Obstetric+history+and+examination

1. Obstetric history and
examination
Dr Bassam Akhdar
Consultant
Obstetrician&Gynecologist
Makassed hospital

2. Key points
• Always introduce yourself .
• Say who you are.
• Ensure the patient is comfortable and warm.
• Do not do vaginal or breast exam. alone.
• All information's are confidential.

3. Demographic details
• Name .
• Age.
• Address , phone nr.
• Occupation.
• Ethnic group.
• Presenting complaint or reason for
attending.

4. This pregnancy
• Gestation , LMP or EDD.
• EDD= LMP +9M+7D
• 13WKS= 3 MON.
• Date as calculated from U/S.
• Single/multiple.

5. • Investigations done during this
pregnancy
( laboratory tests. Triple test. U/S.).
• Ask about contractions, vaginal
bleeding, or loss of fluids.

6. Ultrasound
• What type of U/S have been performed.
- 1st trimester US. For dating.(8-13).
- Early detailed US.(15-16).
- Detailed US. (18-25).
- Targeted Detailed US.
- Growth US.(30-32)

7. Past obstetric history
• List the pervious pregnancies and their
outcomes in order.
- date of delivery.
- place of delivery: home , hospital,
checkpoint.
- gestational age : abortion, preterm, term.

8. Obstetric history
• Mode of delivery: spontaneous..
instrumental .
C section.
• Enfant : sex , weight, wellbeing.
• Miscarriage,D+C. ectopic.
• Postpartum complications :
PPH. Eclampsia
Puerperal pyrexia.

9. Features that are likely to have impact on
future pregnancies
• Recurrent miscarriage :
Increased risk of miscarriage.
IUGR.
• Preterm delivery :
Increased risk of preterm delivery.
• Early onset preeclampsia:
Increased risk of PET.
IUGR.

10. • Abruption : increased risk of recurrence.
• Congenital abnormalities.
• Macrosomia: risk of GDM.
• IUGR : Increased risk of recurrence.
preeclampsia .
thrombophilia .
• Unexplained SB : GDM .

11. • Gravida: total number of pregnancies.
• Parity : number of live births at any
gestation or stillbirths after 24 weeks.
• Twins count as 2.
• Next pregnancy = G2 P2 (twins)
• G: P+A+E+CS+LC
• G0: Nullipara.
• PG, G1: P0+0. G2 P1+0

12. Gynecological history
• Regularity : irregular cycles = PCOD
• Contraceptive history:
OCP , depot progesterone
IUD
• PID : Ectopic pregnancy.
• Date of last cervical smear
• Previous treatment for cervical changes
• Previous ectopic pregnancy.

13. • Previous gynecological surgery:
laparatomy for pelvic mass.
myomectomy.
ovarian cyst.
• History of infertility.

14. Medical history
• DM: Macrosmia.
IUGR.
Cogenital abnormalities.
Preeclampsia.
SB.
HMD.
Neonatal hypoglycemia.

15. • HTN: Preeclampsia.
• Renal disease: Worsening of disease.
Preeclampsia.
IUGR.
Preterm delivery.
• Epilepsy : Convulsions.
Congenital abnormalities .

16. • DVT+ PE: Thrombophilia
Increased risk.
Preeclampsia.
IUGR.
• HIV.
• Connective tissue disease, SLE:
Preeclampsia , IUGR.

17. Surgical history
• Previous operations mainly on abdomen
• Type of anaesthsia.
• Any complications.

18. Psychatric history
• Anti psychotic medication.
• Postpartum blues or depression.
• Depression unrelated to pregnancy.
• Major psychiatric illness.

19. Family history
• First degree relatives :
Congenital anomalies.
Sex linked anomalies.
HTN.
DM.
Genetic disorders.

20. Social history
• Smoking / alcohol /drugs
Increased risk of miscarriage.
IUGR.
SB.
Neonatal death
• Marital status
• Occupation &husband occupation.
• Housing problems.

21. Drug history
• All medication
• Anti HTN
• Antdiabetic
• Antiallergic drugs
• Corticosteroids

22. Allergies
• Allergy to drugs .
• Allergy to substances.

23. Physical examination
• General inspection and appearance:
Face : pallor, exophthalmia, facial palsy.
In pain : renal colic , abruption, PTL.
Looks ill, toxic: septicemia .
Poliomyelitis = asymmetrical pelvis.

24. • Maternal weightand height:
normal wt. gain 12-15 kg.
• BMI < 20 : IUGR , Perinatal mortality.
• BMI > 30 : GDM, PET,Perinatal mortality.
• Height < 150 cm.
> 170 cm.

25. • Blood pressure: seated, semi-recombent.
each visit.
HTN : BP > 140/90 mm Hg on 2
separate occasions 6 H apart and less than 7
days .
< 20 wks Chronic HTN .
> 20 wks Gestational HTN.
PET.

26. • Urine analysis : midstream urine for
asymptomatic bacteriuria.
• Dipstic urine for albumin & sugar each visit.
• Proteinuria : UTI.
PET.
Renal disease.

27. • Heart examination: heart sounds .
murmurs .
• Chest auscultation.

28. Abdominal exam.
• Semi-recumbent position.
• Cover legs with sheet.
• Inspection:
- Shape of uterus .
- Any asymmetry.
- Look for fetal movements.

29. - Look for scars :
Supra-pubic (CS. Laparatomy).
Sub-umbilical.
Rt-paramedian.
RIF.
RUQ.
- Note striae gravidarum, linea nigra .

30. • Palpation:
1: Symphysis-fundal height.
Corresponding date
Large for date : Multiple preg.
Polyhydramnious.
Macrosomia.
Small for date : IUGR,
Oligohydramnious.

31. 2 : Fetal lie : Longitudinal
Oblique
Transverse
3 : Presentation : cephalic , breech , brow,
face, shoulder.
4 : Engagement.
5 : Fetal heart beats.

32. • Vaginal examination:
Indications :
Excessive vaginal discharge
Vaginal bleeding.
Cervical smear .
ROM.
Labour pain .
Induction of labour.

33. • Contraindications :
Placenta praevia.
Prelabour rupture of membranes
• Speculum exam.: cusco speculum
• Digital exam.:
Dilatation & effacement of cervix.
Membranes .
presentation .
station .