Post on 04-Jan-2016
Obstetric history and examination
Dr Bassam AkhdarConsultant
Obstetrician&GynecologistMakassed hospital
Key points
• Always introduce yourself .• Say who you are.• Ensure the patient is comfortable and warm.• Do not do vaginal or breast exam. alone.• All information's are confidential.
Demographic details
• Name .• Age.• D.O.B• Address , phone nr.• Occupation.• Ethnic group.• Presenting complaint or reason for attending.
This pregnancy
• Gestation , LMP or EDD.
• EDD= LMP +9M+7D
• 13WKS= 3 MON.
• Date as calculated from U/S.
• Single/multiple.
• Investigations done during this pregnancy
( laboratory tests. Triple test. U/S.).
• Ask about contractions, vaginal bleeding, or loss of fluids.
Ultrasound
• What type of U/S have been performed.
- Early US for dating.
- Early detailed US.
- Detailed US.
- Extended (anatomical) detailed us.• Were any problems identified?.
Past obstetric history
• List the pervious pregnancies and their outcomes in order.
- date of delivery.
- place of delivery: home , hospital, checkpoint.
- gestational age : abortion, preterm, term.
Obstetric history
• Mode of delivery: spontaneous.. instrumental . C section.• Enfant : sex , weight, wellbeing.• Miscarriage,D+C. ectopic.• Postpartum complications : PPH. Eclampsia
Puerperal pyrexia.
Features that are likely to have impact on future pregnancies
• Recurrent miscarriage :
Increased risk of miscarriage.
IUGR.• Preterm delivery :
Increased risk of preterm delivery.• Early onset preeclampsia:
Increased risk of PET.
IUGR.
• Abruption : increased risk of recurrence.• Congenital abnormalities.• Macrosomia: risk of GDM.• IUGR : Increased risk of recurrence. preeclampsia . thrombophilia .• Unexplained SB : GDM .
• Gravida: total number of pregnancies.• Parity : number of live births at any gestation or stillbirths after 24 weeks. • Twins count as 2.• Next pregnancy = G2 P2 (twins)• PG : P1+0• Next pregnancy = G2 P1+0
Gynecological history
• Regularity : irregular cycles = PCOD• Contraceptive history:
OCP , depot progesterone
IUD • PID : Ectopic pregnancy.• Date of last cervical smear • Previous treatment for cervical changes• Previous ectopic pregnancy.
• Previous gynecological surgery:
laparatomy for pelvic mass.
myomectomy.
ovarian cyst.• History of infertility.
Medical history
• DM: Macrosmia.
IUGR.
Cogenital abnormalities.
Preeclampsia.
SB.
HMD.
Neonatal hypoglycemia.
• HTN: Preeclampsia.• Renal disease: Worsening of disease. Preeclampsia. IUGR. Preterm delivery.• Epilepsy : Convulsions. Congenital abnormalities .
• DVT+ PE: Thrombophilia
Increased risk.
Preeclampsia.
IUGR.• HIV.• Connective tissue disease, SLE:
Preeclampsia , IUGR.
Surgical history
• Previous operations mainly on abdomen• Type of anaesthsia.• Any complications.
Psychatric history
• Anti psychotic medication.• Postpartum blues or depression.• Depression unrelated to pregnancy.• Major psychiatric illness.
Family history
• First degree relatives :
Congenital anomalies.
Sex linked anomalies.
HTN.
DM.
Genetic disorders.
Social history
• Smoking / alcohol /drugs Increased risk of miscarriage. IUGR. SB. Neonatal death• Marital status• Occupation &husband occupation.• Housing problems.
Drug history
• All medication• Anti HTN• Antdiabetic• Antiallergic drugs
• Corticosteroids
Allergies
• Allergy to drugs .• Allergy to substances.
Physical examination
• General inspection and appearance:
Face : pallor, exophthalmia, facial palsy.
In pain : renal colic , abruption, PTL.
Looks ill, toxic: septicemia .
Poliomyelitis = asymmetrical pelvis.
• Maternal weightand height:
normal wt. gain 12-15 kg.• BMI < 20 : IUGR , Perinatal mortality.• BMI > 30 : GDM, PET,Perinatal mortality. • Height < 150 cm.
> 170 cm.
• Blood pressure: seated, semi-recombent. each visit. HTN : BP > 140/90 mm Hg on 2
separate occasions 6 H apart and less than 7 days .
< 20 wks Chronic HTN . > 20 wks Gestational HTN. PET.
• Urine analysis : midstream urine for asymptomatic bacteriuria.
• Dipstic urine for albumin & sugar each visit.• Proteinuria : UTI.
PET.
Renal disease.
• Heart examination: heart sounds .
murmurs .• Breast exam.: not necessary if no complaint.• Chest auscultation.
Abdominal exam.
• Semi-recumbent position.• Cover legs with sheet.• Inspection:
- Shape of uterus .
- Any asymmetry.
- Look for fetal movements.
- Look for scars :
Supra-pubic (CS. Laparatomy).
Sub-umbilical.
Rt-paramedian.
RIF.
RUQ.
- Note striae gravidarum, linea nigra .
• Palpation:
1: Symphysis-fundal height.
Corresponding date
Large for date : Multiple preg.
Polyhydramnious.
Macrosomia.
Small for date : IUGR,
Oligohydramnious.
2 : Fetal lie : Longitudinal
Oblique
Transverse
3 : Presentation : cephalic , breech , brow, face, shoulder.
4 : Engagement.
5 : Fetal heart beats.
• Vaginal examination: Indications : Excessive vaginal discharge Vaginal bleeding. Cervical smear . ROM. Labour pain . Induction of labour.
• Contraindications : Placenta praevia. Prelabour rupture of membranes• Speculum exam.: cusco speculum• Digital exam.: Dilatation & effacement of cervix. Membranes . presentation . station .
• Digital exam.:
Dilatation & effacement of cervix.
Membranes .
presentation .
station . • Bishop score : 0,1,2,3 points for dilatation,
consistensy, length,position of cervix,and station of presenting part