A 69 year-old-woman with pelvic pressure and palpable buldge presents for evaluation. She recalls some mention of a cystocele diagnosis, given by her primary care provider. Today, she request formal evaluation by a gynecologist. (Blueprints OG Lippincott chapter 18)

In discussing her symptoms, the patient points out that her voiding function has changed as the prolapse has grown in severity. Initially, the patient reported stress urinary incontinence, but as the prolapse worsened, the incontinence improved. While she is happy with the resoulution of her incontinence, she currently experiences some incomplete bladder emptying, which is improved upon manual reduction of the prolapse. How do you counsel her about her risk of incontinence after an isolated anterior wall repair (with no other concomitant surgery)?

A 37 y.o woman has just delivered her second baby, she had a previous premature delivery at 34 weeks. After the placenta was delivered the midwife noticed a perineal tear. The tear extended from introitus in the midline and she could see torn muscle fibers suggestive of the torn end of the external anal spinchter. She has called you to review the patient.

How would you manage this patient ?

Ny. X 24 years came to the ER with complaints of headaches since the last day of examinations obtained expecting her first child, gestational age 37-38 weeks blurred vision denied heartburn (-) on physical examination found BP 190/120 mmHg pulse 90 x/m breathing 16 x/m at Leopold found the lower left back head FHR 140 x/m contraction irregularity in the examination pelvic score of 1 was found, pelvis size wide laboratory investigation hb obtained 11.5 g%.. platelets 9000/ mm3..LDH 510 iu /L..Proteinuri +2.. SGOT 10 u/L SGPT 15 u/L (usulan UNAND)

If ny. X breastfeeding what is the best antihypertensive agent should you give

Mrs. Selly 20 years-old primipara is 36 hours postpartum following cesarean delivery for failure to progress. She is complaining of abdominal pain and has a fever of 38 C. She is not yet tolerating oral intake because of nausea. You diagnose metritis.

Which of the following is the most frequent cause metritis:(William24 hal 684)

A 30-year-old, gravida 4, para 3 at 37 weeks’ gestation by last menstrual period in delivery room, with preexistionf cardiac is comfortable a rest, but cannot stand up to brush her teeth without experiencing chest pain. Adequate and Regular uterine contraction.

According of the above base on clinical classification of the New York Heart Association (NYHA):

A P1, 24-year old, Miranda gave birth to 4.3 kg at home and she intended to breast feed her baby. She was doing fine during the first two hours, but then there was a sudden onset of massive vaginal bleeding and she was bought to the nearest emergency unit. There she fell unconsious, her blood pressure fell markedly until unpalpable.

RR. 16x/m. Heart rate 120 bpm. Lung were normal. Uterine fundus was palpable at the level of umbilicus, contraction was poor. Bladder was empty.

She was put into Trendelengburg position, her head was turned to one side, and an oxygen mask was used to deliver 5 liters of oxygen per minute. Two intravenous lines were accessible.

At this time bed side clot test showing blood clot in 1 minute and haemoglobin level was found 5 gr %. Exploration of birth canal revealed no injury requiring further intervention.

The most likely birth canal injury requiring intercention in such a case is:

The couple came to the privat practice with complaints want to get pregnant. This couple has been married 2 years. Current wife age 30 years. Height 151 cm and weight 55 kg , a history of sexual intercourse 2-3 times a week. From anamnesis we found a history of menstrual was regular, and no hystory of pain during Menstruation.

The wife of the couple asked, overall cause of infertility according to female factors.

The couple came to the clinic with complaints: want to get pregnant. This couple has been married 3 years. Current wife age 36 years. Height 151 cm and weight 73 kg, a history of sexual intercourse 2-3 times a week. From anamnesis we found a history of menstrual pain since the age of 20 years and intermittent treatment for vagina discharge odor complaints and itchy since before marriage. (konsensus hiferi)

In this case, the couple should get treatment at facilities:

A 28 years old woman comes to outpatient clinic as she feels that the fetal movement was decreased. She states that this is the first pregnancy and she was forgotten about her last menstrual periode because she had irregular menstruation. During this pregnancy, she has already performed USG in first and second trimester.

