By the end of this presentation, students :
1. Should be able to refine communication and clinical care skills in taking a pertinent comprehensive medical history
2. Assessing risk and patient adherence to health care recommendations.
3. Should be able to use this information to formulate a diagnosis and management plan while communicating important findings and recommendations to the patient
incorporating her socioeconomic and cultural context
1. HISTORY AND EXAMINATION IN
OBSTETRICS AND GYNAECOLOGY
Dr.Elhadi Ibrahim Miskeen MBBS, MD
Dr. Suad Elnour , MBBS, MD
College of Medicine University of Bisha, KSA
Clinical skill Course – skill lab
2022
2. INTRODUCTION
n Obstetrics was originally a separate branch of medicine,
and gynecology was a division of surgery.
n Over time, an increasing knowledge of the pathophysiology
of the female reproductive tract led to a natural integration
of these two areas, and obstetrics and gynecology merged
into a single specialty.
n Currently, many obstetrician–gynecologists also provide
routine general medical care for women throughout their
lives.
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3. Objectives
n Should be able to refine communication and clinical care
skills in taking a pertinent comprehensive medical history
n Assessing risk and patient adherence to health care
recommendations.
n Should be able to use this information to formulate a
diagnosis and management plan while communicating
important findings and recommendations to the patient
n incorporating her socioeconomic and cultural context
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4. General advices and principles
n When meeting a patient for the first time, always introduce
yourself; tell the patient who you are and why you have
come to see them.
n Make sure that the patient is seated comfortably.
n Some women will wish another person to be present, even
just to take a history, and this wish should be respected.
n The questions asked must be tailored to the purpose of the
visit.
n At a booking visit, the history must be thorough and
meticulously recorded.
n Once this baseline information is established, there is no
need to go over this information at every visit.
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5. HISTORY AND EXAMINATION IN
OBSTETRICS AND GYNAECOLOGY
OBSTETRICS
History
- Detailed history and Examination for the
assessment of mother and fetus,
identify risk factors in them and plan
management
6. 1. Demographic details
- Name - Husband’s name
- Age - Age
- Education - Education
- Residence - Occupation
- Occupation - Consanguinity
- Date and Time
7. 2. Main complaints
3. Obstetric History
4. Gynaecological History
5. History of present pregnancy
7. Past medical and surgical History
8. Family History
9. Social History
10. Drug History.
8. n 1. Demographic details
Ø Age: Old associated with
Ø chromosomal abnormalities e.g. trisomy 21
Down's syndrome
Ø Medical disorders e.g diabetes and hypertension
Ø Elderly primigravida (35 years) medical and
obstetric problem
Ø Multiple pregnancy (multipara) dizygotic twins
Ø Hydatidiform mole
n Young Age associated with
- per-eclampsia-eclampsia
9. - Consanguinity:
n Single gene inheritance Autosomal recessive
n e.g sickle cell anaemia sex- linked e.g.
haemophilia
10. n 2. Main Complaints
(3-4 complaints and duration)
2.1. Reason for admission or ante-natal visit
e.g. hypertension, Breech, repeated
caesaren section
2.2. Obstetric complaints Pain, Bleeding,
leakage liquor, absent foetal movement,
swelling
2.3. Medical or surgical Fever, vomiting,
cough
11. 3. Obstetric History
3.1. Duration of marriage; infertility, Assisted
3.2. Gravida Para Stillbirth
Abortion
Gravida:
Total number of pregnancies irrespective of
outcome.
Used only if woman is currently pregnant.
n Para: Total number of all deliveries (alive or
stillbirth) that have reached 28 weeks (24
weeks).
12. 3.3. Detailed description of all previous
deliveries (28 weeks or more)
- Gestational age
- Ante-natal complications (hypertension-
anaemia- bleeding)
- Spontanous or induced (indication)
- Mode of delivery Spontanous vaginal,
caesarean section (indication), forceps
(indication) ventous (indication), Breech
extraction, Destructive operation
- Complications of delivery Bleeding,
Retained placenta
13. Baby
Alive, SB
n Weight
n Apparent malformation
n Apgar
n Condition now and age
- Purperium
n Normal
n Bleeding, fever, urinary, DVT,
anaemia, breast feeding.
