11/13/24, 8\:11 PM Guide | Obstetric history

Obstetric history

Table of contents

Introduction

An obstetric history involves asking questions relevant to a patient's current and previous pregnancies. Some of the
questions are highly personal, therefore, good communication skills and a respectful manner are absolutely essential.
Taking an obstetric history requires asking many questions that are not part of the 'standard' history taking format. Therefore, it’s
important to understand what information you are expected to gather.
It's also worth noting that before 18 weeks gestation, most obstetric conditions are unlikely, therefore, your history should be
gynaecology focussed (e.g. abdominal pain at 8 weeks gestation could be an ectopic pregnancy).

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain that you'd like to take a history from the patient.
Gain consent to proceed with history taking.

Key pregnancy details

It is useful to con
which questions are most relevant and what conditions are most likely.
Gestational age is calculated from the woman's
accurate estimated delivery date can be calculated.
Gestational age, gravidity and parity should also be included at the beginning of your presentation of a patient's history.
Gravidity (G) is the number of times a woman has been pregnant, regardless of the outcome (e.g. G2).
Parity (P) is the total number of times a woman has given birth to a child with a gestational age of 24 weeks or more, regardless
of whether the child was born alive or not (stillbirth).
Example of gravidity and parity calculation
A patient is currently 26 weeks pregnant and already has two children. She reports having had a miscarriage at 10 weeks
and a stillbirth at 28 weeks\:
G5\: The patient's gravidity is 5 because she has had 5 pregnancies in total
P3\: The patient's parity would be 3 because she has had 3 pregnancies, which resulted in the birth of a child with a
gestational age of greater than 24 weeks (one of which was a stillbirth)
How does parity work for twins?
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Whilst there is some debate regarding parity and twins, in clinical practice, a 2021 study in Wales showed 84% of
clinicians described a twin pregnancy as P2.
1
As a result, you should be aware that in clinical practice, a mother who has carried twins to a viable gestational age will
often be referred to as P2, but from an academic perspective, they would be deemed P1.
General communication skills
It is important not to forget the general communication skills relevant to all patient encounters. Demonstrating these
skills will ensure your consultation remains patient-centred and not checklist-like (just because you're running through a
checklist in your head doesn't mean this has to be obvious to the patient).
Some general communication skills which apply to all patient consultations include\:
Demonstrating empathy in response to patient cues\: both verbal and non-verbal
Active listening\: through body language and your verbal responses to what the patient has said
An appropriate level of eye contact throughout the consultation
Open, relaxed, yet professional body language (e.g. uncrossed legs and arms, leaning slightly forward in the chair)
Making sure not to interrupt the patient throughout the consultation
Establishing rapport (e.g. asking the patient how they are and o
Signposting\: this involves explaining to the patient what you have discussed so far and what you plan to discuss next
Summarising at regular intervals

Presenting complaint

Use open questioning to explore the patient’s presenting complaint\:
" W h a t’ s b r o u g h t y o u i n t o s e e m e t o d a y ?"
" T e l l m e a b o u t t h e i s s u e s y o u’ v e b e e n e x p e r i e n c i n g .
"
Provide the patient with enough time to answer and avoid interrupting them.
Facilitate the patient to expand on their presenting complaint if required\:
" O k , c a n y o u t e l l m e m o r e a b o u t t h a t ?"
" C a n y o u e x p l a i n w h a t t h a t p a i n w a s l i k e ?"
Open vs closed questions
History taking typically involves a combination of open and closed questions. Open questions are e
consultations, allowing the patient to tell you what has happened in their own words. Closed questions can allow you to
explore the symptoms mentioned by the patient in more detail to gain a better understanding of their presentation.
Closed questions can also be used to identify relevant risk factors and narrow the di

History of presenting complaint

Once the patient has had time to communicate their presenting complaint, you should explore the issue with further open and
closed questions.

