History taking in Obs and Gynae Flashcards
What information is gathered within a gynaecological history?
Usual history
Additional information - LMP, how long it lasts, contraception?, last smear?
Sexual history
Obstetric history
What is menorrhagia?
Heavy painful bleeding
Menstrual flow > 80ml.
Ask questions like - does it soak through your clothes? How many times do you change your tampon/towel? How does it affect your quality of life?
What can prolapse into the vagina?
Uterus, cervix, bladder and rectum can all prolapse into vagina.
Patients will describe its something hanging down, inability to release bowel, incontinence.
What are some questions we may ask about pelvic pain?
Pain related to cycle
Superficial pain or deeper
Painful during intercourse
Urinary symptoms
What are some possible causes of early pregnancy bleeding?
Miscarriage Recent trauma Associated pain Clots? Is the bleeding/pain constant? Cramp like pains? Have to exclude ectopic pregnancy.
What is involved in a Gynae examination?
General
Abdominal examination first
Pelvico-vaginal examination
Spectulum
What is a cuscos speculum?
Self retaining speculum used for cervical examinations, Pap smears, IUD insertion etc. Can be plastic or metal.
What is a sims speculum?
Double bladed vaginal speculum used for examining the vagina and cervix. Mainly used for looking at the vaginal walls.
What information can be gathered from a vaginal examination?
Position of the uterus Size of uterus Mobility of uterus Adnexal masses Tenderness Cervical excitation
What is parity?
The number of times a woman has given birth to a foetus with a gestational age of 24 weeks or more, regardless of whether the child was born stillborn or alive.
What information is asked during an obstetric history?
Parity General history Gynae history POH FH/Genetic history SH - other children , where will new baby fit in?
What must be asked during a past obstetric history?
All previous pregnancies and outcomes Date Type of delivery LB/SB Weight and sex of baby Any problems encountered during pregnancy/delivery/postnatally.
What is involved in an Obstetric examination?
General examination including BP.
Abdominal examination
Foetal Heart rate
Urine
What are the stages in measuring fundal height?
Mother semi-recumbent with an empty bladder.
Palpate fundus with 2 hands.
Secure measuring tape down at top of fundus.
Measure to top of symphysis pubis.
Measure along longitudinal axis of measurement.
What are the features of a pregnant abdomen?
The abdomen is distended compatible with pregnancy.
The fundal height is X which is/is not in keeping with gestation
The lie - longitudinal/transverse/oblique
The presentation - cephalic/breech/back up/back down.
Head is X/5 palpable
Fatal heart rate = X
