‫بسم اهلل الرمحن الرحيم‬

Obstetric History

by

Dr. Ahmed moharib

Other sources :

• Dr. Mohamed hatem • Dr. shoug A. Rahhal • Dr. rafik

• Dr. Fathia Alshreqi • Dr. Malek Haddad

Writing by students :

• Mohamed Ramadan Omran

• Khadija Ibrahim Halim

Reviewed by :

•
•

Sebha 2022
Two type of obs Hx :

1. antenatal Hx
2. postnatal Hx

To distinguishes b/w the two we should simply ask the patient if she had
gave birth yet or not (‫)ولدت وال مزال‬

N.B before introduce the case, we should till the examiner the type of Hx
that we are going to present, e.g I will introduce antenatal Hx.

❖ Steps of antenatal Hx : (13 steps)

1. personal data (biodata).

2. main compliant “M/C”.
3. analysis of main compliant
4. whats done in the hospital Hx:
5. Antenatal HX =HX of current pregnancy
6. past obstetric HX
7. gynecological Hx.
8. Past medical Hx .
9. past surgical Hx .
10. Drug & allergic Hx .
11. Family HX
12. social HX.
13. Future planes.

Sebha 2022
 • Stand on the right side of the patient .
• ask for her permission & Introduce your self .

1. personal data (biodata):

a) Name : triple name. (to differentiate one patient from another / also give her
confidence & good communication)
b) Age & Sex : some diseases related to age , in young female they predispode to
difficulty / or preterm labor , and in old females > 35y are at risk for placenta
previa & congenital anomalies (most commonly downs’ $ )
c) nationality : some diseases are endemic and related to specific country or
region , e.g hyditiform mole (‫ )الحمل العنقودي‬is most commonly related to Asian
countries , Egypt : hepatitis & bilharziasis, Libya : leishmaniasis (‫& )العجيالت‬
respiratory disease in (‫ )الخمس والساحل بسبب المصانع‬, African countries : sickle cell anemia
& malaria
d) address : evaluate the state of health for admission in the hospital ( also in case
of emergencies if she lives far away from hospital )
e) occupation: some diseases are related with certain occupations e.g prolonged
standing cause → varicose veins
f) blood group + Rh isomerization : e.g O ( Rh + ve )

N.B if the patient is Rh – ve we ask about her husband Blood Group & Rh
isomerization b/c she is at risk for Rh incompatibility (erythroblastosis fetalis)
(‫)مرض تكسرالدم‬

G) Gravida : total number of pregnancies including current pregnancy

i.e (living births + abortions + stillbirth)
h) parity (para) : total number of deliveries either living or death after 24week
i) Miscarriage (abortions ): total number of death births before 24 week.

*N.B in case of pregnancy with twin they are considered as G1 but P2 .

*N.B normal gestational age = 40 weeks = 280 days .

1st trimester 1 day → 14week OR (13 week + 6 days)

2nd trimester 14week → 28 week OR (27 week + 6 days )
3rd trimester 28 week → delivery
*N.B preterm from 24 week to below 37 week/ term from 37 week to below 40week/
post-date more than 40 week to below 42 week ,post-term above 42 week
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Sebha 2022
* in extra we ask about :
1 - number of children and data of birth & type of delivery & their health state
2 - previous cesarean section (when & why : most commonly fetal distress )
3 - mention chronic diseases as HTN , DM , Asthma.
4 - Date of admittion (DOA) and time of admittion (TOA).
j ) gestational age (GA) :

FLMP : is the first day of last menstrual period

To find out the GA first we need to determine the period b/w the FLMP & the date of
Hx taking by weeks and days for e.g

FLMP = 2/3/2022 date of Hx taking = 22/9/2022 .

# of days 31 days 30 days 31 days 30 days 31days 31days 30days

in that
month
Days 1 2 3 2 3 3 1 Total =
remaining 15 day
month Mar Apr May Jun Jul Aug Sep
weeks 4 4 4 4 4 4 3 Total =
27
week

e.g month Apr consist of 30 days → 4 weeks and 2 days .

The remaining days in month Mar are 31- 2 = 29 day → 4 weeks & 1 day .
The past days in month Sep are 22 days → 3 weeks & 1 day .
After analysis each month , we need to add the total number of days with the total
number weeks, which is → 15 days ( 2 weeks & 1 days ) + the total number of weeks
27 = 29 week + 1 days. So GA = 29 week & 1 days .
N.B We should know how many days in each month of the year simply → each knuckle
= 31day & b/w the knuckles = 30 day . (except Fib = 28 day )

Sebha 2022
 k ) expected day of delivery (Edd):

also we need the FLMP and follow the next role .

