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Practical issues, History taking & Clinical examination in O&G . Hervinder Kaur Consultant Obstetrician & Gynaecologist, UHCW Obstetric & Gynaecology Lead for Warwick Medical School. LEARNING OBJECTIVES.

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practical issues history taking clinical examination in o g

Practical issues, History taking & Clinical examination in O&G

Hervinder Kaur

Consultant Obstetrician & Gynaecologist, UHCW

Obstetric & Gynaecology Lead for Warwick Medical School

learning objectives
  • To develop the basic clinical skills of history taking, clinical examination and case presentation in O & G.
  • To obtain knowledge of the common clinical problems in O & G.


  • Booking visit :
  • History taking
  • Investigations ( booking bloods & scan)
  • Down’s syndrome screening
  • Health promotion advice- smoking, alcohol, drug abuse & diet
  • Management plan
  • High/Low risk pregnancy?
learning objectives cont
  • Examination of pregnant women
  • Pre eclampsia, IUGR, Large for dates , polyhydramnios, breech/ transverse lie, twins , previous caesarean, grand multiparous , Obesity & placenta previa
  • Medical disorder- Diabetes , thyroid problems, essential HTN, Cardiac, renal, drug misuse, Hepatitis/HIV.
  • Pre-operative counselling for C-section
  • Emergency Obstetric Admissions
  • Abdominal pain
  • Preterm labour/ SROM
  • Ante/postpartum bleeding
  • Pre eclampsia/ Eclampsia

Obstetric Day Assessment Unit

  • Antenatal fetal assessment- CTG, USS (growth/liquor/doppler)
  • Maternal assessment-BP/urine, blood test (PET, GTT)

Labour Ward

  • Induction of labour
  • Management/Complications of labour
  • Normal deliveries
  • Fetal Monitoring in labour
  • Pain relief in labour
  • Instrumental deliveries & Caesarean section- elective/emergency
  • Twins
  • Preterm labour
  • HDU care- PPH, Severe pre eclampsia/eclampsia


  • Early pregnancy scan
  • Miscarriage
  • Ectopic pregnancy
  • Molar pregnancy


  • History taking
  • Gynaecological examination-abdomen, pelvis (speculum, digital bimanual)
  • Investigation & management of menstural abnormalities
  • Investigation & management of pelvic pain/endometriosis

Diagnosis & management of menopause

  • Urogynae clinic-Management of prolapse

& incontinence

  • Infertility clinic- Management of male & female infertility
  • Oncology –Management/follow-up of gynae cancer

& management of abnormal smear (colposcopy clinic)

GUM clinic

  • Obtain sexual lifestyle history
  • Understand relevance of confidentiality and

being non-judgmental.

  • Genital examination and swabs from couple
  • STD- diagnosis & treatment
  • Pre/post test counselling for HIV


  • Home visits - Postnatal examination

(caesarean scar, perineal tears)

  • Pre eclapmsia surveillance
  • Community midwife ANC
portfolio cases
  • Obstetrics:

1. A normal pregnancy delivery and puerperium

2. Antepartum/postpartum haemorrhage

3. An abnormality of fetal growth and development

4. Pre-eclampsia

5. Medical disease complicating pregnancy

6. Multiple pregnancy

7. Abnormal labour

8. A third stage abnormality



1. Menstural disorder

2. Endometriosis

3. Prolapse

4. Incontinence

5. Infertility

6. Postmenopausal bleeding

7. Early pregnancy complication

obstetric history
Obstetric History
  • Age
  • Gravidity
  • Parity- (Preg>24 wks)+(Preg< 24wks)
  • LMP; menstural cycle; conceived on pill; EDD
  • History of this pregnacy :
  • Presenting complaints- when did they occur & how long they lasted, any investigation or treatment already ?
  • Low/high risk pregnancy?
  • Any problems in antenatal care so far ?
  • Fetal movements
obstetric history11
Obstetric History
  • Previous pregnancy:

- Previous miscarriages

- Gestation & mode of delivery

- Length of labour & complications

- Third stage complications

- Postnatal problems

  • Medical & surgical history
  • Drug history & allergies
  • Family history- hereditary disorders, HTN,DM, twins or congenital malformation
  • Social history- smoking, alcohol, drug misuse, occupation, housing & marital status
  • Consent, explanation & beware of supine hypotension
  • General examination


