History Taking

OBSTETRICS
December 9, 2015

HISTORY TAKING 2.) Mother D consults at 34 weeks AOG, with the following
obstetrical history:
1sT Pregnancy: Ectopic Pregnancy, 8 weeks; right
Prenatal check-up is usually done in the clinic
salpingectomy
History
2nd Pregnancy: Full term, vaginal delivery, girl, alive
1. Socio-demographic risks
3rd Pregnancy: Full term, vaginal delivery, boy alive
2. Obstetric
4th Pregnancy: Twins baby boys, 35 weeks, CS, both alive
3. Menstrual
Answer: G5 P3 (2-2-1-4)
4. Sexual
*1ST 3 numbers: always total to the gravid
5. Contraceptive
6. Family and Genetic
7. Medical
8. Nutritional
MENSTRUAL HISTORY
9. Infection
 Age of menarche, characteristics and # of pads use
10. Psychological
 Subsequent menses: # of days and pads used
OBSTETRIC HISTORY
- Past obstetrical history: OBSTETRICAL INDEX
 Previous operative interventions (forceps, cesarean
section, ectopic pregnancy, etc.)
 Abnormal presentations
 Placental abnormalities (placenta previa, abruption)
Assess for Risk Factors:
GP (TPAL) SCORING  Obstetrical history
G: number of pregnancy irrespective of the pregnancy 1. Multiple pregnancy
outcome 2. Diabetes Mellitus
3. UTI
P: Number of pregnancies that have reached the age of 4. Hypertension disorder
viability (20 weeks). Delivery of pregnancy: ONE if 5. Multiparity
delivered, ZERO if aborted 6. Prolonged pregnancy
7. Macrosomia
T: number of full term pregnancies (37 weeks & 1 day up 8. Premature rupture of membranes
to 40 weeks) 9. Poly or oligohydramnios
10. Uterine and ovarian abnormalities
P: number of premature babies (<37 weeks) 11. IUGR (Intra-uterine Growth Restriction)

A: number of abortions (<20 weeks) including ectopic  Medical history

pregnancies and H-mole; induced or spontaneous 1. Genetic
2. Cardiovascular
L: number of children currently alive 3. Gastrointestinal
*G P (T-P-A-L): correct way of writing (ex: G7 P5 (4-1-2-5) 4. Endocrine disorders
Ex: G1P0 PU10 5. Hematologic disorders -30% thalassemia
G1-first pregnancy
P0-no delivered babies yet  Familial history
PU-Pregnancy Uterine 1. Twinning
2. Diabetes Mellitus
EXAMPLE CASES: 3. Hypertension
1.) Mother B consults at 20 weeks AOG, with the following
obstetrical history  Immunization status of the expecting mother
1sT Pregnancy: Abortion, 8 weeks, completion curettage
2nd Pregnancy: Full term, NSD, girl, alive
3rd Pregnancy: Twins baby boys, 35 weeks, CS, both alive
Ans: G4P2 (1-2-1-3)
*ung twins po ay counted as 1 sa GP pero pagdating sa TPAL
iquantify na
*sa G score always count ung present pregnancy
 DETERMINING EXPECTED DATE OF CONCEPTION /
DELIVERY DETERMINING AGE OF GESTATION (AOG)

1. NAEGELE’S RULE 1. Manual Computation

a. First is to determine the FIRST DAY OF THE LAST - number of days since LMP to the present day
MENSTRUAL PERIOD. STEPS:
b. Next is subtract 3 months, add 7 days, and add 1 a. Determine the LMP
year (-3 +7 +1). This formula is only applicable if b. Take note of the Days in each month:
the LMP is from APRIL to DECEMBER. January 31
refer to example #1 February 28
c. If the LMP falls within JANUARY to MARCH, just add March 31
9 to months, 7 to days and nothing to year April 30
(+9 +7 +0) refer to example #2 May 31
June 30
July 31
August 31
September 30
October 31
November 30
December 31
(for the nurses, they use their knuckles  )
c. Subtract the LMP day from the number of days in that
month.
d. Add all the days in each month including your answer in
letter C until the present day
e. Get the total then divide it by 7. The whole number will be
the weeks and the remainder will be the days
…ok hope the example helps…

Example: LMP: March 2

Present day: December 6
Step 1:
31 – 2 = 29
(31 kasi 31 days ang March. 2 kasi yan ung LMP day)

Step 2:
March 29
April 30
May 31
June 30
July 31
2. Timing of ovulation August 31
 Add 267 days to the date of the last ovulation to September 30
estimate the date of delivery October 31
November 30
December 6 (6 po kasi un ang present day)
TOTAL: 279

Step 3:
OBSTETRICS: History Taking 

279 / 7 = 39 remainder 6
(279 is from the total. 7 po is constant. Remainder 6 yan po
ung remainder pag manual divide ung as in lapis at papel
method )

Step 4:
39 remainder 6 is translated to 39 weeks and 6 days

FINAL FINAL ANSWER: AOG is 39 weeks and 6 days

2
 2. Mc Donald’sRule
*Formula: AOG = Fundic Height in cm / 4

Example: Fundic Height is 24 cm

AOG: 24 / 4 = 6
AOG = 6 months (24 weeks)

*For 20 weeks and below:

FH (in cm) x 8/7

3. Timing from quickening

Multipara- 16-18 weeks AOG
Primipara- 18-20 weeks AOG

4. Ultrasound
 determines the gestational age prior to the 3rd
trimester

ULTRASONOGRAPHY IN PREGNANCY – accuracy for AGING:

• Error of 7 days in the First Trimester
• Error of 10 days up to 26 weeks AOG
• Less accurate for aging in the 3rd trimester

5. Height of the fundus

12 weeks AOG - above symphysis pubis
16 weeks AOG- halfway between the s. p. & umbilicus
20 weeks AOG- level of the umbilicus
36 weeks AOG- below the sternum

Bartholomew's Rule of Fourths

- estimates AOG by the relative position of the uterus in the
abdominal cavity

OBSTETRICS: History Taking 