1. add 7 days on the FLMP days.

2. Any month Before the Month Mar (Jan , Fib , Mar) we add 9 months to the
FLMP month on the same year
e.g FLMN 2/3/2022 so → EDD = 2+7 / 3+9 / 2022 . so → EDD = 9/12/2022.

3. Any month After the month Mar (Arp ,May ...etc.) we subtract 3 month from the
FLMP months and add 1 year
4. N.B If we add 7 days on FLMP days then we enter a new month we add the
remaining days to that new month and add 1 month to the result

e.g FLMN 27/7/2022 →

EDD = ( 27 + 7 = 31+ 3 remaining days ) / 7-3 / 2022+1 year
so EDD = 3 / 4+1 / 2023 → EDD = 3/5/2023

5. N.B in case of assisted pregnancy (IVF) we subtract 14 days from the resulting
EDD

summery :

e.g : ms ‫ حليمة أحمد محمد‬28 y old Libyan teacher ( employer/student/teacher /house

wife ) living in sebha , her blood group O Rh +ve she is G5P3M1 3alive
(2 boys & 1girl),her FLMP was --- EDD is --- GA is now at ---- wk of
pregnancy , had 1 previous c/s due to breach presentation ( ‫علي حسب كل دكتور شن‬
‫ )يحب‬, she is known case of HTN , she was admitted to hospital since 6 days
back in 22/sep/2021 at 9:15 am due to → ( 1. main complaint / or 2. referred →
see next )

2. main complaint “M/C”:

1) it’s the symptom by which the patient comes to hospital

2) in patient own words no medical terms /and don’t give any deferential diagnosis
3) write the duration
4) short terms / and in chronological manner

Sebha 2022
 ❖ e.g She admitted to hospital …. since 6 days back in 22/sep/2021 at 9:15
am due to /or complaint of e.g abdominal pain for 3 days / low lying
placenta discovered accidentally
5) or the patient either :-
✓ referred from privet clinic , ( outpatient clinic ; OPC)
✓ referred from ( outpatient department ; OPD ) at the same hospital
✓ comes through reception
❖ e.g She admitted to hospital …. since 6 days back in 22/sep/2021 at 9:15 as
referred case from OPC due to high blood sugar for control / or for high blood
pressure assessment / or for C/S ….etc

N.B if patient have more than one complain you should take most important one
&put the other complains as associated symptoms

3. history (analysis) of presenting complaint :

it depend on exact disease of each case e.g high blood sugar / high blood
pressure/abdominal pain / vomiting / placenta previa …. Etc
** see Analysis of presenting complaint & DD in page 18.

N.B we should ask about fetal movement after > 20 weeks ( how many movement in
12 hr, is it normal or  ) & the conscious state at the time of admission

4. whats done in the hospital :

in details :

1. the patient admit to the OPD / or referred from OPC

2. history was taken
3. examination wase done :
1. general examination :
•tempreture . • Blood pressure.
2. Abdominal examination .
3. Vaginal examination : in active labor most confirm the cervix dilatation / or closed

Sebha 2022
N.B PV is contraindicated in two common cases (most done in speculum) :
✓ in placenta previa → Hemorrhage .
✓ pre labor rupture of membrane → infection .

4. analysis (investigation) :
✓ blood sample → result
✓ urine → result
5. ultra sound U\S (‫ أسئلة مهمة‬5 ‫) تلفزيون‬:
✓
single or multiple fetus , intrauterine or ectopic pregnancy.
✓
fetal heart beat
✓
amount of liquor (amniotic fluid)(‫)زايدة والناقصة‬
✓
placenta after 20 week
✓
presentation ( descend ) by cephalic / breach …etc
6. Cardiotocography ( CTG ) :

Not before 30 weeks of gestation → b/c the fetus is not mature and
underdeveloped autonomic nervous system

7. Where did she was referred next :

a) ICU → Rarely
b) Antenatal ward (‫)قسم‬
c) Labor ward (‫)صالة‬
d) What’s done to her → same pervious 6 steps

8. Medication givin :
In details including every day routine

✓ Canula was inserted

✓ IV fluid
✓ Analgesia
✓ Antipyretic
✓ Antibiotic or any drug….etc

9. Hospital plain :
a) Discharge (‫)خروج‬
b) Observation (‫)مالحظة‬
c) Labor :
1. Normal 2. Cesarian section 3. Induction of labor , which is → (contraindicated
in case of placenta previa )

Sebha 2022
5. Antenatal HX =HX of current pregnancy :

1. Pregnancy planned or unplanned ? :

➢ Always planned even if she is on contraceptive then → stopped in .

