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