Obstetric history Flashcards
What is gravidity?
Number of times a woman has been pregnant regardless of outcome
What is parity?
Number of times a woman has given birth to a child with a gestational age >24 weeks regardless of whether the child was a live or not
What is hyperemesis gravidarum?
Severe vomiting in pregnancy
What clinical features is hyperemesis gravidarum associated with?
Electrolyte disturbance
Weight loss
Ketonuria
What is reduced foetal movements associated with ?
Foetal distress and early foetal demise Still birth Foetal growth restriction Placental insufficiency Congenital malformations
What might cause vaginal bleeding in pregnancy
Cervical bleeding - ectropion, infection, cervical cancer
Placenta praevia and abruption
What may cause abdominal pain in pregnancy?
UTI
Constipation
Pelvic girdle pain
Placental abruption
What might abnormal vaginal discharge in pregnancy be a result of?
STI or rupture of membranes
What are the typical features of pre-eclampsia
Headache (frontal and severe)
Visual disturbance (flashing lights or blurring of vision)
Epigastric pain
Oedema (hands, feet and face)
Reduced foetal movements
When is oedema normal in pregnancy?
When mild in the later stages
Describe the onset and course of nausea and vomiting in pregnancy
Begins 4-7th weeks
Peak 9th-16th week
Resolves by 20 weeks
When do women begin to feel foetal movements?
16-24 weeks
Primigravida women will not feel movements till 20 weeks
What must you ask about when a patient presents with vaginal bleeding in pregnancy?
Pain Trauma including domestic violence Fever/malaise Recent ultrasound scan results Cervical screen history Sexual history Past medical history Fatigue and symptoms of hypovolaemic shock
What should you ask a patient presenting with vaginal discharge in pregnancy
Volume
Colour
Consistency
Smell
What can untreated UTIs in pregnancy lead to?
Increased risk of foetal death, developmental delay and cerebral palsy
What are some common symptoms of urinary tract infections
Dysuria
Frequency
Urgency
Fever
What conditions may cause a fever in pregnancy?
UTI
Cervical infection
Chorioamnionitis
What might fatigue in pregnancy indicate
Anaemia
What might weight loss in pregnancy indicate?
Hyperemesis gravidarum
Malignancy
Anorexia nervosa
What is pruitis a sign of in pregnancy?
Obstetric cholestasis
Where is the pruitis of obstetric cholestasis typically experienced?
Palms and soles of feet
How is accurate gestation estimated
Ultrasound scan to measure crown rump length
When are women offered scan to detect foetal abnormalities?
18+0 and 20+6 weeks
What are some key findings to note from foetal anomaly scans?
Growth of foetus - clarify if within normal limits for current gestation
Placental position - if low lying then greater risk of placenta praevia
Foetal anomalies
List some forms of screening women are offered during pregnancy
Downs syndrome
Rhesus status and presence of antibodies
Hep B, HIV and syphilis
What details of the pregnancy would you want to ascertain?
Singleton/multiple gestation
Clarify if patient took folic acid prior to conception and during first 12 weeks
Explore planned mode of delivery
Ask about any medical illnesses during pregnancy
Which vaccinations should pregnant women be up to date in?
Flu
Whooping cough
Hep B if at risk
What should you ask a pregnant woman about in terms of mental health
Any mental health diagnoses?
Any current thoughts of self harm/suicide
What would you want to know about a woman’s previous obstetric history
Gravidity
Parity
Term pregnancies - gestation at delivery, birth weight, method of delivery, complications, assisted reproduction
Still birth - gestation
Other pregnancies - miscarriage (gestation, investigations for cause and management), termination of pregnancy (gestation and method), ectopic pregnancy (site, management)
Which parts of the gynaecological history would you ask a pregnant woman
Cervical screening - confirm the date and result of last cervical screen, ask if any treatment is abnormal and check follow up is in place
STI Endometriosis Bartholin's cyst Cervical ectropion Malignancy - cervical, endometrial, ovarian
What should you ascertain in the PMH from a pregnant woman?
Any medical conditions
How well controlled the disease is
Treatments
Complications - include hospital admissions
Surgery - abdo surgery may cause scars and adhesions, previous C-section increases risk of uterine rupture, loop excision of transitional zone has increased risk of cervical incompetence
How does diabetes affect pregnancy?
Blood glucose control can deteriorate significantly resulting in poor maternal and foetal health (macrosomia)
What can untreated/undertreated hypothyroidism result in?
Congenital hypothyroidism with significant neurodevelopmental impact
Describe how epilepsy can complicate pregnancy
Risk to mother and foetus (miscarriage)
Many anti-epileptics are teratogenic
Describe how previous venous thromboembolism may complicate pregnancy
Increased risk as pregnancy is a pro-thrombotic state
What should be given to women who have already had a VTE and are now pregnant
Prophylactic treatment - LMWH
What is important to know in the drug history of an obstetric history
Prescribed medications and over the counter medications - if patient still taking them, when did they stop, any side effects since becoming pregnant, teratogenic ones
Contraception - method, check patient has stopped using it, check they have had device removed if coil/implant
Give some examples of teratogenic drugs
ACEi Sodium valproate Methotrexate Warfarin Retinoids Trimethoprim
What is folic acid used for in pregnancy
Reduce the risk of neural tube defects
When is folic acid recommended in pregnancy?
Daily for first trimester of pregnancy
What dose folic acid is recommended daily
400 micrograms
What is oral iron used for?
Anaemia
What are some important medical conditions to ask about in terms of family history?
Inherited genetic conditions - CF and sickle cell
T2DM - increased risk if first degree relative
Pre-eclampsia - increased risk if maternal mother or sister affected
What is important to ask about in the social history of an obstetric history?
Accommodation Support network Who else lives with them ADLs Smoking Alcohol Recreational drug use Diet and exercise Occupation and maternity plans Domestic abuse
List the structure of obstetric history
Introduction, wash hands and consent Gravidity and parity Presenting complaint History of presenting complaint Systems enquiry ICE Summarise and signpost Current pregnancy - gestation, scan results, screening and other details Immunisation history Mental health history Previous obstetric history - term and other pregnancies Gynaecological history - cervical screening and conditions/treatments PMH DH and allergies FH SH Close consultation
