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Gynaecological Patient(Part 1)
Prof. M.C.Bansal.
MBBS, MS. FICOG, MICOG
NIMS medical College ,Jaipur.
Founder Principal & Controller ;
Jhalawar Medical College And Hospital , Jhalawar.
Ex. Principal & controller;
Mahatma Gandhi Medical College And Hospital ,
Sitapur, Jaipur .
Women patient should be greeted and made
comfortable before one starts interrogating.
Let her be sure and confident that her privacy is
ensured.
Her preference regarding the presence of her partner ,
parent or relative during history taking and clinical
examination should be asked for and accepted.
Woman herself comes or bring her daughter / daughter
in law or any other relative/ friend as patient to her
gynaecologist for variety of problems , both
gynaecological or non gynaecological, as she feels
comfortable and friendly with him or her.
There fore gynaecolgist is her a primary health care
taker; more or less a family physician.
Getting elaborate information about her
problem will depend on her confidence in
doctor, opportunity for gynaecologist to
assess the patients general condition
,mood , ability and willingness to
communicate and variety of non verbal
clues.
Patient should be given enough time to
narrate her problem in her own words
before asking leading questions.
Significant Points of History Taking
Age.
Residence rural / urban ; contact number / postal
address.
Assess her socioeconomic status/ marital
status .,educational back ground.
Chief Complaints in chronological order with
duration.
History of present Illness.
Menstrual History.
Gynaecological history.
Obstetrical history . Contraceptive history.
Sexual history.
Menopausal history in women > 40.
Significant Points of History Taking----
Medications/ resent surgical procedure done.
Personal habits smoking , alcohol ,
substance abuse .
Past medical and general surgical history.
Family History.
Dietary history.
Occupational history / exposure to any
occupational hazard .
Symptoms pertaining to other system/
organs.
Common disorders by Age Group
Childhood: foreign body , vulvo-vaginitis, vaginal
discharge , intra vaginal tumor(cervical grapes
sarcoma,hydrocolpos , hemato colpos ), Ovarian
tumors ( teratomas, embryomas)
Adolescence: precocious/ delayed puberty ,
Menstrual disorders, dysmenorrhoea, PCOS, ovarian
germ cell tumors , uterovaginal anomalies.
Reproductive age : Menstrual irregularities, Fibroids ,
PID / STDs , benign lesions of female genital tract , CIN,
breast lumps and cancer , pregnancy related problems,
contraceptive use/their failure/ side effects.
Older Age: menopause related problems.,
malignancies of Cervix, endometrium , myometrium ,
ovary, vulva ,vagina and secondaries from distant
organs like breast/ stomach.
Residence rural / urban ; contact number /
postal address
Knowing her residential address and contact
number will help in developing good repot
and good follow up.
Certain gynaecological problems are more
common in urban and industrialized town
dwellers like STDs , Problems due to repeat
MTPs, Endometriosis, ovarian tumors, PCOS
.
Rural folk is more likely to have problems
due to multiparity ---Utero vaginal prolapse
and late stages of malignancies etc.
ground .
cycleDuration
are : 2-7 days
Pain Mild tolerable pain in
sacral / supra pubic
region
Volume of blood flow is assessed by number of pads /
tampons used whether the pads are fully/ partially
soaked , presence of clots. It can be better assessed by
pictorial Soaked -
Pad Area charts- 1st day 2nd 3rd 4th 5th 6th 7t
Day Day Day day Day h
D
a
y
// / /
X1
X /// //
5
///
X20
Daily 89(<1oo) Normal blood loss
Points
Tampons X1 // /
x5 ///
X 15 //////
Blood Flow calculation
The chart consists of pads and tampons that are soaked lightly,
moderately or heavily.
Clots are assigned a score 1 for clot size of 1 penny, 5 for 50 pennies and
flooding.
A total score of > 100 indicates excessive bleeding.
LMP should always be noted as to rule out pregnancy , decide the day of
many investigations and operative procedure ( in proliferative phase /
post ovulatory phase of menstrual cycle.
Gynaecological History
Past history of gynaecological problem is
important., like vaginal infection ,pelvic
pain , myomas , ovarian cyst,
endometriosis, PID, STD and drug /
operative treatment given . Present
problem may be recurrence /complication
or squeal of previous disease.
Previous investigations ,treatment , event
during sickness and operative notes if
available should always be scrutinized.
Obstetrical History
Age of marriage period of marital relationship when dealing with
infertility .
Parity, Number of miscarriage, IUFD , neonatal death
( obstetrical / Neonatal cause? )., MTP , molar and ectopic
pregnancy in order of sequence of events.
H/o each pregnancy--- includes any problem(obstetrical ,medical /
surgical ) arising in 1st/2ndr or 3rd trimester ; any treatment given
and its and response , ended as Ectopic/ abortion/ PROM, preterm
/term or post term pregnancy. Mode of delivery(sp N VAG?
I9nstrumental / LSCS delivery ?), fetal out come-- IUGR/ IUFD
/Small for date / premature / normal weight/ over weight baby .
Any resuscitation problem / Apgar score/ Usher score /neonatal
problems which are likely to be repeatative in nature.
Thecae all information can be collected from ANC card MCH card
and hospital records at which last delivery was managed.
History of postnatal events like fever , sepsis, DVT, convulsions,
wound infection , persistent High BP/ Glycosurea /proteinuriaetc.
Co Relation OF obstetrical History and
present Gynaecological disease
Null parity---Endometriosis, fibroids, cancer
endometrium , breast cancer .
Multi parityAdenomyosis, prolapse, cervical
cancer , ovarian cancer , urinary incontinence,
DUB due to enlarged uterine size.
Recent delivery / miscarriage sepsis. Chronic
PID / Pelvic Pain /RPOC, secondary infertility,
cervical erosion/ cervical ectropia , perineal tears,
chronic Iron deficiency anaemia, intra uterine
synecae , mastitis/ breast abscess.
Molar pregnancy Gestational Trophoblastic
neoplasia.
Details of Contraceptive
used
Abnormal uterine bleeding/ dysmenorrhoea may be
related to IUCD / OCS .
Galactorrhoea- amenorrhea syndrome due to prolong use
of combined OCs, they also protect against ovarian and
endometrial carcinoma if use for > 5years.May increase
risk of cancer cervix.
Tubal ligation may be responsible for DUB due to disturbed
ovarian vascularity / pelvic congestion syndrome.
Levonorgestrol containing IUCD (LUG-IUS) causes
amenorrhea.
Patient taking Inject able contraceptive can develop
osteoporosis and menopause like symptoms.
Barrier contraceptives protect against STD, HIV .HPV and
CIN--- decreased cancer cervix.
Sexual History
Women often feel sigh in giving details regarding their sex
life. Gynecologist by now must have earned her confidence
and faith; can ask her comfortably regarding timing ,
frequency , use of contraception, veganism's, lack of
orgasm, dyspareunia, vaginal dryness and immediate out
flow of semen from vagina.
History about sex life of partner and his habits regarding
sex play.
Vaginismus may due to tight introitus or of