
infection; if Ig A/Ig M = recent infection (indication for abortion!)
Cytomegalovirus:
Increase the likelihood of abortion, miscarriage, premature birth, congenital malformation
Treatment: AntiCMV immunoglobulin/Viferon
Herpes simplex virus I:
Affect face, upper and lower extremities
Herpes simplex virus II:
Affect only genital area
Treatment:
Antiviral acyclovir, valacyclovir
Human papillovirus (HPV):
Usually without symptoms, some affected people will show genital warts
Treatment:
warts may be treated or removed with chemicals, freezing, burning, laser, or surgery
Viral hepatitis:
Nausea, vomiting, headache, fatigue
67. Preventions of complication of pregnancy and laboring in womens consultation
Reduce maternal morbidity and mortality
Reduce fetal morbidity and mortality
Family planning, prevention of abortion, infertility treatment
Prevention of malignant diseases in women
Reduction of gynecological disease

68. Flat pelvis, etiology, diagnostic, mechanism of labor

A type of anatomical narrowed pelvis ( )
Flat plain (13.6%)
Ploskoranitichesky (6.5%)
Reduced pelvis (21.8%)
Obscheravnomernosuzhenny (8.5%)
Etiology:
Reduced size of pelvis
Childhood rickets
Dystrophic changes of bone tissue
Diagnosis:
External pelvic examination/Pelvinometry
Mechanism of labor:
Natural way. If failure, c-section
69. Fetal skull/Skull of newborns

1. occipital-frontal ( ) = 12 cm
2. occipital-mental ( ) = 13-13.5 cm
3. suboccipital-bregmatic ( ) = 9.5 cm
4. submental-bregmatic ( ) = 9.5 cm
5. suboccipital-frontale ( ) = 10.5 cm
6. biparietal ( ) = 9.25 cm
7. bitemporal ( ) = 8 cm

70. Extra-genital diseases in pregnancy

(a) Diseases of cardiovascular system ( - )
I Hypertension disease (4-5%
II Hypotensive disease (12%)
III Heart defects ( ):
Mitral stenosis/aortic stenosis
Mitral regurgitation/aortic regurgitation
Mitral valve prolapse
(b) Diseases of respiratory organs ( )
I Bronchitis (chronic > acute)
II Pneumonia (Left sided/right sided)
III Bronchial asthma
(c) Diseases of kidney and urinary tract ( )
I Pyelonephritis (6-7%)
II Glomerulonephritis (0.1-0.2%)
III Kidney stones ( ) (0.1-0.35%)
(small stones spasmolytics ; big stones laparoscopy)
IV Cystitis
(d) Anemia (40%)
(e) Diseases of NS and visual organ ( )
I Epilepsy
II Myasthenia
III Myopathy
IV Multiple sclerosis ( )
V Schizophrenia
VI Postpartum depression
VII Myopia
(f) Diseases of digestive system ( )
I Acute intestinal obstruction ( )
II Pancreatitis (acute/chronic)
III Acute appendicitis (indication for surgery!)
IV Gastritis
V Gastroduodenitis
VI Ulcer
VII Colic
VIII Hemorrhoid
IX Cholecystitis
(g) Thrombophilia/Thrombocytopathy
(h) Diseases of endocrine system ( )
I Diabetes mellitus
II Hyperthyroidism/Hypothyroidism
III of adrenal
IV of suprarenal

(i) Sexually transmitted diseases ( )

I Syphillis
II Trichomonas (3.6-9.1%)
III Chlamydia (3-12%)
IV Gonorrhea
V Herpes simplex virus I & II
VI Toxoplasma
VII Uroplasma
VIII Symphysitis
IX Human papillovirus
(j) Diseases of bones ( )
I Osteomalacia
II Osteoporosis
*Must perform biochemistry test (general & specific)
Standard glucose, bilirubin, ALT/AST, cholesterine, phosphatase
Specific calcium level in serum (symptoms: teeth imperfection/ loss of hair)
(k) tuberculosis (0.3%)
(l) Pathology of sexual system ( )
I Fibromyoma (0.1-1.5%)
II infantilism