Obstetric History
Taking an obstetric history usually begins with asking about previous pregnancies, including dates, outcomes, and complications.
For pregnant patients, a more detailed obstetric history History Ideally, women who are planning to become pregnant should see a physician before conception; then they can learn about pregnancy risks and ways to reduce risks. As part of preconception care... read more is taken regarding prior pregnancies and the current pregnancy.
Gravidity and parity
The basic obstetric history is documented in a specific format, noting gravidity and parity.
Gravidity (G) is the number of confirmed pregnancies; a gravida is a term for a person who has had at least one pregnancy.
Parity (P) is the number of deliveries at ≥ 20 weeks of gestation. The numbers for parity are recorded along with other pregnancy outcomes:
Term deliveries (≥ 37 weeks)
Preterm deliveries (≥ 20 and < 37 weeks)
Abortions (including spontaneous pregnancy losses Spontaneous Abortion Spontaneous abortion is pregnancy loss before 20 weeks gestation. Diagnosis is by pelvic examination, measurement of beta subunit of human chorionic gonadotropin, and ultrasonography. Treatment... read more at < 20 weeks, induced abortions Induced Abortion In the United States, about half of pregnancies are unintended. About 40% of unintended pregnancies end in induced abortion; 90% of procedures are done during the 1st trimester. In the United... read more , ectopic pregnancies Ectopic Pregnancy Ectopic pregnancy is the implantation of a pregnancy in a site other than the endometrial lining of the uterine cavity—ie, in the fallopian tube, uterine cornua, cervix, ovary, or abdominal... read more , or molar pregnancies Gestational Trophoblastic Disease Gestational trophoblastic disease is proliferation of trophoblastic tissue in pregnant or recently pregnant women. Manifestations may include excessive uterine enlargement, vomiting, vaginal... read more )
Living children
Multifetal pregnancy is counted as 1 pregnancy in terms of gravidity and for all parity numbers, with the exception of living children (eg, for a woman who has had a singleton pregnancy and a twins pregnancy and all children are living, this is noted as 3).
In this documentation format, the numbers are recorded as:
G (gravidity number) P (parity number, noted as 4 numbers for term pregnancies, preterm pregnancies, abortions, and living children)
For example, the history of a patient who has had 1 term delivery, 1 set of twins born at 32 weeks, 1 spontaneous abortion, and 1 ectopic pregnancy is documented as G4 P1-1-2-3.
Obstetric outcomes and complications
In addition to gravidity and parity, taking an obstetric history in a nonpregnant patient usually focuses on prior obstetric complications that may impact future pregnancies or reproductive or general health.
Past obstetric history that may impact future pregnancies includes
Gestational age at delivery
Spontaneous labor or induction
Length of labor
Mode of delivery (vaginal, operative, cesarean)
Birth weight and sex of newborn
Complications that require further evaluation to determine etiology (eg, stillbirth Stillbirth Stillbirth is fetal death (fetal demise) at ≥ 20 weeks gestation (> 28 weeks in some definitions). Management is delivery and postpartum care. Maternal and fetal testing is done to determine... read more , congenital anomaly)
Complications that tend to recur (eg, gestational diabetes Diabetes Mellitus in Pregnancy Pregnancy makes glycemic control more difficult in preexisting type 1 (insulin-dependent) and type 2 (non–insulin-dependent) diabetes but does not appear to exacerbate diabetic retinopathy,... read more , preeclampsia Preeclampsia and Eclampsia Preeclampsia is new onset or worsening of existing hypertension with proteinuria after 20 weeks gestation. Eclampsia is unexplained generalized seizures in patients with preeclampsia. Diagnosis... read more , preterm delivery Preterm Labor Labor (regular uterine contractions resulting in cervical change) that begins before 37 weeks gestation is considered preterm. Risk factors include