Table of Contents
Remember history taking in obstetrics requires you to ask extra questions on the current pregnancy and obstetric history.
Abdominal pain
Exploring symptom
- Pain
- Site
- Onset
- Character
- Radiation
- Associated symptoms
- Timing
- Exacerbating/relieving factors
- Severity
Relevant system reviews
- General
- Fever, sweats
- Obstetric
- Fetal movements
- Contractions/tightening
- PV loss
- Pre-eclampsia symptoms
- Gynaecological
- PV discharge
- PV bleeding
- Urological
- Storage: frequency, volume, urgency, nocturia, incontinence
- Infection: dysuria, haematuria, odour
- Gastrointestinal
- Weight: loss, appetite change
- Work down body: dysphagia, nausea/vomiting, indigestion/heartburn, bowel habit change, tenesmus, blood/mucus in stool
Differential diagnoses and clues
Obstetric
- Unilateral pain + bleeding
- Usually between 4-12 weeks gestation
- <24 weeks gestation
- Associated PV bleeding
- May pass clots or products of conception
- Late pregnancy
- Infrequent, irregular contractions
- >24 weeks gestation (premature if <37 weeks)
- Painful regular rhythmic contractions
- Placental abruption
- Pre-eclampsia
- Uterine rupture
- Chorioamnionitis
- Acute fatty liver of pregnancy
- Round ligament pain
- Symphysis pubis dysfunction
Gynaecological
May cause symptoms due to red degeneration or torsion
- Severe abdominal pain
- May have fever/vomiting
- PV discharge
- Bilateral pelvic pain
- Dyspareunia
- Fever
- May have post-coital bleeding
- Condomless intercourse with new/multiple partners
- Severe unilateral pain
- May have fever/vomiting
General surgical
Any cause of acute abdominal pain in non-pregnant patients (see common abdominal histories)
PV bleeding
Exploring symptom
- Timeframe
- Duration
- Onset (sudden or gradual)
- Progression
- Timing (intermittent or continuous)
- Bleeding
- Pattern (regular/irregular)
- Amount of loss
- Pain with blood loss
- Anaemia symptoms (tiredness, breathlessness on exertion)
Relevant system reviews
- General
- Fever, sweats
- Obstetric
- Fetal movements
- Contractions/tightening
- Gynaecological
- PV discharge
- Pain
Differential diagnoses and clues
Early pregnancy
- Light short-lived bleeding/spotting
- Dark with pink/brown tint
- 6-12 days after conception (near when next menstrual period is expected)
- Unilateral pelvic pain
- Usually between 4-12 weeks gestation
- <24 weeks gestation
- Pelvic pain
- May pass clots or products of conception
Late pregnancy
- >24 weeks gestation (premature if <37 weeks)
- Painful regular rhythmic contractions
- Antepartum haemorrhage
- Continuous abdominal pain
- Uterine contractions
- Painless bleeding >28 weeks
- Sudden profuse intermittent PV bleeding
- Painless bleeding after membrane rupture
- Fetal bradycardia/death
Any time
For example, polyps, cancer, trauma, or ectropion
- Commonly post-coital (contact) bleeding
- May have PV discharge
- Cervicitis
- Vaginitis
- Pelvic inflammatory disease
Try a few questions
What do gravida and para refer to in the obstetric history?
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What are the risk factors for ectopic pregnancy?
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How would you differentiate Braxton-Hicks contractions and labour?
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