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
What is the following?
Linea nigra
What are the following?
Striae gravidarum
What is the following?
Striae Albicans - old stretch marks
What level would the fundus be found at at 12 weeks gestation?
Pubic symphysis
What level would the fundus normally be found at 20 weeks gestation?
Umbilicus
What level would the fundus normally be found at at 36 weeks gestation?
Xiphoid process
What would you assess on palpation of the abdomen in an obstetric examination?
- Palpate 9 regions
- Identify borders of uterus
- Determine foetal lie
- Determine presentation
- Measure symphyseal-fundal height
- Determine engagement
What should the symphyseal-fundal height correlate to?
Gestational age in weeks (+/- 2cm)
What further assessments and investigations would you consider after completing an obstetric examination?
- FHR
- Urinalysis
- BP
- Weight and height measurement
