1 / 17

Obstetric History Taking

Max Brinsmead PhD FRANZCOG March 2010. Obstetric History Taking. Objectives:. To date the pregnancy But ultrasound is more accurate To identify problems requiring pro active care Antenatal care is an exercise in screening To establish rapport

kaida
Download Presentation

Obstetric History Taking

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Max Brinsmead PhD FRANZCOG March 2010 Obstetric History Taking

  2. Objectives: • To date the pregnancy • But ultrasound is more accurate • To identify problems requiring pro active care • Antenatal care is an exercise in screening • To establish rapport • In order to prepare patients for childbirth and parenthood • Is difficult unless there is continuity of care

  3. Components of an Obstetric History • Pregnancy dating • Past obstetric history • Past medical history • Social and Psychological Profile • Drug history • Family History

  4. Pregnancy dating: • Is important because… • Both pre term and post term pregnancies are at risk • As is being small or large for dates • Many tests require dates for accurate interpretation • Begin with LNMP and cycle length • Inaccurate indicator of conception in 1:3 women • Date when fetal movements are first felt • 16 – 22w in Primigravida & 14 – 20w for Multipara • The EDD is calculated by Naegele’s rule • Add 9 months and 7 – 10 days to LMP • Or use an obstetric wheel

  5. The obstetric detective: • A few women keep a menstrual calendar • Go back over important events • Coital history sometimes helps • “When did you first think you might be pregnant” • Assisted conceptions • Date of the 1st missed period • Date of the 1st positive pregnancy test • Fetal movements • Date of the first scan – and its EDD • Date of EDD from the 1st examination

  6. Past Obstetric History • Let the woman tell her own story • This tells you about “where she’s coming from” • But the essential information is… • Date and outcome of all pregnancies • Gestation and birthweight • Complications of pregnancy • Onset and length of labour • Mode of delivery • Complications of the labour, birth or puerperium • The baby • Facilitated by a form or aide memoire

  7. Medical History • “Serious illnesses or operations” • But especially those that may impact pregnancy • Trigger phrases that I use… • Heart problems or rheumatic fever • Asthma, bronchitis or other lung problems • Kidney disease or bladder infections • High blood pressure • Blood clots or thromboses • Nerves or depression • Back or spine problems • Serious accidents or blood transfusions • Sexually transmitted infections • Pap smears and gynaecological operations

  8. Social and Psychological Profile • “Is this a planned pregnancy” • Age, education, occupation & religion • All about the partner (or father of the baby) • The relationship – how long and how good • His age, health, occupation and family • Domestic violence • The in-laws and outlaws • Especially relationship with the patient’s mother • Do you have all your previous children with you? • Pregnancy and birth plans • “Do you wish to meet with a counselor”

  9. Drug History • Smoking, Alcohol, Prescribed and Other Drugs • Trigger phrases that I use… • Do you smoke, how many, do you have to, have you ever stopped • What is your favourite alcoholic drink, how often, how many • Are you taking any other vitamins, minerals or supplements • Have you ever injected yourself with drugs • Do you use pot, marijuana or any other recreational drugs • How about your partner

  10. Family History • Usually Hypertension, Diabetes & Twins • But routine screening makes the latter 2 superfluous • Trigger phrases that I use… • Do you know of any inherited conditions that run in the family like anaemia, birth defects, stillborn babies or babies that did not survive • Have there been any early deaths from heart disease or strokes, blood clots or thromboses • Anyone in the family who suffers from depression or nerves • Epilepsy or any other handicaps • Anyone in your family require Caesarean section

  11. Antenatal care is designed to: • Single out pregnancies that are abnormal, disordered or high risk… • In order to provide interventions that will optimise an outcome • So this is an exercise in screening • That starts with the history

  12. The objective of screening:

  13. The objective of screening:

  14. A typical screening scenario:

  15. Characteristics of a Test • Sensitivity = the chance that the disease will be detected • Positive predictive value = the chance that a screen positive individual will have the disease

  16. 7 Criteria to test a screening program • Is there a good screening test available • Is there an intervention available • Is the disease worth detecting • Will screen positive patients comply • Will the test reach those applicable • Has the program been tested by RCT • Can the health system cope with the program

  17. So never ask a question… • Unless the answer that you get will help you in the care of your patient • And never do an examination or a test • Unless the result is going to influence what you do next • This is especially true for the physiological event that is Pregnancy and Childbirth

More Related