Clinical/Comm Skills - Week 2 - A - Obstetric History Taking Flashcards
Obstetric history
What is obstetrics?
This is the study associated with pregnancy, childbirth and postpartum period.
It is important to take the mothers name and age in obstetric history, as well as their parity and getational age
How is parity written and what does it mean?
Two numbers are given for parity
The first being the number of pregnancies born beyond 24 weeks plus those ending before 24 weeks in which there were signs of life
The second number is the number of pregnancies born before 24 weeks without signs of life
Parity – X = (any live or stillbirth after 24 weeks) | Y = (number lost before 24 weeks)
An obstetric history should begin by asking questions regarding the patients presenting complaint and the history of the presenting complaint
Questions should then be asked regarding the history of present pregnancy
What questions should be asked regarding the history of presenting complaint that are key for a pregnant women?
HPCx -
Nausea or vomiting
Abdominal pain
Vaginal bleeding - eg clots
Dysuria / urinary frequency
Fatigue - may suggest anaemia
Headache/visual changes/swelling
What may severe nausea/vomiting signify?
What may headaches/fever/visual changes signify?
Severe nausea/vomiting - hyperemesis gravidarum
Headaches/fever/visual changes can be a sign of pre-eclampsia
How much weight is lost in a patient with hyperemsis gravidarum?
Patient loses >5% of pre-pregnancy weight due to HG - if condition doesnt improve after rehydration - then possible use of anti-emetics eg cyclizine is indicated
In a patient with hyperemesis gravidarum, they can have hyponatraemia due to the persisten vomiting, what can rapid correction of the hyponatramia cause?
This can cause central pontine myelinosis - neurological disorder caused by severe damage of the myelin sheath of nerve cells in the area of the brainstem termed the pons, predominately of iatrogenic, treatment-induced cause.
The history of presenting pregnancy is covered by three main points (initial, antenatal and recent care)
Initial care - gestational age by early scan
Symptoms of note, investigations aranged and planned care plan
Antenatal care
Recent care
What questions are asked in the initial care?
Is this the patient’s first pregnancy?
How was the pregnancy confirmed? – home testing kit / hCG blood test / ultrasound scan
Last menstrual period (LMP) – first day of the LMP
Was the patient using contraception? – are they still? (e.g. COCP / implant / coil)
Estimated date of delivery (EDD) – estimated by scan or via dates (LMP + 9 months + 7 days)
Did the patient take folic acid during the first trimester?
How long should you take folic acid for if trying to get pregnant?
Folic acid should be taken whilst you are trying to get pregnant and up until 12 weeks of pregnancy - helps to prevent neural tube defects
In the babies antenatal care, important to know clinics attended, investigations and results and any hospital admissions
What can be asked in recent care of the baby>
Fetal movements – usually experienced at around 18-20 weeks gestation
Labour pains – more relevant in the third trimester
Planned method of delivery – vaginal / C-section
Medical illness during pregnancy – if so are they taking any medications?
A past obstetric history should be taken in a obstetrics history also?
What questions are asked here?
Best to take each pregnancy in turn and ask about the phases in a sequence
(antenatal, intrapartum and postnatal problems are main questions)
- Date and place of pregnancy - including spontaneous and therapeutic abortion (spontaneous abortion = miscarriage)
- Antenatal problems
- Intrapartum problems
- Spontaneous or induced labour
- Gestation at delivery
- Mode of delivery
- Baby - sex, weight and need for resuscitation
- Postpartum problems
A brief gynaecological history should also be taken in an obstetrics history consultation
What are the four main areas to cover in the brief gynae history?
Menstrual history - age of menarche/menopause, cycle frequency and duration, abnormal bleedging
Cervical smear history
Contraceptive history
Previous gynae problems and management
Obstertics
- Name and age Parity
- Complaint and HPCx
- (History of present pregnancy - initial, antenatal and recent care
- Past obstetric history
- Gynaecological history)
- Then continue again with normal hx ie PMHx and surgery, DHx, FHx, SHx, Systematic enquiry
In the gynae hisory what would K=6/30 mean?
K = number of days she bleeds for/ number of days between first day of menses
Bleeding last for 6 days and occurs every 30 days
