1. Obstetric history and examination Dr Bassam Akhdar Consultant Obstetrician&Gynecologist Makassed hospital

2. Key points Always introduce yourself. Say who you are. Ensure the patient is comfortable and warm. Do not do vaginal or breast exam. alone. All information's are confidential.

3. Demographic details Name. Age. D.O.B Address, phone nr. Occupation. Ethnic group. Presenting complaint or reason for attending.

4. This pregnancy Gestation, LMP or EDD. EDD= LMP +9M+7D 13WKS= 3 MON. Date as calculated from U/S. Single/multiple.

5. Investigations done during this pregnancy ( laboratory tests. Triple test. U/S.). Ask about contractions, vaginal bleeding, or loss of fluids.

6. Ultrasound What type of U/S have been performed. - Early US for dating. - Early detailed US. - Detailed US. - Extended (anatomical) detailed us. Were any problems identified?.

7. Past obstetric history List the pervious pregnancies and their outcomes in order. - date of delivery. - place of delivery: home, hospital, checkpoint. - gestational age : abortion, preterm, term.

8. Obstetric history Mode of delivery: spontaneous.. instrumental. C section. Enfant : sex, weight, wellbeing. Miscarriage,D+C. ectopic. Postpartum complications : PPH. Eclampsia Puerperal pyrexia.

9. Features that are likely to have impact on future pregnancies Recurrent miscarriage : Increased risk of miscarriage. IUGR. Preterm delivery : Increased risk of preterm delivery. Early onset preeclampsia: Increased risk of PET. IUGR.

10. Abruption : increased risk of recurrence. Congenital abnormalities. Macrosomia: risk of GDM. IUGR : Increased risk of recurrence. preeclampsia. thrombophilia. Unexplained SB : GDM.

11. Gravida: total number of pregnancies. Parity : number of live births at any gestation or stillbirths after 24 weeks. Twins count as 2. Next pregnancy = G2 P2 (twins) PG : P1+0 Next pregnancy = G2 P1+0

12. Gynecological history Regularity : irregular cycles = PCOD Contraceptive history: OCP, depot progesterone IUD PID : Ectopic pregnancy. Date of last cervical smear Previous treatment for cervical changes Previous ectopic pregnancy.

13. Previous gynecological surgery: laparatomy for pelvic mass. myomectomy. ovarian cyst. History of infertility.

14. Medical history DM: Macrosmia. IUGR. Cogenital abnormalities. Preeclampsia. SB. HMD. Neonatal hypoglycemia.

15. HTN: Preeclampsia. Renal disease: Worsening of disease. Preeclampsia. IUGR. Preterm delivery. Epilepsy : Convulsions. Congenital abnormalities.

16. DVT+ PE: Thrombophilia Increased risk. Preeclampsia. IUGR. HIV. Connective tissue disease, SLE: Preeclampsia, IUGR.

17. Surgical history Previous operations mainly on abdomen Type of anaesthsia. Any complications.

18. Psychatric history Anti psychotic medication. Postpartum blues or depression. Depression unrelated to pregnancy. Major psychiatric illness.

19. Family history First degree relatives : Congenital anomalies. Sex linked anomalies. HTN. DM. Genetic disorders.

20. Social history Smoking / alcohol /drugs Increased risk of miscarriage. IUGR. SB. Neonatal death Marital status Occupation &husband occupation. Housing problems.

21. Drug history All medication Anti HTN Antdiabetic Antiallergic drugs Corticosteroids

22. Allergies Allergy to drugs. Allergy to substances.

23. Physical examination General inspection and appearance: Face : pallor, exophthalmia, facial palsy. In pain : renal colic, abruption, PTL. Looks ill, toxic: septicemia. Poliomyelitis = asymmetrical pelvis.

24. Maternal weightand height: normal wt. gain 12-15 kg. BMI < 20 : IUGR, Perinatal mortality. BMI > 30 : GDM, PET,Perinatal mortality. Height < 150 cm. > 170 cm.

25. Blood pressure: seated, semi-recombent. each visit. HTN : BP > 140/90 mm Hg on 2 separate occasions 6 H apart and less than 7 days. < 20 wks Chronic HTN. > 20 wks Gestational HTN. PET.

26. Urine analysis : midstream urine for asymptomatic bacteriuria. Dipstic urine for albumin & sugar each visit. Proteinuria : UTI. PET. Renal disease.

27. Heart examination: heart sounds. murmurs. Breast exam.: not necessary if no complaint. Chest auscultation.

28. Abdominal exam. Semi-recumbent position. Cover legs with sheet. Inspection: - Shape of uterus. - Any asymmetry. - Look for fetal movements.

29. - Look for scars : Supra-pubic (CS. Laparatomy). Sub-umbilical. Rt-paramedian. RIF. RUQ. - Note striae gravidarum, linea nigra.

30. Palpation: 1: Symphysis-fundal height. Corresponding date Large for date : Multiple preg. Polyhydramnious. Macrosomia. Small for date : IUGR, Oligohydramnious.

31. 2 : Fetal lie : Longitudinal Oblique Transverse 3 : Presentation : cephalic, breech, brow, face, shoulder. 4 : Engagement. 5 : Fetal heart beats.

32. Vaginal examination: Indications : Excessive vaginal discharge Vaginal bleeding. Cervical smear. ROM. Labour pain. Induction of labour.

33. Contraindications : Placenta praevia. Prelabour rupture of membranes Speculum exam.: cusco speculum Digital exam.: Dilatation & effacement of cervix. Membranes. presentation. station.

34. Digital exam.: Dilatation & effacement of cervix. Membranes. presentation. station. Bishop score : 0,1,2,3 points for dilatation, consistensy, length,position of cervix,and station of presenting part