14. 3.4. Stillbirth
- Macerated: Intra- uterine foetal death – 24
hours
- Fresh: Intra-partum asphyxia
- Gestational age
- Ante-natal complications
- spontaneous or induced
- mode of delivery
- congenital malformation
- weight
- Puerperium.
16. n Example:
- Married for 10 years
- Gravida VI Para III One SB One Abortion
- First pregnancy:
Term, no ante-natal complications, spontaneous
vaginal delivery without complications, weight 3
kg, now alive and well 8 years old, normal
puerperium.
- second pregnancy: fresh still birth term, Breech,
assisted breech delivery, weight 3.5 kg , no
congenital malformation. Normal puerperium
- 6th pregnancy: Abortion
12 weeks, spontaneous, Evacuation done, had two
pints of blood.
17. 4. Gynaecological History
4.1. Menarche: Age when first menstruation
4.2. Katamina – cycle length and beeding duration 4/28
4.3. LMP: Last Menstrual Period
4.4. EDD: Expected Date of Delivery
4.5. Regular or irregular: 4/28
4.6. Gestational age in weeks: EDD= 40 weeks
4.7. Use of contraceptive pills: 3 months prior pregnancy
4.8. Dysmenorrhea
4.9. Vaginal discharge (colour-amount- odour-Blood-
itchy)
4.10. sexually transmitted Diseases
4.11. Most deliveries 37-42 weeks
18. - Factors making the calculation of pregnancy form
LMP unreliable:
- Uncertain dates
- Irregular periods (anything other than 28 days
regular eycle)
- Pills within 3 months before pregnancy
- Breast feeding within 2 months.
- Infection
n Neagle's formula
n Gestational age from the LMP = 280 days-40 weeks
n 365-90 = 275 +7 =282
19. Example:
- Menarche = 13 years
- Kata = 4/28
- LMP = 4.5.2008
- EDD = 11.2.2009
- Gestational age = 36/52
- No contraceptive pills in last 3 months
prior preg
- white vaginal discharge itchy
20. 5. History of present complains
n Example: Bleeding
n Duration, amount, pain, recurrent, causes.
6. History of Present Pregnancy
6.1. First trimester
Bleeding- hyperemesis- constipation – anaemia-
urinary problems- X-ray- drugs, U/S
6.2. Second trimester
Foetal movement from 20 weeks Bleeding,
liguor, U/S
6.3.Third Trim ester
Foetal movement
Bleeding – liquor
6.4. Any other complications or procedures (malaria,
immunization- screening)
21. 7. Past Medical or Surgical History
7.1. Any PH of Medical – surgical
7.2. Diabetes, Hypertension, Renal, Heart,
Asthma, epilepsy, thyroid
7.3. Hospital admission- blood transfusion-
surgical operation.
n 8. Family History
- Diabetes, hypertension
- Twins
- Malformed babies
9. Social History
n Residence, occupation, habits
22. 10. Drug History
10.1. Allergy
10.2. Drugs used for long duration steroids,
hypotensive, diabetic, epilepsy,
immunosuppersive druge, Asthma,
Psychiatric illnesses
10.3. Drugs using now.
23. Summary
Includes the followings
1. Name
2. Age
3. Gestational age
4. Obstetric history Gr Para Abortions
5. All abnormal deliveries
6. Main complaints
7. Significant PH, FH, SH, Drug
8. plan of management (if know)
9. condition now.
