OG8.2-3 | Obstetric History and Examination — Summary & Reflection

KEY TAKEAWAYS

The obstetric history has three uniquely structured domains: (1) menstrual and reproductive history (LMP, EDD via Naegele's rule, cycle regularity); (2) obstetric history using GPA notation (Gravida = all pregnancies; Para = deliveries ≥20 weeks; Abortion = losses <20 weeks; Living = living children); and (3) medical, surgical, drug and social history targeting known risk factors. The abdominal examination begins with general examination (pallor, oedema, BP, weight) followed by: inspection (scars, shape, fetal movements), SFH measurement in a straight line from symphysis to fundus (Bartholomew's rule: 1 cm ≈ 1 week, 20–36 weeks), Leopold's four grips (fundal → lie; lateral → back; pelvic → presentation/engagement; Pawlik's → degree of engagement), abdominal girth at umbilicus, and fetal heart auscultation (normal 110–160 bpm). SFH discordance ≥3 cm warrants ultrasound. After 36 weeks, transverse or oblique lie is a complication. Engagement in primigravidae at 36–38 weeks is expected; in multigravidae, it occurs in labour. All findings must be documented in the MCP card with risk stratification and counselling notes.

REFLECT

Return to Kavitha's case from the opening hook. She had an incomplete obstetric history and uncertain dates. Having worked through this module, map out the complete history you would now need to elicit: (1) How would you clarify her LMP when she is uncertain — what questions would help triangulate the date? (2) Her notation G2P1L1 — what additional questions about her first delivery are mandatory for safe management of this pregnancy? (3) Her 'kidney problem' medication — which drug class must you specifically ask about, and why? (4) What examination sequence would you perform at 28 weeks to establish gestational age concordance, fetal lie and presentation, and engagement status? Write out your structured clinical approach before your next bedside session.