SOCRATES

The SOCRATES acronym is a useful tool for exploring each of the patient's presenting symptoms in more detail. It is most
commonly used to explore pain, but it can be applied to other symptoms, although some of the elements of SOCRATES may
not be relevant to all symptoms.
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Site
Ask about the location of the symptom\:
" W h e r e i s t h e p a i n ?"
" C a n y o u p o i n t t o w h e r e y o u e x p e r i e n c e t h e p a i n ?"
Onset
Clarify how and when the symptom developed\:
" D i d t h e p a i n c o m e o n s u d d e n l y o r g r a d u a l l y ?"
" W h e n d i d t h e p a i n
" H o w l o n g h a v e y o u b e e n e x p e r i e n c i n g t h e p a i n ?"
Character
Ask about the speci
" H o w w o u l d y o u d e s c r i b e t h e p a i n ?" (e.g. dull ache, throbbing, sharp)
" I s t h e p a i n c o n s t a n t o r d o e s i t c o m e a n d go ?"
Radiation
Ask if the symptom moves anywhere else\:
" D o e s t h e p a i n s p r e a d e l s e w h e r e ?"
Associated symptoms
Ask if there are other symptoms which are associated with the primary symptom\:
" A r e t h e r e a n y o t h e r s y m p t o m s t h a t s e e m a s s o c i a t e d w i t h t h e p a i n ?" (e.g. shortness of breath in pulmonary embolism)
Time course
Clarify how the symptom has changed over time\:
" H o w h a s t h e p a i n c h a n g e d o v e r t i m e ?"
Exacerbating or relieving factors
Ask if anything makes the symptom worse or better\:
" D o e s a n y t h i n g m a k e t h e p a i n w o r s e ?" (e.g. patients with symphysis pubis dysfunction may
makes things worse)
with their symptoms)
" D o e s a n y t h i n g m a k e t h e p a i n b e t t e r ?" (e.g. patients with gastro-oesophageal re
Severity
Assess the severity of the symptom by asking the patient to grade it on a scale of 0-10\:
" O n a s c a l e o f 0-1 0 , h o w s e v e r e i s t h e p a i n , i f 0 i s n o p a i n a n d 1 0 i s t h e w o r s t p a i n y o u’ v e e v e r e x p e r i e n c e d ?"

