Approach to the OB/GYN Patient Flashcards
1
Q
First thing recorded in OB/GYN history
A
CC including gravida para
2
Q
First line of H&P CC
A
“The patient is a n y/o with gravida x and para y and last menstrual period on date, here for…”
3
Q
OB/GYN components of Hx
A
- Previous pregnancies
- Menstrual history
- calculation of due date
- Contraceptive history
- hormones in early pregnancy can cause defects, retained IUDs
- Medical history
- DM, HTN, renal dz, other conditions know to affect pregnancy outcome
- psych: associated menstrual abnormalities
- inheritance patterns
- Surgical/trauma history
- anesthetic complications, transfusions, post-op abdominal adhesions
- Social history
- smoking, alcohol, pets (esp. cats- toxoplasmosis)
- occupation: exposure to solvents, insulators
*
4
Q
10 Components of Prior Pregnancies
A
- date of delivery/termination
- location of delivery/termination
- duration of gestation (in weeks)
- type of delivery/termination
- duration of labor (in hours)
- type of anesthesia
- maternal complications (UTI, bleeding, HTN, postpartum)
- newborn weight
- newborn gender
- fetal or neonatal complications (APGAR, left hospital w/ mother)
5
Q
Nagele Rule
A
Expected Date of Confinement (EDC)
- first day of LMP + 9mo and 7 days
6
Q
Gravida Para definition
A
- gravida - # of pregnancies
- para - # of deliveries > 20 weeks
- para subdivisions (TPAL)
- Term: 37-42+ weeks
- Preterm: 20-37 weeks
- Abortion: <20 weeks
- Live children
7
Q
Symptoms of Pregnancy
A
- missed menses
- urinary frequency
- breast engorgement
- nausea
- tiredness
- easily fatigued
8
Q
Presumptive Signs of Pregnancy
A
- Chadwick sign- dark discoloration of vulva and vaginal walls
- discoloration and cyanosis of vulva, vagina, and cervix
- pigmentation of skin:
- linea nigra- midline of abdomen
- bridge of nose
- chloasma- under the eyes
9
Q
Probable Signs of Pregnancy
A
- Piskacek sign- one cornu of the uterus enlarges slightly
- Hegar sign- uterus softens, able to compress/palpate connection between cervix and fundus
10
Q
Positive Signs of Pregnancy
A
- fetal hearbeat
- endovaginal US: 6w
- Doppler US: 9-12w
- stethoscope: 16-20w
- movement
- endovaginal US: 7-8w
- multiparous woman: 15-17w
- primigravida woman: 18-20w
11
Q
What serum/urine pregnancy tests check
A
human chorionic gonadotrophin (hCG) or B subunit
12
Q
Gynecologic History:
abnormal bleeding range
abdominal pain causes
amenorrhea causes
other symptom
A
- abnormal bleeding
- before age 9 or after age 52
- menses >7 days or bleeding inbetween
- chronic lower abdominal pain:
- endometriosis
- chronic pelvic inflammatory disease
- large pelvic tumors or ovarian CA
- amenorrhea
- pregnancy/menopause MCC
- primary amenorrhea- no menstruation by age 16
- other sx of concern:
- dysmenorrhea, premenstrual tension, fluid retention, leukorrhea, constipation (dyschezia), dyspareunia, abdominal distention
- low back/sacral pain- uterine prolapse, enterocele, rectocele
13
Q
Menstrual History
A
- age at menarche (avg is 12-13)
- interval between periods (normal 21-35 w/ 28 avg)
- duration (avg is 5 days)
- character: scant, normal, heavy, usually w/out clots)
- intermenstrual bleeding (metrorrhagia)
- LMP date of onset
- dysmenorrhea (cramps): age of onset, severity, character, disability
14
Q
Mittelschmertz
A
midcycle pain (may be accompanied by increased vaginal secretions)
indicative of ovulatory cycles
15
Q
Parts of Gynecologic History
A
- Present illness
- Menstrual history
- Contraceptive history
- type, duration, complications (amenorrhea, thrombosis, heavy bleeding (menorrhagia), infection w/ IUD, failure with barrier device)
- Obstetric history
- each pregnancy, delivery, assoc. complications sequentially
- problems w/ infetility
- Sexual history
- assoc. bleeding, dyspareunia
- STIs
- Past history
- family, surgical, meds
- ROS, habits (alcohol, tobacco, drugs), weight and height changes
