History taking and

examination
technique in obstetrics
Dr Sofiah Sulaiman
Dept. of Obs & Gyn Medical Faculty Univ
Malaya
History

Able to interview a patient and obtain relevant

information for clinical management

Able to listen and ask appropriate questions for an

intended purpose during patients interview
Physical
examination
Able to perform physical examination and identify clinical signs

Able to analyse and correlate symptoms and signs in order to make

a clinical diagnosis
History : introduction

Name Gravidity

Age Parit
y
LMP / EDD /gestational age
Occupation

Race Booking status

Gravidity

Term is used when a woman is pregnant at the time of clerking

Refers to total number of pregnancies including the current

one.
Parity

The number of livebirths and stillbirths delivered after

viability period (22 weeks)

Miscarriages, ectopic, molar pregnancies added to

parity (+)

Multiple pregnancy counted as 1 (not 2)

example

A lady is currently in her 5th pregnancy and she delivered 3 children

prior to this and had 1 miscarriage.

Gravida 5 Para 3 + 1
Exercise 1

A lady whos in her 8th pregnancy. She had 3 miscarriages and 1

ectopic pregnancy. She delivered 3 healthy children at term.

Answer :

Gravida 8
Para 3 + 4
Exercise 2

1. A lady is currently in her 3rd pregnancy and she had 2 fetal demised in
utero; at 28 weeks gestation and 20 weeks gestation
Answer : Gravida 3 Para 1 + 1

2. Pregnant for the 1st time with twins

Answer : Gravida 1 Para 0
History : introduction

LMP

1st day of last menstrual period ( Naegeles rule ) if

regular cycle and sure of date

Add 1 year and 7 days and subtract 3 months

History : introduction

Dating scan EDD (1st trimester)

Long cycles

Irregular periods

Using hormonal contraception

Period of gestation

Terminology describes gestational age at clerking.

Eg: LMP: 1/6/16

Clerking at 1/1/17
7 months difference (28 weeks)
Add a week for every 3 months (+2 weeks)
= 30 weeks gestation
Presenting/chief complaint

The symptoms or problem that brings the patient to the

hospital or to see a doctor.

In patient own words

If more than one, should be arranged in chronological

order
History of presenting illness

Elaboration of chief complaint

Describes the onset, nature, aggravating or relieving

factors

The progression of illness/complaints

History of present
pregnancy
Details of pregnancy from the time of diagnosis.

Eg planned or unplanned/ positive urinary pregnancy test

/ 1st visit to hospital(booking) / routine antenatal
invstigations results

Screenig for risk factors

Past obstetrics history

Year Antenatal problems

Onset/Mode of delivery
Complications intra/post
partum
Gestational age

Place of birth Baby details gender/weight/

abn/livebirth
Past gynaecological
history
Age of menarche Intermenstrual bleeding/
dysmenorrhea
Menstruation history
history of sepsis/PID/
gynaecological surgery
Cycle
12 78
28 PAP smear
Flow
Past medical history

DM / Hypertension /Chronic illnesses

Important and relevant to the management of current

pregnancy

Assessment of risk to the pregnancy and risk of pregnancy

to the disease
Past surgical
history
Appendisectomy

tonsilectomy
Drug history /
allergies
What medication - details

Allergies rashes/swollen

Contraindicated in pregnancy?

Change to other medications

Family history

DM

Hypertension

Chromosomal/structural anomalies

Multiple pregnancy
Social
history
Working hours

Environment

Support
Systemic
review
Description of other symptoms experience

Not to missed - sytematic

Summary

At the end

One sentence

Age/gravida/parity/period of gestation/chief complain

Important/relevant history
Important!!!

List of possible differential diagnosis

Looking for certain signs during physical examination.

physical
examination
stand on the right side

general examination

specific examination
general examination

well / distress / happy / sad

height / weight

calculate BMI
Hands

pallor

palmar erythema

koilonychias - iron deficiency

clubbing

pulse rate/rhythm/volume
Blood pressure

sitting

arm - heart level and supported

cuff - 2/3rd of arm and

encircling
systolic - korotkoff 1
diastolic - korotkoff 4
(muffling)
 Face / neck

eyes - conjunctiva (pallor) / sclera (jaundice)

mouth - angular stomatitis (IDA) / central cyanosis / mucous

membrane

Thyroid - exophthalmos / goitre

Legs

peripheral oedema

press on the skin over tibia x 10 secs

could be physiological esp in 3rd trimester
may be pathological if involve face / sacral (preclampsia)
Abdominal examination
(obstetrics)
lie flat on one pillow or slight left lateral if has difficulty in
breathing (supine hypotension)

exposure : xiphisternum to symphysis pubis

inspection / palpation / auscultation of fatal heart

+- percussion
inspection

enlargement of gravid uterus

presence of linea nigra / striae gravidarum / striae albicans

presence of surgical scar

fetal movements (type / length / site )

others (abn vessels / hernias )

Palpation

Gentle and not causing pain

keep glancing at her face

cautious : placenta praaevia / premature contraction

superficial and deep

superficial palpation

To elicit whether the abdomen is soft and non tender (rigid and
tender)

use the flat of your hands

feel the whole abdomen in quadrants

contractions can be felt

deep palpation

palpate the uterus (anterior wall)

to assess the fetal lie / presentation / liquor volume

liver / spleen / kidneys / inguinal region

site / size / shape / margin / mobility / tenderness / consistency

symphysio-fundal height

clinical assessment

12 weeks - symphysis pubis

22 weeks - umbilicus

36 weeks - xiphisternum
Symphysio-fundal
height
measured in centimetres

measuring tape from fundus to symphysis pubis

fundus is located by using the left hand (ulna side) from
xiphisternum downwards
after 20 weeks

= no of weeks (+-2 cm or 3 cm after 36 weeks)

Symphysio-fundal height
(SFH)
fetal examination

number of fetus - number of fetal poles

single fetus has 2 poles

more than 2 poles may indicate multiple pregnancy or singleton

with uterine fibroid/ovarian mass
Fetalexamination

Leopolds manoeuvre -

fundal grip
lateral grip
pelvic grip
Fetal lie

longitudinal axis of the foetus in relation to the longitudinal axis of

the uterus

longitudinal / transverse / oblique

Fetal
presentation
The lowest fatal part of the foetus in the uterus - above or
entering the pelvic brim

cephalic / breech (longitudinal lie)

head - pole feels harder / rounder and ballotable
fixed / mobile - engagement

oblique / transverse lie - shoulder / arm

Engagement

Widest diameter of the fetal head (BPD) entered the pelvic brim

described in fifths palpable above the symphysis pubis

2/5th, 1/5th and 0/5th palpable - engaged

3/5th, 4/5th and 5/5th palpable - not engaged
Fetal parts/back

Palpable during lateral grip

placement of cardio probe/fetoscope/pinard - fetal heart

back - feels firm

fetal parts - irregular / limbs movement

Liquor volume

adequate - corresponding SFH/poles and parts felt

polyhydramnios - uterus larger than dates

difficult to feel fetal parts
fluid thrill

oligohydramnios - uterus smaller than dates

Auscultation

Fetal heart - rate and rhythm

placement of fetoscope - anterior shoulder/fetal back

cephalic - lower right/left maternal abdomen
breech - upper right/left maternal abdomen
Summary

inspection:
distended abdomen
striae gravidarum/albicans
linea nigra
surgical scars
fetal movement
summary : palpation/auscultation

superficial-consistency/tenderness
deep- irritable/contracting uterus
singleton estimated fetal weight
lie amount of liquor
presentation fetal heart
rate/rhythm
engagement
fetal parts