History taking Flashcards
Where might you take a gynaecological history?
Outpatient clinic (general, infertility, colposcopy)
Pre-operative in theatre assessment unit
Inpatient ward (acute admission, post-operative)
What are the differences in gynaecological history taking?
Personal consultations
Ensure privacy and confidentiality
Time to talk, open questions
Majority of gynaecology is benign
- Effect on lifestyle/QoL
- Full discussion of management options
What is important to take account of in a gynaecological history?
Age - women have clear gynaecological and reproductive timeline (pre- and post-menopausal)
Hidden agenda - may be underlying psychological or sexual abuse
What are the key gynaecological symptoms?
Abdominal pain in early pregnancy
Abdominal pain not in pregnancy
- Dysmenorrhoea
- Dyspareunia
Bleeding in early pregnancy
Bleeding not in pregnancy
- Menorrhagia
- IMB, PCB, PMB
Discharge/infection
Fertility
Prolapse/incontinence
What are the key parts of a gynae history?
PC
HPC
PMH
PSH
Review of symptoms
Menstrual history
Contraception and future fertility plans
Sexual history
Smears
Past gynae history
Past obstetric history
Medical and surgical history
Family history
Social history
What is important to ask in a gynae pain history?
SOCRATES
Associated symptoms - PV bleeding/discharge/dyspareunia
LUTS
Change in bowel habit/dyschezia/haematochezia
Pregnant?
Cyclical (endometriosis)
Non-cyclical - PID/ectopic/ovarian cysts
Dyspareunia
What is important to about in a bleeding in pregnancy history?
Last menstrual period (1st day of bleeding) to estimate gestation
What are periods normally like?
How many days bleeding/how many days between eg 5/28 (number of days period lasts/number of days of cycle) - has it carried on from last period?
Quantify how heavy bleeding is - number of pads/tampons, flooding, symptoms of anaemia
Pain?
How can you quantify how heavy bleeding is?
Number of pads/tampons
Flooding
Symptoms of anaemia
Really heavy if filled a pad and soaking into clothes in 15 minutes or see it dripping into toilet - haemorrhaging level of bleeding
Heavy if too much for woman’s life
What should you ask in a bleeding outside of pregnancy history?
Period history (length/frequency/quantify)
IMB/PCB (red flags for endometrial/cervical cancer)
Other symptoms (pain, LUTS, bowels)
Any previous treatment (contraception/TXA/NSAIDs)
Symptoms of anaemia
What should you ask everyone in a obs and gynae history?
Gravidity - number of pregnancies regardless of outcome, included ectopic, miscarriages, terminations, includes current pregnancy
Parity - number of deliveries after 24 weeks regardless of outcome, does not matter if child alive, stillbirth, neonatal death
Modes of delivery (CS/instrumental/normal)
How many weeks child born?
Any problems in previous pregnancy or delivery?
LMP and period history
Menopause - when? when was last period?
Contraception - implant/coil how long there for? when started contraception?
Smears - starts at 25, UTD?, results?
Any STIs and BV and thrush
What should you ask in a fertility history?
Are they having sex? How often? How are they having sex?
Any previous children for either partner? - not eligible for IVF on NHS if one has previous child
Any pre-existing health problems
Medication (prescription and non-prescription)
- Lots of male factor infertility due to taking protein supplements and steroids
How many times does a couple have to have sex a week before they can be thought of as infertile?
At least 3 times a week before classified as infertile
What questions should you ask in a prolapse history?
Can come with urinary incontinence
Dragging/bulging sensation - when do you feel it? when did it start?
Urinary and bowel symptoms (continence)
Sexual symptoms - ask all women in sexually active - if still sexually active can alter management problems
ICE - what is their main concern as will guide management
- Do they care about the bulge?
- What is main issue? Might just be continence
What is stress incontinence?
Leak of urine when coughing/exercising
Increases in intra-abdominal pressure overcoming sphincter resistance
What is urge incontinence?
Overactive bladder
Key in lock
Unable to control urge to wee
