Obstetrics and Gynecology Past Paper PDF

HISTPRY TAKING Abdominal/pelvic/back pain? pain Site, Nature, Relation to periods, Name, Age, Occupation( patient and her Aggravati...

HISTPRY TAKING Abdominal/pelvic/back pain? pain Site, Nature, Relation to periods, Name, Age, Occupation( patient and her Aggravating and relieving factors. Burning husband), micturition? Address, time since marriage, is the Vaginal discharge: Amount, color, odor, marriage consanguineous? Blood group, blood, rash, pain. Rh. time and date of admission. Use of drugs e.g folic acid tablets? (small Gravidity (i.e. total number of pregnancies yellow-colored pills) including the current one). Was an ultrasound done at 6 or 7 wks? Parity (i.e. number of births beyond 24 Antenatal (period before pregnancy)? weeks gestation). Exposure to any harmful substance. A is the number of miscarriages or Ask for vaccination. termination of pregnancies before 24 Abdominal pain? Do you have any weeks gestation & ectopic pregnancy. contractions? Have you lost any fluid or blood from your Details of the presenting complaint and vagina? duration. Results of all antenatal blood tests- routine and specific. Reason for coming today? Any problems in antenatal care so far? Presenting complaints - when did they Low/high risk pregnancy? occur & how long they lasted, any investigation or treatment already? PAST OBSTETRIC HISTORY INCLUDES: SYSTEMIC REVIEW Pregnancy: as in Hx of present pregnancy (any problems during pregnancy, GA at CNS, CVS, RESPIRATORY SYSTEM, GIT, time of delivery?).e.g PE, miscarriage, URINARY SYSTEM. PTL(preterm labor),congenital abnormality, abruption... Labour/delivery:(Normal vaginal delivery? HISTORY OF CURRENT PREGNANCY. Csection, Labor- Normal? Prolonged, Was the pregnancy planned and Length of labor? Place of delivery? (at spontaneous? home or at the hospital?) Any other How did she know she was pregnant? complications? How did she confirm the pregnancy? Puerperium: Any complications? Baby: Gender of baby? Birth weight? Age of baby? Breast fed? Length of breast HISTORY OF 1ST TRIMESTER. (up to13 weeks) feeding? Obstetrical event and medical events : Nausea, vomiting? Bleeding per vaginum? e.g. Post Op complications FTND (full term normal delivery); vaginal/C- o Ex. 1990, Miscarriage: at 10/52, evac, no post op complications section o Ex.: 1992, Miscarriage:at 22/52, D&E, no Born home/hospital post op complications Male/female baby Weight (healthy at 2.8-3.6 kg, >4kg is GYNECOLOGICAL HISTORY macrosomic). Menstrual history Postpartum complications Menarche (first menses) age of it. periods: regular or irregular Breast fed Cycle length & days of bleeding(5/30 Baby alive and well. days), long cycle (pcos) Contraceptive history: date when o Ex. 2024, FTND, in hospital, male baby, contraceptives stopped 3.5 kg, no Pp complications, breast fed. Cervical smear (PAP smear, liquid bas cytology) (for screening for abnormalities), If not, ask why, when was Complicated birth: done? Year..... Any previous gynecological operations /conditions 39/52 If a woman has undergone treatment for C.S for APH(antepartum hemorrhage) cervical changes, this should be noted. Male/female Knife cone biopsy (performed when there are abnormal cervical cells e.g. Cervical Alive dysplasia)is associated with an increased Weight risk for both cervical incompetence (weakness)and stenosis (leading to Post-op normal preterm delivery and dystocia in labor Breast fed Previous episodes of pelvic inflammatory disease. o Ex. 2013, C.S for APH, female baby alive Previous ectopic pregnancy increases the 3kg, post op normal, breast fed risk of recurrence to 1 in 10. Recurrent miscarriage. pelvic masses such as ovarian cysts and Miscarriage: Fibroids.(uterine fibroids) Year Gestational age (eg. at 10/52) Evacuation PAST HISTORY (MEDICAL & SURGICAL) Special situations in history taking Medical conditions such as hypertension, Antepartum haemorrhage (APH) - Can epilepsy, Asthma or diabetes. Details of happen after 24 weeks only. any previous surgery. Blood Transfusion. The most important thing is to differentiate a serious APH (abruption, placenta praevia) from local causes of DRUG AND ALLERGY HISTORY bleeding. Current medications, Medications taken Always ask: at any time during the pregnancy. - Was there pain with the bleeding Include iron tablets, folic acid. Vitamins (abruption), or painless (dull ache Ask specific detail about at worst) (praevia)? antihypertensive, diabetic, - Did the baby stop moving with the anti-epileptic and thyroid medications. bleeding (abruption)? Any allergies. - Did your womb go hard as if you were having a contraction? - Where was the placenta on scan? FAMILY HISTORY Were you told it was low lying? Any history of hereditary illnesses or (praevia) congenital defects is important and is - Do you feel generally unwell? required to ensure adequate counseling (abruption)- Have you had and screening is offered multiple intercourse in the last 12 hours?