W02: Hx & Examination Flashcards
Describe the basic principles of history taking of Obstetrics and Gynaecology patients
*sexual hx
* obstetric hx
- It is useful to confirm the gestational age, gravidity and parity early on in the consultation, as this will assist you in determining which questions are most relevant and what conditions are most likely.
G and P
* LMPeriod
* Cycle
*Contraception/sexual activity
* Last smear
Outline issues and guidance associated with intimate examination
Consent; chaperone; clear comms.; allow chance to urinate= more comfortable
+ general
+ abdo = allows familiarisation
* allows LN and palpation
+ PV (vaginal exam.)
+ Speculum - viewing cervix
Demonstrate awareness of the need for a chaperone during intimate examination
- provide witness
- provide comfort for patient
Menorrhagia
menstrual periods with abnormally heavy or prolonged bleeding
Prolapse
prolapse results from laxities (similar to hernias) in the ligaments, fascia, and muscles supporting the pelvic organs
*Pelvic organ prolapse is common, affecting 1 in 10 women over the age of 50 years. Mild prolapse often causes no symptoms and treatment is not always necessary.
- RF: childbirth, age, constipation
- Cystocele: bladder into ant vaginal wall
- Uterus-cervical prolapse = procidentia
Other specific conditions
Vaginal bleeding and discharge
Pelvic Pain:
- non OG
- pain timings with menstruations = endometriosis; 1º dysmenorrhea
Early pregnancy bleeding:
- ?pain = ?site
- miscarriage
- ectopic preg.
Ectopic Preg:
- shoulder tip pregnancy dt diaphgram irritation
- fainting/ dizziness / hypovol.
PV
uterus position: ante; axial; retro
size of uterus
mobility ofuterus
adnexal masses
tenderness / cervical excitation = inflamm. / infection / ectopic
Palpating the lateral fornices
Obs Hx: Parity
Para(X+Y)
X = baby delivered dead oralive after 24w
Y=baby delivreddead or alive before 24w
Past Obs Hx
- prev preg. and outcomes; date
- type of delivery
- LiveB/ StillB
- Wt and sex of baby
- Problems encountered during. preg/labour/ post natal
e.g. pre-eclampsia, DVT etc = alter mgmt
Hyperemesis Gravidarum
severe vomitting in pregnancy
SFH
use a tape measure to take a measurement, known as the symphysial fundal height
- 45º
- Palpate fundus witrh 2 hands
- Palpate heel of hand inferior of xiphixternum for hard fundus
- measure fundus to symphysis pubis
= measure once in cm
= number of weeks gestation +/-2cm
= abdn = USS
Obs Examination
General +_ BP
Abdo exam: distension, scars, striae, gravidarum
tenderness
* palpate lie of baby (palpate poles: head and breech) and SFH
* auscultate foetal heart
then Urinalysis
Abn palpation = finish with BP and urinalysis
Fifths Palpable
When 2/5 of the head is palpable abdominally, then the widest part has descended into the pelvis and thus the head is engaged
- no fifths palpable for forceps delivery
- 2/5 =
- 5/5 =
