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Christians.Age: • 20-26 yrs → best age of pregnancy d. ‫ﻟﻮ ﻣﻄﻠﻘﺔ أو أرﻣﻠﺔ ﯾﺠﺐ ﺗﺤﺪﯾﺪ اﻟﻤﺪة " ﺧﻼل ﻋﻤﺮ اﻟﺤﻤﻞ =9 ﺷﮭﻮر" ﻋﻠﻲ اﺳﺎس اﻧﮭﺎ ﺣﺎﻣﻞ‬ .Name: ‫اﻻﺳﻢ رﺑﺎﻋﻰ‬ • Patient named Mrs ---------------------------. ‫* ﻻ ﺗﻜﺘﺐ ﻋﻠﻰ ﺷﻜﻞ‬ • Significance : 1. ‫* ﺗﻜﺘﺐ ﻋﻠﻰ ﺷﻜﻞ‬ • Female patient named -------------------------.‫*ﺗﻜﺘﺐ ﻋﻠﻰ ﺷﻜﻞ‬ ‫ﺧﺎرج ﻣﺼﺮ‬ .... Indicates religion of husband • Circumcised → " Muslims. o Repeated marriage should be mentioned ‫ﻟﻮ أﻛﺜﺮ ﻣﻦ زواج ﯾﺠﺐ ذﻛﺮه‬ o Divorce or husband death timing should be mentioned. Jewish" ‫ﻓﻰ ﻣﺼﺮ‬ • Non Circumcised → cancer cervix 3...General obstetric sheet (I) History: A) Personal history 1.t: o Lowest maternal mortality rate o Lowest prenatal mortality rate 3. Indicates social standard & culture (‫اﻟﺼﻌﺎﯾﺪة ﻋﺎوزﯾﻦ رﺟﺎﻟﺔ )ذﻛﻮر‬ "contraceptive methods" ‫ﺟﺎردن ﺳﯿﺘﻰ ﻣﺶ ﻋﺎوزة ﺗﺨﻠﻒ ﻣﻦ أول ﻣﺎ ﺗﺘﺰوج‬ 2. To get familiar "‫* ﻋﺸﺎن اﻟﻌﯿﺎﻧﺔ ﺗﺄﺧﺬ ﻋﻠﯿﻚ " ﺗﻌﻄﯿﻚ ﻣﻌﻠﻮﻣﺎت أﻛﺘﺮ‬ ( ‫ﻣﺜﺎل: ) إزﯾﻚ ﯾﺎ ﺣﺎﺟﺔ – ھﻨﺪردش ﻣﻌﺎﻛﻰ – ﻋﺎﺷﺖ اﻷﺳﺎﻣﻰ– ﻣﻨﻲ ﻣﺜﻼ ﺗﻘﻠﮭﺎ ﻣﻨﻤﻦ‬ 2..Marital status: o Married since 1999 o Married for 10yrs.

Occupation * Jobs of stress: should be avoided as • Academic teaching → " D.Alcohol * Complications: 1) Abortion 2) Accidental Hge.Residence • Significance : 1.‫2.boys / girls. • -------. 2. • → Health care givers dealing with infections diseases 7. May indicate long period of infertility. Pregnancy after long period of infertility → precious baby 4.males/ females.Recall for any emergency ‫* ﻣﺜﺎل‬ Anti D ‫1. 3) IUGR "‫" اﻟﻤﻮﺿﻮع ﻣﺤﺮج‬ ‫ﺟﻮزك ﺑﯿﺸﺮب ﺳﺠﺎﯾﺮ؟‬ ‫ﺟﻮزك ﺑﯿﺸﺮب ﻛﺤﻮﻟﯿﺎت؟‬ ‫ﺗﻜﺘﺐ ﻋﻠﻰ ﺷﻜﻞ‬ ‫وﻻ ﺗﻜﺘﺐ ﻋﻠﻰ ﺷﻜﻞ‬ ‫ﻛﺎم ﻋﯿﻞ ﻋﺎﯾﺶ‬ ‫أﺻﻐﺮ ﻋﯿﻞ ﻋﻨﺪه ﻛﺎم ﺳﻨﮫ؟‬ "‫" ﺗﻜﺘﺐ ﺑﺎﻟﺘﻔﺼﯿﻞ‬ (‫) ﻣﻨﻄﻘﺔ – ﺷﺎرع – ﻋﻤﺎرة – دور – ﺷﻘﺔ – رﻗﻢ اﻟﺘﻠﯿﻔﻮن‬ .Parity • -------.T & V. • How many of them living? • How old is the youngest one? 5.ﻟﻮ ﺣﺼﻞ ﻟﺨﺒﻄﺔ ﻓﻰ اﻟﻌﯿﺎل ﻓﻰ اﻟﺤﻀﺎﻧﺎت‬ 6.V.Special habits 1.V" • Radio therapy → teratogenicity.• Significance : 1.Smoking 2.ﺣﻘﻨﺔ‬ .

