In addition to his current work, Dr. Amos is using his vast experience to launch Obie, a science-based app that offers personalized fertility advice. You should also ask about fatigue if anaemia is suspected and symptoms of hypovolaemic shock (e.g. A lot of people wonder about about prenatal vitamins side effects. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Clarify if medical or surgical management was required for the miscarriage and if any cause was identified for the miscarriage (e.g. Clarify the gestation at which the termination of pregnancy was performed and the method of management (e.g. Prenatal care in the United States is a health care preventive care protocol recommended to women with the goal to provide regular check-ups that allow obstetricians-gynecologists or midwives to detect, treat and prevent potential health problems throughout the course of pregnancy while promoting healthy lifestyles that benefit both mother and child. OBSTETRICS History Taking December 9, 2015 Prenatal check-up is usually done in the clinic History 1. Start typing to see results or hit ESC to close, Paediatric Intravenous (IV) Fluid Prescribing, Cervical Spine X-ray Interpretation – OSCE Guide, medical MCQ quiz platform at https://geekyquiz.com, Paediatric Growth Chart Interpretation & Documentation – OSCE Guide, Progesterone Depot Injection Counselling – OSCE Guide, Loss of Consciousness History Taking – OSCE guide. self-hygiene, housework, food shopping), NICE. Even the smallest details of birth-related problems, difficulty with pregnancy, multiple births, and illnesses are important.Â. This will help ensure your consultation is more natural, patient-centred and not overly formulaic. Taking a relevant and comprehensive history. The prenatal health history includes mother, father, siblings, children, and grandparents. Medical 8. An obstetric history involves asking questions relevant to a patient’s current and previous pregnancies. ¹. Taking a history from a patient is a skill necessary for examinations and afterwards as a practicing doctor, no matter which area you specialise in. Obs and gyn instruments Aman Shaik. “Prenatal” comes from the same roots as “pregnant.” “Pre” means before or prior to. A collection of surgery revision notes covering key surgical topics. abdominal pain at 8 weeks gestation could be an ectopic pregnancy). Clarify how and when the symptom developed: Ask about the specific characteristics of the symptom: Ask if there are other symptoms which are associated with the primary symptom: Clarify how the symptom has changed over time: Ask if anything makes the symptom worse or better: Assess the severity of the symptom by asking the patient to grade it on a scale of 0-10: Once you have completed exploring the patient’s history of presenting complaint, you need to move on to more focused questioning relating to the symptoms that may be relevant to pregnancy (if not already discussed). Gynaecological instruments Juby Raju. Placental position: if embedded in the lower third of the uterine cavity there is an increased risk of placenta praevia. Summarise the key points back to the patient. You may need to continue taking prenatal multivitamins if you breast-feed your baby. Infection 10. It is important you do not forget the general communication skills which are relevant to all patient encounters. Pruritis in the context of pregnancy is suggestive of obstetric cholestasis (it typically affects the palms and soles of the feet). Ask about previous mental health diagnoses and any current thoughts of self-harm and/or suicide if relevant. The developing embryo and fetus need extra vitamins for healthy development. Establishing rapport (e.g. Ontario Breastfeeding Network. Previous pre-term labour increases the risk of pre-term labour in later pregnancies. Gravidity is the number of times a woman has been pregnant, regardless of the outcome. Facilitate the patient to expand on their presenting complaint if required: History taking typically involves a combination of open and closed questions. You should ask about the results of the scan (or check the medical records if the patient is unsure). cystic fibrosis, sickle-cell disease, thalassaemia) carried by both the mother and father as this may influence the management of the patient and their pregnancy (e.g. Pap smear and hpv vaccine Dr Zharifhussein. Do prenatal vitamins have side effects? Questions about miscarriage, terminations and ectopic pregnancies need to be asked in a sensitive manner in a private setting. ². Demonstrating empathy in response to patient cues: both verbal and non-verbal. As a result, it is essential to ask about symptoms of pre-eclampsia as part of every patient review during pregnancy. This allows us to get in touch for more details if required. Swelling of the hands, feet and face (oedema), Pain in the upper part of the abdomen (epigastric tenderness), Visual disturbance (blurring of vision or flashing lights). Ask if the patient was using contraception prior to becoming pregnant and if so, clarify what method of contraception was being used. Regular prenatal care can help to minimize the possibility of serious complications and can guarantee the healthiest pregnancy possible. A stillbirth is when a baby is born dead after 24 completed weeks of pregnancy. Reduced fetal movements are associated with adverse pregnancy outcomes, including stillbirth, fetal growth restriction, placental insufficiency, and congenital malformations. During pregnancy, a woman’s daily intake requirements for certain nutrients, such as folic acid (folate), … Clarify the trimester at which the miscarriage occurred (miscarriage is most common in the first trimester). Obie takes a holistic approach to improving your fertility, tracking your cycle and ovulation, and helping you get pregnant. Obstetric 3. Offer support services to assist the patient in reducing their alcohol intake. fish-like smell in bacterial vaginosis). Some examples of symptoms you could screen