Obstetric history and examination Flashcards
What are the subsections of an obstetric history?
Personal details; presenting complaint/present circumstances; history of present pregnancy; past obstetric history; systems review
What would you ask about the history of the present pregnancy?
Dates: LMP? length of menstrual cycle? regular menstrual cycle? how many weeks pregnant? EDD (expected delivery date)
Complications of pregnancy: bleeding? HTN? diabetes? anaemia? UTI? concerns about fetal growth? any hospital admissions?
Tests: US scans? blood tests? prenatal diagnostic tests?
How would you estimate gestational age?
From LMP, allowing for cycle length:
1. Measurement of crown-rump length between 9-14 weeks
2. Head circumference between 14 and 20 weeks if no early scan and LMP unknown.
Gestational age calculations are inaccurate after 20 weeks
What would you ask about the past obstetric history?
Mode and gestation of delivery, if operative, why? FBW and sex? maternal or fetal complications? how many pregnancies? how many children?
What is gravida?
The number of times a woman has been pregnant
What is parity?
The number of viable pregnancies a woman has had (over 24 weeks)
What would you ask in the systems review of an obstetric history?
Past gynae: date and result of last cervical smear? any abnormal smears? any difficulties conceiving?
PMH: operations, heart disease. HTN, diabetes, psych problems, epilepsy
Drugs: at time of conception? currently?
FH: twins, diabetes, HTN, PE, autoimmune disease, DVT, thrombophilia
Social: smoke? alcohol? social support?
Allergies: penicillin? latex?
Why do you check the abdomen at <24 weeks; >24 weeks; >36 weeks?
<24 weeks: to check dates, twins
>24 weeks: assess well-being, size and liquor
>36 weeks: to check lie, presentation and engagement
Why do you palpate a pregnant abdomen?
Is the fetus adequately grown? is the liquor volume normal? is the lie longitudinal? is the presentation cephalic and, if so, is it engaged?
