M2T2 Female Obstetric & Gynecological History Sampson 11-21-2007

Front 1

What do you listen for in our patient's stories?

Back 1

-History
-Physical Exam
-Labs/Imaging
-Assessment
-Plan

Front 2

What are some reasons that women go to see their family doctor?

Back 2

Besides depression,

Front 3

What comes after the chief complaint?

Back 3

History of present illness (HPI)

Front 4

Comprehensive woman's health history
What is next?

Back 4

Chief complaint
History of present illness
Gynecologic history
Obstetric history
Medical history
Surgical history
Medications
Medication allergies
Family history
Social history
Review of systems

Front 5

What are the objectives of the OB-GYN History?

Back 5

-Assess health risks
-Assess compliance with recommended screening
-Demonstrate communication skills and build trust by maintaining an awareness of contextual factors.

Front 6

What is objective 1 of the OB-GYN History?

Back 6

Assess health risks

Front 7

What are the health risks we are assessing?

Back 7

Unintended pregnancy
Sexually transmitted infections
Cervical pathology
Breast malignancy
Gynecologic malignancies
Domestic violence

Front 8

What is the second objective of the OB-GYN History?

Back 8

Assess compliance with screening

Front 9

What screening modalities are we assessing compliance with?

Back 9

-GYN exam: cervical and ovarian pathology
-Breast exam
-Breast imaging
-Osteoporosis
-Cholesterol/Diabetes
-Colon cancer

Front 10

What is the third objective of the OB-GYN History?

Back 10

Build trust through an awareness of social factors .

Front 11

What social factors do we need to be aware of?

Back 11

-Culture
-Ethnicity
-Language/literacy
-Socioeconomic class
-Spirituality/religion
-Sexual orientation

Front 12

What are the components of a women's medical history?

Back 12

1. GYNECOLOGIC HISTORY

2. OBSTETRIC HISTORY

Front 13

What does the gynecologic history consist of?

Back 13

-Menstrual history
-Pap smear history
-Contraceptive history
-Sexual history
-Infertility history
-GYN surgical procedure

Front 14

Dysfunctional uterine bleeding

Back 14

abnormal uterine bleeding that cannot be attributed to medications, blood dyscrasias, systematic diseases, trauma, uterine neoplasms or pregnancy

Front 15

Menorrhagia (hypermenorrhea):

Back 15

prolonged (> 7 days) or excessive (> 80 ml) of uterine bleeding occurring at regular intervals. (rrhagia=excessive, to burst forth)

Front 16

Metrorrhagia

Back 16

irregular episodes of uterine bleeding

Front 17

Menometrorrhagia

Back 17

irregular intervals

Front 18

Polymenorrhea

Back 18

bleeding occurring at regular intervals of less than 21 days.

Front 19

Oligomenorrhea

Back 19

bleeding interval greater than 35 days

Front 20

Amenorrhea

Back 20

bleeding interval greater than 6 months.

Front 21

Dysmenorrhea

Back 21

Pain immediately before or with the onset of menstruation

Front 22

What are the components of the menstrual history?

Back 22

-Age of menarche
-age at menopause
-Current cycle characteristics
-Associated symptoms

Front 23

What current cycle characteristics that we should inquire our patients?

Back 23

• First day of last menstrual period (also HPI)
• Frequency of current flow
• Duration of flow
• Amount estimate

Front 24

What do we should obtain about the patient's pap smear history?

Back 24

-Date and results of most recent
-Prior abnormal results

Front 25

If a patient has prior abnormal results, we do we need to know?

Back 25

-Evaluation?
-Treatment?
-Follow-up?

Front 26

What do we need to know about our patient's contraceptive history?

Back 26

-Methods and dates contraception!!
-Complications
-Reasons for changes

Front 27

What do we need to know about our patient's gynecologic infections?

Back 27

-Sexually transmitted infections
-Assessment of past and current risk factors
-Results of routine screening tests (HIV, GC, etc.)
-Other (bacterial vaginosis, yeast etc.)

Front 28

What do we need to know about our patient's sexual history?

Back 28

• Dyspareunia
• Current/past abuse or assault

Front 29

Dyspareunia

Back 29

pain with intercourse

Front 30

Examples of gynecologic procedures

Back 30

-Hysteroscopy
-Hysterectomy
-Bilateral tubal ligation
-Oophorectomy

Front 31

What is the summary of GYN history?

Back 31

-Menstrual history
-Pap smear history
-Contraceptive history
-Sexual history/orientation
-Infertility history
-GYN surgical procedure

Front 32

Gravid

Back 32

Number of times a woman has been pregnant

Front 33

Parity

Back 33

the number of times a female has given birth counting multiple births as one and usually including stillbirths

Front 34

What are the standard elements of the parity

Back 34

F - Full term
P - Pre-term
A - Abortion
L - Living

Front 35

Gravity

Back 35

a technical term that refers to the number of times a woman has been pregnant. A gravida is a pregnant woman. A woman who has never been pregnant is referred to as a nulligravida or gravida 0. A woman who is pregnant for the first time is referred to as a primigravida or gravida 1. A woman who has been pregnant some other number of times is referred to as gravida 2, gravida 3, and so on.

