History

Question 1

Previous Obs History (Beyond 24 wks):

Term pregnancies:
- Gestation - why?
- Mode - Types?
- Gender
- Birth Weight - why?
- Complications - List types of complications

• Assisted reproductive therapies - examples?

Care providers - Consultant or Midwife led and why!!

Answer 1

Gestation – previous preterm labour is a risk factor for subsequent preterm labour.

Spontaneous vaginal
Assisted vaginal (Forceps)
CS

Birth weight – previous small for gestational age (SGA) baby increases the risk of a subsequent one.

Pre-eclampsia
Gestational hypertension
Gestational diabetes
Obstetric anal sphincter injury (3rd, 4th degree tears)
PPH

Clomiphene (Ovulation induction)
IVF –> Increases risk of pre-eclampsia!

Question 2

Other pregnancies:

Miscarriages - what further detail would you want to know?

Terminations - what would you want to ask about?

Causes of miscarriage or stillbirth?

Ectopic pregnancies:
- Ask about site if they know
- Management - What types of management are there?

Answer 2

Outcomes (Spontaneous, medical or surgical management)

Method of management:
- Medical (Methotrexate)
- Surgical

Causes of miscarriage:
- Fetal anomaly
- Abnormal parental karyotype

Ectopics:

(1) Expectant (Monitor serum hCG)
(2) Medical - Methotrexate injection
(3) Surgical (Salpingectomy/Salpingotomy)

Question 3

Define:

Gravida

Parity

Answer 3

Number of pregnancies including current (i.e. ALL)

All about outcomes:

First Number = Total live/still births > 24 wks

Second Number = Number of pregnancies before 24 weeks where baby wasn’t born alive

Still birth at 24 wks is still classed in the first number

Twins is G1P2

Quiz:
https://www.registerednursern.com/gravidity-and-parity-quiz-for-maternity-nursing/

Question 4

Current Pregnancy:

1st day of LMP and/or +ve test - What will this allow you to calculate?

Gets(2)Family - Guide for what to ask?

Any scans so far should be mentioned.

18+0 to 20+6 (20 wk scan) - 4 key areas to look at?

When is a Down’s Syndrome scan performed?

Answer 4

LMP –> EDD - Estimated date of delivery (40+0)

Gets(2) family:

Gestation (wks/days)
EDD
Twins/Singleton
Specialist in charge
Scans

Planned/unplanned? (Anticipated)
Folic acids
Movement
Illness
Your choices - Type of birth etc.

1. Fetal anomalies
2. Placenta position (Clear of internal os)
3. Amniotic fluid index - oligohydroaminos, normal or polyhydraminos
4. Estimated fetal weight - growth (SGA)

Women tend to be offered the fetal anomaly scan between 18-21 wks

11-13 wks

Question 5

Past Gynae History:

3 key areas to touch on?

PMH:

Klot Deaths - Stands for?

Additional conditions to consider:
- Mental health - history of depression or psychosis
- Ask about red-flags –> Self harm
- Blood borne viruses - Hep B/C, HIV etc.

Answer 5

MOSC - Only sexual and contraception

Previous gynae problems/procedures, abdominal surgery etc.
Contraception - Type etc.
Smear history

Kidney Disease
**Clotting problems - DVT, PE, sickle cell etc.

DM
Epilepsy - Meds!!
Asthma - May worsen
Thyroid Disease
HTN and heart problems

Smears - Up to date

Question 6

Drug History:

Ask about all drugs!

What period of pregnancy is particularly important?

Recommended supplementation? Dose?

Answer 6

Contraception - 12 wks
(Ask about drugs taken around contraception)

Folic acid 400ug OD for 12 weeks

Reduces chance of neural tube defects

Question 7

Family History:

Key things you may ask about?

Answer 7

Rhesus status (If negative, anti-D injection)

Inherited conditions - CF, Sickle cell

Gestational diabetes history (mother, sisters etc.)

Question 8

Social History?

LOST - Stands for?

Other important social questions?

Here is a good place to ask about if pregnancy was un/planned etc.

Answer 8

Living situation, financial circumstances

Occupation - plans?
SAD - Smoking, alc, drugs etc.
Travel - Not relevant

Domestic abuse

Financial circumstances