Obs And Gynae Hx And Phy Exam

Front 1

History

Back 1

1. Confirmation of gestation
a. Presenting symptoms of pregnancy
i. Amenorrhoea
ii. Nausea/ vomiting – at all hours of the day
iii. Breast tenderness – cos of engorgement
iv. Quickening = woman’s initial awareness of fetus movt w/in uterus b/w 18-20 weeks (wide variations & subjective), unreliable for 8-9 weeks
v. Emotional changes – constantly pms
vi. Skin changes – eczema flare up, pigmentation >pronounced
b. Last menstrual period (LMP)
i. Period of amenorrhoea NOT= true gestation in 30% of preg (irreg cycles, poor memory, bleeding in early preg mistaken for menstruation)
ii. Do not rely on LMP alone to date preg if access to U/S is available

Hint 1

2. Menstrual history
a. Regularity – if yes, ask “had your menses ever been delayed for few days, 1-2 weeks, occasionally 1 month?”
b. History of heavy or painful menses
c. Last menstrual period
i. Normal timing
ii. Normal duration
iii. Normal amount – no of pads used
iv. Note: even in women w regular 28 day cycles – 20% chance of wrong gestational age