Obstetric & Gynaecology History & Clinical Examination：产科与妇科病史和临床检查课件.ppt
Obstetric&Gynaecology History&Clinical Examination,DR.Mojibina,Obstetric History,AgeGravidityParity-(Preg24 wks)+(Preg 24wks)LMP;menstural cycle;conceived on pill;EDDHistory of this pregnacy:Presenting complaints-when did they occur&how long they lasted,any investigation or treatment already?Low/high risk pregnancy?Any problems in antenatal care so far?Fetal movements,Obstetric History,Previous pregnancy:-Previous miscarriages-Gestation&mode of delivery-Length of labour&complications-Third stage complications-Postnatal problemsMedical&surgical historyDrug history&allergies Family history-hereditary disorders,HTN,DM,twins or congenital malformation Social history-smoking,alcohol,drug misuse,occupation,housing&marital status,Examination,Consent,explanation&beware of supine hypotensionGeneral examination-Colour-Hand,eyes&mouth-Presence of oedema-BP&Urine-CVS&Respiratory system examination,Abdominal Examination,Inspection:abdominal scars,striae gravidarum,linea nigra&oedemaPalpation:-Symphysio-fundal height in cm-Lie:relationship of long.axis of fetus to long.axis of uterus i.e longitudinal,transverse,oblique-Presentation:presenting part of fetus occupying the lower pole of uterus i.e ceph(vertex),breech-Position:Relation of denominator(occiput/sacrum)of presenting part to the quadrants of pelvis i.e ROA,LSP-Engagement:Widest diameter of head below the pelvic brim.No.of 5th head palpable above the pelvic brim-Amniotic fluid Auscultation:FETAL HEART,Lie of Fetus,Longitudinal lie,Transverse lie,Presentation of fetus,Vaginal Examination,VulvaVagina Cervix-dilatation,effacement,position&consistencyPresenting part i.e VertexStation-cm in relation to the ischial spineCaput-swelling on the scalp superficial to periosteum of cranium,as a result of venous congestion,on the part of head most in advanceMoulding-Overriding of the bones of skull Membranes&Liquor,Gynaecological History,Age,Gravidity,ParityLMPContraception,Last cervical smearPresenting complaints:Nature&duration Relation to menstrual cycle Bowel symptoms Urinary symptoms Vaginal discharge Vaginal bleeding Previous Gynaecological&Obstetric History:PID/STIEndometriosisPrevious miscarriages/preg24 wks&outcome,History cont.,MedicalSurgicalFamily history-Fibroids,endometriosis,cancers,DVT/PEMedicationsAllergiesSocial History,Examination,General-Conjunctiva,pulseAbdomen:Inspection-distension of abdomen,mass,previous scarPalpation-tenderness,mass(size,consistency),ascites,lymph nodesPercussionAuscultationVaginal ExaminationVulvaSpeculum(Cuscos&Sims)-vagina(atrophy,mass,trauma,prolapse)-cervix(ectropion,polyp,growth,contact bleeding,uterine prolapseBimanual pelvic exam.uterine/adenexal masses/tenderness,Competencies,Examination of pregnant abdomenExamination of non-pregnant abdomenSpeculum(Cuscos speculum)examination,Demonstration,
