OBSTETRICAL HISTORY AND PHYSICAL EXAMINATION #1

Pearl Elizabeth Armas-Contemplacion, MD, FPOGS

● Renal/Urinary Tract Disorders

● Hepatic/Biliary/Pancreatic Disorders
TABLE OF CONTENTS
● Endocrine Disorders
1. OBSTETRIC HISTORY ● Hematological Disorders
2. GENERAL SURVEY ● Connective Tissue Disorders
A. LEOPOLD’S MANEUVER ● Dermatological Disorders
B. GENITAL EXAM ● Neoplastic Disorders
3. LABORATORY TESTS ● Infectious Diseases
4. FREQUENCY OF PRENATAL VISITS ● Psychiatric Disorders
5. NUTRITIONAL COUNSELING
Note: The purpose of this is to know exactly what
diseases your patient had in the past that may affect the
present pregnancy. Always start with the POSITIVES
OBSTETRIC HISTORY then negatives. Deliveries should be included in the OB
history/OB score.

GENERAL DATA
FAMILY HISTORY
● Patient’s Initials
● Heredofamilial Illness: HPN, DM, CA
● Age
● Communicable diseases: PTB, Hepatitis
● G_P_ (_ _ _ _)P
● History of multifetal pregnancies,
● Civil Status
● congenital anomalies
● Nationality
●
● Religion
*** POSITIVES then negatives.
● Place of Birth
*** relationship/consanguinity to patient
● Current Residence
*** similar to Past Medical History
● Consulted the DLSUMC- ”OPD” for the __ time
on___(date) at ___ (time).
Note: Gender not needed PERSONAL/SOCIAL HISTORY
A. Patient
CHIEF COMPLAINT ○ Blood type
○ Educational attainment
● Subjective ○ Employment/source of income
● Reason for Consult/Admission ○ Smoking: # of sticks/day
Note: You may write exact wordings of your patient: ■ When started/when stopped
“sumasakit ang tiyan ko” or Abdominal tightening ■ (pack years: # of sticks per day/20 x
#of years smoked)
PAST MEDICAL/SURGICAL HISTORY ○ Alcohol intake
■ when started/stopped
● previous medical illness frequency/quantity
● previous surgeries (ask further questions: ○ Illicit drug use
where, when, how was it done, etc.) ■ when started/stopped
● hospitalizations frequency/quantity
● immunizations (Hep B, HPV, Tetanus) ○ Recreational activities
● Neurological Disorders
● Cardiovascular Disorders/HPN B. Partner
● Pulmonary Disorders ○ Blood type
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Obstetrical History and Physical Examination (Pearl Elizabeth Armas-Contemplacion, MD, FPOGS)
February 14, 2018
 ○ Educational attainment Cephalo-pelvic disproportion (maliit ang sipit-
○ Employment/source of income sipitan)
○ Smoking ● Complications: maternal/fetal (ante-, intra-,
■ when started/stopped postpartum)
frequency/quantity
(pack years: # of sticks per day/20 x #of GYNECOLOGICAL HISTORY
years smoked) *one of the risk factors
○ Alcohol intake ● (Breast, Reproductive tract)
■ when started/stopped ○ Infections
frequency/quantity ○ Diseases
○ Illicit drug use ○ Surgery (diagnosis, type, date, place,
■ when started/stopped biopsy result, complications)
frequency/quantity ○ Papsmear (date, results)
○ Intimate Partner Violence
Note: Ask if there is itchiness, color of discharge, vaginal
C. Household warts, and IMPORTANTLY, counter check the
○ Members of the household (enumerate) histopathology result, to know if truly benign or
○ House malignant). Confirm if there is medication given.
■ bungalow/2-storey
■ concrete/wood/etc. SEXUAL HISTORY
■ lighting/ventilation
■ water source/drinking/cooking ● Coitarche - First coitus
■ toilet type ● # of lifetime sexual partners
■ garbage disposal (segregation, etc.) ● Associated signs and symptoms
○ Dyspareunia
■ Pain during sexual contact in
MENSTRUAL HISTORY the vagina (Most common
● M - enarche (start of your menstruation) reason is lack of lubrication)
● I - nterval (regular vs irregular) normal range: ■ Pain in the upper reproductive
21-35 days. If your patient cannot recall just tract during sexual contact
write regular monthly period (Uterus, Ovary, Fallopian tube)
● D - uration ● Masses (myomas) -
● A - mount (how many pantyliners per day) Parang may
Maximum blood flow: 80 ml per day nabubunggo sa loob
● S - igns/symptoms ( headache, dysmenorrhea, ● Infections
pain in the hypogastric area, lumbar pain, give ○ Postcoital bleeding
the pain scale, medication: frequency & dosage) ● Regularity
● Satisfaction
○ Ask for satisfaction (Orgasm)
OBSTETRICAL HISTORY
■ To confirm IPV (Intimate
● OB score: GP(TPAL) No. of pregnancy partner violence)
● Date ● Date of last sexual contact
● Age of Gestation( term or preterm)
● Manner of delivery (vaginal, assisted (use of
CONTRACEPTIVE HISTORY
forceps), caesarian (why it is done).
● Gender ● Types:
● Birthweight ○ Natural (calendar, abstinence,
● Place/attendant (In a lying in? By Obgyne, withdrawal, basal body temperature,
midwife or hilot) cervical mucus method
● Present status ○ Artificial (oral contraceptives,
● Complications intrauterine device, bilateral tubal
● if CS: nominal order (Primary, Secondary ligation, vasectomy, condoms,
Repeat) type of incision (Most common: Low subdermal implant - most recent)
Transverse, Classical) Indication: (Breech, ● When started? When stopped? Reason?
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 ● Adverse effects (headaches, vomiting, epigastric 10 DANGER SIGNS OF PREGNANCY
pain)
SIGNS AND SYMPTOMS POSSIBLE CAUSES

