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History of Present Illness (HOPI) in Obstetrics — Well-Written Examples

What is HOPI in Obstetrics?

In obstetrics, the HOPI covers two interlocking sections:

Current Pregnancy — details of the index pregnancy from LMP to the present complaint
Past Obstetric History — all previous pregnancies in chronological order

SECTION 1: CURRENT PREGNANCY — HOPI

Model Example 1: Routine Antenatal Visit (Booking Visit)

Mrs. Amina H., a 28-year-old G2P1+0, presents to the antenatal clinic at 12 weeks gestation for her booking visit.

Chief Complaint: Routine antenatal registration with mild nausea.

HOPI — Current Pregnancy:

The patient's Last Menstrual Period (LMP) was 14th February 2026, which was a normal period, regular in flow, lasting 5 days. Her cycles are regular, occurring every 28 days. The Expected Date of Delivery (EDD) calculated by Naegele's rule is 21st November 2026. This is a spontaneous conception. She is currently at 12 weeks and 3 days of gestation.

She presents with nausea for the past 4 weeks, occurring predominantly in the morning. There is no vomiting, no inability to tolerate oral feeds, and no weight loss. She denies any episodes of haematemesis. She has not required hospital admission for the nausea.

She has had no per vaginal bleeding at any point during this pregnancy. There has been no abdominal pain, no dysuria, no urinary frequency beyond expected pregnancy changes, and no vaginal discharge of note.

She attended a private clinic at 8 weeks where an ultrasound confirmed a single live intrauterine pregnancy with fetal heartbeat present, and crown-rump length consistent with dates.

She has been taking folic acid 5 mg daily since 4 weeks prior to conception and continues to take it. She is not on any other medications. She has no known drug allergies.

She is a non-smoker, does not consume alcohol, and denies any illicit drug use. She works as a schoolteacher and is not exposed to any teratogens or radiation.

Model Example 2: Emergency Presentation — Antepartum Haemorrhage

Mrs. Fatima L., a 32-year-old G3P2+0, presents to the labour ward at 34 weeks gestation with per vaginal bleeding.

Chief Complaint: Sudden-onset painless per vaginal (PV) bleeding for 2 hours.

HOPI — Current Pregnancy:

LMP was 4th September 2025; cycles were regular, 28-day intervals. EDD is 11th June 2026. The current gestational age is 34 weeks and 1 day. This is a spontaneous conception, unbooked until 16 weeks.

The patient reports a sudden onset of bright red, painless PV bleeding that began approximately 2 hours prior to presentation while she was at rest. She describes bleeding equivalent to 3 soaked sanitary pads. There are no associated uterine contractions, no abdominal pain, and no lower abdominal cramps. She denies trauma to the abdomen. There is no passage of clots or tissue.

Fetal movements were last felt 1 hour ago and are described as reduced compared to her usual pattern. Prior to this episode, she reports the pregnancy has been otherwise uncomplicated except for an ultrasound at 20 weeks which reportedly showed a low-lying placenta — she was advised to return for a repeat scan at 32 weeks but did not attend.

She has had no previous episodes of PV bleeding in this pregnancy. There are no symptoms of pre-eclampsia: no headache, no visual disturbance, no epigastric pain, no facial or hand oedema.

She takes no medications and has no known allergies. She is a non-smoker. She had one previous caesarean section (see Past Obstetric History below).

Model Example 3: Hypertensive Disorder in Pregnancy

Mrs. Grace T., a 35-year-old G1P0, presents at 36 weeks with headache and leg swelling.

Chief Complaint: Severe frontal headache and bilateral leg swelling for 2 days.

HOPI — Current Pregnancy:

LMP was 20th August 2025. Regular 30-day cycles. EDD is 27th May 2026. She is currently 36 weeks and 2 days gestation. This is a spontaneously conceived first pregnancy. Antenatal care has been regular at the district hospital; she has attended 7 antenatal visits.

She presents with a severe frontal headache that has been present for 2 days, described as throbbing in character, rated 8/10 in severity, not relieved by paracetamol. It is associated with blurring of vision (seeing "spots"), occurring intermittently. She denies diplopia.