Obstetric symptoms

Once you have completed exploring the patient's history of presenting complaint, you need to move on to more focused
questioning relating to the symptoms that may be relevant to pregnancy (if not already discussed). We have included a
focused list of key symptoms to ask about when taking an obstetric history, followed by some background information on each,
should you want to know more.
Summary of key obstetric symptoms
Key obstetric symptoms to ask about include\:
Nausea and vomiting\: common in pregnancy and mild in most cases. Hyperemesis gravidarum represents a severe
form of vomiting in pregnancy associated with electrolyte disturbance, weight loss and ketonuria
Reduced fetal movements\: can be associated with fetal distress, and absent fetal movements may indicate early fetal
demise
Vaginal bleeding\: causes include cervical bleeding (e.g. ectropium, cervical cancer), placenta praevia and placental
abruption (typically associated with abdominal pain)
Abdominal pain\: causes may include urinary tract infection, constipation, pelvic girdle pain and placental abruption
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Vaginal discharge or loss of sexually transmitted infections such
as gonorrhoea, and the loss of
Headache, visual disturbance, epigastric pain and oedema\: these are typical clinical features of pre-eclampsia. Mild
oedema is common and normal in the later stages of pregnancy
Pruritis\: associated with obstetric cholestasis (typically a
Unilateral leg swelling\: consider and rule out deep vein thrombosis
Chest pain and shortness of breath\: pregnant women are at increased risk of developing pulmonary emboli
Urinary symptoms\: increased frequency can be common in later pregnancy, but with dysuria, urgency may indicate a
urinary tract infection
Systemic symptoms\: fatigue (e.g. anaemia), fever (chorioamnionitis) and weight loss (e.g. hyperemesis gravidarum)
Nausea and vomiting
advice.
Nausea and vomiting are very common in pregnancy but are typically mild, requiring only reassurance and basic hydration
Nausea and vomiting typically begin between the fourth and seventh week of gestation, then peak between the ninth and
sixteenth week and resolve by around the 20th week of pregnancy.
Persistent vomiting and severe nausea can progress to hyperemesis gravidarum. Hyperemesis gravidarum refers to
persistent and severe vomiting leading to dehydration and electrolyte disturbance, weight loss and ketonuria.
2
Reduced fetal movements
Women typically start to feel fetal movements between 16 to 24 weeks gestation (primigravida women will often not feel fetal
movements until after 20 weeks gestation). A mother will know the "
usual" amount of fetal movements she experiences,
therefore, if a reduction in fetal movements is reported, it should be taken very seriously.
Reduced fetal movements are associated with adverse pregnancy outcomes, including stillbirth, fetal growth restriction,
placental insu
3
You should always ask about fetal movements once the patient is of the appropriate gestation to be able to feel them\:
" H a v e y o u n o t i c e d a n y c h a n g e i n t h e a m o u n t o f y o u r b a b y' s m o v e m e n t ?"
Vaginal bleeding
Vaginal bleeding is an important symptom that can be relevant to a wide range of obstetric and gynaecological diseases.
" H a v e y o u n o t i c e d a n y b l e e d i n g c o m i n g f r o m t h e v a gi n a ?"
Bleeding during early pregnancy is common and can be normal or due to miscarriage or an ectopic pregnancy. If the woman
is later in pregnancy, con
that were carried out.
It is important to ask about pain associated with bleeding and any trauma (including domestic violence). If a patient reports
vaginal bleeding, also asking about fever/malaise, recent ultrasound scan results (e.g. position of the placenta), cervical
screening history, sexual history and past medical history will help narrow the di
You should also ask about fatigue if anaemia is suspected and symptoms of hypovolaemic shock (e.g. pre-syncope/syncope)
if there is heavy bleeding.
Vaginal discharge
All healthy women will have some degree of regular vaginal discharge, so it is important to distinguish between normal and
abnormal vaginal discharge when taking an obstetric history. An initial open question encourages a patient to disclose any
changes\:
" H a v e y o u n o t i c e d a n y c h a n g e s t o y o u r v a g i n a l d i s c h a r g e ?"
You should clarify if they have noticed any changes to the following characteristics of their vaginal discharge\:
Volume (e.g. large amount of clear
Colour (e.g. green, yellow or blood-stained would suggest infection)
Consistency (e.g. thickened or watery)
Smell (e.g.
Urinary symptoms
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Urinary tract infections are common in pregnancy and need to be treated promptly. Untreated urinary tract infections in
pregnancy have been associated with increased risk of fetal death, developmental delay and cerebral palsy.
" H a v e y o u n o t i c e d a n y c h a n g e s w h e n go i n g f o r a w e e ?"
Common symptoms of urinary tract infections that should be asked include\:
Dysuria\: pain whilst passing urine
Frequency\: increased frequency of passing urine
Urgency\: a sudden need to pass urine, with no earlier warning
Fever
Headache, visual changes, epigastric pain, oedema
Pre-eclampsia is a relatively common condition in pregnancy, which is characterised by maternal hypertension, proteinuria,
oedema, fetal intrauterine growth restriction and premature birth. The condition can be life-threatening for the mother and the
fetus. As a result, it is essential to ask about symptoms of pre-eclampsia as part of every patient review during pregnancy.
The key symptoms to ask about include\:
Headache (typically severe and frontal)
Swelling of the hands, feet and face (oedema)
Pain in the upper part of the abdomen (epigastric tenderness)
Visual disturbance (blurring of vision or
Reduced fetal movements
Other symptoms
chorioamnionitis).
Fever is important to ask about when considering infectious pathology (e.g. urinary tract infections, cervical infections,
Fatigue is a non-speci
Weight loss is a symptom of hyperemesis gravidarum and other signi
Pruritis in the context of pregnancy is suggestive of obstetric cholestasis (it typically a

