Obstetric history

How do you define a family?
______________________________
What language does your spouse speak?
______________________________
Where did your spouse go to high school?
______________________________
Where did your spouse go to college?
______________________________
How many total deliveries did you have?
______________________________
What do you understand by full-term, preterm, miscarriages or abortion?
______________________________
How many full-term deliveries?
______________________________
How many preterm deliveries?
______________________________
How many miscarriages?
______________________________
How many are living?
______________________________
Do you or have you had gestational diabetes?
______________________________
yes no

Do you or have you had preterm labor?
______________________________
yes no

Do you or have you had high blood pressure?
yes no

Have you had a previous cesarian section?
______________________________
yes no

Has your labor been induced in your previous pregnancies before your due date?
______________________________
yes no

Has your labor been induced in your previous pregnancies on or after your due date?
______________________________
yes no

Social
Sexually active or not

Taking a Sexual History

Given that women now live approximately one-third of their lives after menopause and continue to be sexually active beyond the cessation of reproductive functioning, the sexual history should now be a routine component of the annual clinical visit of the woman in midlife and beyond.1 Kingsberg suggests that pre- and postsurgical visits (for uterine prolapse, hysterectomy, oophorectomy, mastectomy, etc.), as well as those related to menopause, chronic illnesses, and depression, also lend themselves to inclusion of assessment for sexual disorders.2 Starter Questions

Contraception and Risk of Unintended Pregnancy and STIs in Perimenopausal and Menopausal Women Women over the age of 40 have the second highest proportion of unintended pregnancies, so the need for effective contraception continues into midlife until menopause.3 No contraceptive method is contraindicated by age, and certain methods, such as oral contraceptives (OCs) and other hormonal methods, may stabilize hormone levels and ease the transition through menopause.3,4 The decision about which method to use should be guided by patient preference, lifestyle, behaviors (e.g., cigarette smoking), and medical history.3,4 Safe-sex practices should be discussed with all patients regardless of their age or sexual orientation.

Are you currently involved in a sexual relationship?
______________________________
Do you have sex with men, women, or both?
______________________________
Are you or your partner having any sexual difficulties or concerns at this time, or do you have any questions or concerns about sex?

More extensive questioning can include the following:

Are you satisfied with your current sexual relations?
______________________________
Do you have any sexual concerns you wouldlike to discuss?
______________________________
If a patient responds with answers suggesting she has concerns and wants to discuss them, you might then proceed as follows:

�Tell me about your sexual history�your first sexual experiences, masturbation, how many partners you�ve had, any sexually transmitted infections or past sexual problems you�ve had, and any past sexual abuse or trauma.�
______________________________
How often do you engage in sexual activity?
______________________________
What kinds of sexual activities do you engage in?
______________________________
Depending on the sexual orientation of the patient, ask about the specific forms of sex, including penis in mouth, vagina, or rectum; mouth on vulva.
If the woman is a lesbian, ask if she has ever had penetrative sex with a man, to assess her risk of cervical cancer and sexually transmitted infections.
Do you have difficulty with desire, arousal, or orgasm?
______________________________
If the woman is peri- or postmenopausal, preface these questions with information that many women often experience vaginal dryness and changes in sexual desire around the time of menopause.

Along with sexual activity questions, a standard menstrual and obstetric history should be obtained, inquiring about the age of onset of menses, last menstrual period, characteristics of menstrual periods, problems associated with menses in the past, pregnancy-related problems, and perimenopausal/menopausal symptoms.2

Physical Examination

A comprehensive physical examination should be conducted to detect potential contributors to or causes of sexual problems. This examination, which should be conducted with close monitoring and input from the patient to isolate potentially painful areas, should also be used to educate the patient about her reproductive anatomy and sexual functioning.

