Obstetric Gynaecology History Clinical Examination：產(chǎn)科與婦科病史和臨床檢查課件

Obstetric&Gynaecology History

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ClinicalExamination DR.MojibinaObstetric&Gynaecology ObstetricHistoryAgeGravidityParity-(Preg>24wks)+(Preg<24wks)LMP;mensturalcycle;conceivedonpill;EDDHistoryofthispregnacy:Presentingcomplaints-whendidtheyoccur&howlongtheylasted,anyinvestigationortreatmentalready?Low/highriskpregnancy?Anyproblemsinantenatalcaresofar?FetalmovementsObstetricHistoryAgeObstetricHistoryPreviouspregnancy:-Previousmiscarriages-Gestation&modeofdelivery-Lengthoflabour&complications-Thirdstagecomplications -PostnatalproblemsMedical&surgicalhistoryDrughistory&allergiesFamilyhistory-hereditarydisorders,HTN,DM,twinsorcongenitalmalformationSocialhistory-smoking,alcohol,drugmisuse,occupation,housing&maritalstatusObstetricHistoryPreviouspregExaminationConsent,explanation&bewareofsupinehypotensionGeneralexamination-Colour-Hand,eyes&mouth-Presenceofoedema-BP&Urine-CVS&RespiratorysystemexaminationExaminationConsent,explanatiAbdominalExaminationInspection:abdominalscars,striaegravidarum,lineanigra&oedemaPalpation:

-Symphysio-fundalheightincm-Lie:relationshipoflong.axisoffetustolong.axisofuterusi.e longitudinal,transverse,oblique-Presentation:presentingpartoffetusoccupyingthelowerpoleofuterus i.eceph(vertex),breech-Position:Relationofdenominator(occiput/sacrum)ofpresentingpartto thequadrantsofpelvisi.eROA,LSP-Engagement:Widestdiameterofheadbelowthepelvicbrim.No.of5th headpalpableabovethepelvicbrim-AmnioticfluidAuscultation:FETALHEARTAbdominalExaminationInspectioLieofFetusLongitudinallieTransverselieLieofFetusLongitudinalliPresentationoffetusPresentationoffetusVaginalExaminationVulvaVaginaCervix-dilatation,effacement,position&consistencyPresentingparti.eVertexStation-cminrelationtotheischialspineCaput-swellingonthescalpsuperficialtoperiosteumofcranium,asaresultofvenouscongestion,onthepartofheadmostinadvanceMoulding-OverridingofthebonesofskullMembranes&LiquorVaginalExaminationVulvaGynaecologicalHistoryAge,Gravidity,ParityLMPContraception,LastcervicalsmearPresentingcomplaints:Nature&durationRelationtomenstrualcycle Bowelsymptoms Urinarysymptoms Vaginaldischarge VaginalbleedingPreviousGynaecological&ObstetricHistory: PID/STI Endometriosis Previousmiscarriages/preg<24wks Ectopicpregnancy Pregnancies>24wks&outcome

GynaecologicalHistoryAge,GraHistorycont….MedicalSurgicalFamilyhistory-Fibroids,endometriosis,cancers,DVT/PEMedicationsAllergiesSocialHistoryHistorycont….MedicalExaminationGeneral-Conjunctiva,pulseAbdomen:Inspection-distensionofabdomen,mass,previousscarPalpation-tenderness,mass(size,consistency),ascites,lymphnodesPercussionAuscultationVaginalExaminationVulvaSpeculum(Cusco’s&Sim’s)-vagina(atrophy,mass,trauma,prolapse)-cervix(ectropion,polyp,growth,contactbleeding,uterineprolapseBimanualpelvicexam.–uterine/adenexalmasses/tendernessExaminationGeneral-ConjunctivCompetenciesExaminationofpregnantabdomenExaminationofnon-pregnantabdomenSpeculum(Cusco’sspeculum)examinationCompetenciesExaminationofpr Demonstration DemonstrationObstetric&Gynaecology History

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ClinicalExamination DR.MojibinaObstetric&Gynaecology ObstetricHistoryAgeGravidityParity-(Preg>24wks)+(Preg<24wks)LMP;mensturalcycle;conceivedonpill;EDDHistoryofthispregnacy:Presentingcomplaints-whendidtheyoccur&howlongtheylasted,anyinvestigationortreatmentalready?Low/highriskpregnancy?Anyproblemsinantenatalcaresofar?FetalmovementsObstetricHistoryAgeObstetricHistoryPreviouspregnancy:-Previousmiscarriages-Gestation&modeofdelivery-Lengthoflabour&complications-Thirdstagecomplications -PostnatalproblemsMedical&surgicalhistoryDrughistory&allergiesFamilyhistory-hereditarydisorders,HTN,DM,twinsorcongenitalmalformationSocialhistory-smoking,alcohol,drugmisuse,occupation,housing&maritalstatusObstetricHistoryPreviouspregExaminationConsent,explanation&bewareofsupinehypotensionGeneralexamination-Colour-Hand,eyes&mouth-Presenceofoedema-BP&Urine-CVS&RespiratorysystemexaminationExaminationConsent,explanatiAbdominalExaminationInspection:abdominalscars,striaegravidarum,lineanigra&oedemaPalpation:

-Symphysio-fundalheightincm-Lie:relationshipoflong.axisoffetustolong.axisofuterusi.e longitudinal,transverse,oblique-Presentation:presentingpartoffetusoccupyingthelowerpoleofuterus i.eceph(vertex),breech-Position:Relationofdenominator(occiput/sacrum)ofpresentingpartto thequadrantsofpelvisi.eROA,LSP-Engagement:Widestdiameterofheadbelowthepelvicbrim.No.of5th headpalpableabovethepelvicbrim-AmnioticfluidAuscultation:FETALHEARTAbdominalExaminationInspectioLieofFetusLongitudinallieTransverselieLieofFetusLongitudinalliPresentationoffetusPresentationoffetusVaginalExaminationVulvaVaginaCervix-dilatation,effacement,position&consistencyPresentingparti.eVertexStation-cminrelationtotheischialspineCaput-swellingonthescalpsuperficialtoperiosteumofcranium,asaresultofvenouscongestion,onthepartofheadmostinadvanceMoulding-OverridingofthebonesofskullMembranes&LiquorVaginalExaminationVulvaGynaecologicalHistoryAge,Gravidity,ParityLMPContraception,LastcervicalsmearPresentingcomplaints:Nature&durationRelationtomenstrualcycle Bowelsymptoms Urinarysymptoms Vaginaldischarge VaginalbleedingPreviousGynaecological&ObstetricHistory: PID/STI Endometriosis Previousmiscarriages/preg<24wks Ectopicpregnancy Pregnancies>24wks&outcome

GynaecologicalHistoryAge,GraHistorycont….MedicalSurgicalFamilyhistory-