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Obstetric History

From Mediwikis

Introduction

  • Patient demographic and basic information: How many weeks pregnant, EDD, singleton/multiple pregnancy?
  • Source of referral: e.g. GP, community midwife, clinic etc.

Presenting Complaint

Give the patient time to describe this in their own words. Investigate the information as much as possible:

  • SOCRATES for pain
  • When did problems start?

Features specific for pregnancy- mnemonic

Some say pregnancy is tiring, but really it's just a BRIEF SAP:

  • Bleeding
  • Rashes
  • Immunisations
  • Estimated date of delivery
  • Fetal movements
  • Symptoms of pregnancy
  • Admissions (and other medical problems)
  • Pressure (blood)

History of Pregnancy

  • Screen for:
    • Bleeding
    • Rashes
  • Was this a planned pregnancy?
  • Any difficulties conceiving?
  • Any problems during pregnancy? e.g. worrying features on anomaly scan
  • Any previous admissions?
  • Estimated Date of Delivery- how was this estimated? (e.g. on LMP or by 12 week scan)
  • Do they take Folic acid? When did they start taking it?

Symptoms of Pregnancy

How are these changing? Are they getting better or worse?

  • Nausea, vomiting. Severity? How are they managing food and fluids?
  • Tiredness
  • Constipation
  • Heartburn
  • Breast Tenderness
  • Carpal Tunnel Syndrome
  • Oedema
  • Fetal movements- when did they start?

Antenatal Care

  • When did they first see the midwife?
  • Have they had their dating scan? (12 weeks)
  • Did they undergo screening for Down Syndrome?

Past Medical History

Are they adequately immunised?

Important maternal medical conditions to monitor during pregnancy:

Past Obstetric History

  • Previous pregnancies- Gravidity (Total number of pregnancies) & Parity (Number of births beyond 20 weeks, live or stillbirths)
    • Year, Gestation
    • Mode- Normal Vaginal, Caesarean, Forceps, Ventouse
    • Presentation- Breech?
    • Complications- Haemorrhage, special care for baby.
    • Development of child- any further problems?
  • Termination or Miscarriage: date, method
  • Any antenatal problems e.g. hyperemesis

Past Gynaecological History

  • Contraception
  • Fertility issues
  • Surgery of any kind
  • Cycle length
  • Sexually Transmitted Infections
  • Cervical smear history (note that the cervical screening program usually begins from the age of 25)

Drug History

  • Folic acid (400mcg normally, 5 mg for diabetics or epileptics)
  • Antihypertensives
  • Diabetes management
  • Thyroxine
  • Anti-epileptics

Family History

Use an open question "Does anything run in the family?"

Social History

  • Smoking status
  • Alcohol
  • Occupation
    • Maternity leave
  • Illicit drug use
  • socially supported
  • Other children
  • Marital status
  • Current relationship

Glossary

  • LMP: first day of last normal menstrual period
  • EDD: Estimated Date of Delivery/Estimated Due Date (as calculated from the LMP).
  • Naegele's rule (for calculating the EDD). Represents 280 days after LMP ( = 40 weeks, the average length of gestation)
    • Take the date of the LMP eg: 17th June 2010
    • Add 1 year = 17th June 2011
    • Subtract 3 months = 17th March 2011
    • Add 7 days = 24th March 2011 = EDD
  • Parity: number of deliveries after 24 weeks
  • Gravidity: number of total pregnancies (including this one, terminations, miscarriages and ectopics).
  • Term = 37 to 42 weeks
  • Booking bloods: FBC, HIV status, Rubella, Syphilis, Blood type, Rhesus status, BM, Hep B

Antenatal Scans

  • Receive a dating/viability scan at 10–12 weeks – normal result: ‘a single, uterine viable pregnancy’.
  • Nuccal translucency: scans nuccal neck fold thickness, for risk of Downs’s syndrome. 15–16 weeks.
  • Amniocentesis: Carried out from 12–18 weeks of pregnancy. 0.5-1% chance of pregnancy loss. Offered to mothers with a high risk of Downs’s syndrome or those with previous Downs’s syndrome positive pregnancies.
  • Chorionic Villous Biopsy (CVB)/Chorionic Villous Sampling (CVS): A needle (usually trans-abdominal) takes a sample of the placenta. Used between 11–13 weeks. Background risk of pregnancy loss with CVB is 2%.
  • Anomaly scan: 19–20 weeks – normal result: ‘no obvious fetal abnormality and normal growth rate’.

Notes

  • Bleeding, abdo pain, and discharge: potentially ABNORMAL symptoms
  • Breast tenderness, heartburn, constipation, polyuria, back pain, sickness: NORMAL symptoms of pregnancy
  • Ask about fetal movements after >20 weeks (or earlier in multiparous women), >10 in 24hrs is normal.