Obstetrics and Gynecology/Obstetrical Hx (OSCE)

Obstetrical History - Pregnancy Checkup or Complication During Pregancny

Intro

• introduce yourself

ID

• check: name, age, occupation
• check: marital status

CC

• use this to direct further questioning
• ask about: supportive partner, planned pregnancy, first pregnancy

Hx

HPI/Current Obstetric Hx

Menstrual Hx

• LMP; cycle length; (for EDC calculation)
• regularity = regular vs. irregular (metrorrhagia)
• flow: normal duration, quantity vs. prolonged,heavy (>7d,tamps/day; menorrhagia)
• color (dark red vs. bright (AUB))
• pain (? nonspecific?)
• PMS - headaches, anxiety, breast tenderness (? nonspecific?)
• Menarche, Menopause (? later is worse? nonspecific?)

PAPs Hx

• (last, frequency, abnormal)
• EDC Calculation (LMP + 7d -3mos + 1yr)

Contraceptive Hx

• Types, duration, date last use, compliance, future conception (may affect dates; progesterone/IUDS affect molar)

Current Pregnancy Hx

• Bleeding, discharge, vomiting, fever
• Contractions, fetal movements
• Smoking, drinking, drug use

Nutrition

• folate, vitamin D, caloric intake, iron, calcium

Ix

• Prenatal testing – MSS + NT U/S + fetal anatomy – defects?, dating?
• HIV
• others: thyroid, genetics, glucose tolerance test - outcome?

MAADS

• Meds, Allergies, Alcohol, Drugs, Smoking (esp during pregnancy)
• Immunizations (?unecessary?)

Previous Pregnancy Hx

• GTPALM
  • 1. pregnancies, term, premature (< 37 wks), abortions, live deliveries, multiples
• Year, sex, age children, birth weight
• Labour – type (vaginal or Cesarean), complications
• Postpartum complications (depression - "baby blues", feeding)

PMHx + SxHx

Do you have any health problems (other than the bleeding or whatever)? Have you had any operations or illnesses? Many people have had psychological or emotional illnesses like depression. They may find it difficult to talk about. Have you had any illnesses of this kind?

• ToRCHHS – toxoplasmosis, rubella, CMV, HIV, HSV, syphilis
• Coagulopathy
• Other illnesses/surgery? - Diabetes, HTN, kidney/heart/thyroid disease

FHx

Are there any illnesses that run in your family? Have any of the women in your family had problems with pregnancy? Have any babies been born with a problem or developed one later?

• Heart, diabetes, hypertension, seizures
• Genetic diseases (CF), congenital abnormalities (spina bifida, cleft lip)
• Multiple pregnancies (? nonspecific?)

Social Hx

• Family support, adjustment, abuse

FIFE + Discussion topics

• Feelings towards pregnancy, partner abuse?
• Ideas – what it’s going to be like, breastfeeding, prenatal classes
• Function – affect work? relationship w/ partner?
• Expectations – physician’s role, regular check-ups