History taking and examination in obstetrics: Flashcards
List 5 additional features you may wish to clarify from an obstetric presenting complaint:
PC:
- Nausea/vomiting (hyperemesis gravidarum)
- Abdominal pain (may need imaging)
- Vaginal bleeding - fresh/clots/tissue
- Dysuria/urinary frequency
- Bowel habits
How is the Estimated Delivery Date (EDD) calculated without use of US scan?
LMP + 9 months + 7 days
When do foetal movements usually start to be felt?
18-20 weeks
What is gravidity?
The number of times that a woman has been pregnant
What is parity?
The number of times that she has given birth to a foetus with a gestational age of 24 weeks or more (regardless of whether the child was born alive or was stillborn).
A woman who is nulliparous is…
has not given birth previously (regardless of outcome)
Primagravida is…
a woman in her first pregnancy
Primaparous is..
a woman who has given birth once
A lady who is G2 P2 is said to have had…
Has had two pregnancies and two deliveries after 24 weeks.
A lady who is G2 P0 is said to have had..
Two pregnancies, neither of which survived to a gestational age of 24 weeks.
Sometimes a suffix is added to indicate the number of miscarriages or terminations a woman has had. So this lady who has had two miscarriages would be annotated as G2 P0+2
If a lady who was previously G2 P2 and G2 P0 is pregnant again, what denoted their current gravidity and parity ?
G3 P2 and G3 P0 respectively.
What does SROM mean?
Spontaneous rupture of membranes (water breaking).
May occur before contractions start or remain intact until delivery
What is important to note about membrane is women/amniotic fluid which is visible?
Colour:
- Clear
- Blood-stained
- Yellow/green
What is a miscarriage defined as?
Loss of pregnancy before 24 weeks
What does IUFD mean?
Foetus’ with no sign of life in utero
What is neonatal death defined as?
The death of a baby within the first 28 days of life
What is a partogram?
Graphical record of key data (maternal and foetal) during labour.
Measures include:
- Cervical dialtion
- Foetal HR
- Duration of labour
- Vital signs
When is the uterine fundus able to be palpated?
After week 12
From where is the fundal height measured from?
Pubic symphysis.
What are the 4 different presenting parts of a foetus?
- Normal
- Transverse/shoulder
- Face/brow
- Breech (complete/footling/frank)
What are the 3 different lies of a foetus?
- Longitudinal
- Transverse
- Oblique
Where is the ‘zero line’ in terms of the station during labour?
The zero-line is an imaginary line drawn between the ischial spines of the pelvis.
When is a babys head said to be engaged into the pelvis?
Once it passes the zero-line
When is a baby said to be crowning?
When it passes 5cm inferiorly to the ‘zero-line’.
What examination is contraindicated in late pregnancy and why?
Digital vaginal examination is contraindicated in late pregnancy until Placenta Praevia can be excluded (RISK OF HAEMORRHAGE)
What cervical changes undergo during pregnancy?
Becomes softer and enlarged due to increased vascularity.
There is a thick plug of viscid cervical mucus produced by the endocervical glands that occlude the cervical os
What are the 3 planes of the pelvis?
Inlet
Midplane
Outlet
What do 2/3 of women who die in pregnancy die of?
Pre-existing health problems. 1/3 die due to direct complications of pregnancy.
What are the top 5 causes of maternal deaths?
1) Other indirect causes
2) Cardiac Disease
3) Neurological
4) Thrombosis
5) Psychiatric disorders
What measures can be taken prior to pregnancy to minimise the effects any chronic conditions may have?
- Optimise disease control, defer pregnancy until medical condition is stable
- Rationalise drug therapy to minimise effects on baby - alter medication to drugs ‘safe’ in pregnancy
- Effective contraception until ready to conceive
Give one example of a condition that could worsen during pregnancy and one example of a condition which may improve?
Worsen - mitral stenosis
Improve - RA
What additional care may be provided to mothers it increased risk of complications surround delivery and postpartum care?
- “safest” mode of delivery
- Neonatal support
- Anaesthetic expertise
- HDU/ITU facilities
- Ongoing care postpartum - maternal condition may initially deteriorate
