O&G - Preading

Question 1

What are important topics to cover as part of a pregnancy history?

Answer 1

1. Personal maternity / pregnancy record
2. Previous obstetric Hx
3. Screening test results - listed in personal maternity record
4. US information - listed in personal maternity record
5. Previous antenatal visits
6. Customised growth charts - track symphyseal fundal height + growth calculated from US during pregnancy
7. Birth plan

Question 2

What is the symphyseal fundal height (also called symphesis-fundal height) ?

Answer 2

Symphyseal / symphesis fundal heigh (SFH)

SFH = top of pubic bone to top of uterus (cm)

• SFH should match the gestational age in weeks to within 2cm after 20-weeks e.g. if 24-weeks gestation then normal SFH = 22 to 26 cm

Question 3

What is a Linea Nigra?

Answer 3

Linea Nigra or ‘black line’ or pregnancy line

• A linear vertical hyperpigmentation on the abdomen
• Vertical, midline - from pubic to umbilicus and sometimes to the top of the abdomen
• Less common in fair-skin
• Often fades several months after pregnancy
• Cause:
  
  • ↑ melanocyte stimulating hormone made by placenta –> also causes melasma + darkened nipples
  • melasma = tan / dark irregular well demarcated hyperpigmented macules or patches (can be caused by sun exposure, skin irritation and hormone changes e.g. pregnancy)

Question 4

What does this image show?

What can cause this?

Answer 4

Melasma

• tan / dark brown, irregular, well demarcated hyperpigmented macules or patches
• commonly on face, can also affect arms + back
• W > M

Causes:

• sun exposure
• skin irritation
• hormone treatments e.g. COCP
• hormone changes e.g. pregnancy - if causes by pregnancy it often fades a few months after delivery

Question 5

Issues arising during early pregnancy fall under which department

gynaecology of obstetrics?

Answer 5

Gynaecology

• Until the feotus is grown/viable gynaecology tend to manage ‘women’s health’ issues (~ < 20-weeks)
• Examples of gyn and not obs:
  
  • Ectopic pregnancies

Question 6

What is Gravidity?

Answer 6

No. of times a woman has been pregnant

Often referred to as a woman’s ‘gravida’ or ‘Gravidity’

• Pregnancy counted regardless of outcome - e.g. if pregnancy failed
• Includes current pregnancy
• Nulligravida = 0 pregnancies
• Primagravida = first pregnancies
• Multigravida = multiple pregnancies

Question 7

What is Parity?

Answer 7

No. of births / completed pregnancies

Often refered to as a womans ‘para’ or ‘parity’

• Completed pregnancy = > 24-weeks gestation achieved
• Includes alive & still-births
• Nullipara = 0 completed pregnancies
• Primapara = first completed pregnancy
• Multipara = multiple compelted pregnancies

Question 8

What are some important questions to ask as part of a gynaecological Hx?

Answer 8

• Menstruation:
  
  1. When was your last period? + current day of cycle e.g. 5/28
  2. Menorrhagia? (heavy menstrual bleeding) - clots?
  3. Intermenstrual bleeding
  4. Dysmenorrhoea (painful menstruation)
  5. Amenorrhoea (absence of menstruation)
  6. Menarche (1st menstruation age)
  7. Menopause
• Intercourse related:
  
  1. Sexually active
  2. Dyspareunia (painful intercourse)
  3. Post-coital bleeding
  4. Contraception
  5. STI Hx
• Discharge - onset, colour, odour, amount?
• Incontinence - when, how much, urgency, full bladder?
• Cervical smear HX - when was last one? results?
• Medications:
  
  • ​HRT
  • Oral contraceptives