.: Risau dan Gusar :.

yesterday, i had short case exam which i didn't feel good about it. this was my re-sit posting~obstetrics and gynecology (O&G). I really want to pass this 3rd year. Ya Allah! please help me, your weak servant.



i got this case:
35 years old chinese lady, G2P1.
LMP: 4 August 2009


1. what is her EDD (expected date of delivery) and POA (period of amenorrhea)?


2. please examine her abdomen.
(do running commentary)


3. discussion: causes? investigation? management?



from per abdomen examination, the abdomen is distended by a gravid uterus as evidenced by linea nigra. the umbilicus is centrally located and inverted. there is fetal movement noted. otherwise the abdomen looks normal. the clinical fundal height is 38 week as evidenced by 2 fingers below xyphisternum, fullness of flank and fullness of costal margin. therefore it is equal to date and measures 37 cm. there is a singleton fetus in oblique lie with head at maternal right hypochondrium and breech at maternal left iliac fossa. the fetal back is at maternal right side. the estimated fetal weight is 3.0kg. the liquor is adequate. i will finish my examination by listening to fetal heart sound at anterior shoulder which is at here (direction showed).

so, the diagnosis is 35 years old G2P1 at 37 weeks POA with oblique lie.



i did well for EDD and POA part.
my technique is also correct except I forgot to mention position of fetal back and mistaken folded cutaneous as a transverse suprapubic scar (cesarean section).



during discussion, i did not get what prof. wanted.

for causes, i answered,
laxity (not appropriate for this patient because patient is only G2), polyhydramnios (not appropriate as the liquor is adequate), concomitant mass (cannot as the uterus is equal to date) uterine abnormalities (fair enough for that answer).

the correct answer (reliable to the patient): placenta previa, prematurity and uterine abnormalities.



investigation:
ultrasound: to exclude any causes of unstable lie.
the correct answer should be to see the location of placenta.



management:
my answer: observe the lie for 24 hours
the correct answer: observe the lie for 48 hours.
(still have the subsequent management which I always forgot to mention in front of examiner)



so, the result was only borderline.
prof told me that i have to work harder for my OSCE and theory exams which will be held next Monday in order to pass my 3rd year. i want to pass! Ya Allah, please help me.