- gestations. Have you had a recent smear test History of breast cancer, ovarian cancer, (you must not miss rare but uterine cancer. History of HTN, Diabetes. important cervical pathology)? Familial disorders such as - Remember that an abruption is thrombophilia's. more dangerous to the fetus, and praevia more dangerous to the mother. SOCIAL HISTORY Unemployed partners. ABDOMINAL EXAMINATION living status, total family members, Domestic violence. INSPECTION. Note the apparent size of the abdominal PERSONAL HISTORY distension. Note any asymmetry. Smoking, alcohol and illicit drug. Diet. Fetal movements. Linea nigra (dark pigmented line stretching from the xiphisternum through the umbilicus to the suprapubic area).  Striae gravidarum (recent stretch marks highest point of the fundus to the upper are purplish in color). Striae albicans (old margin of the symphysis pubis. stretch marks are silverywhite). Symphysis-fundal height (SFH): Measured Flattening/eversion of umbilicus. in cm > 25 weeks. Superficial veins. Surgical scars (a low Pfannenstiel incision may be obscured by pubic hair, and Leopold's maneuvers laparoscopy scars hidden within the Fundal grip umbilicus). FETAL LIE(lateral grip): (Lie: relationship of longitudinal axis of fetus to that of the uterus):Longitudinal-fetal head or breech PHYSICAL EXAMINATION IN OBSTETRICS palpable over pelvic inlet. Oblique-the Appearance: ill/well, obese/thin (body head or breech is palpable in the iliac weight), anxious/ depressed fossa. Transverse-fetal poles felt in flanks. Look for : Anemia, Jaundice, Cyanosis, 75% of baby's backs are on the left Dehydration, Edema, Clubbing, probably b/c of the liver on the right. This Koilonychias. is necessary to find the site to auscultate Body mass index (BMI) calculated [weight for the baby's heartbeat. (kg)/height(m)2]. Pregnancy complications are increased with a BMI< 18.5 and>25. PRESENTATION (pelvic grip-two hand technique) VITAL Sign (B.P, PULSE, TEMP, R.R). Blood (part of the fetus overlying the pelvic brim): pressure measured in the seated or semi- Cephalic, Breech, Other(shoulder, compound). recumbent position(45°tilt). ENGAGEMENT(pelvic grip) Thyroid gland Breast (exclude any lumps) engagement or the passage of the maximal diameter of the presenting part Auscultation of the heart and lungs. beyond the pelvic inlet, is estimated using the palm width of the five fingers of the hand. If five fingers are needed to cover the head above the pelvic brim, it is five PALPATION. fifths palpable, and if no head is palpable, NORMAL UTERINE SIZE it is zero-fifths palpable. In nulliparous women, engagement The uterus normally becomes palpable at usually occurs by 37 weeks but in 12 weeks’ gestation. It reaches the level multiparous women it may not occur until of the umbilicus at 20 weeks’ gestation. It the onset of labour. is at the xiphisternum at 36 weeks’ This is a one-handed technique that uses gestation. a cupped right hand to grasp and assess SYMPHYSIS-FUNDAL HEIGHT(fundal the lower pole of the uterus (usually the level): The uterine size is objectively fetal head). measured with a tape measure from the  A head that is only two-fifths palpable is Fibroids usually considered to be engaged. Large fibroids can cause major problems throughout pregnancy, especially at and just after, delivery. AMNIOTIC FLUID VOLUME: Tense abdomen with It is therefore relevant and important to fetal parts not easily palpated. Compact abdomen with fetal parts easily palpable. determine the size, position and number of fibroids antenatally. This will in turn allow decisions to be PALPATION OF UTERINE CONTRACTION. made regarding the mode and timing of delivery. Remember that the SFH may be AUSCULTATION OF THE FETAL HEART much larger than the gestational age The fetal heart is best heard at the equivalent measurement. anterior shoulder of the fetus using: A doppler ultrasound device (Sonicaid- dopple can be use) from about 12 weeks’ gestation. A fetal stethoscope (Pinard- stethoscope) from about 24 weeks gestation. In a breech presentation it is often heard at, or above, the level of the maternal umbilicus. The rate and the rhythm of the fetal heart should be determined over 1 minute. VAGINAL EXAMINATION A vaginal examination (speculum or digital examination) is not part of a routine obstetric examination but may be indicated to diagnose rupture of membranes or onset of labor. Special situations in the obstetric examination Hypertension/pre-eclampsia: blood pressure, urine for protein, Check for pretibial and sacral oedema, Remember to look with an ophthalmoscope at the fundi for hypertensive changes, Listen to the lung bases for pulmonary oedema.