Drugs 4. ‫1.Complaints of pregnancy complications a) preterm labour → " lower abd.Special habits 5.Coffee & tea → anemia 6. dogs & goats → Toxoplasmosis “Recurrent abortion" 5. → during antenatal care.Husband : 1.Name 2.اﻟﻤﺸﯿﻤﺔ ﺳﺎﻗﻄﺔ‬ ‫4 – ﺣﺮﻛﺔ اﻟﻄﻔﻞ ﻗﻠﯿﻠﺔ‬ ‫ﺑﺘﺸﺘﻜﻰ ﻣﻦ إ ﯾﮫ؟‬ .Age 3.‫ﺗﻜﺘﺐ ﻋﻠﻰ ﺷﻜﻞ‬ • She is referred from outpatient clinic while they accidentally discovered ………. Complaints of associated diseases: .4) Congenital 5) Preterm labour 3..Vaginal douches: High Vaginal douches: 8..اﻟﻜﯿﺲ ﻓﺮﻗﻊ‬ ‫3.Socioeconomic Varicocele ← ‫ﻣﺜﺎل :ﺳﻮاق‬ ‫*اﻟﻌﯿﺎﻧﮫ ﺗﺪﺧﻞ اﻟﺨﺮﻃﻮم ﻧﻔﺴﮫ ﺟﻮه‬ transmit infection Complicate pregnancy "infertility" ‫اﻟﻤﻔﺮوض ﻧﺬﻛﺮ اﻟﺰوج ﻓﻰ ﺣﺎﻟﺔ‬ B) Complaint: " Patient own words" chronological manner 1.Occupation 4.Domestic animals * Cats. • Hypertension → Elevated blood pressure..اﻟﻄﻠﻖ اﻟﻤﺒﻜﺮ‬ ‫2.. Pain" b) PROM → “passage of watery vaginal fluid" c) Placenta previa → " recent vaginal bleeding d) Fetal distress → "↓ fetal movement".

enlargement" 3.etc 2...3rd trimester events 7.Pregnancy symptoms 2.Seek for medical advice 4.Medications 9.1st trimester events ‫إ زاي ﻋﺮﻓﺖ أﻧﻚ ﺣﺎﻣﻞ؟‬ ‫إ زاي ﺗﺄﻛﺪﺗﻰ أﻧﻚ ﺣﺎﻣﻞ ؟‬ ‫ﻋﻤﻠﺘﻰ أﯾﮫ ﻟﻤﺎ ﻋﺮﻓﺘﻰ‬ ‫إ ﯾﮫ إﻟﻰ ﺣﺼﻞ ﻓﻰ أول 3 ﺷﮭﻮر‬ ‫إزاي ﻋﺮﻓﺘﻰ أﻧﻚ ﻋﺪﯾﺘﻰ أول 3 ﺷﮭﻮر‬ 5. 3.Other systems review 8... C) History of present illness 1..M → Elevated blood sugar • Placenta previa → " Lower inserted placenta • Ployhydramnios→ Excessive abd.2nd trimester events 6.Pregnancy test 3.Seek for medical advice : "Ante natal care" . breast heaviness ….Symptoms of pregnancy: … ‫ﺗﻜﺘﺐ ﻋﻠﻰ ﺷﻜﻞ‬ • The story started when she missed a period & suffered from nausea.Investigations ‫أﯾﮫ إﻟﻰ ﺣﺼﻞ ﻓﻰ ﺛﺎﻧﻰ 3 ﺷﮭﻮر‬ ‫أﯾﮫ إﻟﻰ ﺣﺼﻞ ﻓﻰ ﺛﺎﻟﺚ 3 ﺷﮭﻮر‬ 1.. vomiting.‫ﺗﻜﺘﺐ ﻋﻠﻰ ﺷﻜﻞ‬ • She is referred from…….Pregnancy test: … ‫ﺗﻜﺘﺐ ﻋﻠﻰ ﺷﻜﻞ‬ • Pregnancy test was done in blood & urine & it was positive.• D.Control of condition " Antenatal care" . → for antenatal care to control her condition.

