Presenting Complaints

  • Per Vaginal Bleeding

    Fresh blood / clots

  • Per Vaginal Discharge

    Colour, consistency, associated symptoms

  • Abdominal Pain

    Nature, severity, onset, location, radiation

  • Urinary Symptoms

    Frequency, dysuria

  • Severe Nausea / Vomiting

    Onset, frequency, contents, blood, fluid status

  • Symptoms of Pre-Eclamptic Toxaemia

    Headache, visual changes (blurring / stars), abdominal pain, seizures

  • Galactorrhoea

Current Pregnancy

  • Confirmation of Pregnancy

    How was the pregnacy diagnosed?

    Urine test, blood test, ultrasound

  • Dates

    LMP, EDD, GA

  • Scans

    Size, location, morphological issues

  • Other Investigations

    ABO group, rhesus group, rubella status

  • Number of Pregnancies

  • Foetal Movements

  • Complications of This Pregnancy

    Gestational diabetes, pre-eclampsia

  • Medications for this Pregancy

    Folic acid, iron, antiemetics

  • Plan for Delivery

    Vaginal / caesarean

Obstetric History

  • Gravidity

    Number of times pregnant

  • Parity

    Number of live births

  • Miscarriages

  • Terminations

  • Previous Pregnancies

    Length, mode of delivery

  • Past Complications of Pregnancy

    Before / during / after delivery

Gynaecologic History

  • Past Subfertility

    Amount of time attempting pregnancy, medications, IVF

  • Menstrual Periods

    Regularity, duration, flow, pain

  • Pap Smear

    Last smear, result

  • Past Gynaecologic Disease

    Ectopic pregnancy, STDs, PID

  • Past Gynaecologic Surgery

    D&C, LETZ

Past Medical History

  • Past Medical Issues

    Doctor visits, hospital admissions

  • Hypertension

    Latest BP readings, meds, complications

  • Diabetes

    Diagnosis, control, management, complications

  • Thyroid Disease

    Hypothyroidism / hyperthyroidism

  • Epilepsy

    Frequency / last seizure, type of seizures, Rx

  • DVT / PE

    Where, when, ?provoked, management

  • Asthma

    When diagnosed, severity, medications

Medications

  •  

    Obstetric Medications

    Click for a summary of important drugs

  • Current Medications

    Indication, dose & frequency, length of course

  • Potentially Teratogenic Medications

    Check pregnancy class of drugs

  • Vitamins / Supplements

  • Alternative Medicines

    Herbs, homeopathic remedies

  • Allergies / Adverse Drug Reactions

    When? What was the reaction?

  • Vaccinations

    Up to date?

Family History

  • Known Genetic Conditions

    Cystic fibrosis

  • Other Conditions in the Family

    Heart disease, cancer, diabetes, autoimmune Dx

  • Family Obstetric History

    Twins, recurrent miscarriage

Social History

  • Vocation

    Education, occupation, souce of income, leave

  • Relationship Status

    Single / de facto / married / separated / divorced

  • Social Supports

    Partner, family, friends

  • Diet

    On an average day

  • Recent Travel

    Especially to developing countries

  • Exercise

    Amount per week

Substance History

  • Alcohol

    Average per day / week, CAGE

  • Smoking

    Pack-years, years since quitting

  • Recreational Drugs

    Especially IV drug use