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OBSTETRICS HISTORY

Early pregnancy Greet the patient, congratulation


IP DUKKRZ FDQ I DGGUHVV \RXI F ongratulation on your pregnancy
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Emergency is my patient haemodynamically stable? check VS
Bleeding case, BP low ask vitals BP very low sitting standing IG OLNH WR SXW
2 large IV cannula, start fluids, take blood for blood grouping and cross matching.
History
Explore present pregnancy pyelonephritis, epilepsy
Ask the present complaint first
Menstrual history
Early pregnancy when was your last menstrual period, regular or irregular
Obstetrics
- Previous pregnancy
- how many
- any complications during pregnancy or labour
- mode of delivery
- birth weight
- any miscarriages
- any previous gynaecological problems ovarian cyst rupture and torsion
(emergency)
Past obstetrics history
Sexual history IP JRLQJ WR DVN \RX VRPH VHQVLWLYH TXHVWLRQVI LV WKDW OK?
- Are you in a stable relationship
- Any contraception
- STD
- PID in the past
- Stable partner
BLOOD GROUP
PAP SMEAR when, was it normal
Current obstetrics history
- So far, how is your pregnancy?
- How did you confirm your pregnancy (for early pregnancy)
- Is it planned or unplanned
- Are you aware of your blood group
- Have you done any antenatal check-up (blood test, U/S)
o FBE for Hb
o Rubella antibody
o VDRL for syphilis
o Hep B, Hep C, HIV antibody
o TFT
o Midstream urine (MSU) culture & sensitivity
o Indirect Coombs test
o BSL

o Down syndrome screening


o Have you done your ultrasound at:
18 weeks check size of the baby, site of placenta, single or
twins
26-28 weeks Glucose Challenge Test (sweet drink test)
After second trimester 16-18 weeks fetal movement chart
how many baby kicking 10 kicks for 12 hours (case of
decrease fetal movement)
34-36 weeks GBS low vaginal swab
anti D injection for Rh(-) is given at 28 weeks, 34 weeks, and
72 hours within the delivery (ask in any trauma, ectopic,
abortion, or miscarriages case give half a dose)
Presentation, fundal height,
Social history
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Whom do you live with must have good support from the family, any financial
problem, any stress
Who will bring you to the hospital
If there is another child who will look after your other child TKHUHV VRFLDO
worker
Family history
- Any similar problem (Down syndrome, Neurotube
malformation, congenital problem)
- Twins
- Miscarriage
- Epilepsy
- DM
- Hypertension

defect, any

fetal

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Past medical history
- Any significant illness in the past or hospital admission (heart murmur in
pregnancy)
Occupation
Any medication
- Any allergy to medication
Antenatal FOLIC ACID at least for 3 months

EXAMINATION
GA: well, distress, pallor, jaundice, oedema, any signs of dehydration
VS: temp, PR, RR, BP sitting & standing

Abdomen:
Inspection
- Asymmetry
- Any scar (previous SC)
Palpation
- Fundal height
- Fetal heart sound
- Fetal lie normal longitudinal (transverse)
- Fetal presentation cephalic, breech
- In late pregnancy head engaged or not
Auscultation
- Fetal heart sound
Speculum

- Always ask for consent


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the bimanual examination
- Os close or open
- Any bleeding
- Any clot
Bimanual examination
Ask for serum Beta HCG (early pregnancy)
Office test:
- Pregnancy test
- Random BSL
- Urine dipstick: protein (rule out eclampsia), keton (rule out dehydration),
glucose (DM), nitrates (UTI)
Normal antenatal visit
- 1-28 weeks every 4 weeks
- 28-36 weeks every 2 weeks
- >36 every week
Pre-pregnancy counselling for high-risk pregnancy such as DVT, epilepsy, DM,
mitral stenosis
- Antenatal blood test before pregnancy
- Folic acid take before pregnancy & during pregnancy
- Ultrasound 12, 18, 32 weeks
- After 36 weeks ultrasound every week
- CTG after 32 weeks twice a week
- Tell patient that we work as a multidisciplinary team in a high risk clinic
GP, obstetrician, neurologist/cardiologist, we will do frequent and regular
follow-up to monitor you & your baby

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