Obs and gynae Flashcards
What to establish early on in obstetric consultation?
Gravidity and parity
Gravidity= the number of times a woman has been pregnant, regardless of outcome
Parity= total number of times a woman has given birth to a child with a gestational age of 24 weeks or more- regardless of whether the child was born alive or not
Key obstetric symptoms?
Nausea and vomiting, reduced fetal movements, vaginal bleeding, abdominal pain, vaginal discharge or loss of fluid, headache+ visual disturbance+ epigastric pain+ oedema= pre-eclampsia, pruritis, unilateral leg swelling- rule out DVT, chest pain+SOB, systemic symptoms
When is nausea and vomiting common in pregnancy? When can fetal movements be felt?
Between 4th and 7th week of gestation, peak 9th-16th week, resolve by 20th week
Start between 16-24 weeks
What to ask about with vaginal bleeding?
Pain, associated trauma, fever/ malaise, recent USS results, cervical screening hx, sexual hx, past medical hx, fatigue if anaemia suspected, symptoms of hypovolaemic shock
Changes in what for vaginal discharge? Common symptoms of UTIs?
Volume, colour, consistency, smell
Dysuria, frequency, urgency, fever
Weight loss symptom of? Pruritis?
Hyperemesis gravidarum, obstetric cholestasis
Systemic enquiry for ob hx?
Systemic: fatigue- anaemia, fever- chorioamnionitis, UTI
Resp: dyspnoea e.g. PE, anaemia, chest pain- PE
Gastro: abdo pain- placental abruption, vomiting e.g. hyperemesis gravidarum
GU: urinary freq, dysuria and urgency- UTI, abnormal discharge- vaginal candidiasis, gonorrhoea
Neuro: visual changes, motor/ sensory changes, headache
MSK: pelvic pain e.g. symphysis pubis dysfunction
Derm: rashes, skin lesions, linea nigra
Things for current pregnancy?
Gestation and EDD- using USS to measure crown-rump length, scan results between 18+0 and 20+6 weeks, screening- Down’s, rhesus status+ ABs, hepatitis B, HIV and syphilis, other details: singleton/ multiple, folic acid before conception and during 1st trimester, planned mode of delivery, medical illness, immunisation hx- flu, whooping cough, hep B, mental health
Things for previous ob hx?
Gravidity and parity, term pregnancies> 24 weeks: gestation at delivery, birth weight, mode of delivery, complications, assisted reproduction, any stillbirths (24+ weeks born dead,) other pregnancies< 24weeks: miscarriages- gestation, other management, termination- gestation and management method, ectopic pregnancy- site and how managed
Gynae hx in ob hx?
Cervical screening- date and result of last one, tx if abnormal, previous conditions and tx
Past medical hx in ob hx?
Especially diabetes, hypothyroidism, epilepsy, previous VTE, blood-borne viruses, genetic disease
Abdo/ pelvic surgery, previous c-section, LETZ, allergies
Drug hx? Teratogenic drugs? Common in pregnancy?
Current/ stopped meds, contraceptions, SEs
ACEi, sodium valproate, methotrexate, retinoids, trimethoprim
Folic acid, oral iron, antiemetics, antacids, aspirin
Family hx?
Genetic conditions, type 2 diabetes, pre-eclampsia
Social hx?
Living, smoking, alcohol, drug use, diet and weight, occupation, domestic abuse
Key initial gynae details in hx?
Last menstrual period, gravidity and parity
Key gynae symptoms?
Abdo and pelvic pain, post-coital vaginal bleeding, IM bleeding, post-menopausal bleeding, abnormal vaginal discharge, dyspareunia, vulva skin changes and itching, systemic symptoms
Examination details?
Intro, hygiene, explain, verbal consent, chaperone, bimanual, speculum
Qs for dyspareunia?
Superficial on genitalia or deep within the pelvis
Duration, location, nature
Causes of vulval skin changes?
Infections- candida, bacterial vaginosis and STIs, vaginal atrophy, lichen sclerosis
Menstrual hx within gynae hx?
Duration of periods- average= 5 days, frequency- regular+ predictable?, volume of flow (heavy= >80mls or >7 days,) menstrual pain, 1st day of last period, age of menarche, age of menopause- hot fluses+ vaginal dryness if perimenopausal
Contraception in gynae hx? Reproductive plans?
Combined, POP, depot injection, long-acting reversible contraceptives- coil, implant and copper coil, barrier methods, previous hx
Considering having children in the future
Past medical hx for gynae hx? Relevant to gynae?
Ectopic pregnancy, STIs, endometriosis, Bartholin’s cyst, cervical ectropion, malignancy
Surgeries, cervical screening- date+ result, treatment, vaccinated against HPV
Migraine w/ aura, previous VTE, breast cancer, bleeding disorders
Obstetric hx?
Gravidity and parity, current pregnancy, previous pregnancies- age, birthweight, mode of delivery, complications
Drug hx? Common for gynae conditions?
St John’s wart–> increases metabolism of COCP reducing its effectiveness, ABx may cause secondary vaginal thrush
HRT- duration, method of delivery, frequency, type
Tranexamic acid- menorrhagia, contraceptives, HRT, NSAIDs, GnRH analogues- endometriosis
Family hx in gynae hx?
Ovarian, endometrial/ breast cancer, bleeding disorders, blood clots