. bleeding) (Vaginal discharge) ( excessive vomiting ) (fever. L.Pump failure (heart failure) " Palpitation ..Placenta previa " bleeding" 5. (‫)اﻟﻄﻔﻞ ﺑﯿﻨﺒﺾ – ﺑﯿﻨﻜﺶ – ﺑﯿﺮﻗﺺ – ﺑﯿﺮﻓﺲ‬ 5.. ↑ Abd size ...Pyelonephritis " fever. ‫اﻷﻣﺮاض اﻟﺘﻰ ﺗﮭﻤﻨﻰ‬ 1.Ledema" 6. loin pain) If –Ve : ‫ﻛﻠﮭﻢ‬ … ‫ﺗﻜﺘﺐ ﻋﻠﻰ ﺷﻜﻞ‬ * The 1st trimester was smooth as no symptoms suggestive of → ‫وﺗﻘﻮﻟﮭﻢ‬ If +Ve : • At the 1st trimester the patient suffered from ‫أو‬ • The patient has noticed ‫إزاى ﻋﺮﻓﺘﻰ أﻧﻚ ﻋﯿﺘﻰ‬ Gradual enlargement of her abdomen & She felt the fetal movements “Quickening" & still felt up till now.Polyhydramnios " ↓ fetal movement.اﻷﻣﺮاض اﻟﺘﻰ ﺗﮭﻤﻨﻰ‬ (lower colicky pain.. dyspnea. blurred vision" 2.. Polyuria. polydepsia parasethia ...Blood sugar (D.‫ﺗﻜﺘﺐ ﻋﻠﻰ ﺷﻜﻞ‬ If –Ve : • The 2nd … ‫ﺗﻜﺘﺐ ﻋﻠﻰ ﺷﻜﻞ‬ trimester was smooth as no symptoms suggestive of → ‫وﺗﻘﻮﻟﮭﻢ ﻛﻠﮭﻢ‬ . dysuria" 3.Pre-eclampsia " Headache.M) " Polyphagia.4-1st trimester events: • threatened abortion • Infection • Hyperemesis gravidarum • Pyelonephritis ‫1. 4. loin pain.2nd trimester events . dysuria.

.‫ﺗﻜﺘﺐ ﻋﻠﻰ ﺷﻜﻞ‬ • The last menstrual period .D 1.No abortion or AUB " in last 3 months " .Ultrasound 4..Menarche ‫أول دورة ﺟﺎﺗﻠﻚ ﻋﻨﺪ ﺳﻦ ﻛﺎم ﺳﻨﺔ؟‬ Normally → 9-14 yr 2.No use of OCP 3..Regular menstruation " at least last 3 months" 2.History " by fundal level" " at 10 the week" ‫أﺣﻖ ﺳﻮﻧﺎر‬ . was → & the patient is sure of that date & she had 1 2 3 ‫3 ﺷﺮوط‬ ‫ﺻﺤﯿﺤﺔ‬ 5.35 days 4.D.Duration → average 2-7 days 3.E..Length of cycle → average 21.If +Ve : • At the 2nd trimester the patient suffered from …… ‫وﺗﻘﻮل اﻟﻠﻲ ﺑﺘﺸﺘﻜﻲ‬ ‫ﻣﻨﮫ او اﺷﺘﻜﺖ ﻣﻨﮫ‬ 6.Examination 3.3rd trimester events: As 2nd trimester D) Menstrual history 1.1st day of last menstrual period ‫أول ﯾﻮم ﻓﻰ أﺧﺮ دورة ﻛﺎﻧﺖ إﻣﺘﻰ؟‬ • to use this period for calculation of EDD the period should fulfill these criteria 1.last menstrual period 2.