24. n Examination
n 1. General Examination
n 1.1. Postion comfortably in supine position
n 1.2. Right side of patient
n 1.3. verbal consent
25. n 1.4. General
Looks well or in pain, comfortable, not dayspneoe
short or tall, canula, catteter etc
1.5. Eyes: conjectiva, pallor. Sclera- jaundice
1.6. Mouth: Dental caries, artificial teeth, anaemia
1.7. Neck: Thyroid, jugular venous presuure, lymph
nodes
1.8. Hand: nails for anaemia- palmer Ereythema
1.9. Pulse: rate, volume, regularity, collapsing, vessel
wall, synchronus, femoral, Peripheral pulses
1.10. Blood Pressure Sitting or lying on left-side
26. 1.11. Breasts: Scars, veins - Nipple
(protruding, fissures, cracks, infection)
- masses
n - Discharge (colostrums , milk, pus, blood)
1.12. Heart
1.13. Respiratory
1.14 . Body Mass Index BMI=
Weight in Kg = 80 = 20
(Hight in meters)2 2 × 2 = 4
27. 2. Obstetric Examination
2.1. Inspection:
Distended – symmetrical- moves with
respiration – umbilicus – surgical scars-
striae gravidarum, linea nigra- ( feotal
movment if seen) Hernial orifices: mainly
anterior abdominal wall.
2.2. Superficial Palpation
- soft, firm, guarding
- Tender, not tender
- Mass
28. n Differential diagnosis of tender abdomen:
Labour, abruption, acute hydramios,
chorioamnionitis,red degeneration fibroid,
twisted ovarian cyst, acute appendicitis,
renal stone, UTI, gall bladder stone or
infection, liver, peptic ulcer, acute
pancreatits, peritonitis, intestinal
obstruction, parasitic.
29. 2.3 Deep palpation
Liver spleen kkidney
Difficult in advanced pregnancy
2.4. Obstetric Examination
- Fundal grip: which part occupies fundus
- Lateral grip: feel back (lie, position, FH)
- First pelvic grip: presentation
- Second pelvic grip: engagement
- Fetal Heart sounds
- Estimation of fetal weight and liquor
- Lower limbs (oedema- Voricose veins)
Vaginal examination is not a routine Done only if
there is an indication.
30. n Example:
- Looks well, not dayspnoeic, comfortable, tall
- not anaemicor jaundiced
- no dental caris or artificial teeth
- thyroid not enlarged
- Pulse 90 /min BP=110/70
- Breasts: nipple protruding, no fissure or cracks no
lump. Colostrums nipple discharge.
- Inspection:
Abdomen symmetrically distended, moves with
respiration, umbilicus flat, suprapubic transverse
incision scar, grid iron scar, no hernia
31. - Superficial palpation: soft- not tender- no
masses
- Obstetric examination.
Fundal hight 34 weeks
Longitudinal lie- cephalic
Left occipito lateral
Head not engaged
Foetal heart heared
Average wt foetus, average amount of
liquor
- lower limbs: no oedema or varicose veins.
32. GYNAECOLOGY
- History and Examination similar to obstetrics
with few differences and modifications.
1. Age:
- Childhood: vulvovaginitis, Prercocious Puberty
- Adolescence: Menstrual problems
- Fibroid 30 years+
- Ovarian cancer: menopause
- Cervical cancer: menopauce
- Endometrial cancer: menopauce
- Prolapse and incontince: menopauce
33. 2. Main Compaints
n Abnormal uterine bleeding, dysmenorrhoe,
dysparunia, pelvic pain, mass, infertility, urinary,
vaginal discharge, Backache.
3. Abdominal mass
n Site, size, consistency, mobility, tender smooth or
irregular, ascites, pelviabdominal.
4. Vaginal examination:
- Indication, privacy , empty blader, good hight third
person
- inspection: vulva
- speculum: cervix
Digital; vaginal, cervix, fornices
- Bimanual; size of uterus, mobile, tender
consistency, adenerae.
34. Conclusion
n Obstetrician–gynecologists must be able to
establish an empathic, trusting professional
relationship with patients
n and be able to perform a general and
women’s health history and physical
examination,
n using this information to formulate a
comprehensive management plan.
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