This document provides guidance on obstetric history taking and examination. It discusses obtaining a detailed personal, medical, surgical, obstetric and family history from the patient. Physical examination involves inspection of general appearance and vital signs, examination of breasts, abdomen, pelvis and fetal assessment. The abdominal examination includes assessing fetal position, presentation and growth. The vaginal examination evaluates cervical dilation and effacement to determine Bishop score for labor readiness. Obtaining a thorough history and physical examination is important for diagnosing any complications, determining gestational age and developing a provisional diagnosis and management plan.

1. Obstetric History and
Examination
DR. AHMED WALID ANWAR MORAD
PROFESSOR OF OBSTETRICS &GYNECOLOGY
FACULTY OF MEDECINE
BENHA UNIVERISITY
2018

2. Key points
 Introduce yourself using the full name .
 Explain what would you like to do and gain her consent.
 Ensure the patient is comfortable and warm.
 Do not do vaginal or breast exam. alone.
 All information's are confidential.

3. APPROACH TO AN OBSTETRIC PATIENT
HISTORY
EXAMINATION
INVESTIGATIONS

4. HISTORY
 History taking is an ART :
- Logical sequence
- Avoid inadvertent omission of important details.
- Guide examination.
 Since pregnancy is a “normal” occurrence, the usual
format of the clinical history should be modified.
 History of past pregnancy may alter the outcome of
current pregnancy.

5. 1-Personal History
 NN→ Name→ Name
 AA→ Age→ Age
 SS→→ sexsex XXXXXXXXXXXXXXXXXXXXXXXXXX
 OO → Occupation→ Occupation
 MM→ Marital status→ Marital status
 RR→ Residency (Address)→ Residency (Address)
 HH→ Special Habits→ Special Habits
 GG→→ Gravidity
 P→ Parity

6. Terminology
Gravida x, para a+ b
x = total number of pregnancies including this one
a = number of births beyond 24 weeks
b= number of pregnancies terminated befor 24 weeks

7. 22--CHIEF COMPLAINTSCHIEF COMPLAINTS
Chief complaint withChief complaint with
durationduration inin chronological orderchronological order
in patientin patient own wordsown words

8. 33--HISTORY OF PRESENT ILLNESSHISTORY OF PRESENT ILLNESS
1.1. AMENORRHOEA:AMENORRHOEA:
Expressed in weeks, Calculated from LMPExpressed in weeks, Calculated from LMP
Diagnosis of pregnancy confirmed???Diagnosis of pregnancy confirmed???
DATINGDATING
 (EDD= LMP +9M+7D)
For accurate estimation:
- Menses – regular, average length, sure
- No recent use of COC pills.
 Obstetric calendar (wheel)
 First trimester ultrasound scan
 Later ultrasound scan

9. Obstetric calendar (wheel(

10. 33--HISTORY OF PRESENT ILLNESSHISTORY OF PRESENT ILLNESS
2.2. SYMPTOMS RELATED TO PREGNANCY:SYMPTOMS RELATED TO PREGNANCY:
 NAUSEA & VOMITING
 FREQUENCY OF MICTURATION
 CONSTIPATION
 HEAVINESS IN THE BREAST
 RISE OF TEMPERATURE
3. ANKLE OEDEMA:ANKLE OEDEMA:
PRESSURE DUE TO GRAVID UTERUS
? HTN, ??? Protein Urea

11. 33--HISTORY OF PRESENT ILLNESSHISTORY OF PRESENT ILLNESS
4.4. PAIN ABDOMEN:PAIN ABDOMEN:
LABOUR PAIN
ABRUPTIO PLACENTAE
PRE-ECLAMPSIA TOXEMIA
DEGENERATION OF MYOMA
ACUTE URINARY RETENSION
TORSION OF OVARIAN CYST
ACUTE CHOLECYSTITISACUTE CHOLECYSTITIS

12. 33--HISTORY OF PRESENT ILLNESSHISTORY OF PRESENT ILLNESS
5.5.BACKACHE:BACKACHE:
Increase in body weight
Hyperextension of the spine
Laxity of joints in pelvis and spine
6. VAGINAL BLEEDING:6. VAGINAL BLEEDING:
- Implantation Hemorrhage,- Implantation Hemorrhage,
- Early pregnancy : Abortion, Ectopic Pregnancy, V.mole,- Early pregnancy : Abortion, Ectopic Pregnancy, V.mole,
- Late pregnancy: Placenta Previa, Abruptio Placenta, Vasa previa- Late pregnancy: Placenta Previa, Abruptio Placenta, Vasa previa