B (3 ‫2.D: Today is: 10/4/2007 = 10/3/2007 ‫ﺻﻔﺮ‬ ‫04 أﺳﺒﻮع‬ LMP ‫ﯾﻌﻨﻰ زود ﺷﮭﺮ ﻋﻠﻰ‬ So Expected gestational age is “14 weeks ± 2 week" E) Contraceptive History: .D ‫ﻋﻠﻰ ﺣﺴﺐ ﻣﯿﻦ أﻗﺮب‬ ( ‫• اﻟﺸﮭﺮ -4 أﺳﺎﺑﯿﻊ وﯾﻮﻣﯿﻦ ) 3 ﺷﮭﻮر – 31 أﺳﺎﺑﯿﻊ‬ ‫• ﻣﺜﺎل‬ 1st day of last menstrual period E.Expected Gestational age: ‫ﺗﻄﻠﻌﮭﺎ ﻗﺪام أو ﺗﺮﺟﻌﮭﺎ ﻟﻮرا‬ ‫ﺗﺤﺴﺐ ﻣﻦ ﺧﻼل‬ Last Menstrual period E.Results: ‫ﯾﻌﻨﻲ ھﻞ ﺑﻌﺪ اﺳﺘﺨﺪاﻣﮭﺎ ﻟﻠﻮﺳﺎﺋﻞ دي ﺣﺼﻞ ﺣﻤﻞ ؟ وھﻞ ﻣﻌﺎھﺎ ﻣﻀﺎﻋﻔﺎت‬ .P 3/7/2006 E.ﻧﺰود 9 ﻋﻠﻰ اﻟﺸﮭﻮر ) 1 ، 2 ، 3 ﻧﺰود 9 ، 4-21 ﻧﻄﺮح‬ 6.D.D: Today is: 10/4/2007 = 40 WK 10/3/2007 EDD ‫ﺑﻤﻌﻨﻰ أﻃﺮح ﺷﮭﺮ ﻣﻦ أل‬ 3/7/2006 = 0 WK • So Expected gestational age is “35 week & 5 days ± 2 week" ***** ‫ﻣﺜﺎل آﺧﺮ‬ 1st day of last M.Methods .‫1.D.ﻧﺰود 7 ﻋﻠﻰ اﻷﯾﺎم‬ N.D.

• Vital signs: Pulse. • In case of transverse lie the abdomen is transverse from side to side. .Abdominal examination a.Feeding ***** Obstetric examination 1. • Pallor.Medical disorders . . for any deformity. • Back examination. DM. • General debilitating disease: thyroid. Inspection: • The size of abdomen & pendulous abdomen is detected in the standing position. • Fetal limb movements.Date . varicose veins & deformities. • Chest &heart examination. in occipito-posterior and mentoposterior. • Breast examination for signs of pregnancy & any abnormalities.Duration . weight & gait. hirsutism.Out come .General examination • A Stand on the right side • A General data: Height. pigmentations & septic foci. The eye for.cardiac. 2. jaundice & edema of the lids.Place of delivery .F) Obstetric History: .Puerperium . cyanosis. • A transverse groove e. • Limb examination for edema. BP. • The neck for goiter enlarged LN & congested neck veins. temperature & respiratory rate.g.

lightening &pelvic pressure symptoms suggests a full term fetus c. causes of oversized uterus Mis-calculation Polydramnios Twins Vesicular mole Macrosomia or hydrocephalus Associated fibroid causes of undersized uterus Mis-calculation Oligohydramnios Transverse lie Missed abortion and IUFD Anencephaly Small size of the uterus . The period of amenorrhea suggests the gestational age. Engagement of the head suggests a full term fetus. b. The size of the fetus & the fundus of the uterus helps. • Masses as hernia. d.• Scars as a cesarean section scar. Palpation: • Superficial palpation.e. • Deep palpation to examine the abdominal organs.Fundal level ü By the ulnar border of the left hand starting at the xiphisternum after centralizing the uterus to correct the dextro-rotation. ü The differences between 32 weeks and term i. b. a. • Obstetric palpation includes. for tenderness & rigidity. ü After engagement. The fundal level descends to the level of 32 weeks. Striae gravidarum & pigmentations as linea nigra." 38-42 "Weeks: a.