prelabor rupture of membranes, uterine abnormalities... read more , fetal growth restriction, shoulder dystocia Shoulder Dystocia Shoulder dystocia occurs during an attempted vaginal delivery (in the second stage of labor [pushing]) when the fetal head delivers but delivery does not progress because the anterior shoulder... read more , postpartum hemorrhage Postpartum Hemorrhage Postpartum hemorrhage is blood loss of > 1000 mL or blood loss accompanied by symptoms or signs of hypovolemia within 24 hours after childbirth. Diagnosis is clinical. Treatment depends on... read more , neonatal group B strep infection Neonatal Sepsis Neonatal sepsis is invasive infection, usually bacterial, occurring during the neonatal period. Signs are multiple, nonspecific, and include diminished spontaneous activity, less vigorous sucking... read more )
Complications that require additional treatment or monitoring in future pregnancies (eg, cervical insufficiency Cervical Insufficiency Cervical insufficiency (formerly called cervical incompetence) is painless cervical dilation resulting in second-trimester pregnancy loss. Transvaginal cervical ultrasonography during the second... read more )
Past obstetric history that may impact future reproductive or general health includes
Injury during vaginal delivery or surgical complications
Thromboembolism
Peripartum cardiomyopathy
Intensive care unit admission
Complications that may persist as chronic disease or are risk factors for future chronic disease (eg, gestational diabetes Diabetes Mellitus in Pregnancy Pregnancy makes glycemic control more difficult in preexisting type 1 (insulin-dependent) and type 2 (non–insulin-dependent) diabetes but does not appear to exacerbate diabetic retinopathy,... read more [ 1 Obstetric history references Obstetric and gynecologic history are often considered a distinct part of the medical history. This history includes past medical history related to reproductive and overall gynecologic health... read more ], gestational hypertension Hypertension in Pregnancy Recommendations regarding classification, diagnosis, and management of hypertensive disorders (including preeclampsia) are available from the American College of Obstetricians and Gynecologists... read more or severe preeclampsia Preeclampsia and Eclampsia Preeclampsia is new onset or worsening of existing hypertension with proteinuria after 20 weeks gestation. Eclampsia is unexplained generalized seizures in patients with preeclampsia. Diagnosis... read more [ 2 Obstetric history references Obstetric and gynecologic history are often considered a distinct part of the medical history. This history includes past medical history related to reproductive and overall gynecologic health... read more ], postpartum depression Postpartum Depression Postpartum depression is depressive symptoms that last > 2 weeks after delivery and meet criteria for major depression. Postpartum depression occurs in 10 to 15% of women after delivery.... read more [ 3 Obstetric history references Obstetric and gynecologic history are often considered a distinct part of the medical history. This history includes past medical history related to reproductive and overall gynecologic health... read more ], postpartum psychosis)
Obstetric history references
1. Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ. 2020;369:m1361. Published 2020 May 13. doi:10.1136/bmj.m1361
2. Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the american heart association [published correction appears in Circulation. 2011 Jun 7;123(22):e624] [published correction appears in Circulation. 2011 Oct 18;124(16):e427]. Circulation. 2011;123(11):1243-1262. doi:10.1161/CIR.0b013e31820faaf8
3. Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet. 2014;384(9956):1775-1788. doi:10.1016/S0140-6736(14)61276-9
Gynecologic History
Taking a gynecologic history consists of asking patients about any symptoms or concerns that prompted the visit. The history should include a menstrual history, sexual history, urinary tract symptoms or history, and previous or current gynecologic conditions and treatments.
