HISTORY TAKING

HISTORY TAKING

Biographic Data Age Occupation Civil Status Menstrual History Breast Health Contraceptive Use Medical History Family History Domestic Violence Maternal Attitude and Reaction Towards Pregnancy

OBSTETRIC HISTORY

History of Past Pregnancies Number of past pregnancies, pregnancy outcome, complications, labor time, method of delivery, complications of labor, puerperium, and complications of puerperium TPAL, GP Signs of first pregnancy: Uterus is tense and firm, frenulum is intact, labia majora in close apposition, vagina is narrow with numerous rugae, cervix is soft but do not admit tip of finger until very end of pregnancy Signs of previous pregnancy: Pendulous and lax abdominal wall, abdominal striae, labia gapes wider, hymen is transformed to myrtiform carunculae, cervix admits tip of cervix, sites of healed laceration of the cervix can be identified

OBSTETRIC HISTORY

History

of Present Pregnancies
1.Clinical

Signs and Symptoms 2.Pregnancy Tests 3.Ultrasound

CLINICAL SIGNS AND SYMPTOMS

PRESUMPTIVE SIGNS Amenorrhea Breast Changes Urinary Frequency Quickening Easy Fatigability Leukorrhea Nausea and Vomiting Chadwicks Sign Skin Changes

PROBABLE SIGNS Hegars Sign Uterine Growth Ballottement Uterine Suffle Goodels Sign Braxton-Hicks Contractions Fetal Outline (+) Pregnancy Test Elevated BBT

 POSITIVE

SIGNS Fetal Heart Tone Funic Suffle Fetal Movement X-ray Ultrasound

PREGNANCY TESTS

Human Chorionic Gonadotropin (HCG) A glycoprotein similar in structure to folliclestimulating hormone, luteinizing hormone, and throtropin. Detectable in the serum for 5% of patients in 8 days after conception and in more than 98% of patients by day 11. Pregnancy Test for HCG can be done by : Using urine as specimen Using blood as specimen

Urine Pregnancy Test Can be performed accurately 42 days after the LMP or 2 weeks after the first missed period. Cause of false positive results: Proteinuria, hematuria, cross reaction with LH, high TSH, secreting tumors Cause of false negative results: Missed abortion Ectopic pregnancy Too early pregnancy Urine stored too long in room temp. Interfering medications

The pregnancy test becomes negative about: One week after delivery 2 weeks after abortion 2-4 weeks after evacuation of vesicular mole Uses of pregnancy test: Diagnosis of pregnancy Diagnosis of fetal death Diagnosis of ectopic pregnancy Diagnosis and follow-up of gestational trophoblastic diseases

ULTRASOUND

Transvaginal ultrasound is the most accurate means of confirming intrauterine pregnancy and gestational age during the early first trimester than the abdominal ultrasound. Gestational sac (GS) is the earliest structure that can be visualized. The fetal or embryonic pole is first seen on TVUS images at approximately 5-6 weeks gestation. FHB can be detected by Doppler principle ultrasound after 8 weeks.

PHYSICAL EXAMINATION

PHYSICAL EXAMINATION

Basically, the conduct of the assessment of the patient during antenatal visits is: Interviewing the patient regarding her general wellbeing and any concerns or complaints Weighing Blood pressure assessment Urinalysis for protein and glucose Abdominal palpation after 24 weeks Rectal or vaginal examination

VITAL SIGNS

Blood

Pressure Roll-Over Test Mean Arterial Pressure (MAP) Pulse Rate Respiratory Rate Temperature

Physical assessment should be performed systematically. One technique is by the cephalocaudal method. Head and scalp Eyes Nose Ears Mouth and teeth Neck Breast Skin Back Rectum Extremities

ABDOMINAL PALPATION: LEOPOLDS MANEUVER

Leopolds Maneuver is preferably performed after 24 weeks gestation when fetal outline can be already palpated. Preparation: Instruct woman to empty her bladder first. Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles. Place a small pillow under the head for comfort. Drape properly to maintain privacy. Explain procedure to the patient. Warms hands by rubbing together. (Cold hands can stimulate uterine contractions). Use the palm for palpation not the fingers.

LABORATORY TESTS

BLOOD TESTS Hematocrit and Hemoglobin Blood type and Rh factor Leukocyte count Differential smear VDRL HIV screen Antibody screen Rubella antibody titer DM Universal Screening Determination of estriol and human placental lactogen Maternal Serum Alphafetoprotein (AFP)

Causes of Elevated AFP: Underestimated gestational age Open NTDs Fetal nephrosis and cyctic hygroma Fetal GI obstruction, omphalocele, gastroschisis Prematurity, low birth weight, IUGR Abdominal pregnancy Multiple fetuses Fetal demise

 Causes

of low AFP: Overestimated gestational age Missed abortions Molar pregnancies Chromosomal abnormalities

URINALYSIS Collect urinary specimen by midstream or clean catch technique. A complete urinalysis should be conducted on the first clinic visit and repeated at 28-30 weeks. Microscopy Glucose Protein leukocyte

FETAL ASSESSMENT

FETAL ASSESSMENT

Fetal Heart Rate AFP/Triple Screen Amniocentesis Amniotic Fluid Analysis Percutaneous Umbilical Blood Sampling Obstetric Ultrasound Transvaginal Scans Biophysical Profile Fetal Movements Counting Amniotic Fluid Index Umbilical Artery Doppler Velocimetry Fetoscopy Amnioscopy Amniography Magnetic Resonance Imaging Radiography Nonstress Test Contraction Stress Test or Oxytocin Challenge Test