➢ Unplanned if she is on contraceptive then the pregnancy occur as result of failure
in the contraceptive
➢ Any pre-pregnancy counseling

2. Spontaneous (‫ )حمل طبيعي‬or assisted pregnancy (‫)زراعة‬ ?:

➢ Spontaneous pregnancy after intercourse
➢ If assisted we ask :
a) Where ‫أين‬
b) When ‫متى‬
c) Date of induction ‫تاريخ الزراعة‬
3. FLMP :

➢ Sure or unsure .
➢ Regular period or not : duration of the cycle (‫ \ )كل قداش تجيك‬how many days the
menses last (‫ )قداش تقعد‬. e.g regular , every 28 day , last for 3 days .

N.B Most be non-lactating, & not on any contraceptive.

4. Diagnosis if pregnancy (‫)كيف عرفتي روحك حامل‬:

➢ Pregnancy suspected by Amenorrhea & pregnancy test at home ( urine kit)

➢ Pregnancy diagnosed by: blood test (B-HCG) level & USS (both are confirmatory)

N.B we should state the exact time of pregnancy diagnosis (conformation) after
2ry amenorrhea e.g 2 weeks after amenorrhea the pregnancy was diagnosed by
USS & B-HCG blood test.
N.B to find the Approximate GA we add 4 weeks after date of conformation e.g
she took USS 2 weeks after amenorrhea so the GA → was 6 week Approximately
➢ Blood B-HCG is confirmatory: beginning from 10-14 day of pregnancy.
➢ USS is confirmatory by :
a- transvaginal USS after 5 weeks.
b- abdominal USS after 7 weeks .
c- USS : confirm pregnancy , alive or not , intrauterine or ectopic pregnancy ,
single or twins , any pelvic tumor.
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Sebha 2022
5. Booking visit (‫ )أول زيارة وتفتح فيها ملف‬:

➢ 1st time visit “booking visit” to the doctor / hospital or clinic .

• We document the data & the GA ( most be from 8-14 week ).
• We ask about USS : single or multiple / fetal heart beat
• We ask about Investigations: cbc (Hbs gm/dl) blood sugar (mg/dl) blood
pressure (mm/hg) , Urine analysis in early pregnancy is important → b/c of
risk of abortion due to silent UTI

▪ N.B if she is not a known case HTN , any increase in BP is considered

abnormal.
▪ N.B ( BP & blood sugar measurement ) is “base line” in early pregnancy
and should documented since the 1st booking visit , and following visits
b/c it’s so important in diagnosis of ( preeclampsia & gestational DM )
• Ask about drugs , & supplements of vitamins and minerals and since when
e.g antibiotics , iron , ) folic acid → prevent neural tube defect) …etc.
• Is her antenatal follow up “booking visits” are regular, or not & the
frequency of visits

a) N.B normal booking visit : (‫)*مصادر مختلفة‬

✓ First 28 week (32 week*)→ 1 time / month
✓ 28-37 week (32-36 week*)→ 2 times / month
✓ After 37 week (36 week*) till delivery → 1 time / week

b) N.B any abnormalities e.g twins ,DM ,risk to abortion , preeclampsia

,epilepsy … etc. the booking visit is changed to adapt the case into:
✓ First 28 week → 2 time / month
✓ 28 week till delivery → 1 times / week

c) N.B investigation : for mother CBC (Hb,MCV,MCHC,PLT),urine analysis

(Acetone, protein, pus cells, bacteria “culture”) viral screen (HBV, HVC,
HIV) Rft (urea, creatinine) Lft (AST,ALT,LDH) blood sugar (Hba1c, FBS,
RBS) for fetus USS, CTG, Doppler, pinard

Sebha 2022
 • In summary : e.g

The pregnancy was planned , spontaneous , she was sure that her FLMP was at
…. MC is regular ever 28 day , last for 3 days ,she was not lactating, not on
contraceptive use , EDD is -------- GA is -------- Pregnancy was suspected by
2ry amenorrhea & home pregnancy test And diagnosis was confirmed by USS in
e.g 02/oct/2021 of 6 week gestational , 1st booking visit was 10 week of
gestational age in privet clinic , Hx was taking , examination was done ,
investigation of CBC , Blood fasting sugar , UEC, LFT, routine urine study, viral
screen, blood group & Rh and the results was in normal range , her Hb = 11gm/dl
USS show single sac , intrauterine , fetal heart was seen ,no drugs are given her
booking visit where ( irregular / regular ) in the past ------ months, and there was /
or no other complication till today .
• N.B each following visits we should mention any HX , examinations ,
investigation , treatment done in the summary
• N.B any complication should be mentioned in the summary e.g any hospital
admission , USS abnormalities , increase in BP ,vaginal discharge , uti …etc and
there managements