13. 33--HISTORY OF PRESENT ILLNESSHISTORY OF PRESENT ILLNESS
7.7. Decreased FETAL MOVEMENT:Decreased FETAL MOVEMENT: 10/ 12 hrs10/ 12 hrs
PRIMI: 18 weeks
MULTI: 16 weeks
8..Excessive ENLARGEMENT OF THE ABDOMEN:Excessive ENLARGEMENT OF THE ABDOMEN:
Multiple pregnancy ,
Hydramnios,
accidental hemorrhage,
Macrocosmia,
Miscalculation.

14. 33--HISTORY OF PRESENT ILLNESSHISTORY OF PRESENT ILLNESS
9.9.VAGINAL DISCHARGEVAGINAL DISCHARGE::
RUPTURE OF MEMBRANE
PHYSIOLOGICAL LEUCORRHOEA
CANDIDIASIS
CERVICITIS
10. HISTORY OF TT/ IRON+ CA SUPPLIMENTHISTORY OF TT/ IRON+ CA SUPPLIMENT

15. 3-HISTORY OF PRESENT ILLNESS
 Pregnant female for ( weeks) as her LNMP ( / / ) and EDD ( / / ) and
pregnancy is confirmed by pregnancy test since( / / )
 Analysis of the complaint ( onset, course duration)
 History of current pregnancy
 details of the 1st
,2nd
& 3rd
trimester
 admission and examination
 Investigations : lab tests & U/S scans pattern
 the expected management
 System review ( (

16. 4-Menstrual & gynecological history
 Cycle :
- 1st
day of LNMP ( was it conform to the usual in terms of
timing, volume, and appearance)
- Regularity
- Length
- OCP use.
 Surgical procedures
 Hx of infertility
 Sexually transmitted diseases
 Uterine anomalies

17. 5-Past obstetric history
Gravidity, Parity
Outcomes
 Gestational age: abortion, preterm, term
 Delivery
 Date
 Mode
 Place
 Infant : sex ,weight, wellbeing
 Complications

18. 6-Past medical/ surgical H
- Some medical conditions may have impact on the course of
the pregnancy or the pregnancy may have an impact on the
medical condition examples:
 Heart disease
 Hypertension
 Dm
 Epilepsy
 Thyroid disease
 B asthma
 Any previous surgery.
 Kidney disease
 UTI
 Autoimmune disease
 Psychiatric disorders
 Hepatitis
 Venereal diseases
 Blood transfusion

19. OBSTETRIC HISTORY
 7- Drug history and allergy.
 8- Social Hx → Cigarette smoking, illegal drug use, domestic
violence, psychiatric illness specially in postnatal period.
 9- Family Hx
- Hereditary illness → DM., Hpt., thalassemia, sickle cell
disease, hemophilia
-Congenital defects eg. neural tube defects, Down
syndrome
-Twins

20. OBESTETRIC PHYSICAL EXAM

21. Key points
 Wash your hands
 Introduce yourself using the full name .
 Explain what would you like to do and gain her consent.
 Ask patient to empty the bladder .
 Do not do vaginal or breast exam. alone.
 Ensure the patient is comfortable and warm.

22. Key points
 For abdominal exam: Uncover the patient’s abdomen
from the xiphi sternum to the pubic hairline, .
Abdominal wall relaxation is maximized by (arms
along side and hips slightly flexed)
 Advise the mother to indicate if she should feel weak
or nauseous.
 All information's are confidential.

