Obstetrics and Gynecology - A.M. Gromova 2000

Diagnosis of pregnancy and prenatal care
Methods of examining a pregnant woman
Taking the patient's medical history

The examination of pregnant women begins with taking a comprehensive medical history. Obstetrical history has specific features that distinguish it from anamnestic data in other clinical disciplines. It should cover all issues that may, even indirectly, relate to the Pregnancy and expected childbirth. To obtain a thorough history, the interviewer must follow a systematic approach and be able to analyze every piece of information gathered.

The medical history should include the following aspects:

Biographical and demographic data: full name, age, occupation and place of work, and place of residence. Among these details, the woman's age is of great significance, particularly for primigravidae (first-time pregnant women). The age range between 18 and 25 is considered the most favorable for a first birth; women who give birth for the first time at an earlier age or over 30 experience various complications significantly more often. Attention must be paid to occupations associated with occupational hazards (radiation, vibration, chemical hazards, etc.).

Complaints: pregnant women may present with various complaints which, on the one hand, can be subjective Signs of Pregnancy (changes in taste, smell, nausea), and on the other hand, may indicate the onset of serious complications (spotting, abdominal pain). Complaints are also frequently associated with various somatic disorders in the expectant mother.

Family history: it is necessary to determine whether the families of both the pregnant woman and her partner have a history of conditions such as psychiatric disorders, Sexually Transmitted Infections, tuberculosis, neoplasms, cardiovascular diseases, or endocrine Metabolic Disorders, as well as whether multiple pregnancies have been observed among relatives.

Personal medical history: It is important to clarify the Specifics of the pregnant woman's development during childhood and Puberty, and to identify past illnesses and their complications. Special attention should be paid to acute and chronic infectious diseases (childhood infections, tuberculosis), which often cause delays in physical and sexual development, laying the groundwork for infantilism. Rickets suffered in childhood can lead to pelvic bone deformation, posing a risk of complicated labor. Past infectious and general somatic diseases acquired in adulthood that may affect the course of pregnancy, labor, and the postpartum period must also be clarified. It is likewise necessary to inquire about living and working conditions, the presence of harmful habits (alcoholism, smoking), and any history of allergies.

Obstetric and gynecological history:

Menstrual function

It is necessary to find out in detail the age at which menstruation began, whether it became regular immediately or not, its duration, painfulness, rhythm, and The amount of Blood loss (scant, moderate, heavy), as well as whether The Nature of the Menstrual cycle changed after marriage, childbirth, abortions, or gynecological diseases; and the date of the last menstrual period.

The age of menarche for girls is currently considered to be 12–14 years. The onset of the first menstruation after age 15, an extended period (more than 1–1.5 years) for menstrual function to become established, and painful periods are characteristic of genital hypoplasia and ovarian hypofunction. Disruptions in menstrual function occurring after the onset of sexual activity, childbirth, or abortions are most commonly associated with inflammatory processes in the FEMALE REPRODUCTIVE Organs.

Sexual function

It should be ascertained at what age the woman became sexually active, the duration of her marriage, whether this is her first marriage and if it is officially registered, the husband's age and health, Methods of Contraception used, and the probable date of conception.

Reproductive function

Data concerning the course and outcome of previous pregnancies are of great practical importance. The dates, course, and outcome of every pregnancy, delivery, and abortion must be ascertained with utmost diligence (complications, prior surgeries, and obstetric interventions, the newborn's birth weight and subsequent development), along with the postpartum and post-abortive periods, and the character of Lactation. The date of the first fetal movement should also be noted.

The evaluation of these data is vital for predicting the course of the current pregnancy and frequently provides an opportunity to prevent potential complications during both Pregnancy and Childbirth.

Secretory function

The presence of leukorrhea (vaginal discharge), its characteristics, underlying causes, and any treatments administered are investigated. Pathological discharge from the genital tract indicates inflammatory conditions of the reproductive organs, cervical pathology, etc.

Gynecological diseases

It is important to determine what conditions the woman suffered from, when, and for how long, what treatments were administered, the outcome of the illness, and any history of gynecological surgeries. These data are also utilized to predict potential complications and plan preventive measures.

Course of the current pregnancy

Special attention must be paid to the course of pregnancy During the first, second, and third trimesters. It is necessary to establish the date of the woman's first prenatal visit and her gestational age at that time, baseline blood pressure, Hemoglobin levels, weight, and urinalysis results. The regularity of antenatal clinic visits, the dynamics of blood pressure, weight, and blood and urine test results should be recorded, and any illnesses contracted during the current pregnancy as well as complications (threatened Miscarriage, anemia, etc.) must be identified. In the third trimester, particular focus should be placed on detecting symptoms of late-onset Preeclampsia (edema, Hypertension, albuminuria); the total weight gain throughout the pregnancy should be noted, and therapeutic and preventive measures carried out at the antenatal clinic (physioprophylactic preparation for childbirth, breast preparation, attendance at maternity school, etc.) must be documented, along with the date of maternity leave issuance and the estimated date of delivery as determined by the antenatal clinic.