Ideas, concerns and expectations

A key component of history taking involves exploring a patient’s ideas, concerns and expectations (often referred to as ICE) to
gain insight into how a patient currently perceives their situation, what they are worried about and what they expect from the
consultation.
The exploration of ideas, concerns and expectations should be
This will help ensure your consultation is more natural, patient-centred and not overly formulaic.
It can be challenging to use the ICE structure in a way that sounds natural in your consultation, but we have provided several
examples for each of the three areas below.
Ideas
Explore the patient's ideas about the current issue\:
" W h a t d o y o u t h i n k t h e p r o b l e m i s ?"
" W h a t a r e y o u r t h o u g h t s a b o u t w h a t i s h a p p e n i n g?"
" I t’ s c l e a r t h a t y o u’ v e g i v e n t h i s a l o t o f t h o u g h t a n d i t w o u l d b e h e l p f u l t o h e a r w h a t y o u t h i n k m i gh t b e go i n g o n .
"
Concerns
Explore the patient's current concerns\:
" I s t h e r e a n y t h i n g , i n p a r t i c u l a r , t h a t’ s w o r r y i n g y o u ?"
" W h a t’ s y o u r n u m b e r o n e c o n c e r n r e ga r d i n g t h i s p r o b l e m a t t h e m o m e n t ?"
" W h a t’ s t h e w o r s t t h i n g y o u w e r e t h i n k i n g i t m i gh t b e ?"
Expectations
Ask what the patient hopes to gain from the consultation\:
" W h a t w e r e y o u h o p i n g I’ d b e a b l e t o d o f o r y o u t o d a y ?"
" W h a t w o u l d i d e a l l y n e e d t o h a p p e n f o r y o u t o f e e l t o d a y’ s c o n s u l t a t i o n w a s a s u c c e s s ?"
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" W h a t d o y o u t h i n k m i g h t b e t h e b e s t p l a n o f a c t i o n ?"
For further information, see the Geeky Medics ideas, concerns and expectations OSCE guide.

Summarising

Summarise what the patient has told you about their presenting complaint. This allows you to check your understanding of
the patient's history and provides an opportunity for the patient to correct any inaccurate information.
Once you have summarised, ask the patient if there’s anything else that you’ve overlooked. Continue to periodically
summarise as you move through the rest of the history.

Signposting

Signposting, in a history taking context, involves explicitly stating what you have discussed so far and what you plan to
discuss next. Signposting can be a useful tool when transitioning between di
provides the patient with time to prepare for what is coming next.
Signposting examples
Explain what you have covered so far\:
a c h i e v e t o d a y .
"
" O k , s o w e’ v e t a l k e d a b o u t y o u r s y m p t o m s , y o u r c o n c e r n s a n d w h a t y o u' r e h o p i n g w e
What you plan to cover next\:
"
p r e g n a n c y .
" N e x t I’ d l i k e t o q u i c k l y s c r e e n f o r a n y o t h e r s y m p t o m s a n d t h e n t a l k a b o u t y o u r c u r r e n t

Systemic enquiry

A systemic enquiry involves performing a brief screen for symptoms in other body systems which may or may not be relevant
to the primary presenting complaint. A systemic enquiry may also identify symptoms that the patient has forgotten to mention
in the presenting complaint.
Deciding on which symptoms to ask about depends on the presenting complaint and your level of experience.
Some examples of symptoms you could screen for in each system include\:
Systemic\: fatigue (e.g. anaemia), fever (e.g. chorioamnionitis, urinary tract infection), weight loss (e.g. hyperemesis
gravidarum)
Respiratory\: dyspnoea (e.g. pulmonary embolism, anaemia), chest pain (e.g. pulmonary embolism)
Gastrointestinal\: abdominal pain (e.g. placental abruption), vomiting (e.g. hyperemesis gravidarum), re
oesophageal re
Genitourinary\: urinary frequency, dysuria and urgency (e.g. urinary tract infection), abnormal vaginal discharge (e.g. vaginal
candidiasis, gonorrhoea)
Neurological\: visual changes, motor or sensory disturbances, headache (e.g. pre-eclampsia)
Musculoskeletal\: pelvic pain (e.g. symphysis pubis dysfunction)
Dermatological\: rashes, skin lesions, linea nigra

Current pregnancy

Sensitively enquiring about the current pregnancy is important to ascertain details that may in
patient about pregnancy planning and if arti
important.
Open questions can often lead to a patient explaining their pregnancy journey\:
“ C a n y o u t e l l m e m o r e a b o u t t h i s p r e gn a n c y ?”
Follow-up questions to ask about pregnancy planning and the date the patient found out they are pregnant are helpful\:
“ W h e n d i d y o u
This can be useful as a patient may have missed screening opportunities if they did not realise they were pregnant until a
gestation beyond the dating scan. It can also decipher if this was a planned pregnancy.

