Personal data:

name
husbands name

I age
age

residence

half education
level

of education blood grouping

ocuppation

consanguinity
durationofmarray

presenting complaints +history of P.C

Obstetrical history

Gravidity
Parity
+

Past pregnancies

-Duration
- Complications during pregnancy
- Onset of labor
- Duration of labour
- Mode of delivery
- Place of delivery
- Complications after delivery (retained placenta,
PPH, DVT, UTI, psychosis, anaemia…etc).

Outcome of the pregnancy:

- Newborn weight
- Condition of the newborn (alive/dead,
cried immediately, taken to N.I.C.U.
- Breast-feeding / Bottle-feeding.
- Age of the baby now / Milestones.

In case of caesarean section you have to ask about:

-Elective/emergency.
- Cause of C/S.
- Blood transfusion.
- Complications
- Stay in hospital.

In case of stillbirth you have to ask about:

- Fresh/macerated.
- Cause(S): HTN, DM, PROM, prematurity..etc
- Weight of the baby.
 - Malformations.
- Mode of delivery.

In case of abortion you have to ask about:

- Gestational age.
- Spontaneous or induced.
- Evacuated or not.
- Blood transfusion.
- Complications: bleeding, perforation infection.
- Possible cause(s).

Gynaecological history

Menarche. • Kata. 5/28. • The cycle:

! Pattern.
! Amount.
! Associated pain.
! Vaginal discharge (colour, amount, consistency, odour,
• Gynaecological surgery
itching)
! Use of contraceptives.
! history of pap smear and mammography
! Sexual history

History of current pregnancy

-LMP
-EDD
-GA
 Past medical and surgical history
! Hypertension.
! Diabetes.
! Asthma.
! Hospitalization.
! Blood transfusion
! Epilepsy
! HIV
! Venous thromboembolic disease ( risk of
Thromboembolism, pre-eclampsia, FGR)
! Connective tissue diseases (SLE) ( risk of pre-eclampsia,
FGR) -
Type of operation including gynaecological operation
(D&C , myomectomy… etc), date and complication(s).
- Type of anesthesia used and complication(s).

Family history
Hypertension,
diabetes,
asthma.
- Twin pregnancy.
- Congenital malformations/handicaps.
- Anaemia and Cardiac disease.

Drug history:
• Regular use of medication
(chronic use).
• Allergy to any drug specially
penicillin.
• Pre-conceptual or early use of folic acid.
• Current use of medication.
Social history:

Housing condition.
Abnormal habit e,g smoking