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Common obstetric histories

History taking > Common presenting complaints

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

Ectopic

  • Unilateral pain + bleeding

  • Usually between 4-12 weeks gestation

Miscarriage

  • <24 weeks gestation

  • Associated PV bleeding

  • May pass clots or products of conception

Braxton Hicks contractions

  • Late pregnancy

  • Infrequent, irregular contractions

Labour

  • >24 weeks gestation (premature if <37 weeks)

  • Painful regular rhythmic contractions

Other obstetric differentials

  • Placental abruption

  • Pre-eclampsia

  • Uterine rupture

  • Chorioamnionitis

  • Acute fatty liver of pregnancy

  • Round ligament pain

  • Symphysis pubis dysfunction

Gynaecological

Fibroids

May cause symptoms due to red degeneration or torsion

  • Severe abdominal pain

  • May have fever/vomiting

Pelvic inflammatory disease

  • PV discharge

  • Bilateral pelvic pain

  • Dyspareunia

  • Fever

  • May have post-coital bleeding

  • Condomless intercourse with new/multiple partners

Ovarian torsion / haemorrhage / rupture

  • Severe unilateral pain

  • May have fever/vomiting

General surgical

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

Implantation

  • Light short-lived bleeding/spotting

  • Dark with pink/brown tint

  • 6-12 days after conception (near when next menstrual period is expected)

Ectopic

  • Unilateral pelvic pain

  • Usually between 4-12 weeks gestation

Miscarriage

  • <24 weeks gestation

  • Pelvic pain

  • May pass clots or products of conception

Late pregnancy

Labour

  • >24 weeks gestation (premature if <37 weeks)

  • Painful regular rhythmic contractions

Placental abruption

  • Antepartum haemorrhage

  • Continuous abdominal pain

  • Uterine contractions

Placental abruption

  • Antepartum haemorrhage

  • Continuous abdominal pain

  • Uterine contractions

Placenta praevia

  • Painless bleeding >28 weeks

  • Sudden profuse intermittent PV bleeding

Vasa praevia

  • Painless bleeding after membrane rupture

  • Fetal bradycardia /death

Any time

Cervical pathology

For example, polyps, cancer, trauma, or ectropion

  • Commonly post-coital (contact) bleeding

  • May have PV discharge

Other differentials

  • 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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Now try some OSCE stations…

  1. Pre-eclampsia
  2. Abdominal pain in pregnancy
  3. Antepartum haemorrhage
  4. And there’s more

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Common presenting complaints