History Taking in Obstetric and Gynecology. For 4th year medical students

1. History Taking in Obstetric
and Gynecology. For 4th year medical students
Hashem Yaseen MBBS, MSc (O&G), JBOG, Arab.BOG, MRCOG

2. Obstetric and Gynecology Department

4. The time in life when a
girl becomes sexually
mature. It is a process
that usually happens
between ages 10 and 14
for girls
Permanent cessation
of menstrual cycles.
12 months without a
menstrual period. At
age of 45 to 55 ,

6. What is special about
OBGYN History
taking?
● Obstetric History
● Past obstetric surgical history
● Fertility and sexual history
● Partner notification
● Correlate S&S with menstrual cycle
● Add gynecological causes to
non-gyne CC
● Contraception to drug history
● Cervical smear history

7. Overview
MENSTRUAL
HISTORY
Pelvic
Pain
Common
presenting
symptoms
Obstetric
History

8. Lorem ipsum dolor sit amet at nec at
adipiscing03
● Donec risus dolor porta venenatis
● Pharetra luctus felis
● Proin in tellus felis volutpat
Lorem ipsum dolor sit amet at nec at
adipiscing02
● Donec risus dolor porta venenatis
● Pharetra luctus felis
● Proin in tellus felis volutpat
Lorem ipsum dolor sit amet at nec at
adipiscing01
● Donec risus dolor porta venenatis
● Pharetra luctus felis
● Proin in tellus felis volutpat
Past obstetric Hx05
● Date of marriage, marriage
conception period,
● Full Hx of each pregnancy.
Review of
systems
04 ● Review all systems in relation to Hx
of present illness.
Hx of presenting
complaint
03
● Telling your story
● Analysis CC
● Associated symptoms
● Important negative symptoms - DDx
● Management history
Presenting
complaint02
● It’s duration
● From ER or referal
● Booking visit (Pregnancy)
Patient profile01
● Name, Age, occupation, address
● Name & occupation of husband
● Gravida , para
● LMP

9. Lorem ipsum dolor sit amet at nec at
adipiscing03
● Donec risus dolor porta venenatis
● Pharetra luctus felis
● Proin in tellus felis volutpat
Lorem ipsum dolor sit amet at nec at
adipiscing02
● Donec risus dolor porta venenatis
● Pharetra luctus felis
● Proin in tellus felis volutpat
Lorem ipsum dolor sit amet at nec at
adipiscing01
● Donec risus dolor porta venenatis
● Pharetra luctus felis
● Proin in tellus felis volutpat
Family history10
● Chronic disease
● Cancers
● Genetic diseases
● consanguinity
Drug history09
● Types, Dose
● Compliance
● OTC
● Contraception
Past surgical
history
08
● Any surgical procedures
● When
● Complications
● Outcome
Past medical
history07
● Any significant diseases and its duration
● Complications
● Disease control
Gynaecological
Hx
06
● Menstrual Hx
● Contraceptive Hx
● Cervical smear history

10. Lorem ipsum dolor sit amet at nec at
adipiscing03
● Donec risus dolor porta venenatis
● Pharetra luctus felis
● Proin in tellus felis volutpat
Lorem ipsum dolor sit amet at nec at
adipiscing02
● Donec risus dolor porta venenatis
● Pharetra luctus felis
● Proin in tellus felis volutpat
Lorem ipsum dolor sit amet at nec at
adipiscing01
● Donec risus dolor porta venenatis
● Pharetra luctus felis
● Proin in tellus felis volutpat
Spouse history13
● STI - reinfection
● Infertility
● Confidentiality
Sexual history12
● Use a simple pattern of questioning, and be
straightforward and unambiguous .
● explain why you need to ask these types of
question.●
Social history11
● Smoking
● Alcohol
● Insurance

11. Overview
MENSTRUAL
HISTORY
Pelvic
Pain
Common
presenting
symptoms
Obstetric
History

12. last menstrual period
The first menstrual period, (average
age 12)

13. last menstrual period
The first menstrual period, (average
age 12)

16. Primary amenorrhoea: periods
have not started by age 16.
Secondary amenorrhoea: there
have been no periods for ≥6
months but there was previous
menstruation.between periods (intermenstrual, IMB)
• after intercourse (postcoital, PCB)
• more than 1 year after the menopause
(postmenopausal, PMB).

17. last menstrual period
The first menstrual period, (average
age 12)

18. last menstrual period
The first menstrual period, (average
age 12)
Primary dysmenorrhoea is pain arising from uterine
contraction that is most intense just before and during peak
menstruation.
Secondary or progressive dysmenorrhoea, due to
underlying pathology such as endometriosis or chronic
infection, often manifests as pain that lasts beyond the
normal menstrual cycle. Infection, pelvic adhesions and
endometriosis can cause generalised pain

20. Overview
MENSTRUAL
HISTORY
Pelvic
Pain
Common
presenting
symptoms
Obstetric
History

29. Overview
MENSTRUAL
HISTORY
Pelvic
Pain
Common
presenting
symptoms
Obstetric
History

30. Dyspareunia
Dyspareunia is pain during intercourse:
1. felt around the vaginal entrance (superficial)
2. within the pelvis (deep).
Vaginismus: Pain due to involuntary spasm of
muscles at the vaginal entrance
Persistent deep dyspareunia suggests
underlying pelvic pathology.
Dyspareunia can be due to vaginal dryness
following the menopause.

