Gynaecological history

Introduction

• Wash hands
• Introduce self
• Ask Patient’s name, DOB and what they like to be called
• Explain and obtain consent

Presenting complaint

• Determine symptoms which brought patient in

History of presenting complaint

• Exploreevery symptom
  • Timeframes
  • Symptom-specific questions (see exploring symptoms)
• Relevant systems reviews (see systems review)
  • General
  • Gynaecological (The 4 P’s)
  • Gastrointestinal (∆∆ IBS, malignancy, appendicitis, diverticulitis etc.)
  • Urological (∆∆ UTI, incontinence etc.)

Menstrual history

• 1^st day of last menstrual period
• Menarche (usually 12-13 years) ± menopause (usually 48-55 years)
• Regularity and cycle length (range from 21-35 days)
• Duration of periods (range from 3-7 days)
• Character of periods (heaviness, number of pads per day, flooding, pain)

Obstetric history – GMC

• Gravida and para
  • Gravida/gravidity = pregnancies
  • Para/parity = birth of fetuses over 24 weeks, regardless if born alive or not
• Miscarriages, ectopic pregnancies and terminations
  • Stage
  • Treatment
  • Complications
• Children (living)
  • Number
  • Ages
  • Birthweights
  • Type of deliveries
  • Previous problems during pregnancy/delivery

Sexual history

• Partners
  • Current partner (male/female, relationship duration)
  • Previous partners (last three or all in last 6 months), high-risk encounters
• Intercourse: type, pain/discomfort, contraception used
• Subfertility

Contraception and cervical smear history

• Contraception: current use, previous methods
• Cervical smears: date of last smear, results

A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

Rest of history as normal

• PMHx: including previous abdominal surgery
• DHx: including HRT/hormones, over-the-counter remedies, allergies
• FHx: breast/bowel/ovarian cancer
• SHx

Test your knowledge with a few questions!

A 45 year old female presents pelvic pain. What is in your gynaecological differential diagnosis and which clinical features would help differentiate these causes?

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How would you classify PV bleeding? List three causes of each.

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Time to try some OSCE stations…

1. Pelvic pain I
2. Pelvic pain II
3. Abdominal pain during pregnancy
4. Vaginal discharge
5. Find lots more here