History and examination Flashcards
What are the first things to establish in an obs history?
Estimated date of delivery (EDD) and current gestational age in weeks/40
Using
• measurements of fetus from dating scan
• last menstrual period, gestational wheel and apps)
Most pregnancies are 37-42. Past due date is 40+
Gravidity:
• Total number of pregnancies including current and any miscarriages/terminations/ectopic pregnancies
• Twin pregnancies are counted as 1 pregnancy
• Only used if pregnant
Parity
• 2 numbers
• 1st number is number of livebirths at any gestation and births after 24 weeks whether live or stillbirth (twins count as 2 births)
• 2nd number includes all other pregnancies as above
When are fetal movements first felt?
16-20 weeks
Qs about contractions
Freq/strength/pain inbetween/analgesia required
What symptoms do you ask about in an obs hx
- Contractions (freq/strength/pain inbetween/analgesia required)
- Vaginal loss (blood/fluid)
- Urinary symptoms (UTI? Abdo pain? Tightening due to bladder and uterus irritation)
- Bowel history (Constipation more common due to progesterone and decreased movement in abdomen)
- Vomiting/heartburn
- Appetite/weight loss
If pt reports vaginal loss in pregnancy, what do you need to clarify?
- Colour
- Bleeding (provoked or unprovoked, placental localisation, blood group)
- Odour
- Volume (pad needed or not)
- Timing (esp if rupture of membranes suspected)
- Associated pain
- Associated systemic symptoms (fevers/rigors)
What other symptoms should be asked about in an obs hx?
- Headaches/visual distrubances (pre-eclampsia toxaemia PET) due to papilloedema
- Seizures (PET)
- Liver pain (PET)
- Vomiting (hyperemesis gravidum)
- Oedema
- Calf swelling (DVT)
- Chest pain (Pulmonary embolus)
What Qs should be asked about current pregnancy?
- Midwife/obstetric led care
- Planned? (preconceptual folic acid, spontaneous conception/fertility treatment, contraception?)
- 1st trimester dating scan
- 1st trimester screening results (Trisomy 21, FBC, blood group, antibodies, haemoglobinopathies, HIV, Hep B, syphilis, rubella)
- Diagnostic tests (amniocentesis/chorionic villus sampling)
- Hospital admissions
- Hospital follow ups
- 2nd trimester (results of anomaly scan)
- 3rd trimester (additional scans)
- Plans for place and mode of delivery
What Qs should be asked about previous pregnancies?
- Number, outcomes, dates
- Miscarriages (how many weeks gestation, spontaneous/medical/surgical)
- Complications
- Terminations (weeks gestation, fetal abnormality, medical/surgical, any complications)
- Ectopic pregnancies (conservative/medical or surgical treatment)
- Still births (weeks gestation, mode of delivery, weight of baby, any investigations)
- Live births (ante/intra/post partum problems, weeks gestation as delivery, induced/spontaneous labour, mode of delivery, sex and weight of baby)
- Stay on neonatal unit
- Post partum depression
- Method of feeding
What should be asked about smears?
- Date of last
- Previous abnormal results
- Previous cervical treatments
- Plans for post natal contraception
What specific parts of the PMH are you interested in for obs?
- Diabetes
- Hypertension
- Cardiac disease
- Thrombosis/bleeding disorders
- Epilepsy
- Psychiatry
- Previous surgery
- Obstetric cholestasis
What do you ask about in FH for obs hx?
- Inherited conditions (CF, sickle cell, anaemia, bleeding disorders)
- Fetal anomalies
- Pre-eclampsia
What Qs form a menstrual hx
- Menorrhagia (heavy menstrual bleeding)
- Dysmenorrhoea (painful periods)
- Amenorrhoea (no periods)
- Length of cycles
- Period heavy/painful, changes
- Impact on daily life
- Intermenstrual/post-coital bleeding
- Post menopausal bleeding
- Irregular? (acne, hirsutism, weight change, nipple discharge)
- Vaginal discharge (any change, colour/odour, relationship to menstrual cycle, amount)
What Qs form fertility & obs hx in a gynae history?
- Previous pregnancies (outcomes, mode of delivery, birth weight, postnatal complications)
- Fertility treatment required
- How long it took to conceive
What urogynae Qs should be asked?
- Incontinence
- Frequency
- Urgency
- Nocturia
- Dysuria
- Flow
- Prolapse
- Impact of activities of daily living
What Qs should be asked about pelvic pain?
- SOCRATES
- Relationship to menstrual cycle
- Pain with intercourse: superficial/deep (dysparenuria)
- GI symptoms (bloating/constipation)
- Therapies already tried
What Qs should be asked in a sexual and reproductive hx?
- If in relationship: gender of partner
- Sexually active?
- Impact on sex life?
- STI history, PID
- Contraception methods used: bleeding pattern, missed pills, renewal dates
What are the 2 types of speculum used in O&G?
Cusco
Sim’s
What general things should be done before abdo exposure in obs exam?
– Blood pressure measurement and urinalysis (PET)
– BMI
– Jaundice, anaemia, oedema
– Auscultation of heart and lungs
What should be observed in an obs abdo exam?
– Asymmetry – Skin changes – Foetal movements – Scarring – Laparoscopy – Appendicectomy – Transverse suprapubic from previous Caesarean Section
At what gestation can you feel the uterine fundus at the level of the pubic bone
12 weeks
At what gestation can you feel the uterine fundus at the level of the umbilicus
20 weeks
At what gestation can you feel the uterine fundus at the level of the sternum
36-38 weeks
What happens at 40 weeks to the level of the fundus?
Drops below 38 weeks level as presenting part drops down into pelvis
Define SFH
Symphysiofundal height (SFH) Measured with measuring tape facing away, from highest point of fundus to pubic symphysis