She has noted bilateral ankle and leg swelling over the same 2-day period, which is pitting in nature, worse by evening, and extending up to the knees. She has had mild ankle swelling throughout the pregnancy but the current swelling is markedly worse.

There is no epigastric or right upper quadrant pain, no nausea or vomiting. She reports reduced fetal movements over the past 24 hours compared to her baseline.

Her blood pressure was noted to be elevated (162/108 mmHg) at a community health post earlier today, prompting referral. Her previous antenatal visits recorded normal blood pressure up to 30 weeks; at her 32-week visit, BP was 140/90 mmHg and she was advised to monitor closely.

She has no history of pre-existing hypertension, renal disease, or diabetes. She takes only pregnancy supplements (folic acid, ferrous sulphate). She is a nulliparous teacher, non-smoker, lives with her husband.

SECTION 2: PAST OBSTETRIC HISTORY

The past obstetric history should be recorded chronologically, for each prior pregnancy, covering:

Year / gestational age
Mode of onset (spontaneous / induced / assisted conception)
Course of pregnancy (complications)
Mode of delivery (SVD, instrumental, LSCS — indication)
Birthweight, sex, APGAR score (if known)
Maternal and fetal outcome
Puerperium

Model Example — Past Obstetric History (G3P2+0)

For Mrs. Fatima L. above (G3P2+0):

First Pregnancy (2018): A spontaneous conception. Pregnancy was uncomplicated. She was booked at 8 weeks and attended regular antenatal care. At 39 weeks, she went into spontaneous labour and delivered vaginally (SVD). The baby was a live female, birthweight 3.1 kg, APGAR score 9/10 at 1 and 5 minutes. No perineal tears requiring repair. Postpartum period was uneventful. Breastfed for 1 year.

Second Pregnancy (2021): Spontaneous conception. Booked at 10 weeks. Gestational diabetes was diagnosed at 28 weeks on oral glucose tolerance test (OGTT) and was managed with dietary modification alone. At 38 weeks, she was induced due to suspected macrosomia. After 12 hours of labour, progress arrested at 7 cm cervical dilatation; a decision was made for emergency lower segment caesarean section (LSCS) under spinal anaesthesia for failure to progress. The baby was a live male, birthweight 3.9 kg, APGAR score 9/10. She received a course of antibiotics postoperatively. Recovery was uneventful. Breastfed for 8 months.

Current Pregnancy (Third): As described in HOPI above — 34 weeks, presenting with antepartum haemorrhage, background of low-lying placenta on 20-week scan, missed 32-week follow-up scan.

Model Example — Past Obstetric History (with adverse outcomes)

For a G4P1+2 (one living child, two losses):

First Pregnancy (2015): Spontaneous conception. At 8 weeks, she had per vaginal bleeding and lower abdominal cramping. Pelvic ultrasound confirmed a missed abortion (embryonic demise at 7 weeks). Managed with medical evacuation (misoprostol). No surgical intervention required. Histology not performed. Recovered uneventfully.

Second Pregnancy (2017): Spontaneous conception. At 22 weeks, she had cervical dilatation discovered on routine examination (cervical length 18 mm on ultrasound at 18 weeks). A cervical cerclage (McDonald's suture) was placed at 19 weeks. Despite this, she went into preterm labour at 23 weeks and delivered a live male, birthweight 530 g. The baby was admitted to the neonatal intensive care unit (NICU) but succumbed on day 3 of life due to extreme prematurity and respiratory failure. This was classified as a neonatal death. She received postnatal counselling and rhesus prophylaxis (she is Rh-negative, blood group B-negative). The puerperium was otherwise uncomplicated.

Third Pregnancy (2020): Spontaneous conception. Received high-risk antenatal care given prior cervical incompetence. Prophylactic cerclage placed at 14 weeks. Progesterone supplementation commenced at 16 weeks. Pregnancy proceeded to 38 weeks. She underwent elective LSCS due to previous classical uterine incision. Delivered a live female, birthweight 3.2 kg, APGAR 10/10. No maternal or neonatal complications. Currently alive and well, aged 6 years.