-Hand, eyes & mouth

-Presence of oedema

-BP & Urine

-CVS & Respiratory system examination

abdominal examination
Abdominal Examination

Inspection: abdominal scars

striae gravidarum

linea nigra


abdominal palpation
Abdominal palpation

alpation of pregnant abdomen:


  • Examination of uterine fundus

Symphysio- fundal height(cm)

  • Fetal back
  • Presenting part e.g vertex, breech

4. Engagement of presenting part

Four maneuvers

of leopold


Lie of Fetus

Lie: relationship of long.

axis of fetus to long.axis

of uterus e.g longitudinal,

transverse, oblique

Longitudinal lie

Transverse lie


Presentation of fetus


presenting part of fetus

occupying the lower pole

of uterus i.e ceph(vertex),

breech,face,brow or


female bony pelvis
Female bony pelvis





Pelvic diameters:




abdominal examination18
Abdominal Examination

Left Occipito- anterior

Left Occipito- posterior

Position: Relation of denominator (occiput/ sacrum) of presenting part to the quadrants of pelvis e.g


abdominal examination19
Abdominal Examination


Amniotic fluid

  • Auscultation: FETAL HEART

Engagement: Widest diameter of head below the pelvic brim.

No. of 5th head palpable above the pelvic brim e.g 4/5th , 3/5th





Presenting diameters:

g) Face presentation


h) Deflexed OP


i) Brow presentation


j) Normal vertex

Sub-occipito bregmatic

  • Parts of fetal skull:
  • Occipital bone
  • Posterior fontanella
  • Saggital suture
  • Frontal bone
  • Anterior fontanelle
  • Parietal bone
vaginal examination
Vaginal Examination
  • Vulva & vagina
  • Cervix-dilatation ,effacement, position & consistency
  • Presenting part i.e Vertex
  • Station-cm in relation to the ischial spine
  • Caput-swelling on the scalp superficial to periosteum of cranium ,as a result of venous congestion, on the part of head most in advance
  • Moulding- Overriding of the bones of skull
  • Membranes & Liquor
vaginal examination23
Vaginal Examination


Station -3

Station +3

Station- position of presenting part (PP) in cm in relation to the ischial spine

mechanism of labour
Mechanism of labour

LOA position:

Free head

Descent & engagement

Descent & Flexion

Internal rotation


External rotation


Delivery of shoulder

useful website for medical illustration
Useful website for medical illustration
  • Nucleus Medical Media

Normal vaginal delivery anim002

Normal vaginal birth ANC00030

Delivery ANC00037

Birth station of presentation ANC00038

Change in cervix during pregnancy S15551477

gynaecological history
Gynaecological History
  • Age, Gravidity, Parity, LMP
  • Contraception
  • Last cervical smear
  • Presenting complaints: Nature & duration

Relation to menstrual cycle

Bowel symptoms

Urinary symptoms

Vaginal discharge

Vaginal bleeding

gynaecological history27
Gynaecological History
  • Previous Gynaecological & Obstetric History:



Previous miscarriages / preg<24 wks

Ectopic pregnancy

Pregnancies>24 wks & outcome

history cont
History cont….
  • Medical
  • Surgical
  • Family history- Fibroids, endometriosis, cancers, DVT/PE
  • Medications
  • Allergies
  • Social History
  • General- Conjunctiva, pulse
  • Abdomen:
  • Inspection- distension of abdomen


previous scar

  • Palpation- tenderness

mass( size, consistency)


lymph nodes

  • Percussion
  • Auscultation
vaginal examination30
Vaginal Examination
  • Vulva
  • Speculum (Cusco’s & Sim’s)

- vagina (atrophy, mass, trauma, prolapse)

- cervix (ectropion, polyp, growth, contact bleeding,

- uterine prolapse

  • Bimanual pelvic exam. – uterine/ adenexal masses tenderness
competencies mandatory
Competencies (Mandatory)
  • Examination of pregnant abdomen
  • Examination of non-pregnant abdomen
  • Speculum(Cusco’s speculum) examination