Front 36

Nulliparous

Back 36

A woman who has never given birth is referred to as being nulliparous, a nullipara, or para 0. A woman who has given birth a particular number or times is referred to as para 1, para 2, or para 3, and so on. Biparous or bipara are sometimes used as synonyms for para 2.

Front 37

Multiparous

Back 37

A woman who has given birth two or more times is referred to as multiparous. Multiparous can also be used to describe someone who has given birth to more than one offspring at once.

Front 38

Gravida

Back 38

Woman who is or has been pregnant

Front 39

Nulligravida

Back 39

never been pregnant

Front 40

Primigravida

Back 40

A woman who is in or who has experienced her first pregnancy

Front 41

Multigravida

Back 41

pregnant more than once

Front 42

Parity

Back 42

number of births

Front 43

Nullipara

Back 43

never had a pregnancy progress to beyond the age of viability

Front 44

Primiparous

Back 44

completed one pregnancy to the age of viability

Front 45

Mulitparous

Back 45

completed two or more pregnancies to the stage of viability

Front 46

Parturient

Back 46

currently in labor

Front 47

Puerpera

Back 47

just recently given birth

Front 48

Ms. Jarvis: Currently pregnant, with one prior pregnancy that was an ectopic pregnancy

What are her G’s and P’s???

Back 48

G2 P0010

Front 49

Ms. Smith: Three prior pregnancies. One was a miscarriage, the other two were full term. Both children are living

What are her G’s and P’s???

Back 49

G3 P2012

Front 50

Ms. Murphy: One prior pregnancy that was full term and the child is living.

What are her G’s and P’s???

Back 50

G1 P 1001
Or
G1P1

Front 51

Ms. Jones: One prior pregnancy with twins that were born at term and both children are living?

What are her G’s and P’s???

Back 51

G1 P 1002

Front 52

What are the possible outcomes of pregnancy?

Back 52

-Term and preterm deliveries
-Induced Abortions
-Spontaneous abortions
-Ectopic
-Molar pregnancy

Front 53

What do you need to know about you patient's term & preterm deliveries?

Back 53

-Type of delivery
-Fetal complications
-Maternal complications
-Treatment history

Front 54

What do you need to know about your patient's induced abortions?

Back 54

-Estimated gestational age
-Associated medical condition
-Complications
-Methods

Front 55

What do you need to know about your patient's spontaneous abortions?

Back 55

-Estimated gestational age
-Associated maternal conditions
-Methods
-Complications
-Results of recurrent spontaneous abortions

Front 56

What do you need to know about your patient's ectopic pregnancy?

Back 56

-Location of pregnancy
-Treatment modality

Front 57

What do you need to know about your patient's molar pregnancies?

Back 57

Treament history

Front 58

What websites do you visit to get images of molar pregnancies?

Back 58

embryology.med.unsw.edu.au
www.nzhis.govt.nz/.../gfx/miscarriage2.jpg

Front 59

Ms. Jones, How many times have you been pregnant? What happened with each one of those pregnancies?

Back 59

I have been pregnant 4 times and have two healthy children.
The first pregnancy I delivered April 11 1998. It was my first baby, and labor was long, but both me and my son were healthy. The second baby was exposed to rubella and died. Term, no complications
7/1999 Pre-term, congenital rubella 27 weeks, did not survive
2/2001 spontaneous miscarriage, no procedures
4/2005, term, cesarean, gestational diabetes

Front 60

Ms. Jones OB history

Back 60

G4 P 2112
4/1998 Term, SVD no complications
7/1999 Pre-term, SVD fetal demise in utero congenital rubella 27 weeks
2/2001 spontaneous miscarriage, no procedures
4/2005, term, cesarean for failure to progress, gestational diabetes

Front 61

Ms. Jones OB history

Back 61

G4 P 2112
4/1998 Term, SVD no complications
7/1999 Pre-term, SVD fetal demise in utero congenital rubella 27 weeks
2/2001 spontaneous miscarriage, no procedures
4/2005, term, cesarean for failure to progress, gestational diabetes

Front 62

What do you state at the beginning of every HPI

Back 62

“The patient is a 26 yo gravida X para Y with a last menstrual period on DATE here today for CHIEF COMPLAINT”

Front 63

What are the locations of ectopic pregnancies?

Back 63

-Ovarian
-Abdominal
-Infundibular tubal
-ampullar tubal
-interligamentous
-intramural
-interstitial
-cervical

Front 64

If you can't read? What is this?

Back 64

Right ectopic pregnancy.

Front 65

If you can't read? What is this?

Back 65

Right ectopic pregnancy.

Front 66

This is a ultrasound of a ______. Ignore the text

Back 66

Molar pregnancy. Here is the pathology specimen.