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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
  • Relevant systems reviews (see systems review)
    • General
    • Gynaecological (The 4 P’s)
    • Gastrointestinal (∆∆ IBS, malignancy, appendicitis, diverticulitis etc.)
    • Urological (∆∆ UTI, incontinence etc.)

The 4 P’s

PV bleeding

PV discharge

Pain

Pregnancy

  • Fetal movements (if over 16-20 weeks)
  • Contractions/tightening
  • PV blood loss
  • Pre-eclampsia symptoms (headache, visual disturbance, epigastric pain, oedema)

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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Try some practice OSCE stations…

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