Current Pregnancy (Fourth): Spontaneous conception. Cerclage in situ since 13 weeks. Currently at 28 weeks with no complications to date.

SUMMARY TABLE: Key Questions to Cover in Obstetric HOPI

Current Pregnancy

Domain	Key Questions
Dates	LMP (regularity, duration, flow), EDD, gestational age, cycle length
Conception	Spontaneous vs. assisted (IUI/IVF), planned vs. unplanned
Booking	When booked, where, how many ANC visits
Chief Complaint	Onset, duration, severity, progression, associated symptoms
Bleeding	PV bleeding — when, quantity, painless/painful, clots, recurrence
Pain	Abdominal pain — character, location, radiation, relation to contractions
Fetal movements	When first felt (quickening), frequency per day, any change
Hypertensive symptoms	Headache, visual disturbance, epigastric pain, facial oedema
Urinary symptoms	Dysuria, frequency, haematuria (UTI / pyelonephritis)
Vaginal discharge	Colour, smell, volume, itch (infection screening)
Labour symptoms	Show, rupture of membranes (time, colour of liquor), contractions
Scans	Dates, findings (dating scan, anomaly scan, placental location)
Investigations	Bloods (FBC, group & save, OGTT, VDRL, HIV), results
Medications	Folic acid, iron, progesterone, insulin, steroids, any others
Exposure	Smoking, alcohol, drugs, teratogens, radiation, illness in first trimester

Past Obstetric History (per pregnancy)

Domain	Key Questions
Year and gestation	Year of delivery, gestational age at delivery
Mode of conception	Spontaneous, IVF, etc.
Complications	Gestational diabetes, PET, APH, anaemia, infections, IUGR
Labour onset	Spontaneous / induced — indication for induction
Mode of delivery	SVD / vacuum / forceps / LSCS — indication for operative delivery
Uterine incision	Classical vs. lower segment (for LSCS)
Fetal outcome	Birthweight, sex, APGAR scores, alive/stillbirth/neonatal death
Neonatal care	NICU admission, duration, reason
Maternal outcome	PPH, wound infection, DVT, transfusion
Puerperium	Smooth recovery, postnatal depression, breastfeeding

Clinical Tips

Always document Gravida/Para using the full notation: e.g., G4P1+2 (1 term delivery, 2 miscarriages, currently pregnant = G4).
For any LSCS, always clarify: emergency vs. elective, indication, and critically type of uterine incision (lower segment vs. classical), as this determines trial of scar eligibility.
Any stillbirth or neonatal death requires sensitive documentation of gestational age, cause if known, and whether autopsy or histology was performed.
Rhesus status must be cross-referenced with each pregnancy outcome to confirm whether anti-D prophylaxis was given.
Document interval between pregnancies, as short interpregnancy intervals (<18 months) carry increased risk of uterine rupture, anaemia, and preterm birth.

I need only hopi part how to write them examples 10 written examples

Here are 10 well-written HOPI examples covering a wide range of obstetric presentations. Each follows the standard clinical write-up format used in medical records and case presentations.

10 HOPI Examples in Obstetrics

Example 1: Routine Booking Visit (First Pregnancy)

Patient: Mrs. Sarah K., 24 years, G1P0, presenting at 10 weeks gestation. Chief Complaint: First antenatal visit with mild nausea.

Mrs. Sarah K., a 24-year-old primigravida, presents to the antenatal clinic for her first booking visit. Her last menstrual period (LMP) was the 8th March 2026, which was a normal period, regular in flow and duration, lasting 5 days. Her menstrual cycles are regular, occurring every 28 days. The expected date of delivery (EDD) calculated by Naegele's rule is the 13th December 2026, placing her at 10 weeks and 2 days of gestation. This is a spontaneous, unplanned but accepted conception.

She presents with nausea occurring predominantly in the morning for the past 3 weeks. She has had 2–3 episodes of vomiting per day but is able to retain adequate oral fluids and solids. There has been no haematemesis and no significant weight loss. She has not required hospital admission for the vomiting.

