repro Flashcards
obstetric abdominal examination: inspection
scars
striae gravidarum
linea nigra
note for swelling of uterus from end of the bed
obstetric abdominal examination: palpation
upper and lateral edges of mass
feel for fetal poles (head and breech) to find lie
use side of hands to find highest point of uterus (fundus)
obstetric abdominal examination: measuring fundal height
after 20wks
tape measure face fown, measure to top of symphysis pubis
fundal height should be equivalent to gestation in weeks +/-3cm
obstetric abdominal examination: feel for presenting part
place both hands at base of uterus, above pubic bone - warn of possible discomfort
ballot the head gently or note if not possible
obstetric abdominal examination: feel for engagement
after 36wks
estimate how much of head is still palpable on abdominal examination
obstetric abdominal examination: auscultation
listen for fetal heart over baby’s anterior shoulder
110-160bpm
female sexual health + repro history qs
- menstrual Hx: age first/last, length + pattern cycle, intermenstrual or post-coital bleeding
- LMP
- dysmenorrhea, menorrhagia
- pelvic + sexual infections: discharge, pelvic pain, dyspareuria, rash, ulcers
- cervical smear hx
- obstetric hx: parity, gravity, terminations, miscarriages
- infertility: duration of trying to conceive, frequency UPSI
- past + present use contraception
- incontinence: stress + urge
- sexual history: current/prev partners, type of sex, high risk partners
male sexual and repro history qs
- erectile dysfunction: how long, can they develop erection, can they have sex
- premature or delayed ejaculation
- urinary symptoms: dysuria, frequency, nocturia, dibbling, flow
- penile discharge
- testicular swelling, pain, rash
- penile rash, ulcer, lump
- if infertility: duration of time trying to conceive, frequency UPSI
- sexual history: current/prev partners, protection, high-risk partners, prev STI
gravidity
number of times a woman has been pregnant, regardless of outcome
parity
total number of times a woman has given birth to a child with a gestational age 24wks+
regardless of whether child was born alive or not
gynae causes of abdo/pelvic pain
ectopic pregnancy
PID
endometriosis
ruptured ovarian cyst
gynae causes of post-coital bleeding
cervical Ca
gonnorhea
chlamydia
vaginitis
gynae causes of intermenstural bleeding
contraception ovulation misscarriage gonnorhea chlamydia malignancy uterine fibroids
gynae causes of post-menopausal bleeding
vaginal atrophy
HRT
malignancy
gynae causes of abnormal vaginal discharge
BV
chlamydia
gonorrhea
gynae causes of dyspareunia
endometriosis
chlamydia
gonorrhea
gynae causes of vulval skin changes + itching
gonorrhea
thrush
determining whether vaginal discharge is normal or abnormal
volume - change in amount
colour - green, yellow, blood-stained
consistency - thickened, watery
smell
menstrual hisotry
- duration of periods
- frequency of periods/length of cycle
- volume of blood - heavy/light
- dysmenorrhoea
- date LMP
- age at menarche
- menopause if relevant
what to ask about current pregnancies
gestation
any symptoms - nausea, vomiting, backpain
complications - pre-eclampsia, cervical neck incompetence
-recent scan results
what to ask about previous pregnancies
age of kids
birth weight
mode delivery
complication: antenatal, perinatal, postnatal
if relevant, are they breastfeeding - contraindication to COC
causes of reduced fetal movements
fetal distress
early fetal demise
obstetric causes vaginal bleeding
placenta praevia
placental abruption
typical clinical features of pre-eclampsia
headache
visual disturbance
epigasric pain
oedema
previous obstetric history
gravidity and parity
term pregnancies: gestation at delivery, birth weight, mode of delivery, complications, assisted reproduction
stillbirth
misscarriages
terminations
ectopic pregnancies
asking about last sexual contact
when was it?
was it consensual?
regular or casual partner
partner demographics - sex and nationality
type of sex involved
contraception used and consistency of usage
other sexual partners in past 3mo
pelvic bimanual examination: inspection of vulva
hair distribution discharge, ulcers swelling, prolapse masses: bartholin's cyst, vulval malignancy white lesions: lichen scelosus cough: incontinence, prolapse
pelvic bimanual examination: palpation
walls of vagina - irregularities, masses
cervix - consistency (irreg, smooth), pain
uterus - (posterior fornix and lower abdo) smooth, nodular, tenderness, mobility
adnexa (R + L lateral fornices) - feel for any masses
vaginal speculum exam: visualise cervix
cervical os - if open may indicate miscarriage
look for erosions around os: cervical ectropoin, malignancy
cervical masses
ulceration
abnormal discharge
indications for pelvic examination
to assess pathology related to external genitalia, vaginal walls, cervix, uterus and adnexa
to perform e.g. high vaginal or endocervical swabs, cervical cytology
in labour to assess dilatation of cervix, rupture of membranes and to assess progress in labour
what else should be included in maternal obstetric exam
blood pressure
urinalysis
order for obs abdo exam
inspect palpate fundal height presenting part engagement auscultation
when is speculum absolutely contraindicated
APH due to placenta praevia