6. Past obs HX :
Ask about the number of previous deliveries & miscarriages in details ?
1. Abortion : total number of death births before 23 week + 6days
➢ we ask about the year when the pregnancy happen & which week it was ended
& how
➢ what was the management after abortion :
➢ complete or incomplete followed by :
a) D&C dilatation and curettage (‫)توسيع وتنظيف‬
b) Only curettage called → E&C evacuation & curettage (‫)تفريغ وتنظيف‬
➢ Type of anesthesia & complications after abortion : Hge , infection , fever …etc
➢ did she got ANTI-D injection or NOT
2. previous pregnancies (delevaries) :
➢ we ask about the following :
I. the year when the pregnancy happened?
II. date of delivery &which week of GA delivery happened: term , preterm or,
post-date ?
III. Outcome (mode of delivery ) :
a) Spontaneous or induced labour.

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Sebha 2022
 b) vaginal delivery : a. normal are spontaneous only b. assisted by forceps or
vacuum
c) C/S :
1. Cause Due to elective / or emergency e.g fetal distress ( heart beat or O2) ,
postdate ,prolonged normal labour , contracted pelvis ( “ CPD” cephalopelvic
disproportion ) , breach presentation .
2. anesthesia :
✓ Regional (‫موضعي‬/‫ )نصفي‬:
a. epidural (catheter multiple doses)
b. spinal (single dose)
✓ general (‫) كامل‬

IV. took Anti-D shoot? any antenatal, postnatal, neonatal complications during.

➢ Result of delivery (about neonate):

✓ Health state
✓ Sex : male or female ?
✓ weight → normal (2.5-4 kg) , below 2.5kg IUGR , above 4kg , Macrosomia.
✓ lactating type :
a) breast feeding (for how long \ how many times) ?
b) formula milk
✓ any complications after delivery

N.B in every pregnancy 1st , 2nd , 3rd … etc. pregnancies we ask the same
above questions
7. gynecological HX :
1. menarche .
2. menses: duration , last for , regular or not .
3. dysmenorrhea (painful menses), inter-menstrual bleeding .
4. Menorrhagia (  amount of blood loss ) normally 80 ml/ day .
5. Dyspareunia (pain during coitus ) ‫علي حسب كل دكتور‬
6. Previous gynecological pelvic inflammation , STDs , PAP smear, surgeries
include Hysteroscopy (‫)منظار رحم‬
8. Past medical Hx :
a. Ask about any previous admission to hospital / clinic ( before , during , after
pregnancy ) OTHER than that considering the DELIVERY.
b. Ask about :
✓ DOA & for how many days she was admitted
✓ which department
✓ due to
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Sebha 2022
 ✓ any drugs given
✓ complications

9. past surgical Hx :

✓ any surgeries (date – “name of operation”) / anesthesia / blood transfusion /

complications

10. Drug & allergic Hx :

✓ Any chronic medication (long term drugs)
✓ HX of any chronic illness as DM, HTN , Epilepsy , asthma , renal disease ,
cardiovascular diseases …etc.
✓ Ask about any known allergies .

11. Family HX :
✓ any history of : genetic problems running in the family or her husband’s family ,
twins : monozygotic , ( dizygotic → related to genetic factor of family Hx) ,
DM, HTN ,mental retardation , congenital abnormality .

for 1st degree relative (‫أخت‬- ‫أخ‬-‫أم‬-‫ )أب‬, 2nd degree relative (‫أعمام‬,‫)خوال‬

✓ any cancers ? type?

12. social HX :

✓ Date and duration of marriage

✓ Husband name, Age, occupation, any consanguinity
✓ Living condition , home (flat / house), number of occupants
✓ Habit as smoking, drinking alcohol
✓ Animal contact : dog, cat, sheep, chicken
13. Future planes :

✓ Hospital Planes : how & when she will be discharged, when will she be
delivered , what other follow up planes
✓ Lactating planes : by breast feeding or formulas
✓ Contraceptive planes :
Types : natural , IUCD , ligation , oral pills

N.B during lactation estrogen is contraindicated →  lactation .

So progesterone only pills “POP” are allowed NOT the combined oral
contraceptive “COC” Est/prog type pills
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Sebha 2022
 ❖ Steps of postnatal Hx : (14 steps)

➢ personal data (biodata).

