Obstetric history taking

Question 1

What 3 things must you establish about your patient’s obstetric history at the start of the consultation?

Answer 1

1. Current gestational age
2. Gravida number = number of pregnancies they have had (including current)
3. Parity number = number of deliveries they have had (alive or not)

Question 2

What are common obstetric symptoms?

Answer 2

1.N+V
–Hyperemesis gravidarum = severe, associated with electrolyte disturbance, ketonuria and weight loss
2.Reduced foetal movements (?distress)
–Absent foetal movements (?intrauterine death)
3.Vaginal bleeding (cervical bleeding, placenta praaevia, placental abruption)
4.Abdo pain (UTI, constipation, placental abruption)
5.Vaginal discharge (STIs, membrane rupture)
6.Headache, visual disturbance, epigastric pain, oedema (=pre-eclampsia)
7.Pruritis (obstetric cholestasis)
8.Unilateral leg swelling, chest pain, SOB
9.Fatigue, fever, weight loss

Question 3

What are common obstetric symptoms?

Answer 3

1.N+V
–Hyperemesis gravidarum = severe, associated with electrolyte disturbance, ketonuria and weight loss
2.Reduced foetal movements (?distress)
–Absent foetal movements (?intrauterine death)
3.Vaginal bleeding (cervical bleeding, placenta praaevia, placental abruption)
4.Abdo pain (UTI, constipation, placental abruption)
5.Vaginal discharge (STIs, membrane rupture)
6.Headache, visual disturbance, epigastric pain, oedema (=pre-eclampsia)
7.Pruritis (obstetric cholestasis)
8.Unilateral leg swelling, chest pain, SOB
9.Fatigue, fever, weight loss

Question 4

What pattern does N+V normally follow in pregnancy?

Answer 4

-Usually starts between 4th and 7th week
-Peaks between 9th and 16th
-Resolves by 20th week
-Persistent = hyperemesis gravidarum –> electrolyte disturbance, ketonuria, dehydration, weight loss

Question 5

When should foetal movements be felt?

Answer 5

-Should be felt by 15-18 weeks (18-20 if primigravida)
-Should be regular by 24-28 weeks

Question 6

What can a reduction in foetal movements signify?

Answer 6

-Stillbirth
-IUGR
-Placental insufficiency
-Congenital malformations

Question 7

What can vaginal bleeding be a sign of?

Answer 7

-Trauma (?DV)
-Placenta praaevia (so ask for previous scan results)
-Cervical ectropion
-Malignancy (ask about screening)
-STIs
-Can cause anaemia so ask about fatigue / symptoms of hypovolaemic shock eg syncope

Question 8

What should you consider if a woman reports discharge in pregnancy?

Answer 8

-Can be normal for her
-Must ask about:
–Volume
–Colour (green, blood-stained could indicate infection)
–Consistency
–Smell (eg BV)
-Can indicate membrane rupture

Question 9

What should you consider if a woman reports discharge in pregnancy?

Answer 9

-Can be normal for her
-Must ask about:
–Volume
–Colour (green, blood-stained could indicate infection)
–Consistency
–Smell (eg BV)
-Can indicate membrane rupture

Question 10

What are common LUTS in pregnancy and how should they be managed?

Answer 10

-Dysuria
-Frequency
-Urgency
-Fever
-Must be managed promptly due to association with foetal death, developmental delay and cerebral palsy
–Nitrofurantoin 100mg BD for 7 days
–Amoxicillin 500mg TDS for 7 days

Question 11

What are the main pre-eclampsia symptoms?

Answer 11

-Headache (typically severe and frontal)
-Swelling of the hands, feet and face
-Epigastric tenderness
-Visual disturbance (blurred vision, flashing lights)
-Reduced foetal movements

Question 12

What other elements are there of the obstetric history?

Answer 12

1. Systemic enquiry
2. Current pregnancy
   –Gestation
   –Scan results
   –Screening
   –Details of pregnancy eg singleton
   –Imms history
   –Mental health history
3. Previous obstetric history
4. Gynae history (conditions & screening)
5. PMHx
6. DHx
7. FHx
8. SHx