Obstetrics Flashcards
Normal pregnancy
History
Current pregnancy (issues, concerns, how found out, how many weeks)
Common preg symptoms (nausea/vomit, micturition frequency, lethargy, breast tenderness)
DVT symptoms (painful swelling of feet or redness)
PET symptoms (headaches, visual disturbances, epigastric pain, reduced urine output)
Antepartum hemorrhage (vaginal bleeding)
Pre-labour ROM symptoms (leakage of fluid)
Menstrual history (regularity, LMP, length of cycle)
Contraceptive history (types, when and why stop)
Previous pregnancy (outcomes, how many weeks, delivery, complications during pregnancy during birth and after birth, management and reasons if miscarriage/ectopic/termination, birth weight and sex of infants)
Gynaecological history (Pap smears, STIs, diseases, surgeries, fertility problems)
PMHx (DM, CVD, HTN, renal disease, infectious disease such as HIV, hep B or C, DVT, PE, mental health)
Normal pregnancy
Exam
1st visit - baseline height, weight, BMI, CVS exam, res exam, abdo exam, breast exam if indicated
Every visit - BP, urine test for protein
3rd trimester - abdo palp (SFH, lie, presentation, engagement, position, FH)
Speculum - bleeding, prelabour ROM
VE - cervical dilatation, descent (progress of labour)
Normal pregnancy
Investigations
1st visit - urine bHCG, urinalysis, FBC, blood group and antibody screen, syphilis, rubella, hep B, hep C, HIV serology, vit D levels
8 weeks - dating scan
11-14 weeks - down syndrome screening
20 weeks - morphology scan
26 weeks - pregnancy oral glucose tolerance test (POGTT)
36 weeks - vaginal swab for group B strep testing
Normal pregnancy
Management
Lifestyle advice
Anti D - 2 doses at 28 and 34 weeks
36 weeks - consent about vitamin K and hep B vaccine for infant at birth
Abdominal pain
History
HPC (SOCRATES, progression over time) Foetal movement AS (blood, discharge, bladder and bowel symptoms, nausea/vomit, fever) Current pregnancy (issues, concerns, how found out, how many weeks, bleeding, discharge, other pain) Menstrual history (regularity, LMP, length of cycle) Contraceptive history (types, when and why stop) Previous pregnancy (outcomes, how many weeks, delivery, complications during pregnancy during birth and after birth, management and reasons if miscarriage/ectopic/termination) Gynaecological history (Pap smears, STIs, diseases, surgeries, fertility problems)
Abdo pain
DDx
Ectopic Miscarriage Placental abruption Preeclampsia Uterine rupture Labour PID Ovarian cyst rupture, ovarian torsion UTI, renali calculi Appendicitis, IBD, IBS, constipation, bowel obstruction Gastroenteritis, peptic ulcer disease, GORD Cholecystitis, biliary colic, choledocholithiasis, ascending cholangitis, pancreatitis, hepatitis
1st trim bleeding
History
HPC (timing, quantity, quality, progression over time, better/worse, associated symptoms) Foetal movement AS (bladder and bowel symptoms, abdo pain, nausea/vomit) Menstrual history (IMB, PCB) Current pregnancy (issues, concerns, how found out, how many weeks, bleeding, discharge, other pain) Contraceptive history (types, when and why stop) Previous pregnancy (outcomes, how many weeks, delivery, complications during pregnancy during birth and after birth, management and reasons if miscarriage/ectopic/termination) Gynaecological history (Pap smears, STIs, diseases, surgeries, fertility problems)
1st trim bleeding
DDx
Ectopic Miscarriage Ectropion Cervical polyps Cervical cancer UTI Renal calculi Anal fissure Haemorrhoids IBD
Antepartum haemorrhage
History
HPC (timing, quantity, quality, progression over time, better/worse, associated symptoms)
Foetal movement
Menstrual history (IMB, PCB)
Current pregnancy (issues, concerns, how many weeks, bleeding, discharge, other pain)
Previous pregnancy (outcomes, how many weeks, delivery, complications during pregnancy during birth and after birth, management and reasons if miscarriage/ectopic/termination)
Gynaecological history (Pap smears, STIs, diseases, surgeries, fertility problems)
Antepartum haemorrhage
DDx
Placental abruption Placenta praevia Vasa praevia Ectropion Anal fissure Haemorrhoids IBD
High BP
History
Headaches Visual disturbances Epigastric pain Swelling PMHx including HTN, seizures FHx of pre-eclampsia, eclampsia
High BP
Exam
Gen inspect
Vitals including BP
Swelling, oedema
Reflexes
High BP
DDx
Pre-eclampsia
High BSL
DDx
GDM