Spouse
resources
Educational:intellectual level
Living area: areation, sunligh crowding

Menstrual history

First day of the Last menstrual Period (LMP)
When was the first day of your last menstrual period?
Normal range
Definitions:
Menorrhagia
Hypomenorrhea
Oligomenrhea
Amenorrhea
Menopause

Dates: Regular? Sure? Reliable?
Details for gynecologic sheets:
Menarche
Dysmenorrhea (spasmodic, congestive, etc.)
Premenstrual syndrome

Obstetric history

Parity: outcome of previous pregnancies
Gravidity: order of the current pregnancy (if
pregnant now)
Delivery:>28 weeks
Miscarriage: <28 weeks
Systems of terminology
Gravida _____, Para ___
Para a + b (a=delivery, b=miscarriage)
Para a,b,c,d
a= full term delivery
b= preterm delivery
c= miscarriage
d= ?living

Details in an obstetric sheet (Chronolically):
1) Date
2) Place
3) Mode
4) Maturity
5) Fetal life
6) Fetal sex
7) Fetal weight
8) Onset of labor
9) Antenatal complications
10) Postnatal complications
11) Neonatal outcome
12) Breast feeding

Contraceptive history

http://www.mjbovo.com/Contracept/

Pap smear

(Controversial)

Past history

Medical
Surgical & anesthetic
Hospital admission
Drugs
used
Allergy
Blood transfusion

Medical history
Hypertension- Diabetes mellitus
Cardiovascular-Respiratory
Hepatic-Renal-GIT
Endocrine-Neurological
Bleeding tendencyThrombophilia
Others

Family history
Similar conditions as to patient complaint
DM or hypertension
Familial disease e.g thrombophilia, bleeding tendency, PCOS
Fetal anomalies or inborn errors of metabolism
Malignancy
Infections
Complaint
Main complaint
In the patient's own words.
Duration of the complaint.
History of current pregnancy of illness
Analysis of the complaint
Symptoms
Onset, course, severity, duration
What increases/decreases the symptom
Associated symptoms
Others symptoms to prove.disprove
the provisional diagnosis
Investigations done (date, place & results)
Treatment recdeived (details and response)
Any complications
Obstetric symptoms
Emesis gravidarum
Urinary disturbances
Fetal kicks & quickening
Bleeding
ROM
Contractions
Passed Show
Diabetes
Hypertension
Antenatal care
Preg test
BP
Weight
Ultrasound
CBC/Rh
Bl. sugar
As needed
Gunecologic symptoms
A:Amenorrhea
B:Bleeding pv
C:coital difficulty
D:discharge
E:enlargement
F:fertility
G:galactorrhea
H:hirsutism
I:incontinence
P:pain
P:prolapse
P:pruritus vulvae
OTHERS SYSTEMS REVIEW
Cardiovascular-Respiratory-Hepatic-Renal-GIT-Endocrine-Neurological
Medical termination of pregnancy.
Who decides?
Who terminates?

What are the indications of medical termination of pregnancy?

In case the pregnancy is the result of rape or conspiracy.
The woman could not cope with labor.
Due to ailment, the woman would not be able to bring up the child with love and care.
Even if any other person or group comes forward and takes responsibility for bringing up the baby, pregnancy can't go ahead.
We are dealing with a human being.
There is a difference between human pregnancy, family-centered maternity care, and poultry farms.
Other medical indications.

What should happen if these guidelines are violated?
Dishonorable discharge from service with punishment.

Who may violate these guidelines?
Medical doctors, judges, director of health, secretary of health, head of the state, county, city, and others.

Do you know any such situation or incident?
Miscarriage
Abortion
Labor
Premature Labor
Management of the First and Second Stages of Labor
Episiotomy
Cesarean section

What is an episiotomy?
What is a cesarean section?
When is a C-section needed?
What are the risks of C-section?
How is a C-section done?
How long does it take to recover from a C-section?
Why would I want to avoid a cesarean?
Hypertension in Pregnancy
Diabetes in Pregnancy
Irregular Menstrual Periods
    Have you been experiencing high levels of stress?
    How much do you exercise?
    Have you ever had an eating disorder?
    Have you lost weight recently?
    Have you been intolerant of heat or cold?
    Have you had rapid heartbeats, dry skin, hair loss, constipation or diarrhea, or a change in weight (these are symptoms of thyroid abnormalities, which can cause irregular periods)?
    Do you have abnormal body hair?
    Have you gained weight?
    Do you have regular menstrual cycles?
    Is your bleeding always heavy or prolonged?
    How old were you when you started menstruating?
    How long ago did you develop irregular periods?
    When you do have your period, is it accompanied by symptoms such as abdominal cramping, mood changes, and bloating?
    Are you sexually active?
    When was your last period?
    How many times have you been pregnant?
    What was the outcome of each pregnancy (live births, miscarriages, cesarean sections)?
    Have you ever had difficulty getting pregnant?

