Approach to the OB/Gyn Patient Flashcards
What does LMP stand for?
Last Menstrual Period.
Important aspects (5) to get when getting a patient’s menstrual history?
- Age of onset or Menarche.
- Length of cycle or the days b/t periods.
- -Normal cycle is 21-35 days. - Characteristics of cycle:
- LMP.
- Intermenstrual bleeding.
What is intermenstrual bleeding?
Abnormal bleeding between periods.
Important aspects (5) to discuss when getting a patient’s sexual history?
- Age at first intercourse.
- Total number of partners and the timing of those partners (new partners w/in 6 mo, 12 mo, etc).
- “Men, Women or Both.”
- Practices – type of intercourse?
- History of STI – Treated? Test of Cure?
What is the definition of intercourse?
Any penetration of the oral, anal or vaginal cavity.
Important aspects to elicit when asking a patient about their contraception history?
- Current Method:
- -Type, Length of time used, Compliance, Side Effects, Satisfaction. - Previous methods and why discontinued.
Why is it important to know date of the pt’s last pap smear?
It determines the need for cervical cancer screening.
What is the recommended age for cervical cancer screening and what tests are necessary?
- Starts at 21, regardless of sexual history; repeated every 3 years if normal.
- -Includes the PAP Smear ONLY (aka Cytology). - At age 30, PAP Smears include HPV Testing (aka Co-testing); repeated every 5 years if normal.
Why is it important to know the date of the pt’s last mammogram?
It determines the need for breast cancer screening?
When does breast cancer screening start, repeat, and End?
According to the USPSTF, Breast CA screening starts at age 50, every 2 yrs (Biennial) and stops at age 74.
What does USPSTF stand for?
U.S. Preventive Services Task Force
When does breast cancer screening (mammogram) start, repeat, and End?
According to the USPSTF, Breast CA screening starts at age 50, every 2 yrs (Biennial) and stops at age 74.
What does USPSTF stand for?
U.S. Preventive Services Task Force
HPV Prevention?
Gardasil vaccine – recommended for ages 9-40, 3-shot series unless started and completed by age 15 yrs, then only 2 shot series.
Who do we screen for Intimate Partner Violence (IPV)?
All women of “child-bearing age.”
How do we record Obstetric History?
GP(TPAL)
- Gravidity – total # of pregnancies.
- Parity – total # of pregnancies >20 weeks; detailed further in the TPAL.
What does TPAL stand for in regards to Parity?
- Term (37 wks or greater).
- Preterm (36 wks or less).
- Abortion (not carried to term for whatever reason).
- Live births.
What is the obstetric history of a 28 y/o female who is currently 38 wks pregnant. She had an abortion at 8 wks two years ago and delivered a healthy baby boy at 39 wks three years ago?
G-3, T-1, P-0, A-1, L-1
What is the obstetric history of a women who had a singleton at 40 wks, then twins at 30 wks. No other pregnancies?
G-2, T-1, P-2, A-0, L-3
Important aspects to get when asking about pregnancy history details and complications?
- HTN or DM; or other medical conditions.
- Placenta previa or Abruptio placenta.
- Premature rupture of membranes (PROM).
- Intrauterine Growth Restriction (IUGR).
What important aspects in regards to delivery history of the OB patient?
- Delivery Type:
- -Vaginal (spontaneous, assisted w/vacuum or forceps, after a previous cesarean section).
–Cesarean Section (scheduled or planned, performed after failed vaginal delivery).
What does VBAC stand for?
Vaginal birth after cesarean.
What other aspects of delivery are important to get?
- Complications – preterm labor, postpartum hemorrhage, retained placenta.
- Fetal size – recorded/measured in grams.
- Fetal APGAR score – at 1 and 5 minutes.
- Fetal Malformations.
What does APGAR stand for?
- Appearance.
- Pulses.
- Grimace.
- Activity.
- Respirations.
What formula do we use for estimating the due date of a new pregnancy?
Naegele’s Rule
**(Date of LMP + 7 days) - 3 months.
What does EDC stand for?
Estimated date of Confinement.
Example: 31 y/o G2T2P0A0L2, with LMP 08/01/2020…
EDC = (08.01.20 + 7 days) - 3 months = 08.08.20 - 3 months = 05.08.2021.
When do calories increase during pregnancy?
the 2nd and 3rd trimester.
- Avoid alcohol, tobacco, illicit drugs.
- Avoid King Mackerel, Shark, Swordfish, Tilefish.
Examples of medications that are teratogenic?
- ACEi.
- Statins.
- Phenytoin.
- NSAIDs – be specific.
- Tretinoin.
- Tetracyclines.
What should newly pregnant individuals be taking?
A prenatal vitamin; specifically for Folic Acid and Iron.
What are the intervals for follow-up visits during pregnancy?
- ONCE a month for the 1st 28 weeks (7 months).
- -At 24 wks, test for Gestational Diabetes. - Every 2 weeks from 29-36 weeks.
- Every week from 37 weeks to deliver.
Why do we screen pregnant patients for IPV?
Homicide risk is increased during pregnancy.
What vaccines are indicated during pregnancy?
- TDap – always recommended; b/t 27 and 36 wks.
- Flu shot seasonally.
- POSSIBLY Indicated – HepA, HepB and Pneumococcal.
- MMR and Varicella – NEVER indicated.
How often do we screen for IPV?
Every visit – homicide risk is increased during pregnancy.
**Homicide is one of the leading causes of death in the pregnancy.
How often do we screen men for IPV?
When it is suspected.
What are some screening options for IPV?
- HITS – Hurt, Insult, Threaten, Scream.
- WAST – Women Abuse Screening Tool.
- PVS – Partner Violence Screen.
- AAS – Abuse Assessment Screening.
- SAFE-T – Suicide Assessment and Five-Step Evaluation and Triage.
What are some common breast complaints?
Pain, tenderness, lumps, nipple discharge, skin changes, change to size/shape of breast.
What are some common aspects to collect when asking about breast complaints?
- Change with menstruation.
- Hx of surgery/biopsy to that breast.
- Hx of GYN or Colorectal Cancer?
- FH of these cancers or BRCA1/BRACA2?
- Previous mammograms or other imaging?
What are the characteristic of menstrual flow?
Duration, flow amount, associated symptoms (abd. pain, cramping, bloating, HA, mood swings, fatigue, etc).
