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HISTORY TAKING
&
PHYSICAL EXAMINATION
Mizan Tepi University
Dep`t of Biomedical Sciences
Obstetrics and
Gynecology
Obstetrics: deals with the pregnant state and
its sequels
Gynecology: deals with the physiology and
pathology of the female reproductive organs
in the non-pregnant state
Obstetrics
Obstetrics is the branch of medicine that
Aims of Obstetrics
The transcendent objective of obstetrics is
Address
Occupation
Religion
Marital Status :unmarried & unsupported
high risk
Date
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Chief Complaint(s):
E.g. Of Obst.C/C are:
ANC follow up
Vaginal bleeding
Time of onset
Flow---amount, duration,
Leakage of liquor
Pushing down pain
Decreased/ absent fetal movement
Body swelling, headache, blurring of
vision, etc
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hospital b/c of-- Any complaints during the present pregnancyeventful or uneventful ask for danger signs:
Obstetrical
vaginal bleeding
Leakage of liquor
Decreased fetal mov`ts
Headache etc.
Medical: HTN, DM, etc. Other
Fetal movements decreased or increased ? Useful to assess
fetal well being
Other negative and positive statement according to the
patient`s compaints
Date of
deliver
y
Wks of
gestati
on
Length Mode
of
of
labor
delive
ry
Birth Wt AP
out
cx
com
n
e
IP
cx
n
PP
cx
n
Alive
or
not
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2
3
etc
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Past History
Lists childhood illnesses
Lists adult illnesses with dates for at least four
Family History
Outlines or diagrams of age and health, or
age and cause of death of siblings, parents, and
grandparents
Documents presence or absence of specific illnesses
in family, such as hypertension, coronary artery
disease, etc.
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Physical Examination
To interpret physical findings & reach at a Dx:
1st try to know normal physiologic & anatomic changes in
pregnancy.
2nd understand the abnormal findings.
Vital Signs
Bp .mmHg, Rt arm, sitting position, Kort1/4
Wt.---PR-----RR------T-------
Ht.---BMI----
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Abdomen
- General: insp, ausc. palp, perc,
- Obstetric:
Leopold maneuver(I, II, III, & IV)
I..
II..
III.
IV.
Leopold`s Maneuvers
I. Fundal palpation---fundal height, what occupies
fundus
II.Lateral palpation---Lie, side of the back
III.Pelvic palpationPresentation, Descent of presenting
part, Attitude of the fetal head
IV.Pawliks gripPresentation, Descent of fetal head
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Leopold I
involves the examiner placing both of his or her hands
Leopold I
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Leopold II
involves palpation in the paraumbilical regions
Leopold II
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Leopold III
is suprapubic palpation by using the thumb and
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Leopold III
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Leopold IV
The fourth maneuver answers the question, On
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GUS
1. Early---first
2. Late
trimester
To diagnose pregnancy
To date pregnancy
To diagnose pelvic problems/ pathology
contracted pelvis
Inlet
The inlet can only be adequately evaluated
Midcavity (Midpelvis)
The midcavity of the pelvis is evaluated
by assessing the shape of the sacrum
(curved or straight), the width of the
sacrosciatic notch, and the prominence of,
and distance between, the ischial spines. A
contracted midpelvis characteristically
shows a flattened forward projecting
sacrum, prominent ischial spines with a
narrowed interspinous distance, and a
shortened sacrospinous ligament which is
less than two fingerbreadths long.
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Outlet
Evaluation of the outlet consists of:
determining the distance between the
ischial
tuberosities
(normally
approximately 10 cm)
palpating the coccyx to determine its
orientation and mobility (normally mobile
and not protruding into the pelvic cavity)
evaluating
the subpubic angle (>90
degrees) and retropubic angle (flattened
in a platypelloid pelvis and sharply
angulated in an android pelvis)
determining
the
convergence
or
divergence of the pelvic sidewalls
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CNS
Check knee and ankle reflexes.
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Leakage of liqour/---hrs
Vaginal bleeding/----hrs
HPP: elaborate on the C/C
P/E.
G/A: in labor pain
Uterine contraction (frequency/10min
intensity(mild, moderate, severe),
duration in seconds. E.g. 2/40-50/10`
FHB/min. The normal fetal heart rate is 110170
bpm.
Pelvic exam. Speculum-for PROM, APH(no PV)
PV: Cx. dilat.(cm), effacement(%), presentation,
position, station, caput, moulding, color of liquor if
membrane is ruptured.
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Assessment:
Problems identified:
e.g. Teen age, age >35yrs, Primigravida,
nullipara, Post term, bad obstetric hx,
Twin Pregnancy
PIH, GDM etc
Risk Assessment:( look for RF starting from
identification)
Low risk/ High risk pregnancy
( give reason for the risk assessed)
Recommendation:
Investigations:-----------Place, route and time(GA) of delivery( based
on RF)
Cxn. anticipated( maternal/fetal/neonatal)
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6.
7.
8.
9.
Past Hx..
Family Hx
Personal and Social Hx
Review of systems.
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Physical Examination
1.General: like medical/ surgical
2.Pelvic Examination
a) Speculum Examination:
-to inspect the vagina, cervix
b) Digital vaginal examination(PV) &
Bimanual Examination
-to palpate vaginal wall, cervix, uterus
(size in wks), adnexal
structures (ovary,
tubes, parametrium)
-for mass,
-for tenderness
-to palpate pouch of Douglas:
-for fullness, tenderness etc.
-discharge-color, odor,
consistency etc
-blood on examining finger.
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B. Introitus
With the labia still separated by the
middle and index fingers, instruct the
patient to bear down.
Note the presence of the anterior wall of
the vagina when a cystocele is present or
bulging of the posterior wall when a
rectocele or enterocele is present. Bulging
of both may accompany a complete
prolapse of the uterus.
The supporting structure of the pelvic
outlet is evaluated further when the
bimanual pelvic examination is done.
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With
Two
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2.
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D. Bimanual palpation
The pelvic organs can be outlined by bimanual
palpation; the examiner places one hand on the
lower abdominal wall and the finger(s) (one or
two) (see Fig.) of the other hand in the vagina (or
vagina and
rectum
in the
rectovaginal
examination) (see Fig.). Either the right or left
hand may be used for vaginal palpation. The
number of fingers inserted into the vagina should
be based on what can comfortably be
accommodated, the size and pliability of the
vagina, and the weight of the patient. For
example, adolescent, slender, and older patients
might be best examined with a single finger
technique.
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Tumors,
if
E. Rectal examination
1.Inspect the perianal and anal area, the pilonidal
(sacrococcygeal) region, and the perineum for the
following aspects:
a. Color of the region (note that the perianal skin is
more pigmented than the surrounding skin of the
buttocks and is frequently thrown into radiating folds)
b. Lesions
2.
4. Palpate the anal canal and rectum with a welllubricated, gloved index finger. Lay the pulp of the
index finger against the anal orifice and instruct the
subject to strain downward. Concomitant with the
patient's downward straining (which tends to relax the
external sphincter muscle), exert upward pressure until
the sphincter is felt to yield. Then, with a slight rotary
movement, insinuate the finger past the anal canal into
the rectum. Examine the anal canal systematically
before exploring the rectum.
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Graves regular;
Pederson extralong;
Pederson regular
Huffman virginal;
pediatric regular; and
pediatric narrow.
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Assessment:
Plan:
Investigation.
Medical treatment
Surgical treatment.
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A Big Blessing!!!!!
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