HISTORY OF PRESENT PREGNANCY (HPP) Chills and fever Pyelonephritis,

chorioamnionitis
● Last Normal Menstrual Period (LNMP) - Kailan
ang unang araw ng huling normal na regla? Persistent vomiting Hyperemesis gravidarum
○ Pagbabawas - spotting only, not real
menses. Dysuria Urinary tract infection
● Expected Date of Delivery (EDD) - Naegele’s
rule; subtract 3 from the month then add 7 to Swelling of face and Severe preeclampsia
the day fingers
● Age of Gestation (AOG)
○ SAMPLE of AOG COMPUTATION: LNMP: Severe or persistent Severe preeclampsia
Sept. 8, 2017 headache
○ September 22
○ October 31 Blurring of vision Severe preeclampsia
○ November 30
Vaginal bleeding Placenta previa, placenta
○ December 31
abruptia, spontaneous
○ January 31 * 158/7 *
abortion
○ February 13 22 4/7 weeks
● Quickening (date, day/week) - Kailan unang Abdominal pain Preterm labor, severe
gumalaw o sumipa ang baby mo preeclampsia (epigastric
○ Helps determine the age of the baby, pain)
quickening occurs within:
■ 18-20 weeks AOG -primigravid Fluid leakage from vagina Rupture of fetal
■ 16-18 weeks AOG - multigravid membrane
○ NOT pitik - this is the blood flow to the
uterine arteries, leading to its Sudden change in Fetal compromise
engorgement frequency and intensity
● Signs and Symptoms of fetal movements
● Consults done
● Diagnostic test
● _____ months PTC ( ____ weeks AOG): GENERAL SURVEY
● Patient missed her menstrual period
● Place of checkup VITAL SIGNS:
S - ubjective (signs and symptoms) BP, HR, RR, Temp
***DANGER SIGNS OF PREGNANCY*** Weight (pre-pregnancy, present)
O - bjective (BP, weight, FHT, etc.) Height
A - ssessment BMI
P - lan (Lab exams, date, results)
(Medications, Immunization) REGIONAL EXAMINATION
Reminder:
If the chief complaint is not for regular PNCU but for a ABDOMEN
medical/surgical condition > Inspection
HPP vs History of Present Illness (HPI) linea nigra, striae, “scars”, telangiectasia
Palpation
For example: Patient scheduled for cholecystectomy 16 Fundic Height (20-34 weeks)
weeks AOG, still do all HPP then followed by the HPI. Leopold’s Maneuver
Auscultation Fetal Heart Tone (location)
REVIEW OF SYSTEMS (110-160 bpm)
*In Labor: uterine contractions
● NOTE ALL SYMPTOMS ESPECIALLY THE DANGER
(interval, duration, intensity)
SIGNS DURING PREGNANCY
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 LM 1: Fundal Grip (upper left image)
● The doctor facing the mother
● Place both hands and palpate for the uterine
fundus, the uppermost part of the uterus, to
determine which fetal part occupies the uterine
fundus
● Breech - nodular, soft parts
● Head - hard, round, ballotable
● Reporting: LM1 = Breech or Head

LM 2: Umbilical Grip (upper right image)

● The doctor facing the mother
● Palpate the sides of the maternal abdomen and
determine where is the spine (smooth, curved
and resistant feeling) and extremities (small
knob-like parts)
● Convex part of the fetus is on the left maternal
side, therefore fetal back is on the left
Lips: Mild, Nose: Moderate, Forehead: Strong maternal side = LM2

What is the consistency of cervix if the patient is not LM 3: Pawlik’s Grip (lower left image)
pregnant? The nose, kasi it’s firm. ● The doctor facing the mother
● Determines the presentation of the baby
AOG LOCATION ● Non-dominant hand is placed on the fundus and
8-12 weeks Level of symphysis pubis applies pressure, while the dominant hand is
16 weeks Midway between symphysis pubis & placed above the symphysis pubis with the
umbilicus index finger and thumb trying to palpate which
20 weeks Umbilicus part of the baby is occupying the area
36 weeks Xiphoid process ● Breech - nodular, soft
As AOG progresses (37 – 40 weeks), the fundic height ● Head - hard, round, ballotable
decreases because the baby starts to descend ● Reporting: LM3 = Breech or Cephalid

