Introduction to OB/Gyn Rotation (481 GYN) History Taking in OB/Gyn Dr. Hazem Al-Mandeel, M.D Assistant Professor & Consultant Obstetrics & Gynecology Course 481 GYN

Course Contents 2 wks of lectures (theory part) Skill Lab (divided groups) Presentation on relevant instruments in Ob/Gyn (one group) 8 wks of clinical exposure + tutorials 2 wks for exams  total of 12 wks Marks: 10 (attendance & Hx taking) + 35 (continuous exam) + 55 (final exam) Exam parts: MCQS, Written OSCE (10 questions) + Oral OSCE (5 stations)

Important points to remember in History Taking Identify yourself to the patient & her companion Address the patient respectfully Respect the patient wishes & privacy during the interview & examination Ensure cleanliness, good grooming & clothes, and good manners in all patient encounters Avoid casual approach to all patients Maintain the privacy of the patients' medical information & records

Main History Never declare patient identity in a teaching session Personal history: age , marital status & duration of marriage if she is married, occupation ± nationality Gravidity (if she is pregnant) & Parity Last menstrual period (LMP) Present complaint(s) & duration (using the patients’ own wards)

History of Present Complaint(s) Start from the time of the complain and move backward or forward Some patients may not have a complain as those admitted electively (e.g. from the clinic) History of present problem should describe the full details of the complain , onset, duration, characteristics, any associated problems and important positive & negative symptoms Mention any prior investigations of the problem and any treatment(s) received

Obstetrical History Previous pregnancies should be reviewed in chronologic order with the following information: Date (year or how many years ago) and location of delivery Duration of gestation in weeks (if possible) Any important problems or complications during prenatal or antepartum course Duration of & type of labor (spontaneous or induced) Type of delivery (vaginal delivery, instrumental delivery such as forceps or ventose, or cesarean section) & indication Any maternal or fetal complications during peripartum period Birth weight, gender and current status or any complications

How do you lay down number of pregnancies & Abortions GPA system or GTPAL system Gravida (G) describes the total number of confirmed pregnancies regardless of the no. of fetuses or gestational age when the pregnancy ended Parity (P) describes pregnancies that continued for > 20 wks, regardless of number of fetuses & whether alive or stillbirth Abortion (A) is used for the number of abortions, ectopic pregnancy , or molar pregnancy

Gravidity & Parity Examples: A woman who is having 3 deliveries before and one abortion and now she is pregnant: you will say she is gravida 4 para 3+1 A woman with previous live twins delivered at 34 wks, one previous ectopic pregnancy & currently pregnant: ? A pregnant woman had three preterm babies at 24 wks, non is viable is: G? P? A? (GTPAL) First pregnancy will call the woman primigravida Previous delivery(s) after 24 wks will call her multiparous

How to calculate the expected date of delivery (EDD /EDC) Use Nageles rule: add 9 months & 7 days to first day of LMP (or add 7 to the day and subtract 3 from the months) Example: LMP 4-3-2009  EDD: ? Example: LMP 28-4-2009  EDD: ? Remember pregnancy is 40 weeks (not 36) Term pregnancy is completed 37 weeks of gestation (i.e. 38 to 42 wks) Preterm pregnancy is <37 wks Post-term pregnancy is > 24 wks

Gynecological History Menstrual history (length, days of menses, amount of flow, regular cycle or not) Intermenstrual bleeding or post coital bleeding Presence of dysmenorheoa (painful menstruation) Sexual history & dyspareunia (painful coitus) History of contraception Any history of lower genital tract infections In case of infertility, you should take history about the husband as well

Other History Parts Systemic Review Medical history: any significant medical diseases such as DM, HTN, etc… Surgical history: any surgical procedures Medications and allergies Family history: any significant illness esp. those with potential genetic predisposition Social history , habits , smoking, alcohol, drugs abuse, and socioeconomic status if possible