Current symptoms are explored using open-ended questions followed by specific questions about the following:
Pelvic pain Female Pelvic Pain Pelvic pain is discomfort in the lower abdomen and is a common complaint. It is considered separately from vaginal pain and from vulvar or perineal pain, which occurs in the external genitals... read more (location, duration, character, quality, triggering and relieving factors)
Abnormal vaginal bleeding Vaginal Bleeding Abnormal vaginal or uterine bleeding includes Menses that are excessive in frequency (amenorrhea, oligomenorrhea, polymenorrhea), volume, or duration (menorrhagia, or heavy menstrual bleeding)... read more (quantity, duration, relation to the menstrual cycle)
Vulvovaginal discomfort or pain (location, duration, character, quality, triggering and relieving factors)
Menstrual history includes the following:
Age at menarche or menopause
Number of days of menses
Length and regularity of the interval between cycles
Start date of the last menstrual period (LMP)
Dates of the preceding period (previous menstrual period [PMP])
Volume of menses
Passage of blood clots: Any history of passage of clots warrants further evaluation and referral to a gynecologist
Any symptoms that occur with menses (eg, pain, cramping, migraine headaches)
The individual patient's menstrual history is compared with the normal ranges for characteristics of the menstrual cycle (frequency, regularity, duration, and volume of bleeding) (see table ). If there are menstrual abnormalities, the patient is evaluated for the type and etiology of abnormal uterine bleeding Abnormal Uterine Bleeding Abnormal uterine bleeding (AUB) in patients of reproductive age is a bleeding pattern that is not consistent with normal menstrual cycle parameters (frequency, regularity, duration, and volume)... read more .
Usually, menstrual bleeding Menstrual Cycle Hormonal interaction between the hypothalamus, anterior pituitary gland, and ovaries regulates the female reproductive system. The hypothalamus secretes a small peptide, gonadotropin-releasing... read more lasts for ≤ 8 days, with 24 to 38 days between menses; average blood loss is 30 mL (range, 13 to 80 mL), with the most bleeding on the second day. A saturated pad or tampon absorbs 5 to 15 mL. Objective measurement of menstrual volume is done only in research studies, so clinicians should ask the patient about use of pads and tampons and passage of blot clots from the vagina. Descriptions that suggest heavy uterine blood flow include:
Saturating ≥ 1 pad or tampon within 3 hours or less
Saturating > 21 pads or tampons per cycle
Frequently needing to change pad or tampon during the night to avoid leakage of blood on clothing or bedding
Passing blood clots ≥ 1 inch in diameter
Cramping is common on the day before and on the first day of menses. Vaginal bleeding that is irregular, painless, scant, and abnormally brief or prolonged suggests ovulatory dysfunction Ovulatory Dysfunction Ovulatory dysfunction is abnormal, irregular (with ≤ 9 menses/year), or absent ovulation. Menses are often irregular or absent. Diagnosis is often possible by menstrual history or can be confirmed... read more .
Any postmenopausal vaginal bleeding Vaginal Bleeding Abnormal vaginal or uterine bleeding includes Menses that are excessive in frequency (amenorrhea, oligomenorrhea, polymenorrhea), volume, or duration (menorrhagia, or heavy menstrual bleeding)... read more (any volume, including spotting or pink or brown staining) requires further evaluation for endometrial hyperplasia or cancer. Menopause Menopause Menopause is the permanent cessation of menses (amenorrhea) due to loss of ovarian follicular function. Clinical manifestations may include hot flushes, night sweats, sleep disruption, and genitourinary... read more is diagnosed 12 months after cessation of menses. However, perimenopausal women may have irregular bleeding, or postmenopausal bleeding may be misinterpreted as menses. Thus, any heavy, irregular, or prolonged bleeding in women age ≥ 45 years should be further evaluated by endometrial biopsy irrespective of the etiology.