Realated to USG result in fist trimester, now she has 42 weeks and 3 days of gestational age. Because she feels that the fetal movement was decreased, which the first step should be performed

A woman aged 29 years G1P0A0 late period of 3 months with complaints of bleeding a little through the birth canal since 1 week ago. KU Mrs good. Gynceological examination found inscpeculo bleeding (+). V/V not, portio slippery. Vaginal examination positive bleeding. V/V is normal, covered ostium, uterine 12-14 weeks gestation, tenderness (-), adnexa parametrial sin./dex. Normal, CD normal

Appropiate diagnosis is made in the question no. 1, another examination must to be performed is

A 35 years old lady with 2 children came to specialist clinis in the international hospital with th complain of vaginal discharge with her pap smear result that showed : CIN 3+ HPV infection, she ask for the appropiate treatment.

What is the appropiate treatment for the patient:

A woman 45 years old with 2 children came to the specialist clinic in the international hospital with the complain of the post coital bleeding since 3 months ago. The lady had the first menstruation at the age of 13 years old and got married at the age of 17 years old. From the vaginal examination, 0,5 cm mass was seen in the upperlip of the vagina without involvement of the vaginal mucosa.

What is the most likely initial procedure has to be taken after seeing th condition of the cervis

A 55 years old lady come to the specialist clinic with the enlarged abdomen. She was unmarried and menarche at the age of 11 years old. Decrease appetite since 2 months ago, no vaginal bleeding nor pain. Lost 8 kilograms within 4 months

What may prevent her of having the diagnosis

A 21 year old unmarried woman has conducted a general check-up, from abdominal and gynecological ultrasound examination found a cystic mass originating from the left adneksa with a dimater of 4 cm, she did feel pain on lower abdominal and bit longer of menstrual cycle. Physical examination and other laboratory within normal limits

If the cyst removal surgery her then expected her histopatological types are :

Mrs. A, 24 years, G2P1A0 39 weeks gestational age, admitted to your emergency room with complained abdominal cramping with bloody show. In examination, revealed normal vital sign, contraction was 3x/10’/35”. Fetal heart rate was 146 x/m. Estimated fetal weight was 2900 gram. Previous baby was 3200 gram. Vaginal examination revealed: dilatation was 4 cm, effacement 100 %, amniotic membrane was intake, lowest part was head with descent of the head was Hodge II. Denominator was minor fontanella at the left side.

What is the condition of this patient ?

Mrs. S, 29 years, G3P1A1 39 weeks gestational age, reffered by midwife with prolonged second stage. In examination, revealed normal vital sign Obstetric examination revealed contraction was 3x/10’/25”. Fetal heart rate was 160 x/m. Estimated fetal weight 3100 gram. Previous baby was 3000 gram. Vaginal examination revealed : full dilatation, amniotic membrane was absent thick and greenish, lowest part was head with descent of the head was Hodge IV. Denominator was minor fontanella at the left anterior.

Frequent complication of the action above is :

Mrs. S, 21 years, G1P0 send by midwife with failed of induction. Examination revealed : active bleeding from vagina, and shock. Vital sign : BP 80/60 mmHg, HR 134 x/m, skin was wet and acral was cold. Part of baby wasn’t palpable. Fetal heart rate (-).

What is the management?

Your patient delivered a healthy baby 2 weeks ago and wishes to use contraception method after her puerperium. She is breastfeeding exclusively. (Atlas of contraception. Contraception for special group, Nursing mother. hal 87)

For which of the following is there strong evidence that use decrease the quantity and quality of breast milk?

A 30 years woman complain of colorless vaginal discharge with she feel that the smell very bad odor then she feel low self esteem

What is the possible infection of this woman? (William gyn hal 83)

Primigravida full term pregnancy is reffered to hospital by midwife due to unprogressed labor. General condition is weak, normal blood pressure with heart rate 100 bpm. In clininal examination you find uterine contraction is weak and rare, with midline measurement of 30 cm, and only two fifth of the head is palpated. Fetal heart rate is 144 bpm.

