Obstetrics and gynecologic History and Exam

Gravida: pregnancies

Term

Preterm

Abortions/miscarriages

Living children

define GTPAL

Term/preterm deliveries

Miscarriages/abortions

Complications (PPH, preeclampsia, gestational diabetes)

Mode of delivery (vaginal vs C-section)

Neonatal outcomes

components of a thorough obstetric history

Menstrual history (LMP, cycle length, regularity, flow)

Contraceptive use (current/past)

Sexual history (partners, STI risk, pain with intercourse)

Pap smear history & results

STI history

Gynecologic surgeries or diagnoses (fibroids, endometriosis)

components of a thorough gynecologic history

Inspection → palpation (pads of fingers, circular motion)

Assess for masses, skin changes, nipple discharge

components of a breast exam

-pt supine

-locate symphysis pubis

-palpate top of the uterine fundus using the ulnar border of your hand

-measure with tape measure (in cm)

how to assess fundal height

45 degrees

insert the speculum at what angle?

monthly, ideally after menses

when is the ideal time to perform self exams?

left lateral tilt (esp after 20 weeks)

how do you avoid supine hypotension in pregnant patients?

gestational age (weeks) ± 2 cm

interpretation of fundal height (after 20 weeks only)

just above symphysis pubis

expected fundal height at 12 weeks

at umbilicus

expected fundal height at 20 weeks

xiphoid process

expected fundal height at 36 weeks

Multiple gestation

Polyhydramnios

Macrosomia

Incorrect dating

reasons why fundal height may be larger than expected

Fetal growth restriction (IUGR)

Oligohydramnios

Incorrect dating

reasons why fundal height may be smaller than expected

>2 cm discrepancy to dates

when does a fundal height result in reflex ultrasound?