IB CSL O&G
COMMUNICATION SKILLS
Dr D Cheng
O&G
Tues 17-09-02
VIDEO: OBS Hx
Greeting
Past Obs Hx
Where was last delivery (which hosp)
Full-term?
Delivery method (eg. Suction)
Menstrual Hx
Obs Hx
Past Health
Fam Hx
Social Hx
Marital Status
Occupation & Financial Status
- Note: important for young female - if not enough $ may (1) Prostitution (2) Sell drugs
Home environment
Contraception
Sexual Hx
Smoking / Drinking
Drug Abuse Hx
P/E
- General, Nutrition
- Heart/ Chest: hyperdynamic circulation in pregnancy, refer to cardiologist if suspect valvular lesion
- Breast, Thyroid, Abdomen/ pelvis (screen cervical cancer)
- BP, Urinalysis
ISSUES
Living environment + who looks after 1st baby now mother in hospital pregnant with 2nd baby?
VIDEO: GYNAE HX
Similar to surgery Hx
- Reason for seeking
- How problem arose
- Symptomatology
- Past Hx
- Social Hx
- Fam Hx
- Menstrual, Obs, Contraceptive Hx
This Pt: Primary subfertility
Referral Letter
- Married 3y
- Works in law firm
- Good health, no meds
- Appendectomy at age 12y
- Menarche age 15y
- Irregular cycle 4-6w
- Hysterectosalphinography: has vasovagal attach
Have referral letter
\ no need to take Hx from scratch
Go through Hx systematically and fill in gaps
Contraceptive Hx, compliance
Menstrual Hx
Pain: unopposed oestrogen causing XS proliferation
Note: Subfertility
® corpus luteum ® progesterone
If no ovulation ® no CL ® ¯ progesterone ® no breast tenderness (as in this Pt)
Pt has symptoms intermittently \ indicates irregular ovulation or anovulation
Unopposed oestrogen ® thickness of endometrium ® heavy/ prolonged menstruation (metropathia haemorrhagia)
Must exclude pregnancy before further Ix
Paraphrase Hx
Systemic review
Sexual Hx
Surgical complications (long time in hosp?)
Husbands Health
- Dx: tuboperitoneal adhesions +/- anovulation
MUST
do ask about male partner in woman with subfertility (eg. Chemo, radiation, drugs ® azoospermia)
DISCUSSION WITH DR
Older pregnancy
: chance chromosomal disorder, maternal risk
- If older woman concerned about DS, reassure you can do Ix to see if baby affected
- Termination costs $6,000 in HK (Pt pays $200)
- Serial monogamists: only sleep with one person at a time; previous sexual partners
- Number of sexual partners: must ask with STD Pt (contact tracing); not necessary with termination Pt
TPN: Total Parenteral Nutrition
- Termination: may perforate uterus, suction bowel (perforated bowel) - need TPN while waiting for wound to heal
- If complication during termination operation, few women sue (feel guilty for having termination?)
Placenta previa
- One located in the lower uterine segment, so that it partially or completely covers or adjoins the internal os
- Ask Pt if she knows why they have been admitted (eg. Not just say 'Low-lying placenta"; does Pt actually understand implications?
® if Pt understands her condition ® compliance with Tx
Normal placenta usually located on fundus
When uterine contractions occur and cervix dilates ® placenta comes out first (baby asphyxiates because no more GE) (mother has torrential bleeding ® death)
Can do C-section once contractions start
Once Dx of placenta previa made ® advise Pt to avoid coitus as precaution
Interviewing Pt
- Sit at right angles
- If face-to-face: to confrontational and Pt cannot avoid eye contact (note: some cultures, eg. Muslim, woman will not look Dr in the eye, probably will not consult with male doctor for O&G)
- If side-to-side: both parties hurt next to look at other person
Isoimmunisation: mother to baby (or vice versa)
® Rh, Lewis, ABO, etc
Braxton Hicks contractions: light, usually painless, irregular uterine contractions during pregnancy, gradually increasing in intensity and frequency and becoming more rhythmic during third trimester
Post-coital bleeding in pregnancy
® cervical epithelium everted
Do not use medial jargon with Pt's
Twins
- High-risk pregnancy
- Clinical monitoring not enough (foetus may have stopped growing)
\ need US
1/3 of MBBS examination questions
® terminations