➢ main compliant “M/C”.
➢ analysis of main compliant
➢ whats done in the hospital & natal Hx:
➢ post obstetric HX
➢ Antenatal period HX = antenatal HX of current pregnancy .
➢ Past obs HX .
➢ gynecological Hx.
➢ Past medical Hx .
➢ past surgical Hx .
➢ Drug & allergic Hx .
➢ Family HX .
➢ social HX.
➢ Future planes.

before introduce the case , we should till the examiner the type of Hx that we are
going to present , e.g I will introduce postnatal Hx .

• Stand on the right side of the patient .

• ask for her permission & Introduce your self .

1. personal data (biodata) :

see page ; 2

N.B after delivery we only ask about Parity (para) Not gravida b/c she is not pregnant

✓ N.B the day of delivery called day zero

✓ if she delivered yesterday → today is day one
✓ if she delivered 2 days back → today is day two
✓ we say it in normal vaginal delivery , some time also in C/S (‫)على حسب كل دكتور‬

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Sebha 2022
 summery :

e.g : ms ‫ حليمة أحمد محمد‬28 y old Libyan teacher ( employer/student/house wife ) living
in sebha , her blood group O Rh +ve she is P4M1 4alive (2 boys & 2girl), she is 4
day post normal vaginal delivery at week ------ of pregnany , she is known case of
HTN , she was admitted to hospital since yesterdays in 20/Dec/2021 at 6:30 pm due
to ( 1. main complaint / or 2. referred → see next )

2. main compliant “M/C” :

see page ; 5

N.B instead of Abdominal pain you can now say “labour pain”

3. analysis of main compliant :

see page ; 5

with extra note related to delivery :

abdominal pain “labour pain” → most common presentation:

site : lower abdominal pain .

onset: sudden / gradual → most common.
duration: 3 days ago.
course: progressive → most common / regressive.
radiation: radiate to back most common.
nature: colicky most common.
frequency: intermittent → 3 times in ½ hr , each time last for ½ minute.
Aggravating & reliving factor: aggravate by stress & walking / not reliving by drug.
Associated symptoms: vomiting & vaginal discharge.

N.B we ask about vaginal discharge :

✓ watery gush (‫)نزلت اميه العيل وال‬
✓ vaginal show ( bloody & mucous discharge of amniotic membrane remnant )

N.B we analysis any fluid / discharge :

✓ duration
✓ AS CBC (amount / smell/ colure/ blood clots/ content )

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Sebha 2022
 4. whats done in the hospital & natal Hx:
see page 6, with the following notes

1. the patient admit to the OPD / or referred from OPC

if she was inpatient or refered ask about the reason of admission & DOA &
what's management she was received
2. history was taken
3. examination wase done
4. analysis (investigation)
5. ultra sound U\S (‫ أسئلة مهمة‬5 ‫) تلفزيون‬
6. Cardiotocography ( CTG )
7. Where did she was referred next
8. Medication givin
9. Extra steps related to delivery :

1. in case of induction ask for reason ,how was she induction &for how long
2. in case of elective C/S ask about the reason & preoperative preparation
3. ask about delivery in detail as …cervical dilation on admission
4. duration of 1st,2nd,3rd, stages & any complication :

N.B Stages of labour :

a. 1st stage : dilatation of cervix from ( 1cm to full dilatation 10cm ) active labour start
from 3cm , And become short to reach 0cm in lingth “ effacement ”
b. 2nd stage : delivery of fetus start with push down .
c. 3rd stage : delivery of placenta & cord .
N.B normal labour duration 12 to 14 hr
N.B normal 2nd stage duration (‫→ )نزول العيل‬
• nullipara (primigravida) about 1hr to 2hrs.
• multipara about ½ to 1 hr.
• in anesthesia e.g spinal anesthesia normal vaginal delivery she may take about 3hr
N.B normal 3nd stage duration from 10 min to ½ hr.
e.g : (1st stage) at 7:00 pm cervical dilatation after 3hr was 10 cm at 12:00 am , (2nd
stage ) she start pushing am for 2hr (‫ )عطلتي وال‬assisted by forceps or vacuum or not
( ‫ )ساعدوك وال‬,3rd stage of labour duration 15 min , with no assistant or significant
bleeding

5. instrumental assisted delivery

6. We ask about episiotomy / tears (‫)دارولك خياطة وال‬
7. ask about bleeding after delivery & if case of C/S ask about indication & type of
anesthesia

