History taking (Gynaecological, sexual, obstetrics) Flashcards

1
Q

In the UK, pregnant women attend a booking appointment with a midwife at between

A

8 and 12 weeks’ gestation
- much of the histroy is covered here

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2
Q

Overview of obstetric history

A
  • Presenting complaint
  • History of presenting complaint
  • Previous obstetric history
  • Previous gynaecological history
  • Current pregnancy
  • Past medical history
  • Drug history
  • Family history
  • Social history
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3
Q

Previous obstetric history can be split into:

A
  • term pregnancies
  • other pregnancies

A good starting point is to ask about number of children the patient has given birth to. Next, sensitively ask about miscarriages, stillbirths, ectopics and terminations.

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4
Q

term pregnancies

A
  1. Gestation – previous preterm labour is a risk factor for subsequent preterm labour.
  2. Mode of delivery – spontaneous vaginal, assisted vaginal or Caesarean.
    Gender
  3. Birth weight – a previous small for gestational age (SGA) baby increases the risk of a subsequent one.
  4. Complications – e.g. pre-eclampsia, gestational hypertension, gestational diabetes, obstetric anal sphincter injury (3rd, 4th degree tears), post-partum haemorrhage.
  5. Assisted reproductive therapies (ART) – e.g. ovulation induction with clomiphene, IVF. can increase risk of pre-eclampsia
  6. Care providers – was the patient’s care completely with a midwife or was there previous obstetric input, if so, why
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5
Q

other pregnancies: pregnancies not carried beyond 24 weeks

A

1) Gestation – miscarriages can be classified into early pregnancy (12 weeks or less) or second trimester (13-24 weeks).
2) Miscarriages – outcome (spontaneous, medical management, surgical management – evacuation of retained products of conception).
3) Terminations – method of management: medical or surgical.
4) **Identified causes of miscarriage **/ stillbirth – e.g. abnormal parental karyotype, fetal anomaly.

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6
Q

other pregnancies: ectopic pregnancies

A

1) Site of the ectopic
2) Management: expectant (monitoring of serum hCG levels), medical (methotrexate injection), surgical (laparoscopy or laparotomy; salpingectomy (removal of tube) or -otomy (cutting of tube and suctioning of trophoblastic tissue))

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7
Q

define gravidity

A

total number of pregnancies, regardless of outcome.

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8
Q

Parity

A

is the total number of pregnancies carried over the threshold of viability (24+0 in the UK).

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9
Q

what does G3 P2 mean

A

Patient is currently pregnant; had two previous deliveries

Patient is currently pregnant; had two previous deliveries

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10
Q

G1 P1

A

Patient is not pregnant, had one previous delivery

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11
Q

G3 P1+1

A

Patient is currently pregnant, had one previous delivery and one previous miscarriage

(the +1 refers to a pregnancy not carried to 24+0).

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12
Q

Current pregnancy history

A

1) Establish gestational age
2) Establish folate use prior to conception and currently
3) Agreed estimated date of delivery
4) Singleton or multiple gestation

Investgiations that have already been done
5) Bloods
6) Urine MSU
7) Uptake and result of Down syndrome screening
8) Scan results (20 weeks)
- Fetal anomalies
- Placenta position
- Amniotic fluid index (oligohydoaminos, normal, polyhydraminos)
- Estimated fetal weight

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13
Q

when is the estimated date of delivery

A

this date is when the woman will be 40+0.

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14
Q

how is gestation described

A

weeks + days

e.g. 8+4; 30+7; 40+12 – post-dates

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15
Q

how are pregnancies dated

A

1) Crudely by LMP (Naegeles rule)
2) More accuratley using crown-rump length (CRL)

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16
Q

Naegele’s rule

A

uses last menstrual period to estimate gestation

Method
- to the first day of the LMP add 1 year
- subtract 3 months
- add 7 days

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17
Q

Crown-rump length is measured using

A

ultrasound scan between 10+0 and 13+6.

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18
Q

Obestetric history: gynaecological history

A
  • PID
  • STI
  • Ovarian cysts
  • Abnormal smear
  • Myomectomy
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19
Q

obestetric history: PMH

A

Ask the usual questions about past medical history, abdominal or pelvic surgery and mental health conditions. Remember that the medical co-morbidities that are most likely to affect women of childbearing age include:

  • Asthma
  • Cystic fibrosis
  • Epilepsy
  • Hypertension (older women)
  • Congenital heart disease
  • Diabetes – check if type 1 or type 2
  • Systemic autoimmune disease e.g. systemic lupus erythematosus (SLE), rheumatoid arthritis
  • Haemoglobinopathies: sickle-cell disease, thalassaemias
  • Blood-borne viruses: HIV, hepatitis B, hepatitis C
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20
Q

obesteric history: Drug history

A
  • allergies
  • use of drugs in first 12 weeks (teratogeneicity)
  • current drugs inc herbal
  • illicit drugs and alcohol
  • recommend patient takes 400ug of folic acid for first 12 weeks
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21
Q

obstetric history: family history

A
  • heritable: CF and sickle cell
  • pre-eclampsia
  • type 2 diabetes in first degree relative considered RF for gestational diabetes
  • blood clotting disorders and VTE
22
Q

obstetric history: social history

A
  • work
  • who they live with/ support
  • domestic violence
  • mental health problems
  • smoking
  • drugs
  • alcohol
23
Q

partner

A
  • inheritable disease
  • congential
  • epilepsy
  • haemoglobinopathies
24
Q

