O+G H+E
• Nullipara = never given birth or completed Terms:
pregnancy > 20 weeks • G = # of times pregnant regardless of TPAL: (0000) – must add up to # of children
• Nulligravida = never been pregnant outcome • Term pregnancies (> 37 wks)
• P = # of completed pregnancies > 20 wks
Planning • Multigravida = pregnant more than once
• Live twin birth = G1P1
• Preterm births (< 36 + 6 )
• Elderly primigravida = > 35 y.o. woman in • Miscarriage/Abortions <20 wks
A woman currently 10 weeks GA. She has had 2
1st pregnancy • Live birth (inc. stillborn > 20 wks)
miscarriages and one stillbirth at 40 weeks.
è G4 P1 + 1020 (TPAL)
“So, tell me how you feel about the pregnancy news?” ® “So, tell me a little more about your nausea.”
Calculate GA + EDD 1st trimester 2nd trimester 3rd trimester:
• LMP • Confirmed date + method of • Amniocentesis • Antenatal clinic findings (esp. BP
• EDD = 9mths + 7 days from LMP (if pregnancy (16-19/52) + proteinuria)
Current cycles are regular - add more or • Planned or unplanned • Anomaly scan • Vaginal bleeding
subtract depending) • (18-20/52) •
pregnancy • OCP? – when did she stop and # of •
USS (10-12/52)
CVS (1-13/52) • Quickening
# of hosp. admissions
periods before becoming pregnant • Ante-natal care (e.g. shared (1st FM) (16-
• FM? care, midwife led, consultant 20/52)
• HMB > 80mL/day or >6x day period led) ® CARE MODEL
• Onset ® Duration ® Severity (ADL)
Summarize what you have covered so far:
• Course: worsening? ® relieving factors e.g. anti-emetics
HPS • Triggers: food, smells, exercise?
“Ok, so we’ve talked about your nausea any
other concerns?”
• Other symptoms: fatigue,
Fever Chorioamnionitis OR UTI (+ FUND)
UWL Hyperemesis gravidarum | Malignancy
SOB (walking upstairs) fetus pushing on diaphragm?, PE - ?chest pain anaemia? -pale, light-headed, palpitations
Abdo pain UTI (dysuria), placental abruption, constipation, pelvic girdle pain
Dysuria + vulva pain UTI, superficial (Herpes), Bartholin cyst/abscess
N/V (persistent) Hyperemesis gravidarum = UWL, hypoK, dehydrated
Gynae Pelvic pain symphysis pubis dysfunction
(head to Headache / vision issues / light-headed pre-eclampsia
Unexplained bleed From gums, nose + metallic taste in the mouth è Haem
toe) Vaginal Discharge/bleeding Water broke = spontaneous rupture of membranes
Blood = antepartum haemorrhage, placenta praevia, cervical causes
Swelling / ?DVT normal swelling of pregnancy (decrease after elevation)
? pre-eclampsia (Headache/Visual disturbance/Epigastric pain swelling of face)
Breast soreness Mastitis, malignancy
Scars pigmented line on abdomen (linea nigra)
• HTN + DM + DVT/PE Hx of previous pregnancies Children Hx
• Hypothyroid • Date of birth • Birth weight (LBW)
• Renal disease • Duration of pregnancy + comp. (eg. • Problems after birth (TTN, ARDs,
• Asthma Praevia, abruption, pre-eclampsia) Jaundice)
PMHx • Malignancy • Delivery mode + comp. (forceps) • Present condition
• Haem issue (VWF, haemophilia, APS) • Outcome (stillbirth, live?)
• Infections (HIV, HBV)
• Psych condition + meds
• Abdominal or pelvic surgery – can result in adhesions that complicate Caesarean sections
• Caesarean section – increased risk of uterine rupture in subsequent pregnancies
SHx • Loop excision of the transitional zone (LETZ) – increased risk of cervical incompetence
• Surgical terminations of pregnancies
• Regular meds? – (teratogenic è ACEi, MTX, retinoids, trimethoprim) Things done:
• Anti-psychotics – appetite changes • Folic acid (3/12 prior to 3/12 after pregnancy)
• Iodine and Vitamin D
• OTC? - aspirin, codeine, antacid
• Rhesus-Ab injections?
Meds • Herbals? – St John’s wort, rescue remedy
Avoid
• Immunisation (flu, whooping cough, hep B) ® CHECK CURRENT VACCINATION Ø XS vit A (e.g. liver pate)
STATUS!! (inc. MMR, DPT)
• Allergies e.g. penicillin, codeine,
• Diabetes, HTN EU Jew Asian African Medit
• Pre-eclampsia (maternal mother or sister) – increased CF
FHx risk of developing pre- eclampsia Thalassemia
• Psychiatric illness SMA
• FHx of miscarriages/stillbirths/learning difficulties Fragile X
“So, to know how to best care for you and your baby in pregnancy I need to ask • Occupation (maternity leave)
about any drug /alcohol /smoking and recreational drug use • home life (any social support + animals)
• SMOKING: Pack years | nicotine replacement therapy | is partner smoker? o Finances
ADL (harm of passive smoking) o Housing
• Nutrition & exercise • Domestic violence
• ALCOHOL: currently drinking | ave. gram per week • Food intake (toxoplasmosis, listeriosis, salmonella)
• ILLICIT DRUGS
• Discussing teratogens (medications, alcohol, drugs, radiation, fumes) Handover essentials:
1. Name, age, GA – EDD + birth plan (c/s, nvd) – epidural?
• What foods to avoid in pregnancy + Folic acid and Iodine supp. 2. G + P , ABO group, Rhesus +/-, IUTD, infections
• Sleeping on their sides in advanced pregnancy 3. Previous Pregnancies: M/C, S/B, live term
Health • Planned mode of delivery and care (e.g. Midwife led clinic or 4. Recent Ix + results = USS, CTG, OGTT, UA, BP, CVS, cfDNA NIPT
5. PMHx: HTN, GDM or FHx of chr disorders (e.g Down’s)
promotion obstetrician led care vaginal or Caesarean section)
6. Med: aspirin, progesterone, SSRI ® alcohol, drugs, smoking
• Antenatal education 7. Exam - abdo palp (SFM, FM, Ceph/Breech, contractions), bimanual,
vaginal, cervical exam
8. Plan: FU USS, OGTT, M/C/S swab/urine, CTG, referral
