Obs and Gynae history - THH

Question 1

what to confirm at start of history?

Answer 1

• name
• age
• gravidity and parity (if pregnant)

Question 2

how to start history?

Answer 2

PC
HPC (open questions)
- if bleeding, how much? how often changing pads? soaking through clothes?
- get patient’s description of things

Question 3

important past medical history to ask about?

Answer 3

• PMH (medical comorbidities, up to date with smear/ STI checks?)
• Past surgical history (operations? previous C-sections, laparoscopic procedures or cervical biopsies?)
• Past obstetric history

Question 4

important things to ask about for past obstetric history?

Answer 4

• previous pregnancies and deliveries (date, gestation, mode of labour and delivery, birth weights and health of children)
• any previous problems in/after pregnancy and deliveries
• any other problems in this pregnancy
• same partner in this pregnancy
• mental health problems/ traumatic birth?
• was this pregnancy planned?
• previous miscarriages, terminations, still birth?

Question 5

gynae history questions

Answer 5

• menarche/ menopause
• cycle length and regularity
• bleeding characteristics (flooding/clots?)
• contraception

Question 6

sexual and contraception history

Answer 6

• she or partner ever been tested/ tested positive for any STIs
• did they conceive on contraceptives?
• any new partners (esp high risk Hepatitis/ HIV)

Question 7

drug history and allergies

Answer 7

• medications in pregnancy
• or drugs taking previously, including over counter
• folic acid?
• any medications that are contraindicated in pregnancy e.g. NSAIDs

Question 8

social history questions

Answer 8

• any problems at home/ with housing?
• anything that may our a young woman or her child at risk?
• supported at home by friends and family?
• alcohol, drugs, smoking
• is she coming to antenatal appointments/ scans?
• has she booked this pregnancy late
• consanguinity

Question 9

family history questions

Answer 9

e.g. genetic diseases

Question 10

systems review

Answer 10

quick top to tie of symptoms to ensure no other associated problems

Question 11

important pregnancy specific questions to ask

Answer 11

• N&V (hyperemesis gravidarum)
• abdominal pain (imaging/ labour)
• vaginal bleeding/discharge/leaking of waters (fresh red blood, clots, tissue, foul smelling, itchy)
• dysuria/ urinary frequency (UTI)
• fatigue (anaemia?)
• headache, visual changes, swelling (pre-eclampsia)
• systemic symptoms (fever, malaise, rigors, SOB, itching hands and feet)
• fetal movements (if >20/40)
• do we know rhesus status?

Question 12

important gynae questions

Answer 12

• PV bleeding/discharge (post menopausal/ irregular bleeding. post-coital, foul smelling discharge)
• pain (dyspareunia, dyuria, dysmenorrhea, mittleschmerz)
• hormonal contraceptives/ HRT
• menstrual/ menopausal (regularity, age)

Question 13

gynae risk factors to ask about

Answer 13

• nulliparity
• exposure to exogenous oestrogens
• smoking
• FH of uterine/ovarian/breast/cervical/colon Ca

Question 14

red flags for gynae

Answer 14

• unexpected weight loss/gain, anorexia
• change in bowel habit
• abdominal bloating
• PMB
• fever with abdo pain/PV discharge (PID)