Obstetric 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

• Explore every 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.)

Current pregnancy

• 1st day of last menstrual period (gestation = time since then) and when +ve pregnancy test
• Scans so far (intra-uterine? Any abnormalities?)
• Investigations (especially Rhesus group, Down’s syndrome risk, mid-trimester scan)
• Problems/admissions this pregnancy
• Vomiting/hydration

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

Rest of history as normal

• PMHx
• DHx
• FHx
• SHx including drugs, alcohol and smoking

Test your knowledge

What is the differential diagnosis for antepartum bleeding?

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Which infections can cross the placenta and cause fetal abnormalities?

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

Interpretation management

Covered in OSCE Stations

Try some practice OSCE stations…

1. Abdominal pain during pregnancy
2. Pre-eclampsia
3. Antepartum haemorrhage
4. Find lots more here