She reports no per vaginal (PV) bleeding at any point in this pregnancy. There is no abdominal pain, no pelvic pressure, and no vaginal discharge of concern. She has not yet had an ultrasound scan.

She commenced folic acid 400 mcg daily 2 weeks prior to conception and has continued it. She takes no other medications. She has no known drug allergies. She is a non-smoker, does not consume alcohol, and denies illicit drug use. She is employed as a bank clerk and is not exposed to any known teratogens.

Example 2: Antepartum Haemorrhage — Placenta Praevia

Patient: Mrs. Kemi A., 31 years, G3P2+0, presenting at 34 weeks gestation. Chief Complaint: Sudden painless per vaginal bleeding for 3 hours.

Mrs. Kemi A., a 31-year-old woman in her third pregnancy, presents to the labour ward as an emergency. Her LMP was the 3rd September 2025, regular 28-day cycles, EDD 10th June 2026. She is currently at 34 weeks and 4 days gestation. This is a spontaneous conception. She booked at 14 weeks and has attended 5 of 7 scheduled antenatal visits.

She reports a sudden onset of bright red, painless per vaginal bleeding that began approximately 3 hours ago while she was at rest watching television. She has soaked 4 sanitary pads since onset. The bleeding has not stopped. There are no associated uterine contractions, no lower abdominal pain, and no cramping. There is no history of preceding trauma or coitus.

She had an ultrasound scan at 20 weeks that reported a posterior low-lying placenta, and she was asked to return for a repeat scan at 32 weeks. She did not attend that follow-up appointment. There have been no prior episodes of PV bleeding in this pregnancy.

Fetal movements were last perceived approximately 1 hour ago and she feels they are slightly reduced compared to her usual pattern. There are no symptoms of pre-eclampsia: no headache, no visual disturbance, no epigastric pain, and no sudden facial or hand swelling.

She has had two previous lower segment caesarean sections (LSCS). She takes ferrous sulphate and folic acid. She has no known drug allergies. She is a non-smoker and does not drink alcohol.

Example 3: Pre-eclampsia

Patient: Mrs. Diana O., 36 years, G1P0, presenting at 37 weeks gestation. Chief Complaint: Severe headache, visual blurring, and leg swelling for 24 hours.

Mrs. Diana O., a 36-year-old primigravida, was referred from a primary health centre after elevated blood pressure was noted. Her LMP was the 14th August 2025; cycles were regular every 30 days. EDD is 21st May 2026. She is currently at 37 weeks and 1 day of gestation. This was a spontaneous conception following 2 years of trying.

She presents with a severe throbbing frontal headache that started 24 hours ago, rated 9/10 in severity, not relieved by two doses of paracetamol 1g. The headache is associated with blurring of vision and intermittent "flashing lights." She denies diplopia or complete loss of vision.

She has had bilateral lower limb swelling progressively worsening over the past 4 days, now pitting in nature, extending to the mid-shin, worse at the end of the day. She also reports mild facial puffiness on waking.

She has no epigastric or right upper quadrant pain and no nausea or vomiting. Fetal movements are maintained and normal in frequency.

Her blood pressure at the referring facility was 168/112 mmHg. Her previous antenatal BP recordings were within normal limits until her 34-week visit when a BP of 140/90 mmHg was recorded and she was advised close monitoring; she did not return for the planned 36-week visit.

Urinalysis at the referring facility showed 3+ proteinuria on dipstick. She had no pre-existing hypertension or renal disease prior to pregnancy. She takes only folic acid and ferrous sulphate. She is a non-smoker and does not drink alcohol.

Example 4: Preterm Labour

Patient: Mrs. Blessing N., 29 years, G2P1+0, presenting at 30 weeks gestation. Chief Complaint: Painful uterine contractions every 10 minutes for 2 hours.

Mrs. Blessing N., a 29-year-old woman in her second pregnancy, presents to the labour ward with uterine contractions. Her LMP was the 17th October 2025, regular 28-day cycles, EDD 24th July 2026. She is at 30 weeks and 0 days gestation. This is a spontaneous conception, booked at 10 weeks.