for in each system include: Clarify the current gestational age of the pregnancy (e.g. Parity is the total number of pregnancies carried over the threshold of viability (typically 24 + 0 weeks). Confirm the patient’s name and date of birth. Ensure you initially keep a comfortable distance, establishing eye contact and rapportwith the family. Prenatal vitamins are recommended by most doctors if you are planning on becoming pregnant or are pregnant. genetic syndromes). Sensitivity clarify the gestation of the stillbirth if this is not already documented. This can also help inform discussions with parents about the risk of their child having a specific genetic disease (e.g. Pregnancy and Sexually Transmitted Diseases (STD). Health problems facing other blood relatives may also be pertinent. Open questions are effective at the start of consultations, allowing the patient to tell you what has happened in their own words. It’s also worth noting that before 18 weeks gestation, most obstetric conditions are unlikely, therefore your history should be gynaecology focussed (e.g. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. First and Last are required. green, yellow or blood-stained would suggest infection), Smell (e.g. Taking an obstetric history requires asking a lot of questions that are not part of the “standard” history taking format, therefore it’s important to understand what information you are expected to gather. Available from: [. Outcomes of prior pregnancies are Children above the age of 4 may be able to provide some of their own history 2. Parity (P) is the total number of times a woman has given birth to a child with a gestational age of 24 weeks or more, regardless of whether the child was born alive or not (stillbirth). Making sure not to interrupt the patient throughout the consultation. It is important to privately ask all pregnant women if they are a victim of domestic abuse to provide an opportunity for them to seek help. Ask about your lifestyle, including whether you smoke, drink, or take drugs, and whether you exercise regularly. It is important to ask about recreational drug use, as these can have significant consequences on the mother and developing fetus (e.g. Menstrual 4. Blood-borne viruses: HIV, hepatitis B, hepatitis C pose a risk to the fetus during childbirth (vertical transmission). Nausea and vomiting typically begin between the fourth and seventh week of gestation, then peak between the ninth and sixteenth week and resolve by around the 20th week of pregnancy. Caesarian section (will have implications for the choice of future mode of delivery). The condition can be life-threatening for the mother and the fetus. Since then various prenatal screening concepts have been developed, the most successful being Down syndrome risk estimation using multiple serum and ultrasound markers. Smoking increases the risk of a small for gestational age baby. pre-syncope/syncope). Perinatal history, normal newborn 1. This allows you to check your understanding of the patient’s history and provides an opportunity for the patient to correct any inaccurate information. PRENATAL HISTORY Format of History – same as a regular history including Review of Symptoms Add the following additional information regarding the OB/Gyn History Student’s name Date of History Patient’s Name Preceptor’s Name General Information (make sure these are included in the history) Patient’s age Occupation Medications Allergies This form can be emailed to jbrannon@winchesterobgyn.net. The basic components of a pediatric history are as follows: history of presenting illness, past history including prenatal, birth, and postnatal history, past medical history, surgical history, growth and developmental, medications, allergies, immunizations, family history, social history and review of systems. Family and Genetic 7. Sexual 5. Family Health History Checklist: During Pregnancy Gather family history information before seeing the doctor. Explore the patient’s general social context including: Record the patient’s smoking history, including the type and amount of tobacco used. Rhesus status and the presence of any antibodies. It is essential to gain an accurate overview of the medications the patient is currently and has previously taken during the pregnancy. Here, is a commonly followed format. A miscarriage is the loss of a pregnancy before 24 weeks gestation. Available from: [, MBRRACE-UK. Previous gynaecological conditions and treatments: A patient’s past medical history is particularly relevant during pregnancy, as some medical conditions may worsen during pregnancy and/or have implications for the developing fetus. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. uncrossed legs and arms, leaning slightly forward in the chair). Closed questions can allow you to explore the symptoms mentioned by the patient in more detail to gain a better understanding of their presentation. urinary tract infections, cervical infections, chorioamnionitis). Reliability of parents’ observations varies 3. house, bungalow) and if there are any adaptations to assist them (e.g. 2011: Cell free DNA screening tests (also known as “non-invasive prenatal testing or sequencing”) first clinically available, performed between 8-12 weeks. As stated below, asking about stillbirths need to be done in a sensitive manner. cocaine use increases the risk of placental abruption). Offer smoking cessation services (see our smoking cessation guide for more details). We've also just launched an OSCE Flashcard Collection which contains over 800 cards. It is essential to appreciate that taking a comprehensive history in obstetrics and gynaecology involves eliciting confidential and often very ‘personal’ information. cervical, endometrial, ovarian). Some important medical conditions to ask about include: Understanding the social context of a patient is absolutely key to building a complete picture of their health. arranging input from the paediatric team immediately after