You are doing internal examination and found cervix is already dilated 8 cm, no amniotic membranes palpated with mentum on 6 O’clock, what would the diagnosis likely to be?

Patient reffered from midwife’s private practice with poor general condition, somnolent. She has been conducted on delivery for two hours. Vital signs by 70/palpable blood pressure, 120 bpm heart rate.

What is your initial management?

You are attending delivery, patient had already bearing down with good contraction for half hour but there is no further descent of head. Occiput is at left posterior.

What is the diagnosis ?

A 32-year-old woman (gravida 3, para 1, abortus 1) at term is admitted in labor with an initial cervical examination of 6-cm dilatation, complete effacement, and the vertex at -1 station. Estimated fetal weight is 8 lb, and her first pregnancy resulted in an uncomplicated vaginal delivery of an 8-lb infant. After 2 hours there is no cervical change. An intrauterine pressure catheter is placed. This shows three contraction in a 10-minute periode, each with a strength of 40 mmHg.

What is the best course of action at this time? (lange 9 bab 10 no 28)

A 32-year-old woman (gravida 3, para 1, abortus 1) at term is admitted in labor with an initial cervical examination of 6-cm dilatation, complete effacement, and the vertex at -1 station. Estimated fetal weight is 8 lb, and her first pregnancy resulted in an uncomplicated vaginal delivery of an 8-lb infant. After 2 hours there is no cervical change. An intrauterine pressure catheter is placed. This shows three contraction in a 10-minute periode, each with a strength of 40 mmHg.

What is the maximum normal time for the second stage of labor in a primigravida without anesthesia? (lange 9 bab 11 no 1)

With regard to HIV in pregnancy:

A 69 year-old-woman with pelvic pressure and palpable buldge presents for evaluation. She recalls some mention of a cystocele diagnosis, given by her primary care provider. Today, she request formal evaluation by a gynecologist.(Blueprints OG Lippincott chapter 18)

In assesing the above patient., you also find a posterior vaginal wall defect. What is a common symptom that is associate with rectoceles?

Ny. X 24 years came to the ER with complaints of headaches since the last day of examinations obtained expecting her first child, gestational age 37-38 weeks blurred vision denied heartburn (-) on physical examination found BP 190/120 mmHg pulse 90 x/m breathing 16 x/m at Leopold found the lower left back head FHR 140 x/m contraction irregularity in the examination pelvic score of 1 was found, pelvis size wide laboratory investigation hb obtained 11.5 g%.. platelets 9000/ mm3..LDH 510 iu /L..Proteinuri +2.. SGOT 10 u/L SGPT 15 u/L (usulanUNAND)

What is the best diagnose for ny.X

Mrs. Ani 38 year-old-grandemultiparous, post vaginal delivery with oksitoxin drips and spinal anesthesia 2 hours ago. Babyborn wight 4200 gr, alive. The happen early HPP with blood pressure 80/40 mmHg and the mother is syock.

Etiologi early HPP Mrs. Ani is:

A woman, married, G3P3AO, 43 years, no history of abdominal surgery, has gained as myoma uteri diagnosis. Uterine size of 4 months pregnant, good mobility. Hb 12,5gr% and other laboratory examinations, investigations and cytology smears perioperative within normal limits.

Choose the correct answer below:(William Gynhal 1020)

A 30-year-old, gravida 4, para 3 at 37 weeks’ gestation by last menstrual period in delivery room, with preexistionf cardiac is comfortable a rest, but cannot stand up to brush her teeth without experiencing chest pain. Adequate and Regular uterine contraction.

Plan:

A P1, 24-year old,Miranda gave birth to 4.3 kg at home and she intended to breast feed her baby. She was doing fine during the first two hours, but then there was a sudden onset of massive vaginal bleeding and she was bought to the nearest emergency unit. There she fell unconsious, her blood pressure fell markedly until unpalpable.

RR. 16x/m. Heart rate 120 bpm. Lung were normal. Uterine fundus was palpable at the level of umbilicus, contraction was poor. Bladder was empty.

She was put into Trendelengburg position, her head was turned to one side, and an oxygen mask was used to deliver 5 liters of oxygen per minute. Two intravenous lines were accessible.