She reports the onset of regular, painful uterine contractions approximately 2 hours ago, occurring every 8–10 minutes, each lasting 30–45 seconds. She describes the pain as cramping in the lower abdomen and lower back. The contractions have been increasing in frequency and intensity since onset.

She reports a watery vaginal discharge that began 30 minutes before the contractions, which she suspects may be her waters. There has been no PV bleeding. She has had no recent sexual intercourse and no history of recent trauma.

Fetal movements are present and normal. She has had no fever, no dysuria, and no urinary frequency. She had a urinary tract infection at 24 weeks, treated with a course of nitrofurantoin, confirmed cleared on culture. No other pregnancy complications have been noted.

She had no previous preterm birth. Her antenatal cervical length scan at 20 weeks was 27 mm (borderline), for which close monitoring was advised. She takes ferrous sulphate and folic acid. She has no known drug allergies. She is a non-smoker.

Example 5: Gestational Diabetes — Initial Presentation

Patient: Mrs. Rukayat M., 38 years, G4P3+0, presenting at 28 weeks gestation. Chief Complaint: Referred for management of abnormal OGTT result.

Mrs. Rukayat M., a 38-year-old woman in her fourth pregnancy, presents to the high-risk antenatal clinic following an abnormal oral glucose tolerance test (OGTT). Her LMP was the 24th November 2025, cycles regular every 28 days, EDD 31st August 2026. She is currently at 28 weeks and 3 days gestation. This is a spontaneous conception.

She was referred after a 75g OGTT performed 1 week ago returned a fasting glucose of 5.6 mmol/L and a 2-hour glucose of 9.4 mmol/L, meeting the IADPSG criteria for gestational diabetes mellitus (GDM).

She reports no symptoms of hyperglycaemia: no polydipsia, no polyuria beyond normal pregnancy changes, no visual blurring, and no recurrent infections. She has had no hypoglycaemic episodes. She has been monitoring blood glucose at home with a glucometer for the past week and readings range from 5.8–8.2 mmol/L fasting and up to 10.1 mmol/L post-prandially.

She has had no PV bleeding, no abdominal pain, and no symptoms of pre-eclampsia in this pregnancy. Fetal movements are present and normal. An ultrasound at 24 weeks showed polyhydramnios (AFI 24 cm) and an estimated fetal weight on the 85th centile.

She has no pre-existing diabetes. She has a strong family history of type 2 diabetes (mother and two maternal aunts). She had GDM in her third pregnancy managed with dietary modification alone, which resolved postpartum. Her fasting glucose at booking in this pregnancy was 4.9 mmol/L. Current medications: folic acid and ferrous sulphate. No known drug allergies. Non-smoker, does not drink alcohol. BMI at booking was 31 kg/m².

Example 6: Ectopic Pregnancy

Patient: Miss Josephine C., 22 years, G1P0, presenting as emergency. Chief Complaint: Right-sided lower abdominal pain and PV spotting for 6 hours.

Miss Josephine C., a 22-year-old nulliparous woman, presents to the emergency department with acute onset right lower abdominal pain. Her LMP was the 31st March 2026, cycles reportedly regular every 28 days. This makes her approximately 6 weeks and 3 days by dates. She has not had a formal pregnancy test prior to today.

She reports a sudden onset of sharp, constant right iliac fossa pain that started 6 hours ago, rated 7/10 in severity, with mild radiation to the right shoulder tip. The pain has not been relieved by paracetamol. It is associated with nausea but no vomiting.

She reports light PV spotting — dark brown in colour — which began 2 days ago and has been continuous, amounting to less than one pad per day. She has had no heavy PV bleeding and no passage of tissue. She has not experienced fainting but reports one episode of dizziness on standing this morning.

She reports a previous episode of right-sided pelvic inflammatory disease (PID) treated with antibiotics 18 months ago. She has not used contraception for the past 3 months. She is sexually active with a single partner.

A urine pregnancy test performed in the emergency department is positive. She has no known drug allergies. She is a non-smoker. She takes no regular medications.

