This document outlines the components of an obstetric history and examination. It details the information to collect including patient demographics, pregnancy details, past obstetric and medical history, and a physical examination of the patient. The examination involves inspection of the skin and abdomen, measurement of fundal height, identification of fetal parts and position, and assessment of fetal growth, heart rate and movement. Collecting a thorough history and performing a comprehensive physical exam provides important information about the patient's pregnancy and fetal well-being.

1. OBSTETRIC HISTORY
AND EXAMINATION
RAJEEV BAHALL

2. OBSTETRIC HISTORY

3. OBJECTIVES
• Patient demographics
• Current pregnancy details and complaints
• Past obstetric history
• Past gynecological history
• Past medical and surgical history
• Drug history and allergies
• Family history
• Social history
• Systemic review
• Case summary

4. PATEINT DEMOGRAPHICS
• Name
• Age
• Occupation
• Relationship status
• Booking status
• Gravidity
• Parity
• Last Menstrual Period (LMP)
• Estimated Date of Delivery (EDD)

5. • EDD can be calculated from the LMP using Nagele’s rule
(add 1 year and 7 days to the LMP and subtract 3
months)
• If a cycle is >28 days, the EDD will be later and needs to
be adjusted: the number of days by which the cycle is
longer than 28 days is added to the date calculated in
Nagele’s rule
• If a patient recently stopped combined oral contraceptive
pill, her cycles can be anovulatory and LMP is less useful

6. GRAVIDITYAND PARITY
• Terminology: Gravida x, Para y+z:
• X is the total number of pregnancies (including this one)
• Y is the number of births beyond 24 weeks gestation
• Z is the number of miscarriages or termination of
pregnancies before 24 weeks gestation
• Example: A woman who is pregnant for the 4th time with 1
normal delivery at term, 1 TOP at 9 weeks and 1
miscarriage at 16 weeks would be G4, P1+2

7. CHIEF COMPLAINTS
• What brings you in today?
• Tell me what has been going on?
• What seems to be the problem?
• Common reasons for admission are hypertension, pain,
antepartum heamorrhage, unstable lie and possible
ruptured membranes.
• S.O.C.R.A.T.E.S

8. HISTORY OF PRESENT ILLNESS- 1ST
TRIMESTER
• Planned/Unplanned
• Method of confirmation of pregnancy
• General health (tiredness, malaise and other non specific
symptoms)
• Booking (when, where, how many visits)
• Early booking investigations and result (FBC, Hb
electrophoresis, Blood group and Rh, VDRL, HIV)
• History of vaginal discharge, vaginal bleeding, urinary
problems and flu like symptoms
• Imaging (crown rump length usually between 9-14 weeks)

9. 2nd TRIMESTER
• History of foetal movements
• Symptoms of anemia, miscarriage, ectopic pregnancy
(classic triad- amennorhea, abdominal pain, vaginal
bleeding), vaginal discharge, UTI
• Symptoms of preterm labour, diabetes
• Imaging (head circumference)
• Anomaly scanning? (when, where, why)
• Blood pressure check up
• Changes in weight

10. 3rd TRIMESTER
• Any medication due to HTN, DM, EPILEPSY
• Any labour pains, vaginal discharge, bleeding, urinary
problems
• Hospital stays?
• Any plans of delivery?

11. PAST OBSTETRIC HISTORY
• Details of all previous pregnancies (including miscarriages
and terminations)
• Length of gestation
• Date and place of delivery
• Onset of labour (including details of induction of labour)
• Mode of delivery
• Sex and birth weight
• Fetal and neonatal life
• Clear details of complications or adverse outcomes
(shoulder dystocia, post partum heamorrhage, still birth)

12. GYNAECOLOGICAL HISTORY
• Age of menarche
• Regular/irregular cycles
• LMP, duration of menses, cycle length
• Cervical smear history (last smear, when, where, what
was the result, awareness and follow up plans)
• Methods of contraception
• Difficulties in conceiving?

13. PAST MEDICALAND SURGICAL
HISTORY
• Any illness in childhood or adult life (DM, HTN, Hepatitis,
Psychiatric illnesses, epilepsy)
• Previous hospitalizations (when, where, why, how long)
• Past surgery: Any past surgical procedures, particularly
any abdominal or gynaecological operations as well as
any associated complications or reaction to anaesthesia

14. DRUG HISTORY

15. • Current medications before and after conception
(prescribed, over the counter, herbal)
-Name
-Dosage
-Purpose
-Route
-Frequency
• Pregnancy related medication (folic acid, iron, antiemetic)
• Allergies (what exactly happened)
• Don’t forget vitamins and nutritional supplements

16. FAMILY HISTORY
• Major illness in the immediate family members (DM, HTN,
carcinoma of breast, ovary, colon, endometrium)
• Family history of preeclampsia, eclampsia, DM
• Genetic disorders: sickle cell disease, cystic fibrosis,
chromosomal anomalies
• Previously affected pregnancies
• History of twin