Past gynecologic history includes history of
Sexually transmitted infection Overview of Sexually Transmitted Infections Sexually transmitted infection (STI) refers to infection with a pathogen that is transmitted through blood, semen, vaginal fluids, or other body fluids during oral, anal, or genital sex with... read more (STI) or pelvic inflammatory disease Pelvic Inflammatory Disease (PID) Pelvic inflammatory disease (PID) is a polymicrobial infection of the upper female genital tract: the cervix, uterus, fallopian tubes, and ovaries; abscess may occur. PID may be caused by sexually... read more (including diagnosis, frequency, and treatment)
Vulval/vaginal lesions, ovarian cysts Benign Ovarian Masses Benign ovarian masses include functional cysts (eg, corpus luteum cysts) and neoplasms (eg, benign teratomas). Most are asymptomatic; some cause pelvic pain. Evaluation includes pelvic examination... read more , uterine fibroids Uterine Fibroids Uterine fibroids (leiomyomas) are benign smooth muscle tumors of the uterus. Fibroids frequently cause abnormal uterine bleeding and pelvic pressure and sometimes urinary or intestinal symptoms... read more , infertility Overview of Infertility Infertility is a disease defined by the inability to achieve a pregnancy and/or the need for medical intervention to achieve a successful pregnancy. In patients who have not achieved a pregnancy... read more , endometriosis Endometriosis In endometriosis, functioning endometrial cells are implanted in the pelvis outside the uterine cavity. Symptoms depend on location of the implants. The classic triad of symptoms is dysmenorrhea... read more , polycystic ovary syndrome Polycystic Ovary Syndrome (PCOS) Polycystic ovary syndrome is a clinical syndrome typically characterized by anovulation or oligo-ovulation, signs of androgen excess (eg, hirsutism, acne), and multiple ovarian cysts in the... read more , pelvic organ prolapse Overview of Pelvic Organ Prolapse (POP) Pelvic organ prolapse results from laxities (similar to hernias) in the ligaments, fascia, and muscles supporting the pelvic organs (pelvic floor—see figure Pelvic organ prolapse). The prevalence... read more , or urine/stool incontinence (including mode of diagnosis and treatment received)
Pap smear (normal or abnormal), colposcopy (including date, results, and treatment)
Gynecologic procedures such as cervical/endometrial/vulval/vaginal biopsy, hysteroscopy, laparoscopy, hysterectomy (including date, indications, and complications)
Sexual history should be obtained in a professional and nonjudgmental way and includes the following (see CDC: A Guide to Taking a Sexual History):
Gender of partners
Sexual risk behaviors (eg, multiple partners, risk or history of sexual violence)
Use of contraception (especially use of condoms)
Concerns about sexual function Overview of Female Sexual Function and Dysfunction Women commonly have concerns about sexual function ( 1). Concerns that cause personal or interpersonal distress are considered a sexual dysfunction disorder. Approximately 12% of women in the... read more (eg, dyspareunia, sexual interest, arousal, orgasm)
Medical history includes a history of systemic disorders including hematologic, autoimmune, hepatic, cardiac, and renal diseases, diabetes mellitus, and hypertension. Any bleeding disorders or use of medication that affects coagulation (eg, aspirin), nonsteroidal anti-inflammatory drugs (NSAIDs), or antidepressant or antipsychotic medications that affect hypothalamic-pituitary-ovarian axis should be noted.
Social history includes social stressors, exercise patterns, and substance misuse (including smoking) and completion of a drug and alcohol questionnaire. In adolescents, social history includes athletic participation, school absence rate, and decreased participation in hobbies/sports, especially if related to menstrual cycles.
Family history includes history of malignancy, bleeding disorders, infertility, menstrual disorders, fibroids, endometriosis, and thyroid diseases in first-degree and second-degree relatives. Family history of diabetes mellitus or disorders of lipids or triglycerides should be noted and may suggest polycystic ovary syndrome Polycystic Ovary Syndrome (PCOS) Polycystic ovary syndrome is a clinical syndrome typically characterized by anovulation or oligo-ovulation, signs of androgen excess (eg, hirsutism, acne), and multiple ovarian cysts in the... read more .
Review of systems should include any weight changes, fatigue, hirsutism, acne, vision changes, headaches, galactorrhea, changes in bowel habits, abdominal pain, heat/cold intolerance, and urinary and gastrointestinal symptoms. In adolescents, history of self-induced vomiting, eating disorders, undernutrition, easy bleeding/bruising (epistaxis, bleeding gums) is important.
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aspirin |
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