OBGYN History & Examination Flashcards
What are the steps to the abdominal examination of a pregnant woman?
Introduction
Inspection
Palpation
Auscultation
What are the important steps in the introduction when doing an obstetric/gynaecological examination?
Introduce self
Wash hands
Explain procedure
Obtain consent
Offer chaperone
Expose pt to appropriate level with a covering sheet
Position pt comfortably and appropriately
Why might the bed need to be adjusted for a pregnant patient, and how might we need to adjust it?
Lying flat in pregnancy can be difficult, and can cause blood pressure problems.
The head of the bed can be tilted up to 15 degrees.
What equipment do we need to prepare when examining a pregnant woman?
Covering sheet
Measuring tape
Pinnard or doppler stethoscope
BP cuff
What do we look for on inspection of the pregnant abdomen?
Distension (in keeping with pregnancy)
Striae
Scars
Linea nigra
What is the first thing we should palpate in a pregnant abdo examination?
The fundus, so we can measure the symphyseal-fundal height.
How is symphyseal-fundal height measured?
- Find fundus with the side of your hand at the top of the pregnant belly (below the xiphisternum)
- Place the measuring tape upside down at the top of the fundus, then run it down to the pubic symphysis to measure the fundal height.
What are the 4 steps of the pregnant abdo palpation?
- Palpate the fundus
- Palpate the sides with ballotting motion
- Palpate the apex with C-shaped hands
- Palpate to check for engagement with fingertips
What are you looking for when you palpate the sides of the pregnant abdomen?
Shapes and feelings suggesting where the back, head, and limbs are located.
How does the back of the foetus feel when you palpate it?
Smooth, broad, and consistent
How do the limbs of the foetus feel on palpation?
Knob-like structures
How does the head of the foetus feel on palpation?
Hard, rounded, and mobile.
How does the bottom of the foetus feel on palpation?
Soft, non-mobile, and irregular
What 5 things do we describe after examining the pregnant abdomen?
- Symphyseal-fundal height
- Lie of the foetus
- Presentation of foetus
- If foetus is engaged
- Foetal Heart Rate
What re the elements ofa gynaecological history? (Aside from general hx taking elements)
Menstrual hx - age of menarche or menopause, cycle length and duration, last menstrual period.
Contraception
Prior vaginal/pelvic infections of surgery
Be age appropriate
How should we take the obstetric element of a history?
Go chronologically: Number of pregnancies Each pregnancy outcome Gestational ages Pregnancy-related complications Birth-relatedcomplications
When a pregnant woman presents, what are the 4 key aspects of a history that you must ask?
Have they experienced any:
- Change in foetal movements
- PV bleeding
- Tightening (beginning of labour)
- Membrane ruptures
What do we need to know about a current pregnancy?
Gestational age (LMP if early pregnancy) EDD If scans up to date Singleton/multiple If there has been any screening done Folate use around conception
What do we need to know about previous pregnancies?
How many, and how many of them were carried to term. Gestation Mode of delivery Birth weight Complications If any assisted reproductive techniques used Any terminations or miscarriages Ectopics Medical complications during pregnancy
What is gravidity?
The total number of pregnancies, regardless of the outcome
What is parity?
Total number of pregnancies carried over 24 weeks (threshold of viability)
What does G3 P2+1 mean?
3 total pregnancies
2 were delivered, and 1 was a miscarriage
What does G3 P2 mean?
Patient is currently pregnant and has had 2 previous deliveries
How many scans are routine for a pregnancy?
2 - at 12 weeks and 20 weeks
What are the 2 routine scans for?
12 weeks for viability and dating
20 weeks for abnormalities
What are the broad categories of PMH questions you need to ask in an obstetric hx?
Medical hx
Pelvic surgery
Abdominal surgery
Mental health conditions
What medical co-morbidities are common in women of child-bearing age?
Asthma CF Epilepsy HTN Congenital heart disease Diabetes T1 or T2 Autoimmune diseases Haemoglobinopathies BBVs