History and Examination Flashcards
What is asked about in previous obstetric history?
Any carried beyond 24 weeks
Gestation - preterm
Mode - spontaneous vaginal, assisted vaginal or caesarean
Gender
Birth weight - SGA
Complications e.g. pre-eclampsia, gestational HTN, gestational diabetes, obstetric anal sphincter injury (3/4th degree tears) post partum haemorrhage
Assisted reproductive therapies e.g. ovulation induction with clomiphene, IVF
Care providers - just midwife, obstetric input
What is asked about for pregnancies not beyond 24 weeks?
Gestation
Miscarriages - spontaneous, medical management, surgical management e.g. evacuation of retained products of conception
Terminations - medical or surgical
Identified causes of miscarriage or stillbirth e.g. abnormal parental karyotype, fetal anomaly
Ectopic pregnancy - site and management e.g. methotrexate injection, laparotomy, laparoscopy, salpingectomy
What is gravidity?
Total number of pregnancies, regardless of outcome
What is parity?
Total number of pregnancies carried over the threshold of viability (24+0)
If patient is currently pregnant, one previous delivery and one previous miscarriage what is the G and P?
G3 P1+1 (+1 is pregnancy not carried to 24+0)
What is Naegele’s rule?
Assumes gestational age of 280 days at childbirth
EDD by adding a year, subtracting 3 months, and adding 7 days to origin of gestational age
Approx 280 days from LMP
Date of LMP + 7 days + 9 calendar months
What is asked about in history of current pregnancy?
Gestational age of pregnancy
Use of folate prior to conception and currently
Agreed EDD
Singleton or multiple
Uptake and results of Down’s screening
What is noted at 18-20 week scan?
Fetal anomalies
Placenta position - is it clear of the internal os
Amniotic fluid index - oligohydroamnios, normal or polyhydramnios
Estimated fetal weight
What is it important to note in PMH?
Usual questions
Abdominal or pelvic surgery
Mental health conditions
Asthma, CF Epilepsy HTN - older women Congenital heart disease Diabetes Systemic autoimmune disease Haemoglobinopathies BBVs HIV, Hep
What are the mental health red flags in an obstetric history?
Recent significant changes in mental state or emergence of new symptoms
New thoughts or acts of violent self harm
New and persistent expressions of incompetency as a mother, or estrangement from the infant
What should be asked about in drug history?
Allergies and intolerances
Enquire about drugs taken around conception and first 12 weeks
Drugs currently taken, including herbal or complementary therapies
Illicit drugs, alcohol, smoking
400ug folic acid per day for first 12 weeks
What do you need to ask about in an obstetric history?
Current gestation Previous pregnancies Presenting problem Current pregnancy Hx Gynae Hx PMH Family Hx Drug and Social Hx
How would you explore the patients presenting complaint?
As with any other Hx
Review symptoms - bleeding, spotting, discharge, abdomen pain, pruritus, headache, reduced fetal movements
What do you want to find out about the current pregnancy?
When they were booked (first antenatal visit) Results of scans and screening What scans they have had Fetal movements Fetal growth Hospital admissions? Planned mode of delivery
What are the key questions for an emergency gynaecological focused history?
SAMPLE
Signs/symptoms Allergies Medication Past illness/pregnancy Last oral intake Events leading to current clinical picture