    Your Doctor Might Examine the Following Body Structures or Functions:

    Heart rate, blood pressure, and weight
    Heart and lungs
    Pelvic examination

    Your Doctor Might Order the Following Lab Tests or Studies:

    Pregnancy test
    Blood tests for certain hormone levels (thyroid stimulating hormone, cortisol, prolactin, follicle stimulating hormone, 17-hydroxyprogesterone, testosterone, DHEA)
    24-hour urine collection for free cortisol
    Pelvic ultrasound
    Pap smear

Diagnosis and Management of Intrauterine Growth Restriction
Spontaneous Abortion
Postpartum Blues, Depression and Psychoses
Osteoporosis
Vulvovaginitis
Evaluation and Management of Cervical Abnormalities
Postmenopausal Symptoms and Their Sequelae
Dysmenorrhea
Dysfunctional Uterine Bleeding
    Do you have regular menstrual cycles?
    Is your bleeding always heavy or prolonged?
    How old were you when you started menstruating?
    How long ago did you develop abnormal bleeding?
    Have you gone through menopause yet?
    Are you sexually active?
    When was your last period?
    How many times have you been pregnant?
    What was the outcome of each pregnancy (live births, miscarriages, cesarean sections)?
    Have you ever had difficulty getting pregnant?
    What medications are you taking (including over-the-counter drugs and herbal remedies such as ginseng)?
    Are you taking hormone replacement therapy or birth control pills?
    Have you ever had medications injected (Depo-Provera or Norplant) for birth control?
    Have you ever taken estrogen or tamoxifen?
    Are you taking warfarin or other blood thinners?
    Have you ever had cancer of any type?
    Have you ever had an abnormal Pap smear?
    Do you bruise easily?
    Do your gums bleed?
    Do you get nosebleeds?
    Do you have a blood-clotting abnormality or does one run in your family?
    Do you have kidney or liver disease?

    Your Doctor Might Examine the Following Body Structures or Functions:

    Blood pressure, heart rate, weight
    Abdominal examination
    Pelvic exam

    Your Doctor Might Order the Following Lab Tests or Studies:

    Pregnancy test
    Blood tests such as complete blood count, coagulation (clotting) studies, and certain hormone tests (such as thyroid stimulating hormone, cortisol, prolactin, follicle stimulating hormone, testosterone)
    Pelvic ultrasound
    Pap smear
    Rare Endometrial biopsy
Ectopic Pregnancy
Management of Contraception
Response and management to other disasters
Sexually Transmitted Disease
Contraception
    What is contraception?
    What different types of contraception are there?
Premenstrual Syndrome
    Q) What Is Premenstrual Syndrome?
    Q) What Are The Symptoms Of PMS?
    Q) What Causes PMS?
    Q) What Hormones Cause PMS?
    Q) How Do Hormonal Changes Cause PMS?
    Q) Could Calcium And Magnesium Imbalances Be Involved?
    Q) Does Stress Cause PMS?
    Q) How Can I Tell If I Have PMS?
    Q) Should I Get Treatment For PMS?
    Q) What Treatments Work?
    Q) What changes in diet can help?
    Q) How can physical activity help?
    Q) What about stress management?
    Q) What other non-drug treatments can help?
    Q) What Medicines Can Help?
    Q) How Can I Treat Specific Symptoms?
    Q) Where should I start?
    Q) Will PMS get worse?
    Q) Do women with PMS have different hormone levels?
    Q) Can PMS mimic other diseases?
    Q) Can my PMS be depression?
    Q) Can PMS worsen other medical and psychiatric problems?
    Q) What about a woman with PMS on the birth control pill?
    Q) Can I have PMS when I am not menstruating?
    Q) Can I get menstrual A word referring to the normal monthly cycle of women which results in a period each month. The one to two weeks before the period is called premenstrual. cramps if I have PMS?
How might a disorder present differently in women than in men?
Why are women at risk for certain conditions?
What pathophysiologic aspects of disorders are unique in women?
What type of interventions are appropriate?