Obs and Gyn

Question 1

General Obs and Gyn Hx

Answer 1

Introduce, patient name and details, consent

PC

HPC

• SOCRATES

DHx

• Allergies

PMHx

PSHx

ObHx

• Gravida
• Parity
• Birth history
  
  • Age of child
  • Gestation
  • Type of delivery (e.g. c-section)
  • Pre, peri and post natal complications (stays in hospital
  • Child currently

Menstrual Hx

• LMP
• Age of menarche
• Duration and regularity
• Flow
• Irregular bleeding

Gyn Hx (may not be applicable)

• Date of last smear + result
• Prev gyn conditions e.g. PID STIs
• Current contraception

SHx

• Alcohol
• Smoking
• Occupation
• Living situation

FHx

• Gynae cancers

ICE

Question 2

Subfertility Hx

Answer 2

Introduce, confirm patient, consent

PC

HPC

• Coitus
  
  • How often
  • Difficulties
  • Relation to fertile days
• Partners (ones trying to get pregnant with)
  
  • Age
  • Occupation
  • Previous children
  • Smoking and alcohol
  • Current medications
• Gynae questions
  
  • Any current Sx or issues?
    
    • Pain
    • Discharge
    • Bleeding
  • Sx of PCOS
    
    • Greasy skin
    • Obesity
    • Hirsutism (hair growth on face)
• DHx
• PMHx
  
  • Ever had or been treated for an STI or been with someone who has
• PSHx
• ObHx
• Menstrual Hx
• Gynae Hx
• Sexual Hx
  
  • All partners in the last 3 months
    
    • Consensual
    • Type of sex
    • Contraception used
• SHx
• FHx
• ICE

Question 3

Abdo exam in pregnancy

Answer 3

• Introduce patient details consent wash hands
• Position patient 45 degree
• Ask 3 questions: have you got any pain, do you need a wee and how are their fetal movements
• Expose abdomen
• Inspection
  
  • Distended consistent w/ pregnancy
  • Size, shape, asymmetry
  • Linea nigra, striae gravidarum, scars, fetal movements
• Palpation
  
  • Palpate the fundus
  • Lateral palpations both sides. Hold one hand against tummy and use hand on the other side to slowly worm down
  • Deep pelvic palpation - 5th palpable
  • Comment on Lie (longitundinal, oblique, cephalic), Presentation (cephalic, breech) and Position (OP, OL or OA)
  • Measure sympho-fundal height. Numbers down, 0 on symphisis
• Auscultation
  
  • 1 min w/ pinnard on baby ant shoulder, whilst palpating maternal heart so as not to confuse
• Thank redress and assist if needed