At this time bed side clot test showing blood clot in 1 minute and haemoglobin level was found 5 gr %. Exploration of birth canal revealed no injury requiring further intervention.

The Tredelenburg position helped this case in one of the following mechanism :

The couple came to the privat practice with complaints want to get pregnant. This couple has been married 2 years. Current wife age 30 years. Height 151 cm and weight 55 kg , a history of sexual intercourse 2-3 times a week. From anamnesis we found a history of menstrual was regular, and no hystory of pain during Menstruation.

The wife of the couple also asked about assesing ovulation disorders, and the right statement is :

The couple came to the clinic with complaints: want to get pregnant. This couple has been married 3 years. Current wife age 36 years.Height 151cm and weight 73kg, a history of sexual intercourse 2-3 times a week. From anamnesis we found a history of menstrual pain since the age of 20 years and intermittent treatment for vagina discharge odor complaints and itchy since before marriage.

In this couple:

A 36 years old women comes to the emergency room because of vaginal bleeding. She had four living child and her last menstrual periode about 8 mounth ago. Examination shows that vital sign was in normal limit, no contraction or abdominal pain, presenting part was floating, and there’s no heavy bleeding from vagina.

The appropiate diagnosis for this case was :

A woman aged 29 years G1P0A0 late period of 3 months with complaints of bleeding a little through the birth canal since 1 week ago. KU Mrs good. Gynceological examination found inscpeculo bleeding (+). V/V not, portio slippery. Vaginal examination positive bleeding. V/V is normal, covered ostium, uterine 12-14 weeks gestation, tenderness (-), adnexa parametrial sin./dex. Normal, CD normal

Treatment in this case the recommended to the mother is :

A woman 55 years old with 1 children came to the specialist clinic in the international hospital with the complain of vaginal bleeding menopause for 3 years. She had bleeding since 2 months ago, sometime with heavy bleeding. Her height was 152 cm with the weight of 85 kgs. She had also diabetes since she was 40 years old

What is the most likely diagnosis of the patient

A woman 45 years old with 2 children came to the specialist clinic in the international hospital with the complain of the post coital bleeding since 3 months ago. The lady had the first menstruation at the age of 13 years old and got married at the age of 17 years old. From the vaginal examination, 0,5 cm mass was seen in the upperlip of the vagina without involvement of the vaginal mucosa.

What physical diagnostic examination is improtant in that situation

A 55 years old lady come to the specialist clinic with the enlarged abdomen. She was unmarried and menarche at the age of 11 years old. Decrease appetite since 2 months ago, no vaginal bleeding nor pain. Lost 8 kilograms within 4 months.

What tumor marker may help the diagnosis

A 63-year-old woman has bloating associated with tightening ofher clothing around her abdomen. She recently has developed dyspepsia and has lost 15 pounds unintentionally. She is short of breath. Pulmonary auscultaion shows loss of breath sound abdominal percussion cause a wavelike movement of fluid around a central tympanitic area. Pelvic examination demonstrates a fixed, irregular nodular adnexal mass with cul-de-sac nodularity. A chest radiogram shows bilateral pleural effusions. Which of the following is the most likely diagnosis ?

Which of the following is the most likely diagnosis ?

Mrs. A, 24 years, G2P1A0 39 weeks gestational age, admitted to your emergency room with complained abdominal cramping with bloody show. In examination, revealed normal vital sign, contraction was 3x/10’/35”. Fetal heart rate was 146 x/m. Estimated fetal weight was 2900 gram. Previous baby was 3200 gram. Vaginal examination revealed: dilatation was 4 cm, effacement 100 %, amniotic membrane was intake, lowest part was head with descent of the head was Hodge II. Denominator was minor fontanella at the left side.

According the vignette above, what wil be happen to that mother ?

Mrs. S, 34 years, G4P3A1 40 weeks gestational age, second stage of labour. The head of the baby was delivered but the shoulder was stucks. Turttle sign (+). The mother has an uncontrolled diabetes for 5 years. Estimated fetal weight by ultrasound was 4200 gram.

What is this condition called ?