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Sebha 2022
 in summary : e.g

she was presented to hospital reception complaining of labour pain and vaginal
leakage 1hr before admission to OPD she was there since 6:30pm till 7:00pm Hx
was taking , on examination → PV was done on admission found that she is on active
labour cervix was >3cm dilated & unruptured membrane, investigation about Bp is
unknown temp was normal, blood analysis : cbc 11 gm/dl & Blood fastig sugar was
normal & urine analysis wasn’t taking, USS (‫ أسئلة‬5) & CTG was done, next she was
admitted to antenatal ward / labour ward ,at 7:00pm any ( HX, examination ,
investigation was done is mentioned also ) , where IV set was inserted and IV fluid
& analgesic was given , viral screen was done, urine analysis was done ,
( induction of labour was done / or not ) usually in iv bag or IM.
(1st stage) at 7:00 pm cervical dilatation after 3hr was 10 cm at 12:00 am , (2nd stage )
she start pushing am for 2hr (‫ )عطلتي وال‬assisted by forceps or vacuum or not ( ‫)ساعدوك وال‬
,3rd stage of labour duration 15 min , with no assistant or significant bleeding

5. post obstetric HX :
✓ we ask about :
1. pain 2. discharge 3. Fever 4. Outcome 5. Hospital plane

1. pain :

a) Is there any after labour pain or not

After pain → colicky aggravating by walking relived by drug
b) pain at site of episiotomy
c) pain at site of C/S wound
d) Lowe limb pain /swelling / redness, did she walk or not → to avoid DVT .
e) Breast full /painful/tender → engorgement of milk

3. discharge & passage :

a) Postpartum discharge “lochia” : analysis of Duration, Onset & AS CBC .

N.B lochia : is vaginal discharge start from day 1 postpartum , consist of blood ,
Mucous & remnant of placenta tissue
N.B duration of lochia from 2-3 weeks:
a. lochia rubra → red secretion in 1st days
b. lochia serosa →pink secretion after 3 days
c. lochia alba → white secretion after 1st week till 3 weeks
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Sebha 2022
b) Urination (retention or incontinence)
c) defecation (constipated )
d) flatus

N.B causes of constipation and urine retention :

✓ labour pain → Reflex inhibition of vagus nerve (most common) →  bowel
movement &  tone of urinary bladder sphincter.
✓ C/S : pain or ligation of ureter or paralytic ileus
✓ Infection .
✓ Electrolyte disturbance.

if the patient was constipated or she has difficult in urination (urine retention )
Encourage her to pass urine by walk to bathroom , or open tap water (‫)عامل نفسي‬

4. Fever:
a) Usually there is slightly  in the 1st day < 38.5 C and then return to normal
b) Postpartum pyrexia →  in temp > 38.5C after the 1st day of delivery

e) Outcome :
✓ sex
✓ Weight (2.5-4 kg)
✓ Condition & Crying or not
✓ Pass dircetly to mother or went to incubator NICU (why?)
✓ Lactation by breast or not → should be immediate to give immunity to baby ,
and for prolactin & oxytocin secretion → uterine contractions that prevent PPH
&uterine involution
f) Hospital plane

6. Antenatal period HX = antenatal HX; page 7

7. Past obs HX; page 9
8. gynecological Hx; page 10
9. Past medical Hx; page 11
10. past surgical Hx; page 11
11. Drug & allergic Hx; page 11
12. Family HX; page 11
13. social HX; page 11
14. Future planes; page 13
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Sebha 2022
 ❖ analysis of M/C & systemic review :
most common M/C :
✓ Abd pain
✓ vaginal bleeding
✓ watery vaginal discharge
✓ vomiting
✓ decrease fetal movement
✓ headache
✓ post date
✓ discrepancy b/w GA & abdominal size
✓ referred with DM for controlling blood sugar
✓ referred with increase BP for further assessment
✓ referred for elective C/S
✓ referred with increase/decrease amniotic fluid

N.B analysis of any pain is : SOCCRRAATS (Site, Onset,Character “nature”,

Course , Radiation, Reliving factors, Aggravating factors , Associated symptoms
,Timing “duration” , Severity ) & Frequency

