obstetric history and examination dr bassam akhdar consultant obstetrician&gynecologist makassed...
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Obstetric history and examination
Dr Bassam AkhdarConsultant
Obstetrician&GynecologistMakassed hospital
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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.
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Demographic details
• Name .• Age.• D.O.B• Address , phone nr.• Occupation.• Ethnic group.• Presenting complaint or reason for attending.
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This pregnancy
• Gestation , LMP or EDD.
• EDD= LMP +9M+7D
• 13WKS= 3 MON.
• Date as calculated from U/S.
• Single/multiple.
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• Investigations done during this pregnancy
( laboratory tests. Triple test. U/S.).
• Ask about contractions, vaginal bleeding, or loss of fluids.
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Ultrasound
• What type of U/S have been performed.
- Early US for dating.
- Early detailed US.
- Detailed US.
- Extended (anatomical) detailed us.• Were any problems identified?.
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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.
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Obstetric history
• Mode of delivery: spontaneous.. instrumental . C section.• Enfant : sex , weight, wellbeing.• Miscarriage,D+C. ectopic.• Postpartum complications : PPH. Eclampsia
Puerperal pyrexia.
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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.
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• Abruption : increased risk of recurrence.• Congenital abnormalities.• Macrosomia: risk of GDM.• IUGR : Increased risk of recurrence. preeclampsia . thrombophilia .• Unexplained SB : GDM .
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• 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)• PG : P1+0• Next pregnancy = G2 P1+0
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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.
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• Previous gynecological surgery:
laparatomy for pelvic mass.
myomectomy.
ovarian cyst.• History of infertility.
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Medical history
• DM: Macrosmia.
IUGR.
Cogenital abnormalities.
Preeclampsia.
SB.
HMD.
Neonatal hypoglycemia.
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• HTN: Preeclampsia.• Renal disease: Worsening of disease. Preeclampsia. IUGR. Preterm delivery.• Epilepsy : Convulsions. Congenital abnormalities .
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• DVT+ PE: Thrombophilia
Increased risk.
Preeclampsia.
IUGR.• HIV.• Connective tissue disease, SLE:
Preeclampsia , IUGR.
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Surgical history
• Previous operations mainly on abdomen• Type of anaesthsia.• Any complications.
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Psychatric history
• Anti psychotic medication.• Postpartum blues or depression.• Depression unrelated to pregnancy.• Major psychiatric illness.
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Family history
• First degree relatives :
Congenital anomalies.
Sex linked anomalies.
HTN.
DM.
Genetic disorders.
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Social history
• Smoking / alcohol /drugs Increased risk of miscarriage. IUGR. SB. Neonatal death• Marital status• Occupation &husband occupation.• Housing problems.
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Drug history
• All medication• Anti HTN• Antdiabetic• Antiallergic drugs
• Corticosteroids
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Allergies
• Allergy to drugs .• Allergy to substances.
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Physical examination
• General inspection and appearance:
Face : pallor, exophthalmia, facial palsy.
In pain : renal colic , abruption, PTL.
Looks ill, toxic: septicemia .
Poliomyelitis = asymmetrical pelvis.
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• 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.
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• 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.
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• Urine analysis : midstream urine for asymptomatic bacteriuria.
• Dipstic urine for albumin & sugar each visit.• Proteinuria : UTI.
PET.
Renal disease.
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• Heart examination: heart sounds .
murmurs .• Breast exam.: not necessary if no complaint.• Chest auscultation.
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Abdominal exam.
• Semi-recumbent position.• Cover legs with sheet.• Inspection:
- Shape of uterus .
- Any asymmetry.
- Look for fetal movements.
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- Look for scars :
Supra-pubic (CS. Laparatomy).
Sub-umbilical.
Rt-paramedian.
RIF.
RUQ.
- Note striae gravidarum, linea nigra .
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• Palpation:
1: Symphysis-fundal height.
Corresponding date
Large for date : Multiple preg.
Polyhydramnious.
Macrosomia.
Small for date : IUGR,
Oligohydramnious.
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2 : Fetal lie : Longitudinal
Oblique
Transverse
3 : Presentation : cephalic , breech , brow, face, shoulder.
4 : Engagement.
5 : Fetal heart beats.
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• Vaginal examination: Indications : Excessive vaginal discharge Vaginal bleeding. Cervical smear . ROM. Labour pain . Induction of labour.
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• Contraindications : Placenta praevia. Prelabour rupture of membranes• Speculum exam.: cusco speculum• Digital exam.: Dilatation & effacement of cervix. Membranes . presentation . station .
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• Digital exam.:
Dilatation & effacement of cervix.
Membranes .
presentation .
station . • Bishop score : 0,1,2,3 points for dilatation,
consistensy, length,position of cervix,and station of presenting part