Professional Documents
Culture Documents
Obstetrics and Gynaecology
Obstetrics and Gynaecology
Hannah Thackray
Amy Laycock
Introduction
Introduce yourself
Check patients identity
Explain your intention
Gain consent
Wash hands
Chaperone
Bladder emptied?
General Inspection
End of the bed
- ? comfortable
- ? clues around the bed
Distended abdomen consistent with
pregnancy
General Examination
Hands
- koilonychia/pale palmer creases
- palmer erythema
Pulse
Blood pressure
Chloasma
JACCOL
Heart sounds/lung bases
Position
Semi-recumbent
Abdominal Inspection
Quiz Time!!!!
Linea Nigra
Striae Albicans
Striae Gravidarum
Pregnant Man!
Palpation
Always ask if patient is in any pain
Ask patient to let you know if she
experiences any discomfort
Use palmer aspect of the fingers
One hand moving at a time for lie
Two hands for presenting part
Symphysis-Fundal Height
Feel for top of fundus
Feel for symphysis pubis - GENTLE
IUGR
foetal growth potential
- TORCH
- chromosomal abnormalities
- structural abnormalities
- maternal
- drugs/alcohol/smoking
- malnutrition
- uteroplacental perfusion
- DM
- poor trophoblast invasion
- multiple gestation
Oligohydramnios
Not enough produced
- renal agenesis
- multicystic kidneys
- urinary tract obstruction
- IUGR
- maternal drugs (NSAIDs)
Too much lost
- PPROM
Wrong dates
Constitutionally large
Multiple gestation
Maternal DM
Polyhydramnios
Polyhydramnios
Maternal - DM
Placental AV fistula
Foetal
- multiple gestation
- oesophageal/duodenal atresia
- anencephaly
- longitudinal
- oblique
- transverse
Presenting part
- cephalic
- breech
Engaged
- fifths palpable
Auscultation
Pinard stethoscope
Hand held Doppler
Feel mothers pulse
Listen over anterior shoulder
One minute
Extras
Urine dipstick ketones
Blood pressure
Summary
This is a . year old lady who has
presented at . weeks gestation
It is a singleton/multiple pregnancy
The foetus is in a . position
It is a . presentation
The head is/is not engaged
Obstetric Examination
Video
Gynaecology History
Station
Gynae History
Take your time!!
Read the information outside the station
.. and breath!!
Gynae History
Introduce yourself
Check patient name & DOB
Explain
Consent . Is that OK?
Gynae History
Presenting complaint
Pts own words
Identify most troublesome symptom
Gynae History
GH tailor the Hx to the individual!
LNMP
No. days bleeding / Length of cycle
Age of Menarche / Menopause
Post menopausal bleeding
IMB / PCB
Dyspareunia
Gynae History
GH continued..
PV discharge
Pruritus
Climacteric symptoms
Hot flushes, vaginal dryness
Contraception
Urinary symptoms
Bowel function
Obstetric History
OH
No. of pregnancies
Result of each pregnancy + Gestation
Miscarriage
ToP
Delivery
Mode of delivery
NVD
LSCS
Forceps/Suction
PSH
Any previous operations?
Ever had an anaesthetic?
Allergies
What happens when you take it?
? True allergy ? Or just sensitivity
FH
RoS If taken a comprehensive Hx
shouldnt be any
Summarise
Thank the patient!!!
Turn to the examiner
Give a concise summary of relevant
information
Differential Diagnosis
Common things are common!!!!
Start with the commonest
Include the serious
~ 3 differentials is fine
If you cant justify it dont say it!!!
Investigations
1st I would like to examine the pt!!
Sensible - not excessive!
Blind Surgeons Retire Early !
Bloods
FBC, Ca125, beta-hCG
Secretions
urine, PV swabs, cervical smear
Investigations
Radiology
USS (?transvaginal)
X-ray hysterosalpingography (HSG)
CT/MRI
Extras
HyCoSy
Biopsy endometrial / cervical loop
Surgical exploration
Blind surgeon?
Management
1 Conservative
Lifestyle advice
Physiotherapy
2 Medical
Drug therapy
3 Surgical
Least invasive where possible
Gynae History
Previous LOCAS
Menorrhagia & Dysmenorrhoea
Endometriosis / Adenomyosis
Fibroids
Dysfunctional uterine bleeding
PCOS
Post-menopausal bleeding
Gynae History
Possible topics
Pelvic pain
Menorrhagia
Amenorrhoea/Oligomenorrhoea
Sub-fertility
PCB/IMB
Key Points!!
Take your time
Be nice to the patient!!
Common things are common
Blind Surgeons Retire Early
Practice!!!!!!!!!!!
Any Questions?