The document provides guidance on taking medical histories for various gynecological issues. It discusses taking histories for menorrhagia, postmenopausal bleeding, sterilization counseling, recurrent miscarriages, vaginal discharge, and infertility. Key details to obtain include menstrual dates and characteristics, contraceptive use, previous procedures, family histories, symptoms, and related medical conditions. The goal is to gather relevant information on a patient's condition and identify potential underlying causes or risk factors.
The document provides guidance on taking medical histories for various gynecological issues. It discusses taking histories for menorrhagia, postmenopausal bleeding, sterilization counseling, recurrent miscarriages, vaginal discharge, and infertility. Key details to obtain include menstrual dates and characteristics, contraceptive use, previous procedures, family histories, symptoms, and related medical conditions. The goal is to gather relevant information on a patient's condition and identify potential underlying causes or risk factors.
The document provides guidance on taking medical histories for various gynecological issues. It discusses taking histories for menorrhagia, postmenopausal bleeding, sterilization counseling, recurrent miscarriages, vaginal discharge, and infertility. Key details to obtain include menstrual dates and characteristics, contraceptive use, previous procedures, family histories, symptoms, and related medical conditions. The goal is to gather relevant information on a patient's condition and identify potential underlying causes or risk factors.
The document provides guidance on taking medical histories for various gynecological issues. It discusses taking histories for menorrhagia, postmenopausal bleeding, sterilization counseling, recurrent miscarriages, vaginal discharge, and infertility. Key details to obtain include menstrual dates and characteristics, contraceptive use, previous procedures, family histories, symptoms, and related medical conditions. The goal is to gather relevant information on a patient's condition and identify potential underlying causes or risk factors.
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MENORRHAGIA-------HISTORY TAKING
o o o o o o o o o o o o o
Last menstrual period (LMP) - date of first day of bleeding.
Cycle length and frequency, e.g. 5/28, 5 days of bleeding every 28 days. How heavy is the bleeding? Number of tampons per day/clots/flooding/double protection. Any intermenstrual bleeding (IMB). Any postcoital bleeding (PCB). Age of menarche/menopause. Any postmenopausal bleeding (PMB). Any pain during/after periods Any abnormal vaginal discharge Any weight gain/loss,lethargic/cold intolerance Any scan done before Contraception Easy bruisibility
POST MENOPAUSAL BLEEDING
-----HISTORY TAKI
Any exogenous oestrogens taken.
Use of Tamoxifen . History of PCO Ovulation induction drugs Family history of Hereditary non-polyposis colorectal carcinoma. Obesity diabetis Use of combined oral contraceptives decreases risk Any trauma Any bleeding disorder Vaginal atrophy symptoms Duration of bleeding Amount of bleeding Duration of menopause
STERILIZATION----COUNSELING
Age Married for Parity LMP Stability of the relationship Discussion about reversible methods of contraception Female sterilization Procedure
Stress on word irreversible
Done under G/A (complications of G/A) Procedure related complications( bleeding,infection,damage to gut,ligation of round Ligament) Failure rate (1 in 200) Risk of luteal phase pregnany Risk of etopic pregnancy Male sterilization outdoor procedure done under L/A no complications usually failure rate 1in 2000
male sterilization preferred over female sterilization
HISTORY TAKING IN RECURRENT MISCARRIAGES
Maternal and paternal age
Ethnicity
Occupation
Consanguinity
Type of miscarriage
The gestational age at which the miscarriage occurred
How the diagnosis of miscarriage was made
Findings on ultrasound scan, if it was used
Details regarding how the miscarriage was managed
Results of any fetal karyotype performed.
IF ANY ALIVE BABIES THEN
Gestational age at birth
Complications during pregnancy and delivery
Mode of delivery
Weight of the baby
Current condition of the baby.
Gynaecology history should include:
Complete menstrual history, including last menstrual period, cycle
length, regularity of cycle, and symptoms of intermenstrual bleeding Cervical smear history and any previous treatment for abnormal smears, such as large loop excision of the transformation zone (LLETZ) or cone biopsy
Contraceptive history, such as the method, duration of use, and
adverse effects (if relevant)
History of previous pelvic inflammatory disease
History of any infertility treatment (e.g., ovulation induction or assisted
conception
The medical history should particularly include:
Inquiry about the presence of autoimmune disease, arthritis, diabetes,
thyroid dysfunction, vascular thrombosis, and skin disorders A family history regarding the medical conditions mentioned above A family history of congenital abnormalities, recurrent miscarriage, or pregnancy complications
The surgical history should focus on:
Previous abdominal surgery
Cervical surgery (e.g., knife cone biopsy) or uterine surgery (e.g., hysteroscopic septal resection or myomectomy)
The number of surgical uterine evacuations performed as the
management option for previous miscarriage.
Last of all inform the patient that still 70 perent chance of having a baby VAGINAL DISCHARGE ---HISTORY TAKING
Age of the patient
When do it occursaround menstruation or around day 14
Consider physiological
Consistency --thick,curdy-----candidiasis (ask about OCPs/diabetis)
Thin watery-----bacterial vaginosis
Odourfishy smell----bacterial vaginosis
o Foul smelling discharge--PID
Colour white candidiasis
o Transparent---bacterial vaginosis o Green -----trichomoniasis
Ask about IUCD------ actinomycosis
Any lower abdominal pain,backache fever,-----PID
Any related menstrual problem
HISTORY TAKING IN INFERTILITY
FEMALE Age Duration of marriage Marital history Ist marriage of both partners Cousin marriage Type of infertility Duration of infertility Any history of contraception Any history of weight gain/weight loss Element of PCO Element of hyperprolactinemia Any thyroid problem Autoimmune disorders Cervical factors(d&c,amputation of cervix,cauterization) Uterine factor( any surgeries,IUCD) Tubal factor(ectopic pregnancy,pelvic T.B,BTL) Any history of radiation/chemotherapy
MALE Age any autoimmune disease Ist marriage diabetis
Occupation Habbits Any previous surgeries Any chemo/radiotherapy
