Questions to ask in analysis of obstetrics history taking on hopi for any complaints

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Here is a comprehensive, structured guide to HOPI (History of Presenting Illness) questions in obstetric history taking, covering any complaint a pregnant patient may present with.

Obstetric History Taking: HOPI for Any Complaint

1. Opening / Chief Complaint

Start with open questions:

"What brings you in today?"
"What is your main concern?"
"Can you tell me more about what you've been experiencing?"

Allow the patient to speak without interruption, then clarify.

2. History of Presenting Complaint — SOCRATES

For any symptom the patient describes (pain, bleeding, discharge, swelling, headache, etc.), explore using SOCRATES:

Letter	Question
S – Site	Where exactly is the symptom? (e.g., where is the pain/bleeding?)
O – Onset	When did it start? Was it sudden or gradual?
C – Character	What is it like? (e.g., sharp, dull, crampy, colicky; bright red vs. dark blood)
R – Radiation	Does it spread or move anywhere?
A – Associations	Any other symptoms alongside it? (e.g., fever, dizziness, vomiting, discharge, reduced fetal movement)
T – Timing	Is it constant or intermittent? Getting better or worse?
E – Exacerbating/Relieving factors	What makes it worse or better?
S – Severity	On a scale of 0–10, how severe is it? How does it affect your daily activities?

3. Obstetric-Specific Symptom Screen (HOPI Expansion)

After SOCRATES, ask these focused pregnancy-related questions regardless of the complaint, as they contextualise risk and differential diagnosis:

A. Key Pregnancy Details

What is your gestational age (weeks)?
What is your Last Menstrual Period (LMP)?
What is your Expected Date of Delivery (EDD)?
Was the pregnancy planned or unplanned?
Was it a spontaneous or assisted conception (IVF, ovulation induction)?
Have you had any ultrasound scans this pregnancy? What did they show?
Are you certain of your dates?

B. Antenatal Course So Far

When did you first notice the pregnancy (pregnancy test, amenorrhoea)?
Have you attended regular antenatal visits? Any missed?
Are you taking folic acid / prenatal vitamins / iron?
Have you had any antenatal screening tests (Down's syndrome, anomaly scan, OGTT, etc.)? Results?
Have you had any admissions or complications during this pregnancy?

C. Pregnancy-Specific Symptoms to Screen For

Regardless of the presenting complaint, ask about:

Symptom	Screening Question
Nausea/Vomiting	Any nausea or vomiting? Severity? Ability to keep fluids down?
Vaginal Bleeding	Any bleeding PV? Amount, colour (fresh red vs. dark), clots, passage of tissue?
Vaginal Discharge / Fluid Loss	Any watery, mucoid, or offensive discharge? Did you feel a gush of fluid (PROM)?
Fetal Movements	Are you feeling the baby move? Normal frequency? Any reduction?
Contractions / Uterine Tightenings	Any tightenings or contractions? How frequent? How long? Painful?
Headache / Visual Disturbance	Any headaches, blurred vision, flashing lights, or floaters?
Epigastric / RUQ Pain	Any pain under the ribs on the right side? (Pre-eclampsia/HELLP)
Swelling (Oedema)	Any swelling of the hands, face, or legs? When did it start?
Urinary Symptoms	Dysuria, frequency, haematuria? (UTI/pyelonephritis risk)
Bowel Changes	Constipation, diarrhoea?
Shortness of Breath / Chest Pain	Any breathing difficulty, palpitations, or chest tightness?
Pruritus	Any generalised itching, especially palms and soles (obstetric cholestasis)?
Seizures / Fainting	Any fits, blackouts, or loss of consciousness?

4. The "TMO IS U" Mnemonic (for Focused Obstetric HOPI)

A structured mnemonic used in case presentations:

Letter	Stands For
T	Time of onset / Trimester
M	Menstrual history (LMP, cycle regularity)
O	Obstetric history (gravida/parity)
I	Investigation results (USS, bloods, screening)
S	Symptoms of current complaint
U	Urgency / red flags present?

5. Past Obstetric History — GTPAL System

For every obstetric patient, establish the GTPAL (or G/P with FPAL):

G – Gravida: Total number of pregnancies (including current)
T – Term: Pregnancies delivered ≥ 37 weeks
P – Preterm: Deliveries 20–36+6 weeks
A – Abortions: Miscarriages or terminations before 20 weeks (including ectopic, molar)
L – Living children: Number of currently living children

For each previous pregnancy, ask:

Year and gestation at delivery
Mode of delivery (NVD, instrumental, LSCS — and reason if CS)
Birth weight and sex
Fetal/neonatal outcome (alive and well, NICU admission, stillbirth)
Complications: pre-eclampsia, GDM, APH, PPH, IUGR, congenital anomalies
Any previous caesarean — type of uterine incision?

6. Maternal Medical History

Chronic conditions: Diabetes mellitus, hypertension, autoimmune diseases (SLE, APS), cardiac disease, thyroid disease, epilepsy, asthma, renal disease
Previous VTE (DVT/PE) or thrombophilia
Previous surgeries (especially pelvic/gynaecological, including cervical procedures)
Current medications — including over-the-counter, herbal, supplements
Allergies

7. Menstrual & Gynaecological History

LMP and regularity of cycles
Previous gynaecological conditions: fibroids, PCOS, endometriosis, cervical dysplasia
Previous STIs / PID
Contraceptive history (especially IUCD — was it removed prior to pregnancy?)
Last Pap smear / cervical screening result

8. Family History

Diabetes, hypertension, pre-eclampsia, thromboembolic disease in first-degree relatives
Genetic conditions, chromosomal abnormalities, consanguinity
Recurrent miscarriages or stillbirths in the family
Congenital anomalies

9. Social History

Smoking — number of cigarettes/day, current or ex-smoker
Alcohol — units per week
Recreational drug use (including cannabis)
Occupation — any occupational hazards or teratogenic exposures?
Partner/relationship status and support at home
Housing situation
Domestic violence screening (ask sensitively and alone): "Do you ever feel unsafe at home?"
Significant stressors or mental health concerns (anxiety, depression, previous perinatal mental health history)

10. Systems Review (Relevant to Pregnancy)

Briefly screen:

Cardiovascular: palpitations, orthopnoea, PND, syncope
Respiratory: cough, wheeze, dyspnoea
Neurological: headache, visual changes, paraesthesiae
Urological: dysuria, haematuria, loin pain
Gastrointestinal: heartburn (very common), nausea, constipation

Key Red Flags — Escalate Immediately If Present

Red Flag	Consider
Severe headache + visual disturbance + oedema	Pre-eclampsia / eclampsia
Heavy PV bleeding + abdominal pain	Abruption / placenta praevia
Sudden gush of fluid	PPROM / PROM
Reduced or absent fetal movements	Fetal compromise
Generalised itching (palms/soles) + no rash	Obstetric cholestasis
Seizure in pregnancy	Eclampsia
Unilateral leg swelling + shortness of breath	DVT / PE
Severe vomiting + inability to keep fluids	Hyperemesis gravidarum

Sources: Creasy & Resnik's Maternal-Fetal Medicine: Principles and Practice (7th ed.); Berek & Novak's Gynecology (16th ed.); Geeky Medics Obstetric History Guide; AMBOSS OB/GYN History & Examination

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