Obstetric history and examination Flashcards

1
Q

What are the main components to the obstetric history?

A
  • Presenting complaint/HPC
  • Obstetric specific
    • Personal history
    • Course in hospital
    • History of current pregnancy
    • Past obstetric history
    • Menstrual history
    • Contraceptive history
  • Past medical and surgical history
  • Drug history and allergies
  • Family history
  • Social history
  • Systemic review
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2
Q

What are aspects of the personal history you would want to ask about?

A
  • Name
  • Age
  • Gravida
  • Parity
  • LMP
  • Estimated Date of Delivery (EDD)
  • Period of Gestation (POG)
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3
Q

What would you want to know about a mothers course in hospital?

A
  • Investigations
  • Treatment
  • Any complications
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4
Q

What would you want to know about the current pregnancy?

A
  • Planned/unplanned
  • Antenatal care
    • Screening results
    • Number of visits to hospital
    • Any current complications
    • Any high-risk factors
    • Any current concerns
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5
Q

What would you want to know about past obstetric history?

A
  • Date of deliveries
  • Place
  • Mode
  • POG at delivery
  • Outcome - include neonatal complications, apgars, stillbirths
  • Antenatal complications
  • Postnatal complications
  • Feeding
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6
Q

What would you want to know about menstrual history in an obstetric history?

A
  • LMP
  • Period and cycle length – period length /cycle length. 4/28 indicates that the cycle was 28 days long and the period was 4 days long
  • Regularity of cycle
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7
Q

What would you want to ask about in the family history?

A
  • Chronic medial disorders
  • Consanguineous Marriage
  • Inherited diseases - thrombophilia
  • Obstetric disorders with +ve FH - pre-eclampsia, multiple pregnancy, chromosomal anomalies, inborn errors of metabolism
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8
Q

What would you want to ask about in the social history?

A
  • Occupation
  • Income
  • Smoking
  • Alcohol
  • Illicit drug use
  • Housing
  • Level of education
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9
Q

What would you want to ask about in the contraceptive history?

A
  • Methods
  • Duration used
  • Side effects and efficacy
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10
Q

What would you want to specifically ask about in a postnatal obstetric history for SVD?

A
  • Specific post-natal problems - bleeding, lactation, perineal trauma, healing, pain
  • Hypertensive during pregnancy?
  • Diabetic during pregnancy?
  • VTE prophylaxis?
  • Enquire about the baby
  • Plans for contraception
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11
Q

What are the main steps to an obstetric examination?

A
  • Introduction, explanation, consent
  • General inspection
  • Inspection of abdomen
  • Palpation of abdomen
  • Other exams - Foetal heart monitor, urinalysis, BP, weight and height measurement
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12
Q

What would you want to inspect for on general inspection for an obstetric examination?

A
  • Hands - Pulse, CRT, Peripheral oedema
  • Face
    • Conjunctival pallor
    • Jaundice
    • Melasma
    • Oedema
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13
Q

How would you position a patient in late pregnancy for late pregnancy?

A

Left lateral position

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14
Q

What might you look for on inspection of the abdomen in an obstetric examination?

A
  • Shape of the abdomen - may give an indication of the fetal lie
  • Fetal movements – 20-24 weeks onwards
  • Surgical scars – e.g. previous caesarean section
  • Cutaneous signs of pregnancy
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15
Q

What are cutaenous signs of pregnancy?

A
  • Linea nigra
  • Striae gravidarum
  • Striae albicans
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16
Q

What is the following?

A

Linea nigra

17
Q

What are the following?

A

Striae gravidarum

18
Q

What is the following?

A

Striae Albicans - old stretch marks

19
Q

What level would the fundus be found at at 12 weeks gestation?

A

Pubic symphysis

20
Q

What level would the fundus normally be found at 20 weeks gestation?

A

Umbilicus

21
Q

What level would the fundus normally be found at at 36 weeks gestation?

A

Xiphoid process

22
Q

What would you assess on palpation of the abdomen in an obstetric examination?

A
  • Palpate 9 regions
  • Identify borders of uterus
  • Determine foetal lie
  • Determine presentation
  • Measure symphyseal-fundal height
  • Determine engagement
23
Q

What should the symphyseal-fundal height correlate to?

A

Gestational age in weeks (+/- 2cm)

24
Q

What further assessments and investigations would you consider after completing an obstetric examination?

A
  • FHR
  • Urinalysis
  • BP
  • Weight and height measurement
25
Q

What mnemonic could you use to remember the important aspects of an obstetric history?

A

GMC

  • Gravia/parity
  • Miscarriage, ectopic and terminations - stage, treatment
  • Children (living) - age, number, type of deliveries