31. Vaginal discharge
STI.
Partner
Recurrence
Previous treatment

32. Pelvic masses
Abdominal distension and bloating
Pressure symptoms
Ovarian, uterine, tubal, cervical, and non-gyne .

33. Incontinence (urinary, fecal)
-Involuntary voiding or leakage of urine or faeces .
- is most frequent in women who have born children.
- stress incontinence with urinary leakage on coughing, sneezing or
sudden exertion.
- a strong desire to pass urine even when the bladder is not full
(urgency) and leakage (urge incontinence)

34. Prolapse
'something coming
down’
Weakness in the pelvic
floor muscles
● The anterior and
posterior vaginal
walls
● Cervix
● The entire uterus

35. Overview
MENSTRUAL
HISTORY
Pelvic
Pain
Common
presenting
symptoms
Obstetric
History

36. Obstetric History
● Age
● Gravidity
● Parity ( G __ P__ + __ )
● Abortions
● last menstrual cycle (LMP)
● Expected date of confinement
(EDC) or Expected date of
delivery (EDD)
● gestational age (GA) in weeks,
Term , preterm, post date
● Any significant medical
illness

37. Obstetric History
● Age
● Gravidity
● Parity ( G __ P__ + __ )
● Abortions
● last menstrual cycle (LMP)
● Expected date of confinement
(EDC) or Expected date of
delivery (EDD)
● gestational age (GA) in weeks,
Term , preterm, post date
● Any significant medical
illness

38. Obstetric History
● Age
● Gravidity
● Parity ( G __ P__ + __ )
● Abortions
● last menstrual cycle (LMP)
● Expected date of confinement
(EDC) or Expected date of
delivery (EDD)
● gestational age (GA) in weeks,
Term , preterm, post date
● Any significant medical
illness

39. Obstetric History
● Age
● Gravidity
● Parity ( G __ P__ + __ )
● Abortions
● last menstrual cycle (LMP)
● Expected date of confinement
(EDC) or Expected date of
delivery (EDD)
● gestational age (GA) in weeks,
Term , preterm, post date
● Any significant medical
illness

40. Obstetric History
● Age
● Gravidity
● Parity ( G __ P__ + __ )
● Abortions
● last menstrual cycle (LMP)
● Expected date of confinement
(EDC) or Expected date of
delivery (EDD)
● gestational age (GA) in weeks,
Term , preterm, post date
● Any significant medical
illness

41. Obstetric History
● Age
● Gravidity
● Parity ( G __ P__ + __ )
● Abortions
● last menstrual cycle (LMP)
● Expected date of confinement
(EDC) or Expected date of
delivery (EDD)
● gestational age (GA) in weeks,
Term , preterm, post date
● Any significant medical
illness

42. Q1. A 56-year-old multiparous woman presents with 2 episodes of
mild vaginal bleeding. On questioning; last cycle was 18 months ago,
and she describes painless bleeding, without clots and changed one
pad only. Choose the single best answer from the list below to
describe her symptom:
(a) Normal menstrual bleeding
(b) Newly onset menstrual cycle
(c) Intermenstrual bleeding
(d) Postcoital bleeding
(e) Postmenopausal bleeding

43. Q2. A 36-year-old nulliparous woman presents with abnormal uterine
bleeding of 2 years duration. On questioning her cycle is regular,
9/30 days, and she describes passing large clots and flooding
through onto her clothes. Choose the single best answer from the list
below to describe her symptoms:
(a) Heavy menstrual bleeding
(b) Menorrhagia
(c) Prolonged, heavy menstrual bleeding
(d) Prolonged menstrual bleeding
(e) Irregular heavy menstrual bleeding

44. Q3. A 24-year-old newly married woman presents with acute lower
abdominal pain, it is associated with vaginal bleeding. She has
missed period of 2 weeks duration. She denies nausea or vomiting.
The most serious diagnosis that should be excluded initially is:
(a) Ectopic pregnancy
(b) Miscarriage
(c) Ovarian torsion
(d) Ruptured ovarian cyst
(e) Uterine cancer

45. Q4. The first menstrual period experienced by the female is
called:
(a) Puberty
(b) Menarche
(c) Menopause
(d) Thelarche
(e) Menorrhagia

46. Q5. A woman currently pregnant who has had a previous term delivery and one
early miscarriage. Regarding Gravidity and Parity:
(a) G2P3A1
(b) G3P1A2
(c) G3P2A1
(d) G1P2A3
(e) G2P2A1

47. Feedback
www.linkedin.com/in/hashem-yaseen-88714b146