Gestation

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Clarify the current gestational age of the pregnancy (e.g. 26 weeks and 5 days would be written as "26+5").
Accurate estimation of gestation and estimated date of delivery (EDD) is performed using an ultrasound scan to measure the
crown-rump length.

Scan results

Women are o
scan results (or check the medical records if the patient is unsure). The key
Growth of the fetus\: clarify if it was within normal limits for the current gestation
Placental position\: if embedded in the lower third of the uterine cavity, there is an increased risk of placenta praevia
Fetal anomalies\: note any abnormalities identi

Screening

There are several types of screening that women are o
Down's syndrome screening
Rhesus status and the presence of any antibodies
Hepatitis B, HIV and syphilis
You should clarify if the patient has opted for screening and, if so, what the results were.

Other details of the pregnancy

Check if this is a singleton or multiple gestation
Clarify if the patient took folic acid prior to conception and during the
Explore the planned mode of delivery (e.g. vaginal or Caesarean section)
Ask about any medical illness during pregnancy (clarify what type of illness and if the patient is still receiving any treatment)
Ask about hospitalisation during pregnancy or emergency reviews (e.g. vaginal bleeding or reduced fetal movements)

Immunisation history

Check the patient is currently up to date with their vaccinations including\:
Flu vaccination
Whooping cough vaccination
Hepatitis B vaccination (if at risk)

Mental health history

Pregnancy can have a signi
suggestive of psychiatric illness (e.g. depression, bipolar disorder, schizophrenia).
Ask about previous mental health diagnoses and any current thoughts of self-harm and/or suicide if relevant.
Patients with mental health problems prior to or during pregnancy may require referral to the perinatal mental health team.
Ask about any medications prescribed for the patient’s mental health. A risk-bene
existing medications and alternatives that may be safer.

Previous obstetric history

It is important to ask about a woman's previous obstetric history, as this may help inform the assessment of risk in the current
pregnancy and have implications for the mode of delivery.

Gravidity and parity

Gravidity is the number of times a woman has been pregnant, regardless of the outcome.
Parity is the total number of pregnancies carried over the threshold of viability (typically 24 + 0 weeks).

Term pregnancies (>24 weeks)

Gestation at delivery\:
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Previous pre-term labour increases the risk of pre-term labour in later pregnancies
Birth weight\:
A high birth weight in previous pregnancies raises the possibility of previous gestational diabetes
A low birth weight (small for gestational age) in a previous pregnancy increases the risk of a further small for gestational age
baby
Mode of delivery\:
Spontaneous vaginal delivery
Assisted vaginal delivery (e.g. forceps)
Caesarean section (will have implications for the choice of future mode of delivery)
Complications\:
Antenatal period\: pre-eclampsia, gestational diabetes, gestational hypertension, placenta praevia and shoulder dystocia
Postnatal period\: post-partum haemorrhage, perineal/rectal tears during delivery and retained products of conception,
postnatal depression, postpartum psychosis
Assisted reproduction\:
Clarify if IVF or other assisted reproductive techniques were used for any previous pregnancies.
Stillbirth
As stated below, asking about stillbirths needs to be done sensitively.
A stillbirth is when a baby is born deceased after 24 completed weeks of pregnancy.
Sensitively clarify the gestation of the stillbirth if this is not already documented.

