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OBGYN 4MB > Obstetric History And Examination > Flashcards

Obstetric History And Examination Flashcards

Main points of hx and exam in obs

1
Q

What personal details do you need to ask a woman in an obstetric hx?

A
  1. Name
  2. Age
  3. Occupation
  4. Gestation
  5. Gravidity
  6. Parity
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2
Q

Define Gravidity

A

Gravida = the number of times a woman has been pregnant, irrespective of duration

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3
Q

Define Parity

A

Parity = number of completed pregnancies, whether live birth or stillbirth, of at least 24 weeks gestation or with a birthright of >500g.
A suffix denotes the number of pregnancies miscarried or terminated.

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4
Q

What is the presenting complaint?

A

Reason for being in hospital, attending clinic etc.

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5
Q

What needs to be established in the history of current pregnancy?

A
  1. Dates - needed to use Nagles rule to calculate EDD
  2. Symptoms of pregnancy
  3. Complications of pregnancy
  4. Tests patient has had
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6
Q

List the symptoms of pregnancy

A
  1. Amenorrhea
  2. Urinary frequency
  3. Nausea +/- vomiting
  4. Breast tenderness
  5. Weight gain
  6. Mood changes
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7
Q

What complications can occur in pregnancy?

A
  1. PV bleeding
  2. HTN
  3. DM
  4. Anaemia
  5. UTI
  6. Concerns about foetal growth
  7. Other
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8
Q

List the booking bloods

A
  1. FBC
  2. Group and antibody screen
  3. HIV
  4. Hep B
  5. Rubella
  6. Syphilis
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9
Q

What scans do patients normally get in pregnancy?

A
  1. Dating scan - usually around 12wks
    - Crown-rump length used to date from 7-14wks
    - Biparietal diameter or femur length for 14-20wks
  2. Anomaly scan - usually around 20wks
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10
Q

What needs to be included in the past obstetric history?

A
  1. Past pregnancies in order
  2. Year or age of child
  3. Gestation
  4. Antenatal complications
  5. Mode of delivery and complications
  6. Birth weight
  7. Postpartum complications
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11
Q

What questions should be asked about gynaecological history?

A
  1. IMB
  2. PCB
  3. Date of last smear and if one was ever abnormal
  4. Prior contraception
  5. Subfertility and treatment
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12
Q

What other things need to be asked in the history?

A
  1. Past Med and Surgical history
  2. Psychiatric hx
  3. Review of systems
  4. Drugs - regular medication and whether took preconceptions folic acid
  5. Allergies - esp penicillin or latex
  6. Family hx
  7. Personal/social hx
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13
Q

List the important aspects of family hx

A
  1. Hx of twins
  2. Diabetes
  3. HTN
  4. Preeclampsia
  5. Autoimmune diseases
  6. VTE
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14
Q

What aspects of the social hx are relevant?

A
  1. Smoking
  2. Alcohol
  3. Drugs
  4. Married or stable relationship
  5. Support at home
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15
Q

How do we position and expose the patient for an obstetric exam?

A

Get the patient to lie as flat as is comfortable and expose them from just below the bra line to the waist

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16
Q

List the features we are looking for on general inspection

A
  1. Distension
  2. Foetal movement
  3. Scars
  4. Skin changes - striae gravidarum, Linea Nigra, umbilicus, excoriations
17
Q

What are the landmarks for measuring the symphiseal fundal height?

A
  1. The fundus of the uterus in the abdomen

2. The upper margin of the symphysis pubis

18
Q

What can be determined from the SFH?

A

SFH (cm) is approx = gestation from 20wks +/- 2cm

19
Q

Define the lie of the foetus

A

The lie is the relationship between the long axis of the mother and the foetus

20
Q

List the different lies

A
  1. Longitudinal
  2. Transverse
  3. Oblique
21
Q

What else should we not forget to establish on palpation of the abdomen?

A

Liquor volume

22
Q

Define presentation

A

The foetal part that occupies the lower segment or pelvis

23
Q

List the possible presentations

A
  1. Cephalic
  2. Breech

Can only be assessed if the lie is longitudinal

24
Q

Define engagement

A

Engagement of the head occurs when the widest diameter of the head descends into the pelvis described as fifths palpable

25
Q

At what stage is the head said to be engaged?

A

If the head is only 2/5 palpable itvis said to be engaged

This can only be assessed if presentation is cephalic

26
Q

Where do we auscultate the foetal heart rate, what do we use and what is the normal range?

A

The foetal HR is auscultated over the anterior shoulder using a pinards stethoscope. The normal range is 110-160 bpm

27
Q

What else should be done to complete the obstetric exam?

A
  1. BP
  2. Urinalysis
  3. Examine fundi, reflexes, temperature, epigastrium, legs and chest if clinically indicated

OBGYN 4MB (25 decks)

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