Obstetric history and examination Flashcards
What are the main components to the obstetric history?
- 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
What are aspects of the personal history you would want to ask about?
- Name
- Age
- Gravida
- Parity
- LMP
- Estimated Date of Delivery (EDD)
- Period of Gestation (POG)
What would you want to know about a mothers course in hospital?
- Investigations
- Treatment
- Any complications
What would you want to know about the current pregnancy?
- Planned/unplanned
-
Antenatal care
- Screening results
- Number of visits to hospital
- Any current complications
- Any high-risk factors
- Any current concerns
What would you want to know about past obstetric history?
- Date of deliveries
- Place
- Mode
- POG at delivery
- Outcome - include neonatal complications, apgars, stillbirths
- Antenatal complications
- Postnatal complications
- Feeding
What would you want to know about menstrual history in an obstetric history?
- 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
What would you want to ask about in the family history?
- Chronic medial disorders
- Consanguineous Marriage
- Inherited diseases - thrombophilia
- Obstetric disorders with +ve FH - pre-eclampsia, multiple pregnancy, chromosomal anomalies, inborn errors of metabolism
What would you want to ask about in the social history?
- Occupation
- Income
- Smoking
- Alcohol
- Illicit drug use
- Housing
- Level of education
What would you want to ask about in the contraceptive history?
- Methods
- Duration used
- Side effects and efficacy
What would you want to specifically ask about in a postnatal obstetric history for SVD?
- 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
What are the main steps to an obstetric examination?
- Introduction, explanation, consent
- General inspection
- Inspection of abdomen
- Palpation of abdomen
- Other exams - Foetal heart monitor, urinalysis, BP, weight and height measurement
What would you want to inspect for on general inspection for an obstetric examination?
- Hands - Pulse, CRT, Peripheral oedema
-
Face
- Conjunctival pallor
- Jaundice
- Melasma
- Oedema
How would you position a patient in late pregnancy for late pregnancy?
Left lateral position
What might you look for on inspection of the abdomen in an obstetric examination?
- 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
What are cutaenous signs of pregnancy?
- Linea nigra
- Striae gravidarum
- Striae albicans