Obstetric History of Presenting Illness (HPI)

Last updated 25.08.13

 

Essential Details

-  Pregnancy

-  Antenatal care

-  Maternal age

-   Downs syndrome

-   Complications: twins, pre-eclampsia, GDM..

-   Comorbidities: HTN, DM, medications..

-  Gestational age: prematurity, IOL, elective LUSCS, steroids, T/F

-  Planned mode of delivery: VBAC, elective LUSCS, vaginal breech

-  Vaginal Loss

-  Ruptured Membranes

-  Vaginal Bleeding

-  Vaginal Discharge

-   Physiological: increases in normal pregnancy

-   Abnormal: + pruritis, odour, pain or urinary S/S

-   Candida, BV, Chlamydia, GBS, Gonorrhoea, Mycoplasma, Ureoplasma..

-  Abdo pain

-  Early pregnancy: M/C, ectopic, abruption

-  Contractions/tightenings: labour, Braxton Hicks

-  Severe pain

-   Uterine rupture: VBAC, hyperstimulation, labour induction

-   Placental abruption: +/- PV bleeding, rigid abdomen

-   Ectopic: + shoulder pain, acute abdomen

-  Fetal movements: RFM

-  Antenatal Ix

-  Blood group: risk of isoimmunisation, Anti-D for APH/Miscarriage/TOP/ECV..

-  Antibodies: previous Anti-D, isoimmunisation

-  Hb (booking & third trimester): anaemia: APH, PPH, planned LUSCS

-  GBS status: SROM, PPROM, PROM, chorioamnionitis

-  Serology: HBV, HCV, HIV, TPHA +/- VZV, Parvovirus, CMV, HSV

-  Rubella immunity: antepartum exposure, post partum vaccination

-  Vitamin D (deficiency): supplementation, risk, retest

-  GCT/OGTT: GDM

-  BP during pregnancy: HTN, Pre-eclampsia

-  Ultrasounds

-  NT at 11.5-14/40 + Morph at 18-20/40

-  Dates

-  Growth (EFW, AFI, SD ratio)

-  Placental position

-  Twins, position (breech, cephalic)

-  Malformations

-  Oligo/polyhydramnios

-  Model of antenatal care: shared, consultant, midwife, GP Obs

 

Current Pregnancy S/S

-  Headache

-  PMHx migraines, headaches

-  Pre-eclampsia: typically frontal & bilateral, +/- scintillations & scotoma

-  Eclampsia: may be pre-ictal S/S

-  HTN in pregnancy

-  Dyspnoea

-  Physiological/anatomical

-  APO: severe pre-eclampsia

-  PE

-  Cardiac murmur

-  Systolic murmurs common & usually benign, related to increased flow

-  Diastolic murmurs are pathalogical

-  Nausea, vomiting

-  80-95% pts

-  Gestational trophoblastic diseae & multiple gestations (twins..): US

-  Hyperemesis Gravidarum

-  Morning Sickness

-   80% throughout day, 2% in morning only

-   Mild, self limiting

-   Begins around 9-10/40, peaks 11-13/40, resolved by 12-14/40

-   Lasts typically < 20 weeks (10% beyond 20/40)

-  Pruritis

-  25% women experince to some degree

-  PUPPS: + rash

-  Obstetric cholestasis: no rash, abnormal LFTs

-  Pemphigoid Gestationis

-  Pruritis Gravidarum = no rash & no other cause found

-  Backache

-  Very common

-  Increased laxity of ligaments (relaxin)

-  Mx by regular exercise, massage

-  Nerve root involvement: neuro defecit

-  Abruption: PV bleeding

-  Pyelonephritis: fever, vomiting, dysuria

-  Reflux

-  Increased incidence with increasing gestation, 70% women in 3rd trimester

-  ? from PG effect on smooth muscle

-  Mx by small meals, antacids, H2RA/PPI

-  Constipation

-  Exacerated by iron supplementation

-  ? from PG effect on smooth muscle

-  Increase fiber +/- osmotic laxatives

-  Avoid stimulant laxatives & magnesium

-  Haemorrhoids

-  Related to PG, pressure & constipation

-  Likely to recur in subsequent pregnancies

-  Mx by avoiding constipation

-  Topical creams: Annusol, Proctosedyl

-  Suppositories: Proctosedyl

-  Thrombosis & prolapse may require Mx (Sx)

-  Carpal Tunnel

-  Oedema from pregnancy

-  Mx by wrist splints & analgesia, steroid injection (rare)

-  Surgery not indicated

-  Rectus Diastasis

-  Varicose Veins

-  Very common, usually benign

-  May be ass w thrombophlebitis

-  Caused by PG & increased venous pressure

-  Rx w TEDS

-  Decreases post pregnancy but may recur in subsequent pregnancies

 Puerperium

 

 

 

References