CLINICAL CASE STUDY 1
A 60-year-old mother of four, visited the doctor complaining of back pain and the sensation of something
"coming down" her vagina, especially when she was standing. In addition, she also complained of dribbling of
urine on coughing, sneezing or on lifting heavy object Pelvic examination revealed a first degree uterine
prolapse and cystocyle.
Questions to consider:
1. What is the anatomical basis for dribling of dribbling of urine on coughing, sneezing or on lifting heavy
object ?
2. What is cystocele?
3. What are the important structures that support uterus? What causes its prolapse?
CLINICAL CASE STUDY 2
A 35-year old female patient complains of irregular and painful menses, and an unexplained abdominal mass.
The patient reports that she has two children. On physical exam a large (15 cm in diameter) mass can be
palpated in the lower abdomen. The surgeon decides to perform an a hysterectomy .
Questions to consider:
1. To excise the uterus what ligaments would the surgeon have to cut?
2. Which blood vessels supplies uterus and need to be ligated?
.
3. What structure would be of great concern while ligating uterine vessels?
CLINICAL CASE STUDY 3
A 24-year-old woman pregnant with her first child had been in the second stage of labor (pushing) for several
hours. The crown of the child's head was just visible through the vaginal orifice, but the obstetrician was
concerned that the woman was exhausted and was no longer able to push effectively. She decided to perform
an episiotomy to enlarge the opening of the birth canal and assist the delivery of the baby.
Questions to consider:
1. What is an episiotomy and when is it performed?
2. Episiotomies are generally made as a midline incision. If the incision tears further during delivery , what
structures could be damaged?
3. What are some potential complications if the perineal body is damaged and not repaired correctly?
CLINICAL CASE STUDY 4
A 26-year-old woman pregnant with her second child experienced considerable anxiety when she thought about
the pain that she would experience during childbirth. Her obstetrician explained that there were several options
that involved the use of local anesthetics which would relieve the pain and said that he usually preferred to use a
bilateral pudendal nerve block.
Questions to consider:
1. What is the distribution of the pudendal nerve and its branches?
2. What other nerves would need to be blocked to provide complete anesthesia to the perineal region?
3. Where is the best place to deliver anesthetic to perform a pudendal nerve block?
4. What landmarks would an obstetrician use to deliver the anesthetic accurately?
5. What other methods of anesthesia might be used to provide pain relief during childbirth?