Obstetric history

Question 1

What is gravidity?

Answer 1

Number of times a woman has been pregnant regardless of outcome

Question 2

What is parity?

Answer 2

Number of times a woman has given birth to a child with a gestational age >24 weeks regardless of whether the child was a live or not

Question 3

What is hyperemesis gravidarum?

Answer 3

Severe vomiting in pregnancy

Question 4

What clinical features is hyperemesis gravidarum associated with?

Answer 4

Electrolyte disturbance
Weight loss
Ketonuria

Question 5

What is reduced foetal movements associated with ?

Answer 5

Foetal distress and early foetal demise
Still birth
Foetal growth restriction 
Placental insufficiency 
Congenital malformations

Question 6

What might cause vaginal bleeding in pregnancy

Answer 6

Cervical bleeding - ectropion, infection, cervical cancer

Placenta praevia and abruption

Question 7

What may cause abdominal pain in pregnancy?

Answer 7

UTI
Constipation
Pelvic girdle pain
Placental abruption

Question 8

What might abnormal vaginal discharge in pregnancy be a result of?

Answer 8

STI or rupture of membranes

Question 9

What are the typical features of pre-eclampsia

Answer 9

Headache (frontal and severe)

Visual disturbance (flashing lights or blurring of vision)

Epigastric pain

Oedema (hands, feet and face)

Reduced foetal movements

Question 10

When is oedema normal in pregnancy?

Answer 10

When mild in the later stages

Question 11

Describe the onset and course of nausea and vomiting in pregnancy

Answer 11

Begins 4-7th weeks
Peak 9th-16th week
Resolves by 20 weeks

Question 12

When do women begin to feel foetal movements?

Answer 12

16-24 weeks

Primigravida women will not feel movements till 20 weeks

Question 13

What must you ask about when a patient presents with vaginal bleeding in pregnancy?

Answer 13

Pain
Trauma including domestic violence
Fever/malaise
Recent ultrasound scan results 
Cervical screen history 
Sexual history 
Past medical history 
Fatigue and symptoms of hypovolaemic shock

Question 14

What should you ask a patient presenting with vaginal discharge in pregnancy

Answer 14

Volume
Colour
Consistency
Smell

Question 15

What can untreated UTIs in pregnancy lead to?

Answer 15

Increased risk of foetal death, developmental delay and cerebral palsy

Question 16

What are some common symptoms of urinary tract infections

Answer 16

Dysuria
Frequency
Urgency
Fever

Question 17

What conditions may cause a fever in pregnancy?

Answer 17

UTI
Cervical infection
Chorioamnionitis

Question 18

What might fatigue in pregnancy indicate

Answer 18

Anaemia

Question 19

What might weight loss in pregnancy indicate?

Answer 19

Hyperemesis gravidarum
Malignancy
Anorexia nervosa

Question 20

What is pruitis a sign of in pregnancy?

Answer 20

Obstetric cholestasis

Question 21

Where is the pruitis of obstetric cholestasis typically experienced?

Answer 21

Palms and soles of feet

Question 22

How is accurate gestation estimated

Answer 22

Ultrasound scan to measure crown rump length

Question 23

When are women offered scan to detect foetal abnormalities?

Answer 23

18+0 and 20+6 weeks

Question 24

What are some key findings to note from foetal anomaly scans?

Answer 24

Growth of foetus - clarify if within normal limits for current gestation

Placental position - if low lying then greater risk of placenta praevia

Foetal anomalies

Question 25

List some forms of screening women are offered during pregnancy

Answer 25

Downs syndrome Rhesus status and presence of antibodies Hep B, HIV and syphilis

Question 26

What details of the pregnancy would you want to ascertain?

Answer 26

Singleton/multiple gestation Clarify if patient took folic acid prior to conception and during first 12 weeks Explore planned mode of delivery Ask about any medical illnesses during pregnancy

Question 27

Which vaccinations should pregnant women be up to date in?

Answer 27

Flu Whooping cough Hep B if at risk

Question 28

What should you ask a pregnant woman about in terms of mental health

Answer 28

Any mental health diagnoses? | Any current thoughts of self harm/suicide

Question 29

What would you want to know about a woman's previous obstetric history

Answer 29

Gravidity Parity Term pregnancies - gestation at delivery, birth weight, method of delivery, complications, assisted reproduction Still birth - gestation Other pregnancies - miscarriage (gestation, investigations for cause and management), termination of pregnancy (gestation and method), ectopic pregnancy (site, management)

Question 30

Which parts of the gynaecological history would you ask a pregnant woman

Answer 30

Cervical screening - confirm the date and result of last cervical screen, ask if any treatment is abnormal and check follow up is in place ``` STI Endometriosis Bartholin's cyst Cervical ectropion Malignancy - cervical, endometrial, ovarian ```

Question 31

What should you ascertain in the PMH from a pregnant woman?

Answer 31

Any medical conditions How well controlled the disease is Treatments Complications - include hospital admissions Surgery - abdo surgery may cause scars and adhesions, previous C-section increases risk of uterine rupture, loop excision of transitional zone has increased risk of cervical incompetence

Question 32

How does diabetes affect pregnancy?

Answer 32

Blood glucose control can deteriorate significantly resulting in poor maternal and foetal health (macrosomia)

Question 33

What can untreated/undertreated hypothyroidism result in?

Answer 33

Congenital hypothyroidism with significant neurodevelopmental impact

Question 34

Describe how epilepsy can complicate pregnancy

Answer 34

Risk to mother and foetus (miscarriage) | Many anti-epileptics are teratogenic

Question 35

Describe how previous venous thromboembolism may complicate pregnancy

Answer 35

Increased risk as pregnancy is a pro-thrombotic state

Question 36

What should be given to women who have already had a VTE and are now pregnant

Answer 36

Prophylactic treatment - LMWH

Question 37

What is important to know in the drug history of an obstetric history

Answer 37

Prescribed medications and over the counter medications - if patient still taking them, when did they stop, any side effects since becoming pregnant, teratogenic ones Contraception - method, check patient has stopped using it, check they have had device removed if coil/implant

Question 38

Give some examples of teratogenic drugs

Answer 38

``` ACEi Sodium valproate Methotrexate Warfarin Retinoids Trimethoprim ```

Question 39

What is folic acid used for in pregnancy

Answer 39

Reduce the risk of neural tube defects

Question 40

When is folic acid recommended in pregnancy?

Answer 40

Daily for first trimester of pregnancy

Question 41

What dose folic acid is recommended daily

Answer 41

400 micrograms

Question 42

What is oral iron used for?

Answer 42

Anaemia

Question 43

What are some important medical conditions to ask about in terms of family history?

Answer 43

Inherited genetic conditions - CF and sickle cell T2DM - increased risk if first degree relative Pre-eclampsia - increased risk if maternal mother or sister affected

Question 44

What is important to ask about in the social history of an obstetric history?

Answer 44

``` Accommodation Support network Who else lives with them ADLs Smoking Alcohol Recreational drug use Diet and exercise Occupation and maternity plans Domestic abuse ```

Question 45

List the structure of obstetric history

Answer 45

``` Introduction, wash hands and consent Gravidity and parity Presenting complaint History of presenting complaint Systems enquiry ICE Summarise and signpost Current pregnancy - gestation, scan results, screening and other details Immunisation history Mental health history Previous obstetric history - term and other pregnancies Gynaecological history - cervical screening and conditions/treatments PMH DH and allergies FH SH Close consultation ```