The limbs which are felt as mobile knobs.4. Detection of engagement if less than if less than 2/5 of the head is felt Maternal Contracted pelvis Tumor in pelvis Placenta previa Full bladder or rectum No cause may be found . The hand is placed on the symphysis pubis with the thumb parallel to one inguinal ligament & the 4 fingers parallel to the other. Lateral umbilical grip 2.5% or the breech in 96%. 1st pelvic grip "Pawlick grip": 3.Causes of non engagement of head in PG Fetal Large head hydrocephalus Malposition malpresentation Multiple pregnancy Short cord Polyhydramnios b. 2. It is done for: 1. The uterus is fixed with by 1 hand at the level of the umbilicus while then both hands are alternated: for the back. The fundus of the uterus is palpated by both hands to detect the part of the fetus occupying the fundus i. which is felt smooth firm & convex.Obstetric palpation : The fundal grip 1. Detection of the parts of the fetus occupying the lower part of the uterus.e the head in 3. While in transverse lie the head is felt on one side & the breech on the other.

e. 6. regular. 7. ý In breech presentation. FHS are heard below the umbilicus in the flank i. • Normally the fetal heart rate is between 110-160 b/m. bradycardia.anterior.2nd pelvic grip 4. FHS is heard by the Pinard stethoscope (20 weeks gestation) or the Sonicaid (10th week gestation). Facing the patient's feet both hands are pushed towards the pelvis: 1. 2) It gives an idea of the fetal position & presentation. The point of maximum intensity of the FHS is heard through the anterior scapula & is determined by the fetal position e. 2.g. 3) Diagnosis of intrauterine fetal death. c.g. lateral to the site of occipitoanterior. To detect the degree of flexion of the head. . tic tac rhythm. On one side of the umbilicus towards the head Values of auscultations of FHS: 1) It is a sure sign of pregnancy. FHS is heard below the umbilicus. ý In occipito. 5) Diagnosis of twins. To detect the engaged head of an unsuspected twin.Auscultation of the fetal heart sound (FHS): 5. FHS are heard above the umbilicus ý In transverse lie. Near the midline at the anterior superior iliac spine ý In occipito posterior (OP). 4) Diagnosis of fetal distress e.

It is a soft blowing sound coinciding with the maternal pulse. 5. Sounds of fetal movements.It is due to increased blood flow in the dilated maternal uterine vessels. Umbilical (funic) soufflé: .Obstetric formula “Gravidity-Parity-Abortion-Living-Dead” e.Single or Multiple . bleeding or discharge.Vaginal examination Indications of vaginal examination 1. 4.g. During labor: see management of normal labor.Lie -Presentation “ if G2 and L2 not preferred to say D0 ” Complications with pregnancy .g. Aortic pulsations.Gestational age . G2 P1 A0 L2 . At the 36 weeks to do cephalo-pelvic disproportion tests if the head is no engaged in a primigravida. 2. 3.It is a soft bowling rapid sound coinciding with the fetal pulse It is due to blood flow in the umbilical vessels.Living viable . 3. Intestinal sounds.Age . . Uterine soufflé: .Differential diagnosis of the FHS: 1. Any complications during pregnancy e. 5. 2. 6-Diagnosis Should be written as in the following method: .

N.B: Don’t Say: * Female patient ………. * G1 P0 A0 L0 in case of primigravida * Gestational age in odd numbers (37wks wrong) But say it in even numbers (36wks plus or minus 2 wks) .

Indeed . . finally what ever you do you couldn’t satisfy all points of view.Remember That Don’t forget that taking a sheet is an Art and actually it is a matter of difference about the way of taking it. A doctor is not considered to be a doctor unless he gives his own comment on the sheet .

Islam El-Sawahly for his generous time and help during the preparation of this work Cover designed passionately by : Asim “Phoenix” .M.Basiony Other works : Summary to A.Gafar Clinical Obstetrics You can find all my works at : MedFlux.com Special Thanks Thanks to Dr.And at the end This is another masterpiece by : Dr.