Other pregnancies (\<24 weeks)

Questions about miscarriage, terminations and ectopic pregnancies need to be asked sensitively in a private setting. It can be
very di
competent to do so.
Miscarriage
A miscarriage is the loss of a pregnancy before 24 weeks gestation.
Gestation\:
Clarify the trimester at which the miscarriage occurred (miscarriage is most common in the
Other details\:
Clarify if medical or surgical management was required for the miscarriage and if any cause was identi
miscarriage (e.g. genetic syndromes)
Termination of pregnancy
Termination of pregnancy is the medical process of ending a pregnancy so it doesn't result in the birth of a baby.
The pregnancy is ended either by taking medications or having a minor surgical procedure.
Clarify the gestation at which the pregnancy was terminated and the method of management (e.g. medical or surgical).
Ectopic pregnancy
An ectopic pregnancy is when a fertilised egg implants itself outside of the uterus, usually in one of the fallopian tubes.
Clarify the site of the ectopic pregnancy and how it was managed (e.g. expectant, medical, surgical).

Gynaecological history

Cervical screening\:
Concervical screening test
Ask if the patient received any treatment if the cervical screening test was abnormal and hat follow up is in place
Previous gynaecological conditions and treatments\:
Sexually transmitted infections
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Endometriosis
Bartholin's cyst
Cervical ectropion
Malignancy (e.g. cervical, endometrial, ovarian)

Past medical history

A patient's past medical history is particularly relevant during pregnancy, as some medical conditions may worsen during
pregnancy and/or have implications for the developing fetus.
Ask if the patient has any medical conditions\:
" D o y o u h a v e a n y m e d i c a l c o n d i t i o n s ?"
" A r e y o u c u r r e n t l y s e e i n g a d o c t o r o r s p e c i a l i s t r e g u l a r l y ?"
If the patient does have a medical condition, you should gather more details to assess how well controlled the disease is and
what treatment(s) the patient is receiving. It is also important to ask about any complications associated with the condition,
including hospital admissions.
Ask the patient if they've previously undergone any surgery or procedures in the past such as\:
Abdominal or pelvic surgery\: may in
Previous Caesarean section\: increased risk of uterine rupture in subsequent pregnancies
Loop excision of the transitional zone (LETZ)\: increased risk of cervical incompetence
Allergies
It's essential to clarify any allergies the patient may have and to document these clearly in the notes, including the type of
allergic reaction the patient experienced.
Medical conditions which are particularly important to be aware of during pregnancy
Diabetes (type 1 or type 2)\: blood glucose control can deteriorate signi
maternal health and fetal complications (e.g. macrosomia)
Hypothyroidism\: untreated or undertreated hypothyroidism can result in congenital hypothyroidism with signi
neurodevelopmental impact
Epilepsy\: seizures during pregnancy pose a risk to both the mother and fetus (e.g. miscarriage) and many anti-epileptic
drugs are teratogenic
Previous venous thromboembolism (VTE)\: pregnancy is a pro-thrombotic state, therefore, women who have previously
developed a venous thromboembolism are at signi
treatment (e.g. low molecular weight heparin)
Blood-borne viruses\: HIV, hepatitis B, and hepatitis C pose a risk to the fetus during childbirth (vertical transmission)
Genetic disease\: it is important to identify any genetic diseases (e.g. cystic , sickle-cell disease, thalassaemia)
carried by both the mother and father as this may in
arranging input from the paediatric team immediately after delivery)
Female genital mutilation (FGM)\: all patients should be asked about FGM at their booking appointment. It is illegal in the
UK, and if a patient is under 18, it must be reported to the police. It is important to ask for and document FGM, as patients
will need to be referred to a clinician with expertise in FGM to discuss delivery and ongoing care during pregnancy. There
may also be further safeguarding considerations for a pregnancy with a female baby.
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Drug history

It is essential to gain an accurate overview of the medications the patient is currently and has previously taken during the
pregnancy. The
occurs.

