Taking a Repro history Flashcards
What are the 4 aspects of a gynaecological history that should never be forgotten?
Generally outline some details about these aspects that are also quite important.
- LMP (Last Menstual Period)
- 1st day is most important information
- Cycle
- How many days bleed?
- How long between cycles?
- Contraception/Sexual Activity
- If sexually active.
- Planning pregnancy?
- Contraceptive? Type etc?
- Know risks
- How are you stopping from getting pregnant?
- Smear Test - Most recent test and the result of it are the most important.
What is Menorrhagia?
How can it be quantified?
Heavy Periods/ Heavy Bleeding
- Quantified by asking about how often pads, tampons etc need to be changed. If there are blood clots present.
- “Flood” - very heavy episode of bleeding
- Impact of the heavy flow on QoL - Such as not going to work or school etc.
What is pelvic organ prolapse?
Pelvic organ prolapse is when one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina.
It can be the womb (uterus), bowel, bladder or top of the vagina.
WHat are some of the symptoms of pelvic organ prolapse that should be asked about when it presents?
feeling of heaviness around your lower tummy and genitals (pelvis)
- dragging discomfort inside your vagina
- feeling like there is something coming down into your vagina – it may feel like sitting on a small ball
- feeling or seeing a bulge or lump in or coming out of your vagina
- discomfort or numbness during sex
- problems peeing – such as feeling like your bladder isn’t emptying fully, needing to go to the toilet more often, or leaking a small amount of pee when you cough, sneeze or exercise (stress incontinence)
When a woman presents with pelvic pain what should be discerned about it?
SOCRATES can be used to discern potential causes. Important aspects include:
- Relationship to period - before, during, after, is cycle involved at all?
- Potentially pregnant
- Is there bleeding?
- Occuring during sex?
How can shoulder tip pain occur in an ectopic pregnancy?
Free fluid in the abdomen causes pain in the diagphram, this shares some innervation with the shoulder tip and so if there is bleeding as a result of an ectopic then blood will have the same effect.
What are the various aspects of a Gynae Examination?
- General
- Abdominal - this can be used to build rapport with the patient prior to the intimate examination. ALso important to do so big pathologies are not missed.
- Vaginal Examination (intimate)
- Speculum
What are some factors that should be noted on vaginal examination?
- Position of the uterus
- Size of the uterus
- Mobility of the uterus
- Adnexal masses
- Tenderness/ Cervical excitation
What is cervical excitation?
Cervical excitation – wiggle the cervix, if there is pain in the pelvis.
What are the important aspects of an Obstetric History?
- Parity - how many times pregnant and reached 24 weeks (including abortions and miscarriages)
- Gynae history
- Previous Obstetric History
- FH / Genetic History (when pregnant genetic history of the family is also important)
- SH - Other children, where they live, who cares for them etc.
- Smoking, Alcohol and Recretional Drugs all important.
What are the important aspects of Past Obstetric History?
- All pregnancies and outcomes.
- Date
- Type of delivery
- Live Births/Still Births
- Weight and Sex of baby
- Any problmes encountered during pregnancy/delivery/postnatally.
What are the aspects of an Obstetric Examination?
- General Examination including BP
- Abdominal Examination
- Family Hisotory
- Urinalysis
Outline how fundal height should be measured.
- Mother semi reclined on bed - too flat, baby squashing tummy.
- Palpate fundus with 2 hands
- Secure tape measurement down at top of fundus.
- Measure to top of pubic symphysis
- Measure along longitudinal axis of measurement.
