Main tasks at the first visit and symptom assessment
During the initial visit to theantenatal clinic or hospital, the physician opens an outpatient medical record or labor and delivery record. The main goal is to conduct a detailed interview with the patient, assess her status, and examine the genital tract.
Special attention is paid to age. If a woman is preparing to become a mother for the first time under the age of 18 or over 30, she automatically falls into the risk group for developing complications. Age over 35 additionally increases the probability of hereditary and congenital pathologies in the child.
The nature of symptoms directly depends on the gestational age and the course of pregnancy:
- Uncomplicated 1st trimester: delayed menstruation, nausea, vomiting, mild malaise.
- Complicated course: spotting from the genital tract may indicate an incipient miscarriage, ectopic location of the gestational sac, or concomitant gynecological diseases.
- Extragenital problems: symptoms from the cardiovascular, renal, pulmonary, or digestive systems.
Impact of past diseases and living conditions
Severe working conditions, poor ecology, and bad habits (smoking, including passive, alcoholism, drug addiction) negatively affect fetal development and the delivery process. However, diseases suffered by the woman since childhood are of no less importance:
- Rickets, poliomyelitis, and tuberculosis can cause pelvic bone deformity, which will seriously complicate natural childbirth in the future. Indirect indicators of past rickets include late tooth eruption and delayed onset of walking.
- Childhood infections (measles, rubella), as well as frequent tonsillitis and rheumatic fever, can cause delayed physical and sexual development.
- Vaginal and vulvar diphtheria sometimes leaves behind dense cicatricial strictures.
- Injuries to the spine, pelvis, and skull are critical for choosing a safe delivery method.
Chronic extragenital diseases may exacerbate against the background of carrying a child, creating a mutual negative impact.
Specific gynecological history
Gathering information on reproductive health includes several key blocks. First of all, the physician must record the first day of the last menstrual period.
- Menstrual function: age at menarche, features of cycle establishment, its duration, volume of blood loss, and presence of pain.
- Sexual function: age at initiation of sexual activity, parity of marriage, presence of pain (dyspareunia) or spotting during intercourse.
- Gynecological diseases: uterine fibroids, ovarian tumors, cervical pathologies, as well as past infections (syphilis, gonorrhea, chlamydia, HIV).
- Surgical interventions: if the patient has undergone uterine surgery (e.g., myomectomy), a uterine scar is formed. In this case, a medical summary with a precise description of the surgical approach (laparoscopy or laparotomy) and the course of the surgery (with or without opening the uterine cavity) is strictly required.
International terminology and obstetric history
In obstetrics, it is customary first to clarify the sequence number of the current pregnancy and upcoming deliveries. Latin terminology is used to unify data:
- Nulligravida — a woman who has never been pregnant.
- Gravida — currently pregnant or has been in the past. Subdivided into Primigravida (first pregnancy) and Multigravida (second and subsequent pregnancies).
- Nullipara — has not delivered a pregnancy reaching the period of fetal viability (though early miscarriages or abortions may be in the history).
- Primipara — has carried one pregnancy to a viable gestational age.
- Multipara — has a history of multiple pregnancies carried to the stage of viability.
If the woman has already given birth, the physician inquires in detail about their gestational age (term, preterm, post-term), method of delivery (spontaneous, cesarean section, obstetric forceps, vacuum extraction), and complications (e.g., preeclampsia).
In the presence of a prior cesarean section, indications, urgency of the intervention, and features of the postoperative period are specified. Perinatal outcomes are also recorded: birth weight and length of previous children, Apgar score, newborn routing, and subsequent neurodevelopmental follow-up (catamnesis).
For quick memorization of international terminology, use the association: the root gravida (from Latin gravis — heavy) means the very fact of pregnancy ("burden"), while the root para (from Latin parere — to give birth) refers exclusively to deliveries that have reached the period of fetal viability.
Class and exam questions
What criteria for fetal viability are adopted in the Russian Federation and WHO?
A fetus is considered viable upon reaching a gestational age of 22 weeks, body weight from 500 grams, and body length of 32–34 cm.
Why is it important to ask about childhood rickets when taking a medical history?
Rickets can lead to persistent pelvic bone deformity. This is a serious risk factor that can significantly complicate the course of natural childbirth.
What is considered a sign of infertility when taking a medical history?
Infertility is suspected if pregnancy does not occur within one year of regular sexual intercourse without using any contraceptive methods.
What else to study on this topic
- Methodology of objective examination: external and internal obstetric examination
- Assessment of fetal condition: ultrasound, cardiotocography (CTG), and dopplerometry
- Laboratory diagnostics in uncomplicated pregnancy
- Apgar score: criteria for assessing the newborn's condition
- Management of patients with a uterine scar after cesarean section
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