General Flashcards
Key symptoms to ask about in obstetric Hx?
Vomiting - hyperemesis Abdominal pain - may require imaging Bleeding - clots/fresh/tissue Dysuria and frequency - UTI Headache/visual changes/swelling - pre-eclampsia Fatigue - anaemia Systemic symptoms - fever/malaise
Hx of current pregnancy
How was the pregnancy confirmed?
LMP
Contraception - were they using? still using?
EDD (LMP + 9months and 7 days)
Folic acid?
Scans - any additional? placental position? foetal growth?
Foetal movements (after 18 weeks)
Labour pains (third trimester)
Planned delivery method
Medical illness during pregnancy - medications?
Previous Obstetric HX
Gravidity - number of times a woman has been pregnant
Parity - X = (any live pr stillbirths after 24 weeks), Y = number lost before 24 weeks)
Previous pregnancies: Date of delivery Length of pregnancy Multipregnancy? Labour - spontaneous or induced Mode of delivery Weight of babies Current health of babies
Complications:
Antenatal - IUGR, hyperemesis gravidarum, pre-eclampsia
Labour - failure to progress, perineal tears, shoulder dystocia
Postnatal - postpartum haemorrhage, retained products of conception
Miscarriages/terminations - needs to be asked sensitively
Previous Gynae Hx
Cervical smears
Contraception
Previous gynae problems and treatments
Gynae surgery:
LLETZ –> icnreased risk of cervical imcompetency
C-sections–> increased risk of uterine rupture/placenta accreta/adhesions
PMH
Thromboembolic disease
Diabetes
Epilepsy - will need neurology input
Hypothyroidism (risk of congenital hypothyroidism)
Drug Hx
pregnancy related: Folic acid Iron Antiemetics Antacids
Teratogenic: ACE-i Anti epileptics Lithium Methotrexate Retinoids Trimethorprim/tetracyclines
Family Hx
Inherited conditions e.g. CF
Pregnancy loss - recurrent miscarriages in mother and sister
Pre-eclampsia
Diabetes in family
Social Hx
Smoking - IUGR
Alcohol - fetal alcohol syndrome
Recreational drug use - esp. cocaine (placental abruption)
Living situation - any carers?
Activities of daily living - being affected by pregnancy?
Occupation
Systemic enquiry
Cardiovascular Respiratory GI Urinary CNS Musculoskeletal Dermatological
Dating scan
10-14 weeks
Also detects multiple pregnancies, screens for chromosomal abnormalities (nuchal translucency)
How is growth measured before 20 weeks?
Foetal growth failry standard up to 20 weeks
<14 weeks - CRL used
>14 weeks - head circumference used
Who looks after:
- high risk pregnancies
- low risk pregnancies
- teenagers
High risk = consultant
Low risk = midwife
Teenagers = teenage midwife service
