Obstetrics History

Case Study: Mrs. Hanaa Ahmed

Mrs. Hanaa Ahmed is 38 years old, G v P ii + ii, came to the antenatal clinic to follow her pregnancy. LMP 16/8/2023. What are the questions you will focus on in history?

How to Take History?

Steps

1. Identification
2. Past Medical History
3. Family History
4. Drug History
5. Social History
6. Obstetrical History (current & previous)
7. Gynaecological History
8. Complain of & History of presenting illness
9. Summary

Remember

• Obstetrical History (if obstetrical case in detail) & Gynae History will be in brief.
• In gynae history, vice versa; Gynae history will be in detail, and obstetrical history will be in brief.

Identification

• Name (at least three names)
• Age
• Occupation
• Blood grouping
• Husband’s name, age, BG, occupation, consanguinity
• Address
• Date of marriage
• Date of first examination

Notes

Women who have their first pregnancy at the age of 35 or more are called elderly primigravida.

Extremes of age (teenagers & elderly) are obstetric risk factors.

Past Medical History, Family History, Drug History, and Social History

Past Medical History

• DM
• ASTHMA
• HEART DISEASES
• HTN
• RENAL DISEASES
• (OTHERS)

Family History

• DM
• ASTHMA
• HEART DISEASES
• HTN
• RENAL DISEASES
• CONGENITAL ANOMALIES

Drug History

• Chronic medications
• Allergy

Social History

Obstetric History

Gravidity Parity LMP EDD History of current pregnancy:

• 1st trimester
• 2nd trimester
• 3rd trimester
• History of previous pregnancies

Risks Associated with Grand Multiparity

• Anaemia
• Increase risk of miscarriage
• Abnormal Fetal presentation
• Preterm delivery
• Uterine atony
• Placenta praevia
• Uterine rupture
• Amniotic fluid embolism
• Postpartum haemorrhage
• Stress incontinence and urinary urgency symptoms

Example: Gravidity and Parity

Ex: A woman who has had six miscarriages with only one live baby born at 32 weeks and is pregnant again will be: gravida 8, para 1. (para 1+6.)(G viii P i+ iv)

OR to say  ‘Mrs Wafaa is in her eighth pregnancy. She has had six miscarriages at gestations of 8–12 weeks and one spontaneous delivery of a live baby boy at 32 weeks. Baby Ahmed is now 2 years old and healthy.

LMP and EDD

• Use LMP to date pregnancy if the cycle was a normal cycle.
• The EDD is calculated by taking the date of the LMP, counting forward by 9 months, and adding 7 days.

Calculation of the Estimated Delivery Date

Month	Day	Year
Month of period - 3 months	Last Period + 7 days	+ 1 year

EDD (by Naegele’s Rule)

• The expected date of pregnancy.
• The median duration of pregnancy is 280 days (40 weeks), and this gives the estimated date of delivery (EDD).

How to Calculate EDD

1. Add 7 to days.
2. Subtract 3 (or add 9) to months.
3. Add 1 to the year if (month is bigger than 3rd month).

EX:

• LMP 7/7/2021AD
• EDD 14/4/202AD
• GA(gestational age) calculate the pregnancy age today

In previous ex GA 34 weeks. GA Calculation

History of Current Pregnancy

1st Trimester (0-13 weeks)

• Folic acid (drug history - teratogens)
• NVP
• Dating scan
• Downs syndrome screening

2nd Trimester (14-26 weeks)

• Quickening
• Vaccination
• Anomaly scanZ (24th wk for heart anomalies specifically and 18-22 generally for anomaly scan)
• Iron supplementationZ

3rd Trimester (27-40 weeks)

• Baby’s movement

• Assessment scan

• Mode of delivery

• Puerperium & breastfeeding

Don’t Forget

In all trimesters:Z

• Bleeding
• UTI (asymptomatic UTI 80%, every visit Urine test is done to exclude)Z
• Signs of anaemia

Previous Obstetric History

1. Organising the Record

• List all pregnancies chronologically (earliest → most recent).
• For each pregnancy indicate the outcome (live birth, miscarriage, stillbirth, termination, etc.).

2. Details to Capture for Every Pregnancy

Item	What to Record
Antenatal course	Any complications during pregnancy (e.g., gestational diabetes, hypertension, infection).
Gestational age at delivery	weeks + days (or “pre‑term,” “term,” “post‑term”).
Labor & delivery	• Duration of labor (first and second stages). • Mode of delivery (spontaneous vaginal, induced, instrumental, elective; forceps or term? Preterm? emergency C‑section at what time). • Complications that occurred during labor or delivery.
Post‑partum haemorrhage (PPH)	Presence or absence of PPH; amount of blood loss; need for transfusion; interventions used.
Neonate information	• Birth weight (grams or kilograms). • Sex of the infant. • Current age of the child. • Vital status (alive and well, ill, or deceased).
Puerperium	Any post‑natal complications (e.g., infection, wound dehiscence, thrombo‑embolism).

3. Parity Summary

Provide a concise overview of the woman’s reproductive history:

• Number of deliveries (e.g., G 5 P 3 A 2 L 0).
• Nature of each birth: term vs. pre‑term, singleton vs. twins.
• Complications: maternal (e.g., pre‑eclampsia, PPH, need for blood transfusion), obstetric (e.g., placenta previa, uterine rupture), and neonatal (e.g., low birth weight, congenital anomaly).
• Outcomes: live birth, stillbirth, miscarriage, or therapeutic abortion; indicate the gestational age at loss and whether any pathology (e.g., product histopathology) was performed.

Possible Complications of Puerperium

• PPH
• Urinary tract infections
• DVT
• Perineal wound
• Psychological complications (e.g., postpartum depression)

Gynaecological History in Current Pregnancy

• Ask about cycle regularity
• Vaginal discharge (colour, odour, itching; if so abnormal)
• Cervical smear
• Contraceptives (prior to conception)
• Gynaecological operations
• Assisted conception

Complain of & History of Presenting Illness

• If no complaint, ask her about:
  • Sleep
  • Appetite
  • Bowel habit
  • Urination

Gynaecological History (for Gynae Case)

Steps

1. Identification
2. Past Medical History
3. Family History
4. Drug History
5. Social History
6. Obstetrical History (in brief)
7. Gynaecological History
8. Complain of & History of presenting illness
9. Summary

Gynaecological History Details

• Cycle
• Menarche
• Kata
• Regularity
• Amount
• Dysmenorrhoea
• Bleeding PCB IMB
• Vaginal discharge (amount, colour, odour, itching, time)
• Dyspareunia
• Cervical smear
• Contraceptives
• Gynaecological operations
• Assisted conception

Summary

• Summarise your history

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