OG35.{1-2,8,11} | History, Examination and Provisional Diagnosis — Summary & Reflection

KEY TAKEAWAYS

This module has guided you through the complete OG clinical encounter in six structured steps. Step 1 established why systematic history and examination are essential: two-patient care, the medico-legal context, the distinction between obstetric and gynaecological encounters, and the ethical requirements of consent, chaperone, and privacy. Step 2 reviewed the surface anatomy that underpins examination, and outlined the GPAL/TPAL obstetric formula, menstrual history components, and the principles of humane examination. Step 3 covered the step-by-step history sequence (PC, HPI, menstrual history, GPAL formula, marital, contraceptive, PMH/family/social) and the complete physical examination — general, systemic, and obstetric abdominal (inspection, fundal height, Leopold's four manoeuvres, FHS auscultation) — with an explicit statement that per-vaginal and per-rectal examinations are outside OG35.1. Step 4 synthesised findings into a provisional diagnosis, demonstrated EDD calculation by Naegele's rule (LMP + 1 year − 3 months + 7 days, adjusted for cycle length), and explained gestational-age–fundal-height correlation. Step 5 addressed supervised bedside practice expectations and the structure of a complete OG case record (16 sections). Step 6 provided a self-assessment checklist spanning all four competencies.

Key facts to retain:
- GPAL: Gravida = total pregnancies (including current), Para = deliveries ≥28 weeks, Abortus = losses <28 weeks, Living = children alive now.
- Naegele's rule EDD = LMP + 280 days ≈ LMP + 1 year − 3 months + 7 days; assumes 28-day cycle; adjust for cycle length.
- Leopold's manoeuvres: (1) fundal grip (pole in fundus), (2) lateral grip (lie and back), (3) Pawlik's/first pelvic grip (presenting part and engagement), (4) second pelvic grip (descent/engagement).
- Fetal heart: normal 110–160 bpm; auscultate over fetal back.
- Fundal height ≈ gestational age in weeks after 20 weeks (±2 cm); >4 cm discordance → investigate.

REFLECT

Think about the last patient interaction you observed or participated in during a clinical posting. Reflecting on the OG clinical encounter you have now studied:

1. Was the history taken in a logical sequence? Were the menstrual history, obstetric formula, and contraceptive history all elicited? If not, what was omitted and how might that omission affect the clinical impression?
2. Were the examination principles — consent, chaperone, draping, dignity — observed? What would you do differently now that you have studied the ethical foundations of the OG encounter?
3. Leopold's manoeuvres require tactile skill that can only be developed by practice. How many supervised examinations do you think you need before you can perform them confidently and independently? What is your plan to reach that number?
4. EDD calculation by Naegele's rule seems straightforward, but cycle-length adjustment is frequently forgotten in clinical practice. Write out the rule from memory now, then check your answer against Step 4. What mnemonic or memory device will you use to ensure you always apply the cycle-length adjustment?