1. Abdominal pain

➢ Site: e.g lower abdominal (‫)وين بالزبط‬

➢ Onset: sudden , acute or gradual (‫)بدأ معاك الوجع فجأة وال بتدريج شوي شوي ؟‬
➢ Timing “Duration”: since when (‫)قداش ليه‬
➢ Characters “Nature”: dull-aching , colicky, throbbing, stitching
(‫)أوصفيلي الوجع ؟ وزي شن مثال نخصة وال مغص‬
➢ Course: progressing , regressing , stay the same “ stationary “
(‫)لما بدا معاك قعد زي ماهوا ؟ وال كل مرة يزيد‬
➢ Frequency: intermittent, episodic
(‫)يمشي ويجي ؟ وال مستمر ؟ كل قداش يمشي ويجي ؟ ولما يجي قداش يقعد ؟‬
➢ Radiating / shifting : e.g to the back
(‫)الوجع يسمع في مكان ثاني ؟ضهرك وال كتفك ؟ وال يتحرك من مكان للثاني‬
➢ Severity : mild , moderate , sever according to effecting on daily activities e.g
posture & interfere with sleep , and consciousness
)‫(يخلي فيك ترقدي؟ لما تتحركي يزيد الوجع؟ يخلي فيك تفقدي الوعي األلم؟‬
➢ Aggravating & Relieving factors : (‫)شن ينقص عليك الوجع ؟ وشن يزيده‬
➢ Associated symptom : as urinary symptoms & fetal movement , nausea , vomiting.
(‫)في حاجة ثانية تشكي منها غير الوجع؟‬

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 2. headach :

➢ Site: "occipital or frontal"

➢ Onset: sudden , acute or gradual (‫)بدأ معاك الوجع فجأة وال بتدريج شوي شوي ؟ في اما وقت صبح وال عشية؟‬
➢ Course: progressing , regressing , stay the same “ stationary “
(‫)لما بدا معاك قعد زي ماهوا ؟ وال كل مرة يزيد‬
➢ Timing “Duration”: since when (‫)قداش ليه‬
➢ Characters “Nature”: dull-aching, throbbing, squeezing
(‫)أوصفيلي الوجع ؟ وزي شن مثال نخصة؟ نبض؟‬
➢ Frequency: intermittent, episodic (‫)يمشي ويجي ؟ وال مستمر ؟‬
➢ Radiating / shifting : e.g to the back of the neck
( ‫)الوجع يسمع في مكان ثاني ؟رقبتك؟‬
➢ Severity : mild , moderate , sever according to effecting on daily activities e.g
interfere with sleep , and consciousness , vision .
)‫(يخلي فيك ترقدي؟ لما تتحركي يزيد الوجع؟ يخلي فيك تفقدي الوعي األلم؟‬
➢ Aggravating & Relieving factors : (‫)لما تاخد مسكن ينقص عليك الوجع؟ قهوة مثال ؟ وشن يزيده‬
➢ Associated symptom : insomnia , fatigue , dyspnea , palpitation , fever , visual
disturbance , nausea and vomiting , epigastric pain , fever

➢ N.B any discharge , fluid analysis AS CBC + ----.

3. Vaginal bleeding : AS CBC IPAD

o Ask about onset, Duration : )‫(أمتى بدى معاك النزيف و قداش ليه؟وقتها طحتي وال قمتي حاجة رزينه شن كنتي تديري ؟‬
➢ Amount: small, mild, moderate )‫(كميته هلبا وال شوية؟ تقريبا كم هكي ؟ هلبا يعني ينزل علي رجليك؟‬
➢ Smell:)‫(فيه ريحة مزعجة وال عادي‬
➢ Colure: bright red “ fresh” or dark “ accumulated ” )‫(لونه فاتح والداكن ؟‬
➢ Blood clots: (‫) الدم زي المية ؟ وال في كتل صغيرة طروف طروف‬
➢ Content& Course: progressive , regressive ..etc
( ‫)لما يبدا معا ك يبدا بشوي ويزيد وال ينقص مع وقت ؟ باهي دم بس وال معاه حاجة ثانية وشن لونها‬
➢ Itching: smell + itching is sign of infiction .) ‫(فيه حكة مزعجة‬
➢ Pain : which comes first? the pain or the bleeding? .
➢ Associated symptoms: vaginal discharge , trauma to the body , sexual intercourse ,
oliguria ..etc
o Any symptom of anemia: headache , palpitation , dyspnea , fatigue.
o previous attack in this pregnancy or in previous pregnancy

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 4. Vaginal watery discharge : AS CBC IPAD

o Ask about onset, Duration : )‫(أمتى بدى معاك و قداش ليه ؟وقتها طحتي وال قمتي حاجة رزينه شن كنتي تديري ؟‬
➢ Amount: small, mild, moderate )‫(كميته هلبا وال شوية؟ تقريبا كم هكي ؟ هلبا يعني ينزل علي رجليك؟‬
➢ Smell:)‫(فيه ريحة مزعجة وال عادي‬
➢ Colure: clear watery, blood stained, greenish )‫(لونه شفاف وال ملون وشن اللون ؟‬
➢ Blood content: (‫)فيه دم وال؟‬
➢ Content& Course: progressive , regressive ..etc
(‫)لما يبدا معا ك يبدا بشوي ويزيد وال ينقص مع وقت ؟ باهي معاه حاجة ثانية زي دم هكي‬
➢ Itching: smell + itching is sign of infiction .) ‫(فيه حكة مزعجة‬
➢ Pain : which comes first? the pain or watery discharge ? .
➢ Associated symptoms: vaginal bleednig , fever, abdominal pain , decrease
abdominal size ,trauma to the body , sexual intercourse , oliguria ..etc
o Fetal movement
o previous attack in this pregnancy or in previous pregnancy
o Aggravating & reliving factors ( ‫)لما تكحي وتعطسي يزيد عليك ؟ باهي لما تقعمزي يخف عليك‬

