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Obstetrics and gynaecology > Obstetric history > Flashcards

Obstetric history Flashcards

1
Q

What is gravidity?

A

Number of times a woman has been pregnant regardless of outcome

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2
Q

What is parity?

A

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

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3
Q

What is hyperemesis gravidarum?

A

Severe vomiting in pregnancy

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4
Q

What clinical features is hyperemesis gravidarum associated with?

A

Electrolyte disturbance
Weight loss
Ketonuria

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5
Q

What is reduced foetal movements associated with ?

A 
Foetal distress and early foetal demise
Still birth
Foetal growth restriction 
Placental insufficiency 
Congenital malformations
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6
Q

What might cause vaginal bleeding in pregnancy

A

Cervical bleeding - ectropion, infection, cervical cancer

Placenta praevia and abruption

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7
Q

What may cause abdominal pain in pregnancy?

A

UTI
Constipation
Pelvic girdle pain
Placental abruption

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8
Q

What might abnormal vaginal discharge in pregnancy be a result of?

A

STI or rupture of membranes

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9
Q

What are the typical features of pre-eclampsia

A

Headache (frontal and severe)

Visual disturbance (flashing lights or blurring of vision)

Epigastric pain

Oedema (hands, feet and face)

Reduced foetal movements

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10
Q

When is oedema normal in pregnancy?

A

When mild in the later stages

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11
Q

Describe the onset and course of nausea and vomiting in pregnancy

A

Begins 4-7th weeks
Peak 9th-16th week
Resolves by 20 weeks

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12
Q

When do women begin to feel foetal movements?

A

16-24 weeks

Primigravida women will not feel movements till 20 weeks

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13
Q

What must you ask about when a patient presents with vaginal bleeding in pregnancy?

A 
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
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14
Q

What should you ask a patient presenting with vaginal discharge in pregnancy

A

Volume
Colour
Consistency
Smell

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15
Q

What can untreated UTIs in pregnancy lead to?

A

Increased risk of foetal death, developmental delay and cerebral palsy

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16
Q

What are some common symptoms of urinary tract infections

A

Dysuria
Frequency
Urgency
Fever

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17
Q

What conditions may cause a fever in pregnancy?

A

UTI
Cervical infection
Chorioamnionitis

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18
Q

What might fatigue in pregnancy indicate

A

Anaemia

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19
Q

What might weight loss in pregnancy indicate?

A

Hyperemesis gravidarum
Malignancy
Anorexia nervosa

20
Q

What is pruitis a sign of in pregnancy?

A

Obstetric cholestasis

21
Q

Where is the pruitis of obstetric cholestasis typically experienced?

A

Palms and soles of feet

22
Q

How is accurate gestation estimated

A

Ultrasound scan to measure crown rump length

23
Q

When are women offered scan to detect foetal abnormalities?

A

18+0 and 20+6 weeks

24
Q

What are some key findings to note from foetal anomaly scans?

A

Growth of foetus - clarify if within normal limits for current gestation

Placental position - if low lying then greater risk of placenta praevia

Foetal anomalies

25
Q

List some forms of screening women are offered during pregnancy

A

Downs syndrome
Rhesus status and presence of antibodies
Hep B, HIV and syphilis

26
Q

What details of the pregnancy would you want to ascertain?

A

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

27
Q

Which vaccinations should pregnant women be up to date in?

A

Flu
Whooping cough
Hep B if at risk

28
Q

What should you ask a pregnant woman about in terms of mental health

A

Any mental health diagnoses?

Any current thoughts of self harm/suicide

29
Q

What would you want to know about a woman’s previous obstetric history

A

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)

30
Q

Which parts of the gynaecological history would you ask a pregnant woman

A

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
31
Q

What should you ascertain in the PMH from a pregnant woman?

A

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

32
Q

How does diabetes affect pregnancy?

A

Blood glucose control can deteriorate significantly resulting in poor maternal and foetal health (macrosomia)

33
Q

What can untreated/undertreated hypothyroidism result in?

A

Congenital hypothyroidism with significant neurodevelopmental impact

34
Q

Describe how epilepsy can complicate pregnancy

A

Risk to mother and foetus (miscarriage)

Many anti-epileptics are teratogenic

35
Q

Describe how previous venous thromboembolism may complicate pregnancy

A

Increased risk as pregnancy is a pro-thrombotic state

36
Q

What should be given to women who have already had a VTE and are now pregnant

A

Prophylactic treatment - LMWH

37
Q

What is important to know in the drug history of an obstetric history

A

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

38
Q

Give some examples of teratogenic drugs

A 
ACEi 
Sodium valproate
Methotrexate
Warfarin
Retinoids
Trimethoprim
39
Q

What is folic acid used for in pregnancy

A

Reduce the risk of neural tube defects

40
Q

When is folic acid recommended in pregnancy?

A

Daily for first trimester of pregnancy

41
Q

What dose folic acid is recommended daily

A

400 micrograms

42
Q

What is oral iron used for?

A

Anaemia

43
Q

What are some important medical conditions to ask about in terms of family history?

A

Inherited genetic conditions - CF and sickle cell
T2DM - increased risk if first degree relative
Pre-eclampsia - increased risk if maternal mother or sister affected

44
Q

What is important to ask about in the social history of an obstetric history?

A 
Accommodation
Support network 
Who else lives with them 
ADLs
Smoking
Alcohol
Recreational drug use
Diet and exercise
Occupation and maternity plans
Domestic abuse
45
Q

List the structure of obstetric history

A 
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
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Obstetrics and gynaecology (67 decks)

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