Obstetric history and examination Flashcards
What things should you include in an obstetric history?
PC Hx of PC Past obstetric history (many problems are recurrent) Gynae history PMH Drugs/allergies FHx SHx
What are common obstetric presenting complaints?
HTN (proteinuria with this = pre-eclampsia) Abdo pain bleeding ?ruptured membranes unstable lie 'small baby' reduced foetal movements
What questions should you ask for someone who presents with bleeding?
How much - compared to a period
When did it start
Pain
Is baby moving
Have you had this before
Have you had a scan yet
What things must you always ask a pregnant woman about?
Pain
Bleeding
Foetal movements (from 26 weeks)
Vaginal loss (bleeding or vaginal discharge)
Headaches
Visual disturbances
Generalised swelling (esp. if high BP)
LL pain/sweeling (esp. if high risk of VTE)
What questions should you include in a history of current pregnancy?
Dates - LMP
EDD
USS
Certainty of dates
Complications of pregnancy -
Pregnancy symptoms (split in 1st and 2nd half)
Bleeding/BP/anaemia/UTI/IUGR/DM
Antenatal admissions
Antenatal tests and investigations -
USS
Blood tests
Screening (Downs/amnio/CVS)
What should you include in a past obstetric history?
Number of pregnancies (parity)
Details of each pregnancy - live/child still alive/ still born sex/weight/gestation mode of delivery complications (ante/post-natal)
How is parity documented?
Para (a) + (b)
a) - deliveries after 24 weeks (live/still born
(b) - losses before 24 weeks (spontaneous/TOP)
What should you include in a gynae history?
Menstrual cycle and symptoms - IMB/PCB
Smear
Contraceptive Hx
Other gynae problems
What are some risks of some drugs being given in pregnancy?
teratogenic
organ development and function
Someone presents in their last trimester with HTN and proteinuria -what are you concerned about?
pre-eclampsia
How should your BP be effected by pregnancy?
It should not - it should be the same as it was before pregnancy
What PMH would you want to know about in a pregnant woman?
Past gynae and surgical Hx (previous operations/treatment)
Medical problems: IHD/DM/BP/Asthma/Epilepsy/Jaundice
DVT/Thrombophilia
Hospitaladmissions
Drugs/allergies:
Pre-conceptual folate
If someone has abdo pain at about 8 weeks pregnant, what might you consider as an important differential diagnosis?
Ectopic pregnancy
What family and social history would you ask about in an obstetric Hx?
Twins
Medical problems: DM/BP/Pre-eclampsia
Inherited diseases
Occupation
Smoking/alcohol
Relationships/accomodation
What is unstable lie?
Foetus adopts unusual positions within uterus
What is unstable lie?
Foetus adopts unusual positions within uterus
Important towards the end of the pregnancy
When do we give weight to reporting of reduced foetal movements?
28 weeks
What would you consider as an important differential for someone who presents with:
Painless bleed which
Starts around 26-28 weeks
Low lying placenta
Lies over cervical Os
What is another way of referring to pre-eclampsia?
PET
What are some symptoms of pre-eclampsia?
HTN Headache Blurred vision Flashing lights Swelling Jitters
Epigastric reflux-type abdo pain
OR
RUQ pain
When is a dating scan generally done? When would this be done earlier?
12 weeks (11-14 weeks)
Ectopic
Threatened miscarriage
If you can’t rely on dates
When do the complications of ectopic pregnancy classically start?
7-8 weeks
What does IUGR stand for?
intra-uterine growth description
Why is it important to find out whether a patient has had a C-section?
If they have, there is a suspicion of high-risk for next pregnancies
Why is it important to find to about previous surgery?
May be scarring - important if you have to do operative delivery
What is the recommended dose of folate that pregnant should started on pre-conception/at conception?
400 micrograms
some exceptions require 5g
How can stressful job impact a woman’s pregnancy/foetal development?
Small babies and pre-term births
What are the different stages of obstetric examination?
Position patient at back raised, position that is comfortable for them
Hands: pulse
Face: conjunctiva (anaemia, jaundice)
Inside mouth and tongue
lymphnodes
Expose adequately
Inspect: Six and shape of uterus prominent veins stretch marks line from typhoid process to pubic symphysis
measure fundal height
palpate for presenting part
palpate for foetal back
palpate for foetal lie
heart sounds
calves (swelling)
BP and urine dip