delivery). Many women claim that prenatal vitamins affect hair and nail growth. Whenever possible the infant’s mother should be present. miscarriage) and many anti-epileptic drugs are teratogenic. History taking forms a cornerstone of medical practice as it helps arrive at a diagnosis. Ask if the patient what their diet looks like on an average day. Hyperemesis gravidarum refers to persistent and severe vomiting leading to dehydration and electrolyte disturbance, weight loss and ketonuria. Check the patient has stopped their contraception or had their contraceptive device removed (e.g. Social factors have a significant influence on a patient’s pregnancy. Prenatal care is necessary to maximize the health of both the mother-to-be and the developing fetus. Gain consent to proceed with history taking. Open, relaxed, yet professional body language (e.g. Once you have summarised, ask the patient if there’s anything else that you’ve overlooked. Learn more about Obie here. Colour (e.g. You will also need to take prenatal vitamins, maintain a healthy lifestyle, prepare for childbirth and delivery, and more. It is useful to confirm the gestational age, gravidity and parityearly on in the consultation, as this will assist you in determining which questions are most relevant and what conditions are most likely. Once the patient has had time to communicate their presenting complaint, you should explore the issue with further open and closed questions. A. Prenatal and birth history B. Developmental history C. Social history of family - environmental risks D. Immunization history II. Parent as Historian A. Parent’s interpretation of signs, symptoms 1. It is important to ask about a woman’s previous obstetric history, as this may help inform the assessment of risk in the current pregnancy and have implications for the mode of delivery. When visiting the doctor for the first time, gather all available information to complete detailed prenatal health history. Oral iron: frequently used in pregnancy to treat anaemia. Name:_____ Date of Birth:_____ Appointment Date:_____ Prenatal History Questionnaire PART 1 Perform prenatal blood tests to do the following: Determine your blood type and Rh (Rhesus) factor. Prenatal vitamins cause few side effects. History taking during pregnancy •The medical history is a structured assessment to get a comprehensive picture of a participants’ health and health problems before and during her pregnancy. Frequency: increased frequency of passing urine. Some of the questions are highly personal, therefore good communication skills and a respectful manner are absolutely essential. macrosomia). Nausea/vomiting in pregnancy. Antenatal period: pre-eclampsia, gestational diabetes, gestational hypertension, placenta praevia and shoulder dystocia. History taking in obgyn gulmakaikhalid. Previous venous thromboembolism (VTE): pregnancy is a pro-thrombotic state, therefore, women who have previously developed a venous thromboembolism are at significantly increased risk of developing further VTEs without prophylactic treatment (e.g. Some claim that taking prenatal vitamins makes hair grow thicker or faster, and that nails could grow faster or … In that way it is very unique, as when assessing these patients, your actually also assessing another the child.Consequently, the approach to history taking in Obstetrics whilst similar to other fields of medicine, includes a number of additional components. If you'd like to support us and get something great in return, check out our OSCE Checklist Booklet containing over 100 OSCE checklists in PDF format. Prenatal vitamins consist of a variety of vitamins and minerals that help your baby get the nutrients that are essential for healthy development. Nutritional 9. Ultrasound in Gynecology meducationdotnet. A key component of history taking involves exploring a patient’s ideas, concerns and expectations (often referred to as ICE) to gain insight into how a patient currently perceives their situation, what they are worried about and what they expect from the consultation. Prenatal tests can provide valuable information about your baby's health. Hysterosalpingography student. If recreational drug use is identified, patients can be offered input from drug cessation services. Ask a doctor before using a vitamin or mineral supplement if you are on a low-salt diet. © 2001-2021 BabyMed.com - All Rights Reserved. Fetal anomalies: note any abnormalities identified. Untreated urinary tract infections in pregnancy have been associated with increased risk of fetal death, developmental delay and cerebral palsy. A high birth weight in previous pregnancies raises the possibility of previous gestational diabetes. Common symptoms of urinary tract infections include: Pre-eclampsia is a relatively common condition in pregnancy which is characterised by maternal hypertension, proteinuria, oedema, fetal intrauterine growth restriction and premature birth. It is also important to ask about any complications associated with the condition including hospital admissions. WebMD provides common contraindications for Prenatal Vitamin oral. Ask about your family health and genetic history. Prenatal History. During the first prenatal visit, a prenatal health history is taken to give the doctor insight into any potential problems that may be faced during the pregnancy. This gives her the chance to ask questions. hyperemesis gravidarum). Clarify if IVF or other assisted reproductive techniques were used for any previous pregnancies. Signposting, in a history taking context, involves explicitly stating what you have discussed so far and what you plan to discuss next. Keep taking prenatal vitamins throughout your entire pregnancy. Persistent vomiting and severe nausea can progress to hyperemesis gravidarum. coil, implant). While many of these tests are routine, some can be a much more personal decision. Termination of pregnancy is the medical process of ending a pregnancy so it doesn’t result in the birth of a baby.