History taking + examination in obs + gynae

Question 1

• Understand the basic principles of history taking of Obstetrics and Gynaecology patients

Answer 1

.

Question 2

Principles of a gynae history

Answer 2

Same as normal
+ additional important info (e.g. last menstrual period, current cycle, contraception, last smear test)
+ sexual history (e.g. parity)
+ obstetric history

Question 3

What additional questions are necessary for a gynae history (4)

Answer 3

LMP (last menstrual period)
Cycle
Contraception/sexually active
Last smear

Question 4

What are some gynae problems people present with

Answer 4

Menorrhagia (abnormal heavy periods)

Pelvic organ prolapse into vagina - cystocele/rectocele/uterine prolapse

Pelvic pain

Early pregnancy bleeding

Question 5

What kind of questions to ask someone presenting with menorrhagia

Answer 5

How frequently they change their pad/tampon

Any clots in the blood

Effect on occupation/lifestyle

Question 6

Principles of a gynae examination

Answer 6

General - hands/arms/face/neck/chest/legs

Abdo - at least inspect + palpate

Vaginal examination + speculum

Question 7

ALWAYS examine before what before vagina

Answer 7

Abdomen

Question 8

Vaginal examination involves feeling for the uterus - what features of uterus should we be looking out for (5)

Answer 8

Position - anteverted anteflexed or retroverted?

Size

Mobility

Adnexal masses (region lateral to uterus)

Tenderness/cervical excitation (pain when doing bimanual palpation)

Question 9

Principles of an obstetric history

Answer 9

General history
+ gynae history
+ past obstetric history - type of delivery, size of baby, complications
+ additional info (parity)

Question 10

What questions to ask during past obstetric history section of an obstetric history

Answer 10

All previous pregnancies and outcomes

Date

Type of delivery

Weight and sex of baby

Any problems encountered during pregnancy/delivery/postnatally, e.g. gestational diabetes, PE

Question 11

Principles of an obstetric examination

Answer 11

General examination

Abdo - inspection/palpation/auscultation of foetal heart

BP + urine dip

Question 12

Findings to say to examiner on obstetric abdomen examination

Answer 12

The abdomen is distended - compatible with pregnancy

The fundal height is … which is/is not in keeping with gestation

The lie is longitudinal/oblique/transverse

The presentation is cephalic/breech

Head is /5 palpable

FH (range 110-160) is heard, rate =