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Obstetric & Gynaecology Series Taking an Obstetric History Priyanka Iyer, ST1 O&G North Middlesex University Hospital 26th April 2023, 6:30pm BRITISH INDIAN MEDICAL @BRITISHINDIANMEDICASSOCIATION @BINDIANMEDICS @BIMA ASSOCIATION BIMA Clinical and OSCE series The British Indian Medical Association (BIMA) - The British Indian Medical Association (BIMA) is a national non-profit organisation founded on developing a supportive network amongst students and doctors across the UK - Provides tutorial series, conference events, networking, careers talks, socials and more! - For more information follow us on social media and stay up to date with latest academic events by joining our mailing lists: BIMA Clinical and OSCE series: https://forms.gle/CidGvWAc9YY9WSSs8 BIMA Fundamentals of Medicine & Pathology series: https://forms.gle/KfAgeoX55GPAWqee8 BIMA Clinical and OSCE series SPEAKER BIOGRAPHY Priyanka is an ST1 O&G Doctor currently working in North Middlesex Hospital in North London. She graduated from King’s College London in 2020 with an Intercalated BSc in Anatomy. She fell in love with Obstetrics & Gynaecology during her Women’s Health rotation in St Thomas’ Hospital. She did an AFP last year during which she worked on a project looking at the safety of symptomatic therapies for multiple sclerosis in pregnancy and breastfeeding. Outside of O&G, Priyanka is passionate about mentorship and medical education and enjoys spending her time outside work reading non- fiction, boxing and enjoying time outdoors when she can! PRIYANKA IYER MBBS, Bsc, King’s College London BIMA Clinical and OSCE seriesLearning objectives ❖ To cover the key questions that make up an obstetric history including questions about the current and any previous pregnancies ❖ To discuss how to present an obstetric history in OSCE scenarios and in daily life when discussing cases with senior colleagues ❖ To demonstrate history taking skills through obstetric case examples BIMA Clinical and OSCE seriesWhat is special about an Obstetric History?Presenting complaints What are the common presenting complaints that you would come across in Maternity Triage?Abbreviations SVD EMCS ELCS IOL PPROM FD EDD EFW AFI Gravity vs Parity ➔ Gravidity is the total number of pregnancies, regardless of outcome. ➔ Parity is the total number of pregnancies carried over the threshold of viability (24+0 in the UK). Examples: 1.A patient is currently 26 weeks pregnant and already has two children of her own. She reports having had a miscarriage at 10 weeks and a stillbirth at 28 weeks 2.Patient is currently pregnant, had one previous delivery and one previous miscarriage 3.Patient is not pregnant, had a twin pregnancy resulting in two live births Obstetric History Taking Presenting Previous Obstetric & Complaint Current pregnancy Gynaecological Hx Past Medical Hx Past Surgical Hx Ideas Social Hx Drug History Concerns Family Hx Drug Allergies ExpectationsQuestions about current pregnancy ❖ Gestation ❖ Singleton or multiple pregnancy ❖ Spontaneous conception or IVF ❖ Last scan - presentation, EFW, AFI, Doppler, Placental site ❖ Any issues with previous scans ❖ Any medical problems during pregnancyObstetric Specific Symptoms - Abdominal pain - Vaginal loss: bleeding, discharge, rupture of membranes - Reduced fetal movements - Headaches, Epigastric Pain, Peripheral oedema, visual disturbances - Itching - Chest pain, SOB, unilateral leg swelling - General mental health - screen for self harm and suicide if relevantPrevious obstetric history Number of pregnancies Number of terminations + ectopic pregnancies + miscarriages Spontaneous conception or IVF Previous mode of delivery Any complications in previous pregnancyAdditional points similar to other histories Gynaecological History Past Medical History Past Surgical History Regular medications Drug Allergies Social History Family History ICE!Key tips when presenting a history Age Gravity and Parity Gestation Presenting complaint Relevant Positive and negative findings Differential diagnosis Next steps: Bedside, Bloods, Investigations Obstetric History Taking Presenting Previous Obstetric & Complaint Current pregnancy Gynaecological Hx Past Medical Hx Past Surgical Hx Ideas Social Hx Drug History Concerns Family Hx Drug Allergies ExpectationsCase 1 30 year old, 32 weeks pregnant attends triage with constant lower abdominal painCase 2 22 year old woman, 20 weeks gestation presents to triage with vaginal bleeding.Case 3 29 year old woman presents to Maternity Triage with a fever. She had a C section 1 week ago.Case 4 32 year old lady presents to Triage 3 weeks after a delivery with chest pain and shortness of breath.Key take home messages ● Consider clinical context - where are you seeing this patient? ● Ask about current and previous pregnancies ● Take time to consolidate your information before you present it back ● Have differential diagnoses in your head for each obstetric symptom which will guide your focussed history takingUseful resourcesTHANK YOU FOR LISTENING ANY QUESTIONS? BIMA Clinical and OSCE series