23. EXAMINATION
 General
 General of the general
 Local of the general
 Breast
 Chest
 Abdominal
 Heart
 Back
 Lower limbs
 Specific
 Abdominal ( ???)
 Pelvic

25. General exam
 GENERAL PHYSICAL EXAMINATION :GENERAL PHYSICAL EXAMINATION :
APPEARANCE, HEIGHT, WEIGHT ,Body Mass IndexAPPEARANCE, HEIGHT, WEIGHT ,Body Mass Index
MODE, MEMORY, INTELEGENCE,MODE, MEMORY, INTELEGENCE,
ORINTATION (TIME ,PLACE AND PERSONS)ORINTATION (TIME ,PLACE AND PERSONS)
GAITGAIT
DECUBETUS , chloasmaDECUBETUS , chloasma
Head, eyes, ears, nose & throatHead, eyes, ears, nose & throat → no changesno changes
ThyroidThyroid → diffuse enlargementdiffuse enlargement
 PALLOR, ICTERUS, LYMPH NODES, CYANOSIS,PALLOR, ICTERUS, LYMPH NODES, CYANOSIS,
CLUBBING, OEDEMA, DEHYDRATIONCLUBBING, OEDEMA, DEHYDRATION

26. General exam
 VITAL SIGNS :VITAL SIGNS :
PULSEPULSE
BLOOD PRESSUREBLOOD PRESSURE
RESPIRATORY RATERESPIRATORY RATE
TEMPERATURETEMPERATURE
 BREAST EXAMINATIONBREAST EXAMINATION
 Chest ,heartChest ,heart
 Ophthalmoscopy hypertensive /diabetic women

27. Blood pressure
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 using 5th
Korotkoff sounds .
< 20 wks Chronic HTN .
> 20 wks Gestational HTN.
PET.

28. Abdominal exam
 Semi-recumbent position.
 Cover legs with sheet.
 Inspection:
- Shape of uterus .
- Any asymmetry.
- Look for fetal movements.
- Look for scars
- Hernia orifices.
- Cutaneous signs of pregnancy → linea nigra,
striae gravidarum, striae albicans, umbilicus flat or
everted, superficial veins

29. Abdominal exam
2-Palpation:
Superficial palpation: Temperature, Tenderness,
Gardening.
Specific palpation:
 Lie
 Presentation
 Engagement
 Fetal back
 Liquor
 Contractions

30. Specific palpation:
* Fundal height → Palpate before 20 wks( fundal level) +
→ Measure after 20 wks (Symphysis-fundal height)
* Leopold's maneuvers
1. Fundal grip
2. Lateral grip
3. First pelvic grip. PAWLIK’S GRIP
4. Second pelvic grip :

31. Symphysis-fundal height

32. Symphysis-fundal height
MEASUREMENTMEASUREMENT

33.  A), First maneuver. One or both hands are placed over fundus and the fetal part
identified.
 (B), Second maneuver. The palmar surface of one hand is used to locate the back of
the fetus and the other hand to feel the irregularities, such as hands and feet.
 (C), Third maneuver. Thumb and third finger are used to grasp presenting part over
the pubic symphysis.

(D), Fourth maneuver. Both hands are used to outline the fetal head.

34. Abdominal exam
3-Ascultation of fetal heart 
*Site: anterior fetal shoulder .
*Time:
- 12 wks by sonicade ( US Doppler device)
- 24 wks by Pinard steoscope
* Duration: rate ,rhythm over 1 min.
4-Percussion polyhydramnious ballotment & fluid
thrill

35. Vaginal examination:
PRE-REQUISITS:PRE-REQUISITS:
 EXPLANATIONEXPLANATION
 EMPTY BLADDEREMPTY BLADDER
 DORSAL POSITIONDORSAL POSITION
 FULL ASEPSISFULL ASEPSIS
 Equipment are presentEquipment are present
ContraindicationsContraindications ::
 Placenta praevia.Placenta praevia.
 Prelabour rupture ofPrelabour rupture of
membranesmembranes

36. Vaginal examination
Vulva and perineum:
 Hyper pigmentation
 Look for abnormalities  Varicose veins/ hemorrhoids,
Warts or herpes
 Cx : Softer, pigmented with  thick ,  yellowish
mucous secretions
 Uterus : enlarged

37. Pelvic assessment
 Check ischial spines if prominent or not
 Diagonal conjugate distance from lower border of the
symphysis pubis to the sacral promontery (pelvic inlet)
 Shape of the sacrum
 Side walls of the pelvis
 Distance between the two sacral promonteries

38. Bishop score

39. Provisional Diagnosis
Name …….., age ……. y, Gx Pa+b , ………. Gestational weeks,
complains of………., most probably……….., complicated or not,
for further investigations and management.

40. E.mail:::awalid217@yahoo.com