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Obstetric History A. Patient'S Profile E. Past Medical and Surgical History

This document contains an obstetric history questionnaire that collects information about a patient's: 1) Personal and family medical history, including any prior illnesses, surgeries, medications, and allergies. 2) Current pregnancy details such as prenatal visits, ultrasound results, estimated due date, and any complications. 3) Past obstetric history including details of previous pregnancies and deliveries. 4) Past gynecological history including menstruation, contraceptive use, and prior procedures. 5) Social history including occupation, living situation, smoking, diet, and potential exposure risks.

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Maxinne Allyssa Cancino Roseño
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782 views1 page

Obstetric History A. Patient'S Profile E. Past Medical and Surgical History

This document contains an obstetric history questionnaire that collects information about a patient's: 1) Personal and family medical history, including any prior illnesses, surgeries, medications, and allergies. 2) Current pregnancy details such as prenatal visits, ultrasound results, estimated due date, and any complications. 3) Past obstetric history including details of previous pregnancies and deliveries. 4) Past gynecological history including menstruation, contraceptive use, and prior procedures. 5) Social history including occupation, living situation, smoking, diet, and potential exposure risks.

Uploaded by

Maxinne Allyssa Cancino Roseño
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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OBSTETRIC HISTORY E.

PAST MEDICAL AND SURGICAL HISTORY


1. Any previous operation procedures done and
A. PATIENT’S PROFILE
type of anesthetic used? Were there
1. What is your name?
complications?
2. How old are you?
2. Any previous illnesses or diseases?
3. When is your birthday?
(Hypertension, Diabetes, Renal Disease which
4. Where were you born?
are known to affect pregnancy)
5. Where do you live? Current address?
3. Hospitalizations? If so, what was the cause?
6. What are the names of your parents? Birthday?
When did it happen?
Age?
4. Patient’s known allergies?
7. What is your religion?
5. Any medications taken?
8. What is your educational level?
9. What is your occupation? Note: You can also ask if the mother underwent
10. What is your marital status? post-partum blues or depression.
11. What is the name of your spouse or partner?
F. FAMILY HEALTH HISTORY
Birthday? Age? Occupation?
1. Can you remember any illnesses from your
12. How many children do you have? Names?
parents or relatives? How old are they? What is
Birthday? Age?
the longevity of the illness?
2. Illnesses or diseases from maternal side?
B. CURRENT PREGNANCY
Paternal side?
1. Did you attend prenatal checkups? When did
3. Deaths in the family – cause and age
you start?
2. Did you have an ultrasound? How many times?
G. SOCIAL HISTORY
When was it?
1. Occupation
Did it show a single or multiple pregnancy?
2. Marital Status
3. When was your LMP?
3. Diet and Weight
4. When is your EDD?
4. Home Situation
5. Woman’s AOG?
5. Smoking, Alcohol use, and Illegal drug use
6. Can you tell me the signs and symptoms you
6. Exposure to cats (risk for toxoplasmosis)
experienced during the first, second, and third
7. Exposure to solvents
trimester?
8. Domestic Abuse, if any.
7. What medications are you taking?
8. Did you have TTS vaccine?
9. Have there been any problems or complications
during your pregnancy?
10. Has there been any bleeding, contractions, or
loss of fluid vaginally?

C. PAST OBSTETRIC HISTORY

Ask according to chronological order of children, if


any.

1. Date of delivery
2. Where it took place?
3. Duration of gestation
4. Type of delivery
5. Duration of labor
6. Type of anesthesia used, if any
7. Maternal complications
8. Newborn gender? Newborn weight?
9. Fetal and neonatal complications

D. PAST GYNECOLOGICAL HISTORY


1. When was your menarche?
2. Regularity or irregularity of period? Duration?
3. Any contraceptive history?
4. Previous cervical smear? If any.
5. Previous gynecological surgery? If any.

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