History

• Patient Details
  • Gestation + Number of Foetuses
• PC + HPC
• Obstetrics Systems Review (FRAB)
  • Foetal Movements → from >20/40.
    • Present? → can you feel the baby move?
    • Frequency? → are they moving as usual? strength + frequency?
    • If Abnormal → when did you last feel baby move?
    • (CTG Interpretation)
  • Rupture of Membranes → sudden gush of fluid.
    • Quantity?
    • Timing?
    • Colour? (Meconium/Blood/Pus) Smell?
    • Has labour started? Contractions? (ROM in abscence of contractions = PROM)
  • Abdominal Pain → SOCRATES.
    • Safeguard → do you feel safe and supported at home?
  • Bleeding (PV) → characterise in detail.
    • Quantity?
    • Characteristics?
    • Painful?
    • Previous episodes? Provoked?
    • Discharge?
  • Discharge / Swollen hands, feet, face / Headache / Visual Disturbances / Fevers / Itching / N&V / Urinary Frequency / Dysuria .
  • Current Pregnancy (HACD)
    • Health → how has pregnancy been so far? medical conditions that have developed during pregnancy? RHESUS STATUS?
    • Antenatal Care → 12 (dating) and 20 (anomaly) week scans + results? vaccinations (flu + whooping cough)? folic acid?
    • Conception → planned pregnany? assisted pregnancy?
    • Delivery Plans
• O&G PMH
  • Obstetric History - ‘Have you been pregnant before? What were the outcomes of those pregnancies?’
    • Gravidity and Parity
      • GMC → gestation, mode of delivery, complications.
    • Other pregnancies and children details (gestation at birth)
    • Complications to mother or baby
  • Gynaecology History
    • 1st day of LMP
    • Cervical Smears → attended? abnormal? treatment? (treatment that removes part of cervix can cause preterm labour)
    • Sexually active
  • Sexual Health
    • Contraception → barrier vs hormone
    • Previous STDs → treated?
    • Partners
    • Consensual
• PMH
  • Medical
  • Surgical → esp. abdominal surgery
• DH
• FH
  • Maternal conditions in pregnancy → pre-eclampsia/hypertension in pregancy, diabetes in pregnancy, pre-term births, thromboembolic disease, serious psychiatric disorders.
• SH
  • Home environment → support system? who’s at home?
    • Do you feel safe and supported at home?

Investigations

• Bedside → examinations: pregnant abdomen, speculum, bimanual. Basic observations. Urine: dip, pregnancy test.
• Bloods → FBC, G&S, Cross-Match, Coagulation Screen. U&Es, LFTs, OGTT.
• Imaging → Assess mother: TVUSS. Assess foetus: foetal ultrasound scan (assess growth and amniotic fluid volume), foetal doppler (assessing blood flow to baby), CTG.

Counselling

• Maternal → manage acute medical issue. Develop ongoing plan (consultant led?).
• Foetal → ongoing monitoring for the remainder of the pregnancy.
• Labour → gestation at delivery, mode of delivery, where delivery will take place (labour ward), interventions (continuous CTG monitoring).

Additional Points