Introduction
There are a number of reasons for taking the obstetric history. A woman visiting the midwife or physician will probably want to have her pregnancy confirmed, find out how far along she is, or whether everything is normal. The history-taking can frequently provide a certain amount of clarity with respect to these points. The history-taking should also serve as an opportunity for the woman and her partner to become better acquainted with the care provider. For the care provider it is important to know how the woman and her partner feel about the pregnancy. Is the pregnancy planned and wanted, is the woman anxious, or is she indifferent? The history-taking should also be used to obtain a good picture of the present status. Moreover, it also forms an important instrument for risk assessment. This part of the history-taking serves to itemise the medical or psychosocial risk factors of the woman, both families and from any previous pregnancies, and to give these factors a place in the obstetric management. Finally, at some point during the pregnancy aspects such as antenatal classes, location where birth is planned to take place and any preferred birthing method, symptoms of the onset of labour (what to expect and when to phone) and the natural course of the labour process, assistance and breast feeding must also be discussed. This does not necessarily have to take place during the first check-up, but should be discussed well before the birth.
The initial consultation
In the first phase of the consultation it is important to talk about the subjects that are most important in the experience of the woman (and her partner) because these can affect the course of the pregnancy and the birth.
Important information is, for example:
- how does the woman feel about being pregnant
- how do her partner and any other members of the family feel about it
- the age (if relevant the possibility for a diagnostic antenatal amniocentesis test or chorionic villus sampling should be discussed)
- are there any other children
- social circumstances: adequate accommodation, employment outside the home, childcare (see psychosocial history as well)
- whether the woman has experienced any complaints since she became pregnant (physiological or pathological symptoms).
If the woman has been pregnant before and/or has given birth:
- how the pregnancy/pregnancies and birth(s) went
- when and where the birth took place and who was involved.
Take note of the present status during the consultation:
- general impression of the woman (lively, healthy, responds satisfactorily)
- mental state.
Note any information that is important for the further management of the pregnancy, labour and postnatal period.
The second phase of the consultation should be more structured. If this has not yet been covered, the following information should be recorded:
- personal data
- physiological symptoms or complaints relating to this pregnancy
- course of any previous pregnancies and childbirths
- genital tract function, contraception
- medical data concerning any past or current diseases, operations, medical interventions and treatments
- family history
- psychosocial history
- lifestyle habits
- intoxicants.
The following aspects are relevant for the above categories.
Personal details
Record these for both the woman and her partner:
- name
- date of birth
- full address
- telephone number
- profession
- religion
- race/nationality
- health insurance.
Consider antenatal diagnostics, work-related intoxicants, religious implications (Jehovah’s Witnesses), race- or culture-related conditions (haemoglobinopathies) or views/beliefs.
Physiological symptoms or complaints related to pregnancy
Physiological symptoms:
- tender breasts
- tiredness (greater need for sleep)
- nausea and vomiting (morning)
- chloasma
- vaginal discharge
- pollakiuria (frequent urination)
- constipation.
Pathological symptoms:
- vaginal discharge
- dizziness
- swollen ankles, hands, face
- gastrointestinal complaints
- hyperemesis
- paresthesias
- visual complaints
- varicose veins
- haemorrhoids
- urination complaints
- defecation complaints.
Some complaints such as vaginal discharge can have both a physiological and pathological background. Further questions and tests are necessary in such cases.
Course of any previous pregnancies and childbirths
Number of
- pregnancies (incl. current)
- births
- abortions
Course of previous pregnancy/pregnancies
- blood loss during the first and second half
- duration of pregnancy (premature birth, postmature birth)
- dysmaturity
- multiple pregnancies
- abnormal positions
- ectopic pregnancy
- molar pregnancy
- hydramnios
- gestational hypertension/pre-eclampsia
- gestational diabetes (GDM)
- intra-uterine foetal demise
- blood group incompatibility
- spontaneous abortion with or without curettage
- induced abortion.
Course of any previous births
- duration of birth
- assisted delivery (which type, what was the indication)
- haemorrhage during labour/post partum (quantity, blood transfusion)
- birth weight of the child
- condition of neonate immediately post partum (asphyxia, birth trauma, congenital abnormalities, perinatal death)
- child’s current state of health.
Course of the postnatal period
- breast feeding/bottle feeding
- postpartum blood loss
- postnatal depression/psychosis
- thrombosis
- infections (mastitis, endometritis).
