Obstetric hx taking learning point:
Pt identification data: to assess risk, eg age>25 must do MOGTT, eg. If you get pregnant at age 25, your risk of having a baby with Down syndrome, for example, is about 1 in 1,250, according to the National Institutes of Health. At age 40, the risk is 1 in 100. If you'll be 35 or older on your due date, you'll be offered genetic counseling.
Occupation, socioeconomic class, does the mother able to take care of the baby after C-sec at home? Does the mother BF when she needs to go to work? the home using well water? can she take water after surgery while recovering?
gravida: G, P and +
multipara will has dx of false labour if dilatation is only 1cm
if +3 indicates recurrent miscarriage, need to find out cause
LMP: naegeles rule, SOD, regular menses, no BF, no hormonal therapy
EDD, REDD, POA
(must knw how to count)
used to detect postdate and also date for IOL for cases like GDM, PIH,...
date also help to identify IUGR, SGA...
read about U/S and discrepancy
C/O what bring pt to hospital? electively admitted? referred case?
(pt came in due to contraction pain? distinguish from braxton hicks, VE see any favourable cervix using Bishop score, ask for any show/leaking of liquor)
HOPI:
must knw disease:
1. GDM/pre-existing DM, clerk MOGTT, presence of risk factors, glycosuria, sx of DM (3Ps, numbness, blurring of vision), HbA1C, family hx of GDM, any congenital anomalies in fetus, any macrosomic baby, polyhydramnios, currently admitted blood sugar profile, insulin how many unit taken, any diet control? mx: IOL? cx that may arise, macrosomic, shoulder dystocia, perineal tearing? neonatal hypoglycemia?
2. Pre-eclampsia, Bp, proteinuria, mx
3. Placenta previa, PV bleed? pain? woody hard uterus?(abruptio) grade of placenta previa, causes such as multiparity,..., mx Mcafree Regime!
4. Postdate
5. Oligohydramnios, how to see AFI
6. Abnormal lie, whether to manually betulkan lie or let it be
anemia, iron metabolism
CVD, how to terminate pregnancy
IOL indications, C-sec indication, trial of scar
HOPP
missed period? UPT? (read UPT test principle, hCG, amino acids...)
failed contraception or planned pregnancy? assess pt's desire of having baby
if not because of missed period? sx of pregnancy? vomitting, abd distension, quickening?
confirm pregnancy where?
BOOKING! READ ABOUT EACH COMPONENT OF BOOKING AND KNOW WHY WE SHOULD KNOW.
(every month till 28, every 2w until 36, every 1w until delivery)
SUBSEQUENT FOLLOW UP? ULTRASOUND OK?
quickening? primid 18-20w, multi 16-18w
sx of pregnancy, breast engorgement, frequency, constipation, ankle edema, backache? (look for any symptomatic tx?)
Immunization
ATT (principle)
hep B (3x) last time...
Rubella secondary sch
Past OBS
consanguinous marriage?
Mode of delivery, Complication? preterm, full term? C-sec? episiotomy? poor spacing? healing scar? exclusive breastfeeding?
Recurrent miscarriage? D&C? (uterine scar...risk of placenta previa...)
any contraception?
Menstrual hx
menorrhagia? oligomenorrhea? amenorrhea?
PCOS? subfertility?
Gynae
PCOS? Uterine fibroid? any malignancy? ectopic pregnancy? recurrent miscarriage?
Pap smear done? when? where? result? (check how many times pap smear must be done every duration?)
PAST MEDICAL, SURGICAL, DM? HPT? HEART DISEASE? ASTHMA? TB?
uterine surgery, risk of placenta previa...
Family hx?
GDM, DM, HPT, HEART DISEASE, twins pregnancy, recurrent miscarriage, stillbirth, congenital abnormalities, gynae malignancy...
Personal and Social hx
socioeconomic status
does husband take care of family
children under care of
smoking, alcohol (husband? pt?)
Drug hx
iron, folic acid, vit b, vit c
*vit b complex contained folic acid
*obimin contain all
insulin for GDM (read back why Oral hyperglycemic Agent cannot be given)
magnesium sulphate for PIH (not sure, read back)
Prostin induction of labour, syntometrine, pitocin...(how to use)
Miseprostol, mifepristone for expulsion of POC
check for drugs use for termination of pregnancy
progesterone for maintaining pregnancy in threatened miscarriage
infection in pregnancy how to treat? common: UTI
any traditional med? any OTC drugs? any allergy?
Dietary
DM diet
Summary
AGE, GRAVIDA, PARA, POA, C/O
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