LM 4: Pelvic Grip (lower right image)

LEOPOLDS MANUEVER ● The doctor facing the feet of the mother
● The area above the symphysis pubis is palpated
to locate the fetal presenting part and thus
determine how far the fetus has descended and
whether the fetus is engaged (means the baby
has already passed through the inlet and stuck
in the pelvic bone).
● Converging hands/fingers (baby still bouncing,
still ballotable) = unengaged
● Unconverged hands/fingers = engaged
● Reporting: LM4 = Engaged or Unengaged

Where do you check for fetal heart tones?

At the fetal back

GENITAL EXAM
1. External exam - scar, lesions, masses, erosions,
inflammation, warts, varicosities, etc. (e.g. presence of
bartholin’s cyst)
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2. Speculum exam - check the cervix for color, erosions,
FREQUENCY OF PRENATAL VISITS
masses, discharge and color, etc. (describe it as you see
it) **speculum can be plastic or metal 4-week intervals until 28 weeks
↓
3. Internal exam - check the cervix - dilatation and every 2 weeks until 36 weeks
effacement (insert 2 fingers, into the vagina and palpate ↓
for the cervix, while the non-dominant hand will be Weekly
placed on top of uterus - on the fundus); amniotic
membrane (check/palpate if it is ● Most important in complicated pregnancies
intact/ruptured/leaking only if the cervix is already ● If patient is hypertensive or diabetic, patient
dilated, usually at 1cm); presentation; station must come back frequently

**Before doing an internal exam, observe the NUTRITIONAL COUNSELING

surrounding area first
**At 12 weeks the fundus is at the level of the *For future references when prescribing vitamins when
symphysis pubis; at 20 weeks at the level of the you’re already a JI or GP
umbilicus
**cervix is usually 2cm - 3cm long ● Maternal weight gain during pregnancy had a
**always complete the physical exam; if not completed, POSITIVE correlation with birth weight
always state WHY (ex. The patient refused) ● Severe nutritional deficiency → lighter, shorter,
**urological exam may or may not be performed, but do thinner babies
so if the patient warrants it to be done ● Body mass index
**Clinical Pelvimetry - checks for the adequacy of the
pelvic bones (reported as
adequate/doubtful/inadequate)

LABORATORY TESTS
Routine examination but explain the rationale behind
each procedure
● Complete Blood Count (CBC) - for anemia
● Blood Type with Rh Factor
○ Always with Rh
○ ABO incompatibility ● Normal Pre-pregnant BMI, patient is allowed to
○ Rh (+) or (-) especially if with foreigner have a weight gain of 25-35lbs all throughout
partner pregnancy
○ Blood Transfusion - If patient delivers
vaginally, you are to lose half liter of OBESITY
blood; If delivers operative by ● ↑ Gestational HPN/Pre-eclampsia
caesarean section, you are to lose 1 ● ↑ Gestational Diabetes
liter of blood ● ↑ Fetal Macrosomia
● Hepatitis B Serology - increase incidence in ● ↑ Cesarean delivery
Philippines
● Blood Sugar Test (FBS is more reliable) - UNDERNUTRITION
Endemic Diabetes VDRL/RPR (Syphilis) ● ↑ low birthweight babies
● HIV - recommended as a universal request or ● ↑ glucose intolerance
test ● ↑ reactive airway disease
● Urinalysis/Urine Culture ● ↑ HPN/dyslipidemia/coronary artery disease
● Papsmear - done during the first prenatal check
● Others BARKER HYPOTHESIS (Fetal Programming)
○ Thalassemia – Electrophoresis ● Fetal Health → Adult morbidity and mortality
○ Phenylketonuria – Phenylalanine
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 ● Intrauterine growth retardation, low birth
REFERENCES
weight, and premature birth have a causal
relationship to the origins of hypertension,
1. Past Trans (2019)
coronary heart disease, and non-insulin-
2. PPT
dependent diabetes, in middle age.
3. Recordings

TRANSCRIBED BY:

1. Group 16B: De Castro, Ganancias, Llanda,

Sayson, Sio, So
2. Subtranshead: Monica Mendoza

***will not be asked in the exam (accdg to 2019 trans)

but can be used later on to choose the best
multivitamins for the patient
***emphasis on Iron,
For patients with normal hemoglobin, recommended YOU CAN DO IT, DOC! KONTI NALANG! #RoadToAudi3
intake of iron is 27mg and this is elemental. In
multivitamins, check the value or Iron and the
number/value in quantity because that is your
elemental. If patient is anemic, you should give at least
100mg