ObstetricGynaecology HistoryClinical Examination：产科与妇科病史和临床检查课件.ppt

1、 Obstetric&Gynaecology History&Clinical Examination DR.MojibinaObstetric HistoryAgeGravidityParity-(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/hi

2、gh risk pregnancy?-Any problems in antenatal care so far?-Fetal movementsObstetric History Previous pregnancy:-Previous miscarriages-Gestation&mode of delivery -Length of labour&complications -Third stage complications -Postnatal problems Medical&surgical history Drug history&allergies Family histor

3、y-hereditary disorders,HTN,DM,twins or congenital malformation Social history-smoking,alcohol,drug misuse,occupation,housing&marital status ExaminationConsent,explanation&beware of supine hypotensionGeneral examination -Colour -Hand,eyes&mouth -Presence of oedema -BP&Urine -CVS&Respiratory system ex

4、aminationAbdominal Examination Inspection:abdominal scars,striae gravidarum,linea nigra&oedema Palpation:-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

5、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 Longitu

6、dinal lieTransverse liePresentation of fetusVaginal ExaminationVulvaVagina 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 pa

7、rt of head most in advanceMoulding-Overriding of the bones of skull Membranes&LiquorGynaecological History Age,Gravidity,Parity LMP Contraception,Last cervical smear Presenting complaints:Nature&duration Relation to menstrual cycle Bowel symptoms Urinary symptoms Vaginal discharge Vaginal bleeding P

8、revious Gynaecological&Obstetric History:PID/STIEndometriosisPrevious miscarriages/preg24 wks&outcome History cont.MedicalSurgicalFamily history-Fibroids,endometriosis,cancers,DVT/PEMedicationsAllergiesSocial HistoryExamination General-Conjunctiva,pulse Abdomen:-Inspection-distension of abdomen,mass

9、,previous scar-Palpation-tenderness,mass(size,consistency),ascites,lymph nodes-Percussion-Auscultation Vaginal Examination Vulva Speculum(Cuscos&Sims)-vagina(atrophy,mass,trauma,prolapse)-cervix(ectropion,polyp,growth,contact bleeding,uterine prolapse Bimanual pelvic exam.uterine/adenexal masses/tendernessCompetencies Examination of pregnant abdomenExamination of non-pregnant abdomenSpeculum(Cuscos speculum)examinationDemonstration