Mrs. S, 21 years, G1P0 send by midwife with failed of induction. Examination revealed : active bleeding from vagina, and shock. Vital sign : BP 80/60 mmHg, HR 134 x/m, skin was wet and acral was cold. Part of baby wasn’t palpable. Fetal heart rate (-).

What is the diagnosis ?

Your patient delivered a healthy baby 2 weeks ago and wishes to use contraception method after her puerperium. She is breastfeeding exclusively.(Atlas of contraception. Contraception for special group, Nursing mother. hal 87)

Your patient has diabetes mellitus and hypertension but she prefer to use “pills” for contraception. She is considering progestin-only pill and combination oral contraception (COC). You give counseling to her about the advantage and disadvantage of progestin-only pill compare with COCs.(Atlas of contraception)

A 30 years woman complain of colorless vaginal discharge with she feel that the smell very bad odor then she feel low self esteem

What is the antibiotics which is usually use to threat this symptoms?(William gynhal 67)

Primigravida full term pregnancy is reffered to hospital by midwife due to unprogressed labor. General condition is weak, normal blood pressure with heart rate 100 bpm. In clininal examination you find uterine contraction is weak and rare, with midline measurement of 30 cm, and only two fifth of the head is palpated. Fetal heart rate is 144 bpm.

From pelvic examination findings, pelvic brim : round, diagonal conjugate 12 cm, symphisis parallel to sacrum, subpubic angle si acute, convergent side walls, bituberous diameter is 7 cm. By analyzing your findings, which causes bellow is unlikely to be?

Patient reffered from midwife’s private practice with poor general condition, somnolent. She has been conducted on delivery for two hours. Vital signs by 70/palpable blood pressure, 120 bpm heart rate.

In your examination you find that there isn’t any contraction, distended abdomen, shifting dullnes. In vaginal examination, you find cervic is not fully dialted, and head could be pushed upward. What is the most appropriate diagnosis?

You are attending delivery, patient had already bearing down with good contraction for half hour but there is no further descent of head. Occiput is at left posterior.

Fetal heart rate shows declining arises from beginning of contraction and goes to normal baseline as soon as the contraction ends. This findings could refer to.....

A 32-year-old woman (gravida3, para 1, abortus 1) at term is admitted in labor with an initial cervical examination of 6-cm dilatation, complete effacement, and the vertex at -1 station. Estimated fetal weight is 8 lb, and her first pregnancy resulted in an uncomplicated vaginal delivery of an 8-lb infant. After 2 hours there is no cervical change. An intrauterine pressure catheter is placed. This shows three contraction in a 10-minute periode, each with a strength of 40 mmHg.

The routine use of midline episiotomy during delivery has been shown to do which of the following?

A 21-years-old G1 now P1 just delivered after a prolonged induction of labor due to being postdates. After the placental delivery she continues to bleed excessively. Your initial intervention to address this bleeding is to active the normal physiologic mechanisms. Which of the following is the most important hemostatic mechanism in combating postpartum hemorrhage?(lange 9 bab 6 no 4)

Which of the following is a disadvantage of uterine exteriorization to repair the ysterotomy during cesarean delivery? (Lange)

With adequate pain control she dilates to 10 cm and second stage begins. Which of the following is the correct order of the cardinal movements of labor?

Your next patient is a 13-year-old adolescent girl who presents with cyclic pelvic pain. She has never had a menstrual cycle. She denies any history of intercourse. She is afebrile and her vital signs are stable. Onphysical examination, she has age-appropriate breast and pubic hair development and normal external genitalia. However, you are unable to locate a vaginal introitus. Instead, there is a tense bulge where the introitus would be expected. You obtain a transabdominal ultrasound, which reveals a hematocolpos and hematometra.

What is the most likely diagnosis?

A 21-year-old nulligravid woman presents to her gynecologist with a 3-day history of painful genital ulcer. Last week she had a low-grade fever and generalized malaise, which has since resolved. She denies any history of genital ulcers. She has had four new sexual partners in the last year and uses oral contraceptives. She reports using condoms

inconsistently. On genitourinary examination, several 1 to 2 mm painful vesicles are noted on the left labia minora. There is no inguinal lymphadenopathy.

