OBSTETRICS HISTORY

Bed No: Date:

BIODATA:
Name. Husband's Name. Age. Occupation. Home address.
Time since marriage. Consanguinity. No. of children.
Gravidity (no. of times she conceived, including this pregnancy, regardless of the outcome)
Parity (no. of times she delivered. Para X + Y, where X are viable deliveries after 24 weeks, and Y are
the miscarriages before 24 weeks, regardless of the outcome. The current pregnancy is not counted.)

(P.s twins are 2 para but 1 gravida)

LMP
EDD: (LMP + 7 days + 9 months) OR Naegele’s rule (MDY) = Add 7 days, then subtract 3 months, then
add 1 year.

Gestational age in weeks: [no. of months from LMP till now x 4] + [1 week additional for every 3
months that pass]

Eg LMP: 12/11/2017

So on 12/7/2018, gestational age will be: (8x4= 32. 32+2= 34.) 34 weeks.

EDD will be: 19/8/2018

Dates calculated from U/S Dating scan (done between 10 to 20 weeks).

Mode of admission: OPD or ER

Date of admission:

Comorbidity: Diabetes/ HTN/ Asthma/ Hep-B/ Hep-C/ TB/ Cancer /AIDS / Epilepsy

PC
HOPC

CURRENT PREGNANCY:
Planned / Unplanned
Booked/ Unbooked
How did she know she was pregnant?
Confirmation of pregnancy: When? How?
FIRST TRIMESTER (at 1st, 2nd and 3rd months):
Morning sickness: Nausea / Vomiting
Fever or rash?
Supplementation: Folic acid (yellow tablets) / Iron / Calcium / Vitamins / Any Drug?
Tests: Blood / X-rays / Ultrasound: At 6 or 7 weeks. [Dating scan between 10 and 20 weeks]
Any complication or symptom: HTN / Abdominal, pelvic, back pain / Burning micturition /
Any infection / Vaginal discharge? (Color/ Quality / Quantity /Bleeding/....)

SECOND TRIMESTER (at 4TH, 5TH and 6th months):

Fetal movements (Quickening): (normally felt around 20 weeks gestation)
Antenatal checkups: Tests: Ultrasound: [At 18-22 weeks (Anomaly scan)]
Supplementation: Folic acid / Iron / Calcium / Any drugs?
Fever or rash?
Complications or symptoms: HTN / Diabetes / Edema / Fits / Infection/ Vaginal discharge:

THIRD TRIMESTER: (at 7TH, 8TH and 9th months):

Fetal movements:
Antenatal checkups:
Tests: Ultrasound:
Supplementations:
Vaccination: (Tetanus toxoid at 28 weeks and 32 weeks)
Complications: Fever / Rash / Infections / Any symptoms/ Vaginal discharge

PAST OBSTETRICS HISTORY

For every prior pregnancy:
Antenatal: Number. Duration of gestation. Booked/Unbooked. Complication: HTN / Fits /
Diabetes
Natal: Delivery Type: NVD with or without instrumentation/ D&C/ D&E/ LSCS. Conducted by:
(+ cord?). Duration. Place of delivery. Complication: Fits/ Bleeding/ retained placenta/
rupture.
Postnatal: Puerperium (till 6 weeks after delivery). Complication: Bleeding/ depression/ fits.
Baby: Age. Sex. Alive or Dead. Birth weight. Crying. Resuscitation (O2 or ICU). Jaundice.
Cyanosis. Congenital anomalies. Feeding and Duration: (Breastfeed/ other). Vaccination.
Miscarriage/Abortion:

PAST GYNECOLOGICAL HISTORY

Age of menarche. Cycle Length. Menses Duration. Flow: Normal / Heavy. Character: Liquids /
Clots. Intermenstrual bleeding. Dysmenorrhea. Dyspareunia. Post coital bleeding.
(To assess amount of blood loss during menses, ask about: No of pads used per day, Type of
pads used (homemade or store-bought) to assess absorption capacity, Soiling of clothes or
bedsheets, passage of clots for how many days, size of clots.)
Contraceptive history.
Pap smear. (sheeshay ki patti ka test)
Previous genital tract infections and their treatment

PERSONAL HISTORY: Appetite. Sleep. Bowel. Micturition. Recent weight gain or weight loss.
Addiction. Allergies. Psychiatric illness. Relations with husband/domestic violence.
PAST MEDICAL HISTORY: Including OTC meds and homeopathic prescriptions.
PAST SURGICAL HISTORY:
BLOOD TRANSFUSIONS:
VACCINATION HISTORY:
DRUG HISTORY:
FAMILY HISTORY: Mother, Father, Siblings, Husband, Children
SOCIO-ECONOMIC HISTORY: House: Rooms, People living. Income/ Breadwinners.
Ventilation. Hygiene. Use of boiled water.

Compiled by Hasan bin Ajmal. Edited by Hafsa Murtaza (D’19)