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OBG: Pregnancy, labour, breast feeding > Obstetric history and assessment > Flashcards

Obstetric history and assessment Flashcards

1
Q

What are 5 key pieces of background information useful to obtain at the start of an obstetric history?

A
  1. Name
  2. Age
  3. Parity (2 numbers: first is births after 24 weeks and before with signs of life, plus miscarriages/terminations before 24 weeks)
  4. Maturity of current pregnancy in weeks
  5. Presenting complaints
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2
Q

What are 6 key areas of the history to ask about in the obstetric history, after initial background information?

A
  1. Menstrual history
  2. History of present pregnancy
  3. Past obstetric history
  4. Past medical and surgical history
  5. Family and social history
  6. Drug history + allergies
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3
Q

What is the purpose of the menstrual history when taking an obstetric history?

A

to define the present gestation and the expected date of delivery (EDD)

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4
Q

How is the estimated date of delivery (EDD) calculated based on the last menstrual period (LMP)?

A

first day of last menstrual period plus 40 weeks; assumes that ovulation occurs 14 days before the next expected menstrual period and that delivery will occur 38 weeks after ovulation

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5
Q

What are 7 points to ask in the menstrual history part of an obstetric history?

A
  1. First day of last menstrual period
  2. Is patient sure of this date
  3. Normal duration of menses in days
  4. Normal interval between first day of one menstrual period and first day of next (usually expressed as duration/ interval e.g. 3/28) (follicular phase is the variable one)
  5. Was the last menstrual period normal?
  6. Did the period occur when expected?
  7. Was the patient taking oral contraceptives?
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6
Q

In addition to the presenting complaint, what are 4 additional things to ask about regarding present pregnancy in the obstetric history?

A
  1. General health
  2. Presence and onset of fetal movements
  3. Smoking habits
  4. Pattern of antenatal care
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7
Q

How should the general approach to questioning about past obstetric history be taken?

A

take each previous pregnancy in turn and ask about phases of each pregnancy in sequence

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8
Q

What are 10 things to ask about for each previous pregnancy in the past obstetric history part of the history?

A
  1. Date and place of previous pregnancy, including spontaneous and therapeutic miscarriage
  2. Antenatal problems - gestation, duration and management
  3. Gestation at delivery
  4. Was labour induced or spontaneous?
  5. Length of labour and complications
  6. Mode of delivery
  7. Baby - sex, weight, need for resuscitation, progress
  8. Third stage complications
  9. Post-natal problems
  10. If there was any intervention, why?
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9
Q

What are 3 things to focus on in the family history part of the obstetric history?

A
  1. Hereditary disorders
  2. Hypertension
  3. Diabetes
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10
Q

What are 4 things to ask about in the social history?

A
  1. Occupation
  2. Smoking + drinking status
  3. Marital status
  4. Attitude to pregnancy
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11
Q

Why mustn’t you leave a woman lying supine for too long when performing an obstetric abdominal examination?

A

supine hypotension may occur due to caval compression by the pregnant uterus impeding venous return to the heart

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12
Q

What should be done if hypotension occurs in a woman due to being supine for too long?

A

Turn patient onto side until she recovers

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13
Q

What are 3 broad areas of the obstetric examination?

A
  1. General inspection
  2. Abdominal inspection
  3. Abdominal palpation
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14
Q

What are 7 things that the general inspection in an obstetric exam should include?

A
  1. General appearance
  2. Colour
  3. Examination of hands, eyes, mouth
  4. Presence of oedema - pressure for 30s over pre-tibial aspect of lower leg (also face, fingers, sacral area, abdominal wall)
  5. Blood pressure
  6. Cardiovascular and respiratory system examination
  7. Breast examination
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15
Q

What are 5 places to assess for oedema in the obstetric examination?

A
  1. Pre-tibial
  2. Face
  3. Fingers
  4. Sacrum
  5. Abdominal wall
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16
Q

What are 3 things to look for on the abdominal inspection in the obstetric examination?

A
  1. Linea nigra
  2. Operation scars
  3. Striae gravidarum
  4. General contour and impression of size
17
Q

What are 8 aspects of abdominal palpation in the obstetric examination?

A
  1. Palpate uterine fundus
  2. Symphysio-fundal height
  3. Ballot uterus on both sides with other hand flat on other side
  4. Presenting part
  5. Station of presenting part
  6. Position
  7. Amniotic fluid - estimate liquor volume. fluid thrill if excess suspected
  8. Fetal heart - listen
18
Q

How can the uterine fundus be palpated?

A

with edge of hand - move inferiorly from xiphisternum until resistance found

19
Q

How can you determine the presenting part of the fetus?

A

ballot both poles; cephalic pole is harder, smoother and more ballotable than the breech

20
Q

What is meant by the station of the presenting part?

A

is the head engaged, i.e. is the widest diameter of the head below the pelvic brim?

21
Q

How can the station of the presenting part be expressed?

A

number of fiths of head palpable below the pelvic brim

22
Q

What technique can be used to determine the presenting part and station of the presenting part?

A

Leopold manoevres aka pelvic grips:

first pelvic grip, use one hand to feel deeply in the region with thumb and first finger spread apart

second pelvic grip, use both hands and come in from either side, moving medially until feel resistance

23
Q

How can the position of the fetus be determined during palpation of the abdomen?

A

feeling the back of the fetus, and therefore determining the side of the occiput in (i.e. left/right)

24
Q

What should be assessed regarding amniotic fluid in the palpation part of the obstetric examination?

A

clinical estimate of liquor volume

if excess suspected, fluid thrill should be tested for

25
Q

What are 2 things that can be sued to listen to the fetal heart rate and how should this always be performed?

A
  1. Pinard stethoscope
  2. Doppler ultrasound

perform this over the fetal back; count rate and compare with the maternal pulse (to check it’s not this you’re hearing)

26
Q

What is the obstetric definition of ‘lie’?

A

the relation of the longitudinal axis of the fetus to the longitudinal axis of the uterus

27
Q

What is the obstetric definition of vertex?

A

area on the fetal head delineated by the anterior and posterior fontanelles and the parietal emineneces

28
Q

What is the obstetric definition of presentation?

A

the presenting part of the fetus, which occupies the lower pole of the uterus

29
Q

What is the obstetric definition of position?

A

the position of the fetus in relation to the denominator of the presenting part to the quadrants of the maternal pelvis. For a cephalic presentation this is the occiput, and for a breech the sacrum. E.g. right occipito-anterior (ROA)

30
Q

What is the obstetric definition of engagement?

A

the head is engaged when the widest diameter has passed through the pelvic brim

OBG: Pregnancy, labour, breast feeding (14 decks)

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