Which of the following is the most likely causal organism?

In discussing her symptoms, the patient points out that her voiding function has changed as the prolapse has grown in severity. Initially, the patient reported stress urinary incontinence, but as the prolapse worsened, the incontinence improved. While she is happy with the resolution of her incontinence, she currently experiences some incomplete bladder emptying, which is improved upon manual reduction of the prolapse. How do you counsel her about her risk of incontinence after an isolated anterior wall repair (with no other concomitant surgery)?

63-year-old G3P2 woman is referred to the urogynecology clinic for evaluation of urinary incontinence. Urinalysis and urine culture done by her PCP 1 week earlier were negative. Her medical history is positive for hypertension and osteoarthritis. She is complaining of leakage of urine following an overwhelming need to void. She runs to the bathroom, but leaks a large amount before she makes it to the toilet. She also has urinary frequency and empties her bladder every 1 to 1.5 hours during the day and gets up four times at night to void. She denies loss of urine with cough, sneeze, and exercise.

As her pregnancy continues, you would expect her cardiac output to increase by which of the following mechanisms: (blueprint)

An 18-year-old G0 F presents to your office for contraceptive counseling. She has never used any method of contraception before and is engaged in a monogamous sexual relationship. Gynecologic history is significant for regular, heavy menstrual cycles using up to eight pads per day, lasting up to 7 days at a time, with severe pain (dysmenorrhea). She smokes one-half pack of cigarettes per day and tells you that her mother and aunt both have Factor V Leiden disease, but that she has never been tested herself or had a thromboembolic event. She will attend college soon and has no plans for a pregnancy in the near future. She indicates her desire for the “most reliable” method of contraception that you can offer.

Which of the following methods of contraception has the least efficacy?

A 62-year-old woman presents to the office complaining of watery vaginal discharge and bleeding for the past 2 months. She has not had a Pap test in 14 years. She states she had a mildly abnormal pap in her 30s, but that was treated with cryotherapy. She states she went through menopause at age 50 and has never been on hormone replacement therapy. She does admit to smoking one-half pack a day for 40 years. Her husband is deceased, and she has not been sexually active in 10 years. Her examination reveals a cervical necrotic mass approximately 5 cm in size. Rectovaginal examination is suspicious for left parametrial involvement. There is no evidence of adnexal masses, but examination of the uterus and adnexa is limited by the patient’s body habitus. You suspect this may be cervical cancer. You obtain a Pap smear and take a biopsy of her cervical abnormality. The Pap test returns with a reading of SCC, and the biopsy confirms this diagnosis. She also received a cystoscopy for hematuria with positive urine cytology. The biopsy also shows SCC. You order a CT scan, which shows a cervical mass measuring 7.7 3 5.0 cm as well as an avid left internal iliac lymph node consistent with locally metastatic disease.

What is the International Federation of Gynecology and Obstetrics (FIGO) stage for her cancer?

Mrs. S, 32-year-old G4P3Ao gravid with chronic hypertension had a normal labor that arrested in second stage at +1 station. She complained of mild dyspneu and fatigue . The fetus had a left occiput anterior presentation and was delivered by forceps. Completion of third stage followed quickly, and the fundus was noted to be firm . The OBGYN was carefully examined, and no laceration were noted. The examiner then noted the lower uterine segment was boggy.

The patient continues to bleed and you have initiated whole blood transfusion. Which of the following is suitable treatment in this situation?

A 28-year-old G2P0 at 39 weeks is in early labor. She is 2 cm dilated and 90% effaced, with contractions every 4 to 5 minutes. The fetal heart tones are reassuring. Her nurse steps out for a moment and returns to find her having a seizure. The nurse administers a 4-g magnesium bolus. The seizure stops. The fetal heart tone variability is flat, but there are no decelerations. This patient is most at risk for mortality from which of the following complications?

