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Gynae History Taking PowerPoint PPT Presentation

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Max Brinsmead PhD FRANZCOG February 2010. Gynae History Taking. A Diagnosis is Made by:. Listening to the patient tell her story Generating a hypothesis Testing the hypothesis By interrogation 50 % By examination 10% By selective testing 40% If at first you don’t succeed...

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Gynae History Taking

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Max brinsmead phd franzcog february 2010 l.jpg

Max Brinsmead PhD FRANZCOG

February 2010

Gynae History Taking

A diagnosis is made by l.jpg

A Diagnosis is Made by:

  • Listening to the patient tell her story

  • Generating a hypothesis

  • Testing the hypothesis

    • By interrogation

    • 50 %

    • By examination

    • 10%

    • By selective testing

    • 40%

  • If at first you don’t succeed...

  • Go back and listen to the patient

  • Major hypotheses in gynaecology 1 l.jpg

    Major Hypotheses in Gynaecology 1

    • Reproductive tract dysfunction

      • Dysmenorrhoea

      • Dysfunctional uterine bleeding

      • Functional ovarian cysts

      • Endometriosis

    • Pregnancy

      • Miscarriage

      • Ectopic

      • Pregnancy-related disease

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    Major Hypotheses in Gynaecology 2

    • Reproductive Tract Infections

      • Vaginitis

      • Pelvic inflammatory disease

    • Reproductive Tract Cancer

      • Cervix

      • Uterus - endometrium

      • Ovaries

    • Benign tumours

      • Fibroids

      • Polyps of cervix and endometrium

      • Ovarian

    • UterovaginalProlapse

      • Urinary dysfunction

      • Anorectal dysfunction

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    Major Hypotheses in Gynaecology 3

    • Psychosexual

      • Pelvic Pain

      • Dyspareunia/ Vaginismus

      • Sexual Assault

      • Libido

      • Homosexuality (not usually a problem for the gynaecologist)

    • Iatrogenic

      • Arising from contraception/HRT

      • Arising from other drugs

    • Other Diseases

      • With pelvic manifestations

      • Infertility

      • Male

    Components of a gynae history l.jpg

    Components of a Gynae History

    • Menstrual history

    • Contraceptive history

    • Sexual history

    • Past gynaecological and other medical history

    • Drug history

    • Bladder and Bowel function

    Menstrual history l.jpg

    Menstrual History

    • Menarche

    • Cycle

      • Usually expressed as daysbleeding/cyclelength

    • Last menstrual period (LMP)

    • Intermenstrual bleeding (IMB)

    • Postcoital bleeding (PCB)

    • Postmenopausal bleeding (PMB)

    • Menstrual pain

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    Menstrual history tips

    • How often do your periods come

      • From the beginning of one period to the beginning of the next

    • What do you mean by regular

      • Do they “come early” or do they “come late”

      • How much early, how late

    • Do you get any bleeding between your periods

      • When does it occur in the cycle

      • Do you know of anything that brings this on

    • Does your period start as a full flow

      • How many days of “mucking about”

    • When was your last normal period

      • First day of the last period

      • Not the date of the missed period

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    Assessing menstrual loss

    • For how long do you have a period

    • How many heavy days

      • How many light days

      • What do you call heavy

      • How many pads or tampons

      • How often do you change

    • Do you change at night

      • How often

      • How many nights

    • Do you pass clots

      • How big

      • How often

    • Do your periods interfere with your life

    • Have you had any “accidents”

    Menorrhagia l.jpg


    Used loosely means excessive menstrual loss...

    What is excessive menstrual loss l.jpg

    What is excessive menstrual loss?

    • Escapes from normal menstrual protection

    • Large clots – frequently

    • Changing at night more than once

    • Lasts longer than 7 days “full flow”

    • Interferes with normal life or duties

    • Causes iron deficiency (anaemia)

      • Other causes excluded

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    Patterns of abnormal menstrual loss

    • Menorrhagia

      • Excessive menstrual loss at regular intervals

    • Metrorrhagia

      • Frequent and irregular menstrual loss

    • Polymenorrhoea

      • Regular cycles at <21 days

    • Oligomenorrhoea

      • Infrequent menstruation (>35 days)

    • Intermenstrual Bleeding

      • Bleeding between menstrual periods

      • Requires careful questioning

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    Assessing pelvic pain

    • Do you get pain with your periods

    • Is this the same as its always been

      • If changing with time how and when

    • Which is the worse day for pain

    • What do you do for the pain

      • Analgesia used. How many tablets Does it help

      • Does the pain interfere with your life. Your sleep

    • Describe the pain

      • Nature and location. Aggravating factors

    • Pain with intercourse

      • Frequency

      • Nature and location

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    Obtaining a sexual history

    • Choose your words carefully, sometimes with preamble

    • How long have you been in your current relationship

      • Is sexual intercourse occurring

      • Have you ever been in a relationship

      • When was the last relationship

    • How many partners have you had in (period of time)

      • or before your current relationship

    • What does you or your partner do to avoid pregnancy

    • Does your partner travel

      • or spend nights away from home

      • or have other sexual partners

    Past gynaecological history l.jpg

    Past gynaecological history

    • Any other serious illnesses. Any operations

    • Any gynaecological operations

      • on your tubes, ovaries or uterus

      • Any vaginal surgery

      • Any curettes or keyhole surgery

      • Any treatment to the cervix for pre cancer changes

    • What was done in those operations

      • What were you told after

    • Do you have regular Pap tests

      • When was the last or where was it done

      • What was the result

      • Has there ever been any abnormality

      • How many have you had in (period of time)

    • Have you ever been treated for inflammation of the pelvis, tubes or for a sexually transmitted disease?

    • Did you have any trouble getting pregnant?

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    Past obstetric history

    • Any infertility treatment(s)

    • Number of pregnancies (G) and births (P)

      • Gravida = number of pregnancies

      • Para = births after 20w (and twins =1)

      • T= termination of pregnancy

      • A= miscarriage E=ectopic

    • Birthweights and mode of delivery

      • Spontaneous or assisted vaginal birth

      • Birth trauma

    • Pregnancy complications

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    Drug history

    • Are you on any drugs or medications

    • Any hormones

      • The pill, injections or implants

      • Patches or hormone creams

      • Vaginal pessaries or creams

      • Details of the drug, dose and dates can be very important

    • Any vitamins, minerals , supplements or herbal remedies?

    • Do you smoke?

    Bladder and bowel functions l.jpg

    Bladder and bowel functions

    • Do you get up at night to pass urine

    • Do you have to get there in a hurry

      • Ever wet before you get there

      • How long can you hold on during the day

    • Do you ever wet

      • If you cough or sneeze

      • A little or a lot

    • Do you have any difficulty emptying your bladder

      • or getting started

      • Do you have good stream

    • Any bladder infections

    • Any difficulty getting your bowels emptied

      • What happens when you strain

    • Can you control your wind

      • How about a loose bowel motion?

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    Infertility Questions

    • The most important calculation is the number of months that the woman has been exposed to the possibility of pregnancy but has not conceived

      • This may not be the same as the couple’s view of how long they have been “trying”

    • Take a careful “contraceptive history”

    • Other useful questions

      • Have you ever been pregnant

      • Have you ever fathered a pregnancy (in any other relationship or tried)

      • How often is intercourse occurring

      • Any (intercourse) problems?

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