Introduction To Obstetrics and Gynaecology BY Dr Usigbe

Introduction To Obstetrics and Gynaecology BY Dr Usigbe Victor Opeyemi MBBS Ogb, B. Sc Physiology © NITMED TUTORIALS 1

Definitions �Gynaecology is the branch of physiology and medicine that deals with the functions and diseases specific to women and girls especially those affecting the reproductive system. �Obstetrics is the branch of health science that deals with pregnancy, child birth and post-partum period. 2

HISTORY AND PHYSICAL EXAMINATION IN O&G 3

INTRODUCTION �In O&G the patient's history is of extraordinary importance. �It not only provides some insight into what might be troubling the patient, but in about 90% of cases, it will provide the diagnosis. �A good history provides clinical guide to the Physical examination to follow. 4

INTRODUCTION �The FORMAT in O/G clerking is similar to the practice in other disciplines but for some peculiarities: �THE CHAPERON(E)…. . �THE CLIENT CONCEPT �(No Presenting complaint e. g. in ANC, Family planning and cancer screening clinics) 5

HISTORY TAKING �There is a generally accepted guide. . . �Bio-social data (Name, Age, Occupation, Address, Religion(sect), Ethnicity, Marital Status etc; note their relevance & peculiarity to the clinical condition) , LMP, EDD, EGA, LCB, Gravidity, Parity) �OBS Hx- Pc, Hx. Pc(including Index Pregnancy Hx), Past Obs Hx, Gyn Hx, PMHx, F&SHx, Review Of Systems and Summary. �GYN Hx- Pc, Hx. Pc, Gyn Hx, Past Obs Hx, PMHx, F&SHx, Review Of Systems and Summary. 6

Presenting Complaint The reason for the visit “Why have you come to the hospital today? ”. �It might be for a routine 1 st visit or a follow up visit. �The Presenting Complaint can almost always be stated in one sentence or less e. g. “Inability to conceive”. �Always inquire about the duration. 7

History of Presenting complaint �What led up to the current situation/ how did it all begin? �Has it been constant, improving or worsening? �Is there anything that makes it worse or better? �Have you received any treatment or investigations? If yes, what, where and when? �What was the outcome of the intervention? �Are there any associated problems? 8

Past History � Note any previous significant medical or surgical illness, and allergies. . . • HIV, Hypertension, heart disease, epilepsy, asthma, DM � Previous hospitalizations for any medical illness? “ � Previous surgery? � Previous blood transfusion? � Any medication on a regular basis? “ � If YES; o Ask her to identify medications she takes regularly. o Some medications are of gynecologic or obstetric significance. (hormones, antibiotics). 9

OB-GYN History �Obstetric history �Menstrual history �Sexual history �Contraception history �Prior gynecologic problems �(Pap smear abnormalities, bleeding problems, STDs, and others). 10

Obstetric History � GRAVIDITY(G) : Total number of pregnancies. � For obstetric patients: Note the outcome of all previous pregnancies and any significant antenatal, intrapartum and postpartum events. � Include details of obstetric complications. � PARITY (P): Number of deliveries beyond viability. � (+) MISCARRIAGE OR ABORTION. � LAST MENSTRUAL PERIOD (LMP) � EXPECTED DATE OF DELIVERY (EDD) � Know the RULE and the CONDITIONS…(Naegeles’ rule = +7; -3 or +9) � ESTIMATED GESTATIONAL AGE (EGA) � LAST CHILD BIRTH (LCB) 11

Menstrual History �Age of onset of menses (menarche) or menopause. �The regularity (or irregularity) of menses. �Frequency, duration, heaviness and any associated symptoms, such as cramps, bloating or headaches. �Note the first day of the last NORMAL menstrual period (LMP) 12

Sexual History �The depth of your sexual history inquiries will depend on the Pc and the clinical circumstances. �For some cases, sexual history is irrelevant and omitted. �For other cases, an short sexual history is adequate. �For some, a full and detailed sexual history is the needed. 13

Sexual History Cont’d �In those cases, questions may include: �Age at first coitus �Current sexual activities (vaginal, oral, anal, manual) �Current frequency of sexual activities �Past sexual activities �Safer sex practices �Number of partners (current and in the past) �Sexual preferences (men only, women only, men or women) �Sexual dysfunctions (problems with arousal, pain, lubrication, orgasm). 14

Contraception �Ask about the method currently used for contraception, duration of use and associated side effects. �Ask about past experiences with contraceptives (traditional or modern). 15