Overview of gynaecological history taking

A
  • Intro: introduce, N and DoB, consent
  • PC
  • History of PC (explore symptoms)
  • Systems review
  • Past medical history
  • Drug history
  • Family history
  • Social history
25
Q

gynaecological history: PC

A

open question ‘what has brought you here today’

26
Q

gynaecological history: HPC

A
  • SOCRATES
  • explore common gynaecological symptoms
27
Q

gynaecological history: HPC

A
  • SOCRATES
  • explore common gynaecological symptoms
28
Q

gynaecological history: common symptoms of gynaecological disease

A
  • vaginal bleeding
  • abdominal or pelvic pain
  • vaginal discharge
  • menstrual history
  • Dyspareunia
  • Vulval itching
  • inferility
29
Q

gynaecological history: Vaginal bleeding

A

3 main forms
- Intermenstrual
- post-coital
- post menopausal

30
Q

Intermenstrual (between menstrual periods) can be caused by .

A
  • infection
  • malignancy
  • fibroids
  • endometriosis
  • pregnancy
  • hormonal contraception
31
Q

Post-coital (after sexual intercourse) causes

A
  • cervical ectropion
  • infection
  • vaginitis
  • malignancy.
32
Q

Post-menopausal (after the menopause) causes

A
  • malignancy
  • vaginal atrophy
  • hormone replacement therapy.
33
Q

gynaecological history taking: abominal/ pelvic pain

A

Use the acronym SOCRATES to elicit the key features of any abdominal or pelvic pain:

Site
Onset
Character
Radiation
Associations
Time course
Exacerbating and relieving factors
Severity

34
Q

gynaecological history taking: vaginal discharge

A

Vaginal discharge is most often a normal and regular occurrence. However, a change in the character of discharge can indicate infection. Inquire about:
*
* Color
* Consistency
* Amount
* Smell

35
Q

gynaecological history taking: menstrual history

A
36
Q

gynaecological history taking: dysparaeunia

A

pain during sexual intercourse. This can be divided into superficial or deep pain.

37
Q

gynaecological history taking: infertility

A
  • duration
  • investgiations that have been performed
  • whether assited cocneption has been attempted
38
Q

gynaecological history: PMH

A
  • pregnancies
  • cervical smear
  • surgical history
  • previous gynae problems
  • previous STI
39
Q

gynaecological history: Pregnancies

A
  • Number of births/miscarriages/abortions/ectopics.
  • Means of delivery, age of child and birth weight.
  • Explore any obstetric/delivery complications.
40
Q

gynaecological history: cervical smear

A

ascertain the date of the last smear, its result, and any treatment arising

41
Q

gynaecological history: drug history

A
  • contraception
  • HRT
  • recent antibiotics- thrush
  • any medications inc over the counter
  • known allergies
42
Q

gynaecological history: family history

A
  • Breast/ovarian cancer/endometrial cancer – can be familial (e.g BRCA 1/2 gene).
  • Diabetes – associated with some reproductive abnormalities.
  • Bleeding disorders – can be associated with menorrhagia.
43
Q

gynaecological history: family history

A
  • Breast/ovarian cancer/endometrial cancer – can be familial (e.g BRCA 1/2 gene).
  • Diabetes – associated with some reproductive abnormalities.
  • Bleeding disorders – can be associated with menorrhagia.
44
Q

gynaecological history: Social history

A
  • weight
  • occupation
  • home situation
  • smoking and alcohol
  • diet and exercise
  • safe sex
45
Q

Overview of sexual history

A
  • Presenting complaint
  • History of presenting complaint
  • Explore other symptoms
  • Menstrual history
  • Sexual contact history
  • Past medical history
  • Drug history
  • Social history
46
Q

sexual history: history of presenting complain

A

use SOCRATES

47
Q

sexual history: other symptoms (screening for common STIs)

A
  • Vaginal bleeding
  • Abdominal or pelvic pain (SOCRATES)
  • Vaginal discharge (colour, consistency, amount, smell)
  • Dyspareunia
  • Vulval intching
  • Infertility
  • Systemic and extragenital symptoms e.g. anal discharge, fever, urinary symptoms, joint pain and eye symptoms
48
Q

sexual history: menstrual history

A
  • last menstrual period
  • if cycle is regular
  • length of period
  • any change to bleeding
49
Q

sexual history: sexual contact history

A
50
Q

sexual history: past medical history

A
  • Previous sexually transmitted infections (including in partners)
  • Previous STI screens including HIV tests
  • Cervical smears – the date of the last smear, its result and any treatments arising
  • Previous gynaecological problems
  • Surgical history – particularly any pelvic or abdominal surgery
  • Pregnancies (a full obstetric history can be found here)
  • Other medical conditions
51
Q

sexual history: drug history

A
  • contraception (type, correct use, previous contraceptive hx)
  • HRT
  • recent antibiotic use
  • allergies
52
Q

sexual history: social hx

A
  • smoking
  • alcohol
  • recreational drug use