History and examinations in Obstetrics Flashcards
History points in obstetrics
Personal details - name, age, occupation, gestation and parity
Presenting complaint: why are they in hospital? HTN, pain, antepartum haemorrhage, unstable lie or PROM
Complications in pregnancy?
Dates: Spontaneous/IVF
LMP - length of cycle, regularity
Week’s gestation
EDD
Complications of pregnancy - bleeding, HTN, DM, anaemia, urine infections
concerns about fetal growth or other problems
Admitted to hospital
Tests - blood tests, USS, prenatal diagnostic testing
Past obstetric history - mode and gestation of deliver, birth weight, sex, complications
Parity + gravity
Past gynaecology hx - last cervical smear (any abnormality)
prior conception - any problems?
FGM?
PMH - previous operations, heart disease, HTN, diabetes, psychiatric, epilepsy, other chronic illnesses
Systems review
Drugs - what she was taking at conception
what was she taking before
what is she taking now
FH - diabetes, pre-eclampsia, autoimmune disease, VTE, thrombophilia, mh
Personal Hx
SH
allergies
VTE
Examination points
General - temperature, pulse rate, oedema and possible
Booking visit - BMI, chest, breast, CVS, legs examined
Blood pressure and urinalysis
Mood - assessed throughout
ABDO EXAM
What are the stages of abdominal palpation in pregnancy?
Semi-prone
Inspection - size of uterus, striae, linea nigra, scars (suprapubic area)
Palpation:
Distance of the funds to pubic symphysis
Palpate with two hands - foetal parts and estimate liquor volume - head is hard and can be balloted and breech is softer and less easy to define
Lie determines if the foetus is in a longitudinal position or transverse or oblique
Presentation - with a longitudinal lie you should be able to feel the head or buttocks - engagement of the head is when the widest diameter descends into the pelvis and described as fifths palpable
What are the key points of postnatal history and examination?
Number of days since delivery
Delivery: gestation, mode of delivery and why
Mode of onset (spontaeous vs induced)
Length of labour and analgesia
Blood loss
Infant: name, sex and birth weight
APGAR score and cordpH
Mode of feeding
Vitamin K given?
History of puerperium:
Lochia - volume and door
Bowels opened and passing urine
Pain - particularly in perineum
Drugs - analgesia
Plans for puerperium - contraception
Obstetric history - parity, antenatal complications, pre-eclampsia, DM
Social/personal Hx - consider home conditions for neonate
VTE risk - update risk assessment
Examination - chest, breast, wound, legs
uterine involution and palpable bladder
What are the aspects of neonatal examination?
Colour (pallor/jaundice/cyanosis), features, posture, behaviour, feeding movement
measure: HR, temperature head measurements, weight
Examine: primitive reflexes, back spine, heart and pulses
Abdomen and genitals, anus, congenital examination of the hip and talipes