With regard to HIV in Pregnancy :

Mrs. S, 29 yo, G3P1A1 39 weeks GA, referred by midwife with prolonged second stage. In examination, revealed normal vital sign, obstetric examination revealed contraction was 3x/10’/35’. FHR was 160 x/m, estimated fetal weight was 3100 gr, previous baby was 3000 gr. Vaginal examination revealed : full dilatation, amniotic membrane was absent, thick and greenish, lowest part head with descent of the

head was Hodge IV. Denominator was minor fontanella at the left anterior.

Frequent complication of the action above is :

Solid food as one of the source of nutritional diet in post caesarean patient will be offered within:

A 19-year-old woman complain of a golf ball-sized mass at the entrance of her vagina. She says that this area is “sore all the time” and began hurting “about 3 days ago”. On examination, the patient has a tender 4 cm mass on the lateral aspect of the labia minora at the 5 o’clock position. There is erythema and edema, and the area is very tender and fluctuant. No cellulitis is noted.

The incubation period of syphilis is which of the following?

Your patient has microcytic anemia with a hemoglobin 9 and normal iron stores. What is the most likely diagnosis?

What should be advised to this woman regarding her delivery plan?

Sonography endometriomas are typicaly describe as which following?

Regarding the coagulation system in pregnancy, which of the following statement is true.

This deceleration most likely reflects which of the following? (late deceleration)

When performing step down in this image as a part of a peripartum hysterectomy particular care must be taken avoid injury to what structure?

Ninety five percent of patiens with SLE experienced all except which of the following clinical manifestation?

Which of the following clinical scenarios meets the definition of amenorea?

Compared with a normally shaped placenta, which complication of 3rd stage labor is more common with underdiagsed succenturiate lobe?

In the US which of the following twin pregnancies would be candidate for fetoscopic laser ablation therapy for TTTS?

Which of the following defines heterotopic pregnancy?

Mrs. XY is a primigravida who is 34 weeks pregnant. Her last two serial scan have shown a small gestational age fetus growing on the 9 th centile. Her last scan shows positive end diastolic flow with a normal PI. She reports having good fetal movements. How should further fetal surveillance be undertaken?

A 30 year old multiparous woman has rapid delivery soon after arriving in emergency room. After delivery the placenta she is noted to have heavy vaginal bleeding. Help has been summoned. Abdominal examination demonstrates the fundus was soft.

What is the most appropriate next step ?

Labor induction and augmentation are NOT associated with which of the following risk ?

For patients with congenital heart disease, what is the most common adverse cardiovascular enent encountered in pregnancy?

Which of the following statements regarding intrapartum management HIV is true ?

A 49 year old woman experiences irregular vaginal bleeding for 3 months duration. You performed endometrial biopsy, which copious tissue with a delivery, lobulated texture. The pathologist report shows proliferation of glandular and stromal elements with dilated endometrial glands, consistent with simple hyperplasia. Cytologic atypia is absent.

Which of the following is the best way to advised the patient ?

A 49 year old woman experiences irregular vaginal bleeding for 3 months duration. You performed endometrial biopsy, which copious tissue with a delivery, lobulated texture. The pathologist report shows proliferation of glandular and stromal elements with dilated endometrial glands, consistent with simple hyperplasia. Cytologic atypia is absent.

What type of tumor is a significant risk for such condition ?

A 49 year old woman experiences irregular vaginal bleeding for 3 months duration. You performed endometrial biopsy, which copious tissue with a delivery, lobulated texture. The pathologist report shows proliferation of glandular and stromal elements with dilated endometrial glands, consistent with simple hyperplasia. Cytologic atypia is absent.

Which one is the TRUE statement ?

A 55 years old nulliparous woman who underwent menopause at age 50 years complaint of a 1 month history of vaginal bleeding and smells. Her medical history reveals she has hypertension and controlled with anti hypertensive agent, and also she has diabetes mellitus controlled with an oral hypoglycemic agent. On examination, she weighs 89 kg and 152 cm tall. Her blood pressure is 150/90 mmHg. Heart and lung examination are normal. The abdomen is obese and no masses are palpated. The external genitalia appear normal, and the uterus seems to be enlarged, without adnexal masses palpated.

What is the probable diagnosis of this patient ?

Amniotic fluid volume is a balance between production and resorption. What is the primary mechanism of fluid resorption?