Family and Social history �Relevant details on spouse (age, occupation e. t. c), patient’s family and familial conditions such as Twinning, DM, HTN, SCD, Allergy, malignancy e. t. c). �Alcohol, smoking, use of hard drugs and living conditions that may be relevant to the current problem or its management. �Impact of the present problem on the patient’s life. 16

Systemic review �Review all relevant systems �Indicate important positive and negative �Summarize the history �Only salient information �About 2 sentences. 17

GENERAL EXAMINATION �General state of health �Height, weight, BMI �Palor, icterus, dehydration, Thyroid, oedema �Lymphadenopathy (were relevant) �Breast examination �Blood Pressure Check 18

ABDOMINAL EXAMINATION � THE GYNAECOLOGICAL PATIENT �INSPECTION � PIGMENTATION, HERNIA OR SCARS �LIGHT PALPATION-for tenderness �DEEP PALPATION WITH DEEP BREATHS-for Organomegaly � ORGANS, MASSES � RELATE ABDOMINO - PELVIC MASSES TO A GRAVID UTERUS use TAPE MEASUREMENT! �PERCUSSION ( not usually indicated in Normal Obstetric examination) � It is indicated in ASCITES, HAEMOPERITONEUM �AUSCULTATION-use of stethoscope, pinard fetal stethoscope, Sonicaid/Hand held doppler. 19

OBSTETRIC EXAMINATION �Obstetric general examination �Obstetric Examination Proper �A special examination only for obstetric case. �However, to appreciate the purpose of doing it, an understanding of certain commonly used terminology is essential. �It includes symphysio-fundal height, lie, presentation, position, descent, engagement, liquor volume/ fetal weight estimation and FHR. 20

OBSTETRIC EXAMINATION. . Symphysio - Fundal Height : � The distance of the uppermost part of the fundus of the uterus to the upper border of the symphysis pubis. � It gives an idea of how far advanced the pregnancy is and is usually measured in centimeters or in terms finger breadths above the symphysis pubis. Lie: � Refers to the relationship of the longitudinal axis of the fetal spine to the longitudinal axis of the uterus. � It can either be longitudinal, oblique or transverse. Presentation: � Refers to the pole of the fetus that presents at the pelvic brim. � It is usually cephalic. � It may also be a breech or shoulder presentation. 21

OBSTETRIC EXAMINATION… Attitude: � The relationship of the fetal limbs to the fetal trunk – flexed or extended. Position: � The relationship of an arbitrary reference point of presention of the fetus to a fixed point on the maternal pelvis. � For convenience, an arbitrary reference point of the fetus is related to a specific point on the maternal pelvis. � In a cephalic presentation the reference point is the occiput, Breech(buttocks)-Sacrum, Shoulder- Acromium Descent: � The proportion of the fetal head palpable above the pelvic brim. � It is based on an imaginary division of the head into 5 “fifths” 22

OBSTETRIC EXAMINATION…. Engagement: � The presenting part is said to be engaged when its widest part has passed through the pelvic brim. � In a cephalic presentation, the widest part is the bi-parietal diameter while in a breech presentation; it is the bitrochanteric diameter. � NOTE- SHOULDER PRESENTATION doesn’t ENGAGE Liquor volume: � Liquor volume assessment is the clinical assessment of the amount of the liquor present in the amniotic sac. � It can be excessive (polyhydramnios), normal, or decreased (oligohydramnios). � Polyhydramnios can be confirmed clinically by eliciting the presence of a fluid thrill. 23

OBSTETRIC EXAMINATION…. Auscultation: � The Fetal stethoscope or sonicaid is placed over the anterior shoulder of the fetus. 24

ABDOMINAL EXAMINATION *LEOPOLD MANOUVRE �SFH OR FSH OR FH � 20 – 36 weeks ± 2 cm � 36 – 40 weeks ± 3 cm �Above 40 weeks ± 4 cm �Upper (Fundal) pole �Lower (pelvic) pole �Descent/ engagement �FHR/ Fetal movement. 25

OTHER SYSTEMS � NOTE ONLY IMPORTANT positive or negative comment for each system relevant to the patient’s main complaint: � CARDIOVASCULAR (Pulse rate and B/P may be included in general examination) �RESPIRATORY �GENITOURINARY �ENDOCRINE �MUSCULOSKELETAL �NEUROLOGICAL 26

Quick test �Mrs E is a 32 yr old woman with presenting complaint of inability to conceive*5 yrs. Obtain a detailed history to determine the cause and proffer a solution. �Mrs M is a 23 yr old woman who presented at the Gynae emergency with bleeding PV*4 hrs following the delivery of a set of twins obtain a brief history. 27

THANK YOU! 28