CLINICAL CASES IN OBSTETRICS AND GYNECOLOGY :

RECOGNIZE MY WORK OF AREAS

STUDENTS’ WORKSHEET

Contributors :

Nurul Hidayati, dr., M.Sc

Tatit Nurseta, dr., SpOG

Fakultas Kedokteran
Universitas Brawijaya
2014
 STORY OF 1001 CASES IN OBSTETRICS AND GYNECOLOGY :
RECOGNIZE MY WORK OF AREAS
Introduction
Exposed with advanced specialistic clinical problems of patients asking medical care, general
practitioners are required to also consume various clinical cases beyond their competency of
practice. In particular situation, medical doctor might be challenged to deal with the female
reproductive cases in their pregnant and non-pregnant state respectively. These unique health
needs of woman are covered in a well-established proficiency. Obstetrics specialty provides
personal care for woman before, during and after pregnancy as this subject concern to prenatal
care and delivery of baby. Gynecology specialty provides care and treats disorder of the female
reproductive and urinary system. For medical doctor, all the cases might come anytime despite
their beyond authority. Therefore, being able to recognize all clinical features indicating problems
on reproductive system whether under circumstance of pregnancy or not, is a worthwhile for
medical doctors. We supply our medical students with ability to be first line identifier in detecting
the obstetrics and gynecology cases so that they can give preliminary diagnosis and management
approaches necessary for a life-threatening case. As medical practitioners to be assigned in a
certain areas of working, medical doctor should take benefit of referral system to direct their
patients to get appropriate medical intervention from the proper medical servicers.

List of topics
- Gestational disorder
- Infection in reproductive system (including concerns on microbiology and parasitology)
- Reproductive oncology
- Radiology exam for reproductive system
- Diagnosis and management approach to obstetrics and gynecology cases
Learning objectives
- Be able to identify various cases representative of obstetrics and gynecology
- Be able to propose proper management approach under the competency of medical doctor
as general practitioner (in referring to level of competency according to SKDI 2012)
- Be able to arrange required referral procedure and management
Module tasks
Setting for students :
You are medical student having an internship in Saiful Anwar Hospital. This night you are a person
in charge with three of your friends in ward of Obstetrics and Gynecology. During your duty, you
find 4 interesting cases by which you must present in a Morning Report agenda tomorrow morning.
Using the attached Obstetric or Gynecology Intake Sheet, record all the available data for each case.
Prepare your tomorrow presentation with your small group of three-four friends in form of oral
presentation by providing the medical records to your supervisor. For successful presentation to
get comprehensive understanding, prepare all relevant content of knowledge to approach the
clinical cases (to anticipate any questions from your supervisor and all the attendance).

1
Task 1 Gestational Disorder
1. Antepartum vaginal bleeding
A 30-year-old G3P4 woman at 32 weeks’ gestation complains of significant bright-red
vaginal bleeding. She denies uterine contractions, leakage of fluid, or trauma. The patient
states that, 4 weeks previously, she experienced some vaginal spotting after engaging in
sexual intercourse. On examination, her blood pressure is 110/60, hear rate 80 bpm, and
temperature 37C. heart and lung examination are normal. The abdomen is soft and uterus
non tender. Fetal heart tones range from 140-150 bpm.
a. What is the next step in therapy?
b. What is the most likely diagnosis ?
c. What will be the long-term management of this patient ?

2. Postpartum vaginal bleeding (Haemorrage Post Partum / HPP)

A 29-year-old G5P4 woman at 39 weeks’ gestation with preeclampsia delivers
vaginally. Her prenatal course has been uncomplicated except for asymptomatic bacteriuria
caused by Escherichia colli in the first trimester treated with oral cephalexin. She denies a
family history of bleeding diasthesis. After the placenta is delivered, there is appreciable
vaginal bleeding estimated at 1000 mL.
a. What is the most likely diagnosis ?
b. What is the next step in therapy?

Task 2 Infection in Reproductive System

A 23-year-old G0P0 woman complains of lower abdominal tenderness and subjective
fever. She states that her last menstrual period started 5 days previously and was heavier
than usual. She also complains of duspareunia of recent onset. She denies vaginal discharge
or prior sexually transmitted diseases. On examination, her blood pressure is 90/70, heart
rate 90 bpm, and temperature 36C. Heart and lung examination are normal. The abdomen
has slight lower abdominal tenderness. No costovertebral angle tenderness is noted. On
pelvis examination, the external genetalia are normal. The cervix is somewhat hyperemic,
and uterus as well as adnexa are exquisitely tender. The pregnancy test is negative.
a. What is the most likely diagnosis ?
b. What are long-term complications that can occur with this condition ?

Task 3 Reproductive Oncology

A 50-year-old G5P5 woman complains for postcoital spotting over the past six
months. Most recently, she complains of a malodorous vaginal discharge. She states that
she had syphilis in the past. Her deliveiries were all vaginal and uncomplicated. She has
smoked one pack of cigarettes per day for 20 years. On examination, her blood pressure is
100/80, heart rate 80 bpm, and temperature 37.5C. heart and lung examinations are within
normal limits. The abdomen reveals no masses, ascites or tenderness. Back examination is
unremarkable, and there is no costovertebral angle tenderness. Pelvis examination reveals
normal external female genetalia. Speculum examination reveals a 3-cm exophytic lesion on
the anterior lip of the cervix. No other masses are palpated.
a. What is your next step ?
b. What is the most likely diagnosis ?