17. SOCIAL HISTORY
• Personal status (smoking and alcohol: amount, duration
and type)
• Occupation
• Educational background
• Socioeconomic status (home conditions, water supply,
sanitation)
• Financial earning of support system
• How many people live in the household
• Domestic violence screening
• Plans for breastfeeding

18. SYSTEMIC REVIEW
• General
• Appearance
• CVS (chest pain, SOB, palpitations, orthopnea)
• GI
• Genital (pain, discomfort, itch, discharge, bleeding)
• Urinary (frequency, urgency, dysuria, nocturia,
incontinence, character of urine)
• CNS
• MSK (pain, swelling, weakness, gait)

19. EXAMINATION INTRO
• Introduce yourself and gain consent
• Explain the need and nature of the proposed exam
• Examiner should be accompanied by chaperone
• Respect patient’s privacy at all times
• Patient should be covered at all times and relevant parts
of her anatomy only exposed
• Ensure room is well lit and comfortabe
• Patient should empty bladder before exam
• Should lie supine with pillow under her head and arms at
the side
• Ask for any tenderness before palpation

20. GENERAL
• Measure BMI (Body Mass Index) [weight (kg)/height (m)2]
• Pregnancy complications are increased with BMI <18.5
and >25
• Measure vitals (BP, Temperature, Pulse, Resp rate)
• Blood glucose levels

21. INSPECTION
• Distention
• Fetal movements
• Scars (especially lower segment transverse/longitudinal in
the event of previous C section)
• Skin changes
-Linea nigra
-Striae Gravidarum
-Striae Albicans
-Distended Superficial Veins (increased IVC pressure due
to gravid uterus)

22. LINEA NIGRA
• Dark vertical line appearing on the abdomen from the
pubis to above the umbilicus during pregnancy due to
increase melanocyte stimulating hormone made by the
placenta

23. STRIAE GRAVIDARUM
• Specific scarring of the skin due to sudden weight gain
during pregnancy. Caused by tearing of the dermis and
results in atrophy

24. SYMPHYSIS FUNDAL HEIGHT
• Distance from the symphysis pubis to the uterine fundus
(top of the uterus). The size of the uterus is directly
related to the size of the foetus.
• Technique: palpate down from xiphi-sternum to determine
the fundus and mark that point. A tape measure is then
placed from the mid-point on the uppermost border of the
symphysis pubis, over the curve of the uterus to the
marked highest point and the measurement in cm is
recorded
• The SFH in cm corresponds to the gestation +or- 2cm and
is the best clinical test for detecting ‘small for dates’ fetus

26. FOETAL POLES
• Leopold maneuver 1 also known as the fundal grip
• Both hands placed over the fundus and the contents of
the fundus determined.
-A hard, smooth, round pole indicates the foetal head
- A softer triangular pole continuous with the foetal body is
the foetal buttocks

28. FOETAL LIE
• Leopolds second maneuver or The lateral grip
• Move hands in a downward direction along sides of the
uterus from the fundus. Lie is the relationship between the
longitudinal axis of the foetus and that of the mother.
• Lie is usually longitudinal, hence lying length-wise in the
same direction as mother’s longitudinal axis.
• Other lies are transverse and oblique
• This procedure can also determine which side is the foetal
back (firm, regular surface) and foetal limbs (lumpy and
irregular)

30. PRESENTING PART
• Leopolds third maneuver or Pawlik’s grip
• The thumb and middle fingers of the right hand are placed
wide apart over the suprapubic area to determine the
presenting part.
• The presenting part of the foetus is the lowest part of the
foetus at the inlet of the pelvis.
• Cephalic or breech presentation can be distinguished as
indicated in the previous slide

32. ATTITUDE AND ENGAGEMENT
• Deep pelvic grip
• 1) The attitude of foetal head
Technique: examiner turns around to face patient’s feet and
each hand placed on either side of lower foetal trunk.
Note made as to which hand touches the foetal head
(called the cephalic prominence)
If cephalic prominence is felt on the same side as the back,
this implies the foetal head is extended (abnormal)
If cephalic prominence is felt opposite side of back, head is
well flexed (normal)

34. ENGAGEMENT
• Technique: continue moving hands down and determine
how far around the head you can get.
• Engagement is defined as having the widest transverse
diameter of the foetal head pass through the pelvic inlet
into the true pelvis.
• Divide the head into fifths.
If 5, 4 or 3 fifths can still be palpated, most of the head is
up, hence the widest part has not engaged
If 2, 1 or 0 fifths can be palpated, the widest part has
engagaed into the pelvis

36. ADDITIONAL UTERINE ASSESSMENT
• Liquor volume
Assessment is made of the volume of amniotic fluid
surrounding the foetus
Reduced volme or Oligohydramnios, the foetal parts are
easily felt
Increased volume or Polyhydramnios, there is difficulty in
feeling the foetal parts
Note any foetal movements

37. AUSCULTATION
• Auscultated with Pinard’s foetal stethoscope or doppler
• Best place to listen is over the foetal back, closer to the
cephalic pole
• Normal foetal heart rate is between 110-160 beats per
minute

39. THANK YOU