Obstetric history taking and examination

By Dr. Ahmad Essmat Assistant lecturer of obs / gyn El-Shatby Maternity hospital Alex. university

History
Personal Hx

Obstetric Hx Menstrual Hx
Surgical Hx Medical Hx Family Hx

History taking
name age address

Personal data
Marital state

occupation Husband data

Name Age Occupation Previous marriages Habit

Consanguinity

Old primi-gravida
Definition Complications
other

pregnancy

delivary

puerperium

1st half

2nd half

LMP

20 w

40w (280d)

1st trimester

2nd trimester

3rd trimester

12w
20w

28w

32w

36w

40w

abortion
1st trimester ab 2nd trimester ab

Delivary (labour)

12w

28w

Labor (3rd trimester)

PTL FT
Post date
Postterm

28w
<37w 40w

42w

1st trimester abortion

2nd trimester abortion

12w

28w

No. of previous preg Gravidity Parity Grand multipara

Course of previous preg

Obstetric history
Nature of prev abortions: No Cause Mode of TOP Type & duration

Nature of previous delivaries Dystocia Duration of labor Time of ROM Mode of TOP Behav of fetus Nature of prev puerp Obst operations CS VBAC Traumatic laceration

Analysis of each

Mode of delivary

Course of pregnancy

Outcome Complications Duration puerperium of delivary during of delivary pregnancy

G1

contraception

G2

contraception

G3

contraception

No. of previous preg

Gravidity:
no. of previous preg., irrespective to mode of TOP (either abortion, ectopic, mole or delivary) . Current preg is included.

Parity:
no.of previous delivaries (>28w) irrespective to no of fetuses or dead or alive. Numerical order E.g.G1P0 , G2P0+1, G4P0+3, G2P1, G3P2, G6P5, G2P0+0+1EP, G4 P1+1+1VM

Grand multipara
Definition Complications
other

pregnancy

delivary

puerperium

Course of previous preg

Abortion PTL FT Post date/post-term

1st trimester

2nd trimester

3rd trimester

12w
20w

28w

32w

36w

40w

abortion
1st trimester ab 2nd trimester ab

Delivary (labour)

12w

28w

Labour (3rd trimester)

PTL FT
Post date
Postterm

28w
<37w 40w

42w

1st trimester abortion

2nd trimester abortion

12w

28w

Nature of previous deliveries

Dystocia Duration of labor Time of ROM Mode of TOP Behavior of fetus Nature of prev puerp Obst operations
CS VBAC Traumatic laceration

Nature of previous abortions

No
Cause Mode of TOP Type & duration

Rhythm of menstrual cycle

Age of menarche

Duration and amount of blood loss

Menstrual history

Associated dysmenorrhea

Date & nature Of LMP

Normal menses
Normal menstruation requires . Age Amount Duration Rhythm

Normal menses

Normal menses
LMP LMP

5d(2d)

28d (7d)

50ml

Menorrhagia (>80ml) or >7d

menorrhagia

hypomenorrhea

hypomenorrhea

Metrorrhagia (metrostaxis)

Oligomenorrhea (>35d)

Polymenorrhea (<21d)

Age of menarche
Age of onset Amenorrhea Importance

Rhythm of menstrual cycle

Regular Vs irregular imp

Duration and amount of blood loss

Rhythm amount

Associated dysmenorrhea
Definition Types imp

Date & nature Of LMP

Naegle`s formula E.g.

examination
Examination of an obstetric case

examination
General exam General condition & configuration
1. 2. 3. 4. Gait Ht Build Pendulous abdomen Local abdominal exam Inspection 1. Hair 2. Pigmentation 3. Edema 4. Scars 5. Movements 6. Abdom enlargement Palpation Superficial palpation Deep palpation (grips) FL F.grip Lateral grip Pawlick grip Percussion & auscultation

Vital signs H&N Breasts Chest & heart Extremities back

General examination

General condition & configuration

Gait In early pregnancy Near FT waddling Other gaits e.g. limping,..

General condition & configuration

Height

Short Tall Measurement

General condition & configuration

Build

Normal wt gain in pregnancy Maternal malnutrition Obesity:

Measurement Impact of obesity on M & F

Impact of obesity on M & F

Maternal: hypertensive disorders of pregnancy gestational diabetes higher risk of cesarean deliveries higher incidence of anesthetic and postoperative complications in these deliveries. DVT Fetal: prematurity Low Apgar scores, macrosomia, neural tube defects increases perinatal mortality higher rates of childhood obesity.

General condition & configuration

Pendulous abdomen

definition How to Dx P.A? Causes P.A in primigravida .. Clinical significance

Vital signs
Pulse B/P Temp R.R.

Head and neck

Scalp: hair fall seborrhea Ears: wax, congestion, oto-sclerosis Eyebrows Eyes: lid edema, conjunctiva, fundus oculi

Head and neck

Face:
chloasma uterinum (pregnancy mask), hirsutism, acne (improves)

Nose:
congestion, chronic sinusitis

Mouth:
vitamen def., hypertrophic gingivits (epulis gravidarum), teeth, tongue

Neck:
thyroid gland, L.N.

Breasts

Local abdominal examination

Inspection
1. 2. 3. 4. 5. 6. Hair Pigmentation Edema Scars Movements Abdom enlargement

1.Hair
Normal hair distribution: Male pattern Female pattern Hirsutism: Def: Causes: Clinical significance

2.Pigmentation
Cloasma utirinum (pregnancy mask) Breast pigmentation Linea nigra Other sites

Causes fate

2.Pigmentation

3.Edema
Physiological edema Pathological edema How to assess edema?

4.Scars

5.Movements
Fetal movements Uterine contractions

Other movements
Peristalsis Muscular Respiratory

6.Abdominal enlargement

Obstetric Grips

Obstetric Grips
Fundal level Fundal grip Lateral (umbilical) grip 1st Pelvic grip Pawlick grip Combined grip

Fundal level

Fundal grip

Lateral (umbilical) grip

1st Pelvic grip

Pawlick grip

Combined grip

Position of pt

Lying flat on her back w pillow under shoulders legs extended

same

same

same

Lying flat on her back w knees & thighs flexed and abducted

As Pawlick

Position of dr
values

Rt facing her face

Duration of pregn

Rt facing her face

Identify fetal parts occupying UUS

Rt facing her face

Position of the back

Rt facing her feet

Identify presentation Engagemen t, station Attitude of head flexed or extended

Rt facing her face

same as1st Pelvic

Rt facing her face

same as1st Pelvic

Important Q:

Diff. fundal levels Causes of uterus > or < expected

Criteria of head, breech Ballottement of the head

Bilateral uniform resistance

Dd occiput and sinciput

P/V
Bishop's score
Cx dilatation effacement Position Consistency Station of P.P.

Bag of membranes
Intact Ruptured . Color of liquor (clear, bloody, meconium stained)

Presenting part
Nature (head, breech, empty, ) Station (-3,-2,-1,0,+1,+2,+3) Position (ant., post., Rt & Lt)

Pelvis
Promontry, sacral hallow, capacity (cavity) Outlet : subpubic angles, ischial spines, Soft tissues and perineum