Which one of the following is most likely to be contraindication for tocolysis at 28 weeks gestation

Mrs B 37 yo came to you office at 32 minggu weeks of gestation accoriding to her last menstrual period. She has no ultrasound examination before and didn”t get ANC routinely. The vital sign is within normal limit. She has BMI 19 kg/m2. During physical examination the uterine fundal height is 22 cm. From ultrasound examination the fetus has biometric value tha correlate with 30 weeks fetus

Which of the f is the next best step in managing this patient?

A 29 yo G3P0A2 woman at 12 weeks gestation came to your office for prenatal visit. She has history of miscarriage in the 1st trimester. She admitted fatigue arthralgia, and photosensitivity.Her BP was 130.80 mmHg. On physical examination you found the malar rash and anemic conjunctiva. Laboratory result from urinalysis revealed proteinuria 3+ and cellular cast. Hemoglobin level was 7,2 gr/dL with peripheral blood smear showing spherocytes and reticulocytosis, platelet count 98.000/mm3 and leucocyte cunt 2600/mm3

According to the disorder above the pregnancy outcome is best in those woman in which ?

Management of hypothyroidism in pregnancy is :

A 22 yo G1P0at 25 weeks gestation with HIV infection on ARV therapy has purified protein derivative (PPD) has performed. Two days later the induration at the test site is noted to be 7 mm. She has no symptoms TBC and her chest radiography shows normal finding.

Your plan is which of the following

These factors are precipitating or predisposing factors of placental abruption, EXCEPT?

Mrs P, 30 yo G2P1A0 30 weeks gestation came to your out patient clinic for routine prenatal visit. She complained of dizzy and fatique lately. No sign of contraction of fetal kick count was 12x/10 hours. Her BP 110.70 mmHg and pulse rate 92x/mnt. You asked for CBC panel and the result was Hb level 10gr/dL, Ht 30,5 %, Leucocyte 11.700, tromb 237.000/uL MCV 80fL, MCH 26, MCHC 31gr/dL, RBC 5,3 106/microliter. Her 1st child was delivered in 38 weeks gestation with birth weight 2500 gram

What is next management for this patient?

Over the next 12 hours er BP rise above 160mmHg on several occasion, most notably to 172/ 102 mmHg. 2 hours after admission and to 168/96 mmHg 9 hours after admission pain . Her head ache does not return and she had no RUQ or visual symptoms. A set of repeat laboratory test result are unchanged and by increasing her labetolol dose to 400 mg TID, her BPs decrease to 140s-1502/70-90 mmHg. She is also started on magnesium sulfate. What change in physical or laboratory examination do you observe that would indicate delivery?

A 33 year old woman G1P0A0,came to hospital with major complaint, watery leakage. She was on her 33 weeks of gestational age. Data from medical record showed that she came previously a week ago, complaining vaginal discharge. Vaginal swab has done.

In case above, what kind of examination should you performed for eshtablishing diagnosis.

Cardiotocography, showed low variability with checkmark pattern and no deceleration. What was your interpretation and the best management through?

A 29 year old G3P2A0 presents to the emergency center with complains of abdominal discomfort for 2 weeks. Her vital signs are : blood pressure 120/70mmHg, pulse 90 beats per minute, temperature 36,9 0C, respiratory rate 18 breaths per minute. A pregnancy test is positive and an ultrasound of the abdomen and pelvis reveals a viable 16 weeks gestation located behind a normal appearing 10x6x5.5 cm uterus. Both ovaries appear normal. No free fluid is noted. Which of the following is the most likely cause of these findings?

Anti D Immunoglobulin should not be given for Rh-negative women in which of the following settings?

The majority of vulvar, vaginal dan cervical cancers appear to have a common cause and usually caused by:

Family planning services in Indonesia is important because it has a role in efforts to reduce maternal mortality. Select the statement that is not true:

One mother after normal delivery, P4 age 35 weight 160 cm. having delivery one day ago, 3000 grams birth weight, breastfeeding, want injectable contraceptives before returning home, the mother wanted contraception progesterone-only contraceptives (POCs), is the correct statement below is :