Prescribed medications

Clarify the prescribed medications the patient has been taking since falling pregnant, noting which they are still taking and
which they have now stopped (including drug name, dose and route).
“ A r e y o u c u r r e n t l y t a k i n g a n y p r e s c r i b e d m e d i c a t i o n s o r o v e r-t h e-c o u n t e r t r e a t m e n t s ?”
" H a v e y o u s t o p p e d t a k i n g a n y p r e s c r i b e d m e d i c a t i o n s i n c e y o u b e c a m e p r e gn a n t ?"
Ask if the patient was using contraception prior to becoming pregnant and if so, clarify what method of contraception was
being used. Check the patient has stopped their contraception or had their contraceptive device removed (e.g. coil, implant).
If the patient is taking prescribed or over the counter medications, document the medication name, dose, frequency, form
and route.
Ask the patient if they're currently experiencing any side e
" H a v e y o u n o t i c e d a n y s i d e e
Teratogenic drugs
Some examples of drugs that are known to be teratogenic include\:
ACE inhibitors
Sodium valproate
Methotrexate
Retinoids
Trimethoprim
Medications frequently used during pregnancy
Some medications are commonly used in pregnancy to both reduce the risk of fetal malformations and treat the
symptoms of pregnancy.
Some examples of medications commonly used in pregnancy include\:
Folic acid (400μg)\: recommended daily for the
the developing fetus
Oral iron\: frequently used in pregnancy to treat anaemia
Antiemetics\: frequently used in pregnancy to manage nausea and vomiting (e.g. hyperemesis gravidarum)
Antacids\: frequently used to manage gastro-oesophageal re
Aspirin\: often prescribed for patients at high risk of pre-eclampsia to take from week 12 until week 36 of pregnancy
Vitamin D (10 μg)\: patients are recommended to take vitamin D during pregnancy in the UK due to common low levels
of vitamin D amongst the population.

Family history

Taking a brief family history can help to further assess the risk of adverse outcomes to the mother and fetus during pregnancy.
This can also help inform discussions with parents about the risk of their child having a speci

Some important medical conditions to ask about include\:
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Inherited genetic conditions\: such as cystic
Type 2 diabetes\: if
Pre-eclampsia\: most relevant if maternal mother or sister is a
developing pre-eclampsia

Social history

Understanding the social context of a patient is absolutely key to building a complete picture of their health. Social factors have
a signi
General social context
Explore the patient's general social context, including\:
The type of accommodation they currently reside in (e.g. house, bungalow) and if there are any adaptations to assist them
(e.g. stairlift)
Who else the patient lives with (including any other children) and their personal support network
What tasks can they carry out independently, and what do they require assistance with (e.g. self-hygiene, housework, food
shopping)
If there is or has been any social worker involvement with the patient or their family
Smoking
Record the patient's smoking history, including the type and amount of tobacco used.
Osmoking cessation guide for more details).
Smoking increases the risk of a small for gestational age baby.
Alcohol
information).
Record the frequency, type and volume of alcohol consumed on a weekly basis (see our alcohol history taking guide for more
O
Excess alcohol use during pregnancy can result in conditions such as fetal alcohol syndrome.
Recreational drug use
It is important to ask about recreational drug use, as these can have signi
fetus (e.g. cocaine use increases the risk of placental abruption).
If recreational drug use is identi
Diet and weight
Ask if the patient what their diet looks like on an average day.
Ask about the patient's current weight (obesity signi
gestational diabetes during pregnancy).
Occupation
Ask about the patient's current occupation and if there are plans in place for maternity leave.
Domestic abuse
seek help.
It is important to privately ask all pregnant women if they are a victim of domestic abuse to provide an opportunity for them to
Explain to the patient that this is a routine line of enquiry during pregnancy and ask sensitively and non-judgementally\:
“ D o y o u f e e l s a f e a t h o m e ?”

Closing the consultation

Summarise the key points back to the patient.
Ask the patient if they have any questions or concerns that have not been addressed.
https\://app.geekymedics.com/osce-guides/history/obstetric-history/ 11/1211/13/24, 8\:11 PM Guide | Obstetric history
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.

Reviewer

Dr Venkatesh Subramanian
Obstetrics & Gynaecology Registrar in London
Dr Katie Sissons
General Practitioner

References

1. Maraj H, Kumari S. No clarity on the de
obstetricians and midwives and a literature review. Published May 2021. Available from\: [LINK].
2. NICE. Clinical Knowledge Summary. Nausea/vomiting in pregnancy. Published\: June 2017. Available from\: [LINK].
3. BMJ. Reduced fetal movements. Published March 2018. Available from\: [LINK].
Source\: geekymedics.com
https\://app.geekymedics.com/osce-guides/history/obstetric-history/ 12/12