The genital tract
Knowing the exact duration of the pregnancy is essential for diagnosing underdevelopment and identifying the threat of premature or postmature birth. The start date and the nature of the last menstruation, the regularity of the cycle and the date (and type) of the first positive pregnancy test should be accurately noted for this purpose. On some occasions the date of conception is known or a basal temperature curve is available. On the other hand, sometimes no menstruation will have occurred immediately prior to the pregnancy, for example in the case of pregnancy immediately following the postnatal period, pill use or a period of amenorrhoea.
If there are doubts about the duration of the pregnancy or the history indicates a possible problem, an ultrasound scan should be performed during the first trimester. If during this examination the crown-coccyx length and/or the biparietal distance (BPD) is measured, the duration of the pregnancy can be determined to within an accuracy of several days. Congenital (bicornuate uterus) or acquired (fibroids) abnormalities, infections or previous interventions (curettage, caesarean section) to the genitals can affect the course of the pregnancy, childbirth or postnatal period.
It is therefore important to obtain information about:
- the last menstruation
- date of the first day of the last menstruation
- did it feel the same as on other occasions?
- how much blood was lost?
- cycle pattern: interval/duration (e.g. 28-30/4)
- contraception: what sort, when stopped?
- gynaecological complaints/conditions/interventions.
Medical data about any past or current diseases, operations, medical treatments or interventions
Pregnancy places a burden on the maternal body and several systems in particular are put under pressure. In addition, abnormalities in certain organ systems can affect the course of the pregnancy, childbirth or postnatal period.
Circulatory system
- hypertension
- peripheral vascular abnormalities
- heart abnormalities
- thrombosis
Respiratory tract
- COPD (chronic obstructive pulmonary disease)
- TB
Digestive tract
- haemorrhoids
- Crohn’s disease
Urinary-renal system
- recurrent urinary tract infections
Musculoskeletal system
- back abnormalities, back complaints
- pelvic abnormalities (symphysis pubis dysfunction, pelvic fractures).
Central nervous system
- epilepsy
- migraine
- multiple sclerosis
Endocrine
- diabetes mellitus
- thyroid gland abnormalities
Miscellaneous
- atopic constitution
- (postnatal) depression
- infectious diseases and vaccinations: rubella, hepatitis A/B
- sexually-transmitted diseases
- operations
- blood disorders
- blood transfusions: reason, when, quantity
- blood donation (not recommended during pregnancy!); blood group
- Rhesus factor (Rh) if known (card)
- allergies.
Family history
The family history serves to establish whether there is an increased risk of complications during pregnancy, labour, or postnatally. It is also aimed at assessing the risk of congenital abnormalities and congenital diseases in the child.
During the general screening the presence of the following factors in the family should be asked after:
- thrombosis (possibly on the basis of familial protein S, protein C or antithrombin III deficiency)
- diabetes mellitus
- hypertension
- multiple pregnancies (also applies to the partner)
- congenital abnormalities (also applies to the partner)
- tuberculosis
- partner’s blood group and rhesus factor if known.
Psychosocial history
This part of the consultation serves to gain an insight into the current psychosocial functioning of the woman (and her partner) and into possible complications that could occur:
- woman’s profession, partner’s profession, (ask her if she is able to cope with her work at home/out of the home)
- living conditions (if she wants to give birth at home)
- marital status (married/divorced/widow/single)
- age of any children
- relationship with partner (if there is a reason to ask this).
Lifestyle
- nutrition (special dietary requirements e.g. vegetarian, Ramadan)
- sleep
- hobbies/sport (horse riding, competitive sport, sauna).
Intoxicants
- alcohol (how much per day and what)
- medication (which, since when, prescribed by whom)
- smoking (how many per day and what)
- drugs (if there is reason to suspect this)
- work-related intoxications (laboratory, anaesthesia, manufacturing processes).
NB. Pre-conception care is a new field of medical interest in which an attempt is made to reduce the chance of congenital abnormalities. In an ideal situation, as soon as the desire to have children is expressed, a history should be taken that focuses on:
- detection of an increased risk of congenital and/or inherited abnormalities so that, if indicated, genetic tests can be performed
- the use of medicines and stimulants that can negatively affect the development of the foetus
- diet (in the case of obesity).
With this approach, insight can be gained prior to pregnancy into whether the child is at increased risk based on the characteristics of the prospective mother and/or her partner, and specific advice can be given.