5. Vomiting : AS CBC ART (Timing “Duration”)

o Ask about onset, Duration : )‫(أمتى بدى معاك و قداش ليه ؟فجأة يتنطر قدامك وال بتدريج قبله غثيان ؟‬
➢ Amount: small, large )‫(كميته هلبا وال شوية؟‬
➢ Smell:)‫(فيه ريحة مزعجة وال عادي ؟ تطعمي مرار وال تحسي طعم زبدة‬
➢ Colure: )‫(لونه شفاف وال ملون وشن اللون ؟‬
➢ Blood content: (‫)فيه دم؟ وال‬
➢ Content: water , food , bloody ..etc (‫)لي يطلع أكل و رغوي ؟ ترجعي دم‬
➢ Associated symptoms: epigastric pain & weight loss, immediately after eating or
drinking “food related” , appetite decrease , urinary symptoms , constipation ,
diarrhea , DM , HTN
➢ Reliving factor : (‫( شن يزود عليكٌ الحالة ؟ شن ادي ٌري بي ٌش يخفف عليك الترجي ٌع ؟ وال مافيش شي يسٌاعدك بي ٌش تخف‬

N.B Onset: ✓ sudden → projectile ,

✓ gradual → not projectile

6. increase /decrease amniotic fluid :

➢ onset: which gestational week.

➢ duration: since when discovered
➢ ask about how she discovered
➢ ask about history of vaginal leakge in current pregnancy
➢ ask about fetal movement
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 ➢ ask about history of HTN & DM
7. decrease Fetal movement :
➢ onset: decreed suddenly or gradually
➢ duration: since when
➢ how many movements was moved per 12hr normally more than 10 times in 12hr
➢ ask about history of trauma
➢ ask about history of vaginal bleeding
➢ ask about history of abdominal pain
➢ ask about history of HTN & DM

❖ systemic review:
CNS: headache, Dizziness, Change in Behavior, Loss of Consciousness Weakness
Abnormal Movement.
G1T: Dysphagia heartburn, Jaundice, Hematemesis, constipation, Diarrhea, melena
bleeding per rectum.
Cardio-Pulmonary: Cough, hemoptysis, Dyspnea, Chest Pain, Palpitations, Syncope
Claudication.
Urogenital: Loin Pain, Dysuria, Polyuria, hematuria, Urethral Discharge
Skin & Musculoskeletal: Pain, Muscle Wasting, Pigmentation, Ulcers.
N.B: If All Systems Are -Ve → Say :" No History Suggestive Of Other System Affection “.

❖ deferential diagnosis “D.D” :

• abdominal pain before 28 weeks:
1- abortion
2- ectopic pregnancy
• d/d of abdominal pain after 28 weeks :
1- labor
2- urinary tract infection
3- diabetic ketoacidosis (if the patient is diabetic)
4- surgical causes : appendicitis , cholecystitis ..etc
• pelvic pain :
1- adenomyosis
2- degenerating uterine fibroid
3- ectopic pregnancy
4- endometriosis
5- ovarian torsion
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6- pelvic inflammatory disease
7- rupture ovarian cyst
8- tubo-ovarian abscess
• vaginal discharge :
1- rupture of membranes
2- leaking (show)
3- infection (vaginitis, cervicitis)
• PV bleeding in early pregnancy :
1- abortion (bleeding followed by pain)
2- ectopic pregnancy (pain followed by bleeding)
3- gestational trophoblastic disease
4- local cause (cervicitis ,vaginitis, cervical polyps , cervical carcinoma )
• PV bleeding after 28 weeks of gestation :
1- abruption placenta (Hx of trauma , painful, heavy, recurrent)
2- placenta previa (causeless, painless, recurrent )
3- vasa previa
4- show
5- local causes
• vomiting :
1- hyperemesis gravidarum
2- gastroenteritis
3- severe preeclampsia
4- acute pyelonephritis
5- acute abdomen including ectopic pregnancy

‫ ال تنسونا من صاحل دعائكم‬،‫بالتوفيق والسداد‬

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