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Obstetrical History and Physical Exam

Obstetrical History and Physical Exam. Jonathan Tankel FRCSC FACOG Dept of Obstetrics and Gynecology and Student Health Service, U of A jtankel@ualberta.ca. Obstetrical History. Early, accurate estimation of gestational age Identify patient at risk of complications

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Obstetrical History and Physical Exam

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  1. Obstetrical History and Physical Exam Jonathan Tankel FRCSC FACOG Dept of Obstetrics and Gynecology and Student Health Service, U of A jtankel@ualberta.ca

  2. Obstetrical History • Early, accurate estimation of gestational age • Identify patient at risk of complications • Ongoing evaluation of health of mom and baby • Anticipate problems and intervene if possible • Patient education, communication

  3. Obstetrical History • Personal/Demographics: • Obstetrical History • Date, Gestation, sex(s), birth weight, mode delivery, length labor, anesthesia/analgesia, outcome, complications • Personal and family history: • Medical: Endocrine , CV/HPT/VTE, Renal, Neurologic, GI (NB Hepatitis), Psychiatric, Autoimmune, Infectious, Blood transfusions, Blood disorders (Thromobophilias, sickle cell, thalassaemia, anemia)

  4. Obstetrical History cont. • Gynecologic History: • Pathology/procedures • Abnormal pap’s and treatment thereof • Surgeries • Medications ( ? Safe in pregnancy) • www.motherisk.org • Allergies • Habits/Substance abuse (talk re alcohol)

  5. Obstetrical history cont. • Genetic History: • Congenital (NTD, Heart, Clefts) • Chromosomes ( Downs, mental retardation, autism) • Advanced maternal age • Inherited: Hemaglobinopathy, MD, CF, Huntington's, Hemophilia, Metabolic , “others?”

  6. Obstetrical History cont. • Ethnicity • Ashkenazi Jew (refer Genetic counselor): Tay sacs, Canavan, CF, Familial dysautinomia, Gauchers……………………, • French Canadian/Cajun: Tay Sacs • Mediterranean/Asian/African/Hispanic: Hemaglobinopthy “what is your family’s country of origin?” • Consanguinity • Recurrent Pregnancy loss

  7. Obstetrical History • LMP • LNMP • Cycle length • Recent use of hormonal contraception • IUCD use? When removed? • If someone comes in with abnormal bleeding, you must assume that they are pregnant

  8. Obstetrical history continued • Current pregnancy history: • Depends on gestation: • Nausea, vomiting, weight loss • Bleeding: when, how much(?), bright vs. dark, post-coital?, associated pain or cramps • Exposure radiation or toxic substances • Fetal Movement (8-20 weeks) • Contractions • Suspected leaking of amniotic fluid

  9. Obstetrical History:ESTIMATED DATE of Delivery • Document EDD by LMP and then EDD Confirmed • IMPORTANT both in prematurity as well as post dates • With regular menses: • Add 7 days to LMP and subtract 3 months • US important if irregular, unsure, on contraception • THE EARLIER THE BETTER!

  10. Obstetrical exam • Initial exam /1st Prenatal visit • BP, weight (BMI to help counseling), • General exam • Head/Neck: Thyroid • CVS: Murmurs • Abdomen: Size of uterus, Fetal Heart • Pelvic Exam: • PAP /Swabs if indicated, screen for chlamydia (CT screen recommended for all but can do Urine NAT) • Bacterial Vaginosis: Routine screen NOT recommend • At 12 weeks, can feel fundus

  11. Obstetrical exam cont • Follow up visits Concerns? • Smoking, stress, spousal abuse increases during pregnancy, drugs, work exercise • Fetal movement • Contractions • Bleeding at each • BP, weight, urine • Inspect abdomen: Fetal lie • Palpation of the abdomen: • Leopolds maneuvers • Symphyseal Fundal Height

  12. Obstetrical exam cont.SFH • Used as an indirect screen for fetal growth between 20 & 36 week. Between 20 and 36 weeks, grows one cm per week. • Correlates with weeks. So it will be 20 +/-2 cm at 20 weeks. (+/- 2 cm) • Measure with patient supine and legs straight • Measure in the midline, cross the umbilicus, must keep legs straight • Discrepancy > 3 cm: • ULTRASOUND

  13. Obstetrical exam:Clinical Pelvimetry • Use to be performed routinely to see if vaginal delivery advisable. • Research shown not useful in detecting CPD and thus labor and delivery should generally be attempted.

  14. Obstetrical exam cont:Leopolds maneuvers • Lie on back, shoulders slightly raised • 4 Maneuvers: • Palpate upper abdomen • Determine location of the back – firm and smooth • Pawlicks Grip: • Face feet, attempt to feel the fetal brow • Can also do an xray

  15. Obstetrical Exam:Bishops Score • NO EXAM IF BLEEDING till Low lying placenta/Previa are excluded • Bishops score: • Predict whether induction will be required, method of induction, has been used in assessing odds of preterm labor • Max score 13

  16. Obstetrical Exam:Dilatation C. Cervix is completely effaced.

  17. Obstetrical exam:Assessing Rupture of membranes • Nitrazine (pH Testing) and Ferning • Nitrazine 87-97% accurate: • pH Vagina normally acidic • pH > 7 can indicate ROM • Can also be increase with BV/Blood • Ferning 84-100% accurate • Due to fluids' protein and NaCl content, form crystals with drying

  18. Obstetrical exam:Station Use where the front of the head in line with the ischial spine.

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