Example 7: Hyperemesis Gravidarum

Patient: Mrs. Fatima Y., 26 years, G2P1+0, presenting at 9 weeks gestation. Chief Complaint: Intractable vomiting with inability to tolerate oral intake for 5 days.

Mrs. Fatima Y., a 26-year-old woman in her second pregnancy, presents to the gynaecology ward with severe, persistent vomiting. Her LMP was the 18th March 2026, regular 28-day cycles, EDD 23rd December 2026. She is at 9 weeks and 0 days of gestation. Spontaneous conception.

She reports nausea and vomiting that began at 6 weeks, initially in the mornings only. Over the past 5 days, the vomiting has become constant, occurring 10–15 times per day, including overnight. She is completely unable to tolerate any oral intake — liquids, solids, or medications. She vomits immediately upon attempting to drink water.

She has had no blood in the vomit (no haematemesis). She reports significant weight loss — she weighed herself 4 days ago and estimates she has lost approximately 3–4 kg. She feels markedly weak and dizzy. She has had no urine output in the past 8 hours.

There is no abdominal pain, no PV bleeding, no fever, and no diarrhoea. She has had no headache or visual disturbance. Fetal viability has been confirmed on a scan done at 7 weeks (heartbeat present, CRL consistent with dates).

She had hyperemesis in her first pregnancy that required a 3-day hospital admission at 8 weeks, which resolved by 14 weeks. She normally takes folic acid and ferrous sulphate but has been unable to take them for the past 5 days. She has no known drug allergies. She is a non-smoker.

Example 8: Intrauterine Growth Restriction (IUGR)

Patient: Mrs. Chidinma E., 34 years, G3P1+1, presenting at 32 weeks gestation. Chief Complaint: Reduced fetal movements and small-for-dates abdomen noted at antenatal visit.

Mrs. Chidinma E., a 34-year-old woman in her third pregnancy, was referred to the high-risk clinic from her routine antenatal visit today. Her LMP was the 28th October 2025, regular 30-day cycles, EDD 4th August 2026. She is at 32 weeks and 1 day of gestation. This is a spontaneous conception, booked at 12 weeks.

She was referred after the midwife noted that the symphysio-fundal height (SFH) measured 28 cm today, which is 4 cm below the expected measurement for gestational age. The SFH at her previous visit (28 weeks) was also noted to be on the lower end at 26 cm.

She reports that she has perceived fewer fetal movements over the past 3 days, describing fewer than 10 movements in a 12-hour period compared to her usual vigorous fetal activity. She has not performed a kick count chart but is clearly aware of the change. She has had no PV bleeding and no abdominal pain.

She reports that her appetite has been poor throughout the pregnancy due to persistent nausea. She has gained only 5 kg by 32 weeks. She has no headache, no visual symptoms, and no leg swelling beyond mild ankle oedema.

She is a known chronic smoker — 8–10 cigarettes per day — and has not been able to stop despite counselling at every antenatal visit. She has a history of essential hypertension pre-dating the pregnancy, for which she was on methyldopa 250 mg TDS since 8 weeks. Her BP readings have been well-controlled throughout. She has no known drug allergies.

Example 9: Premature Rupture of Membranes (PROM) at Term

Patient: Mrs. Amara S., 27 years, G2P1+0, presenting at 39 weeks gestation. Chief Complaint: Sudden gush of fluid per vagina 4 hours ago.

Mrs. Amara S., a 27-year-old woman in her second pregnancy, presents to the labour ward. Her LMP was the 14th August 2025, regular 28-day cycles, EDD 21st May 2026. She is at 38 weeks and 6 days of gestation. This is a spontaneous conception, booked at 8 weeks.

She reports a sudden gush of clear, watery fluid per vaginum that occurred 4 hours ago at 4:00 AM while she was asleep. The fluid soaked through her underwear and bed sheet. Since then, she has had a continuous slow trickle of fluid. The fluid is clear with no foul odour and no blood staining. She has applied a pad which has been soaked through once in the past hour.

She has had no uterine contractions since the rupture. She has no abdominal pain and no lower back cramping. She has no fever and no chills. She reports active fetal movements since the fluid loss, with the baby moving normally.

She has had no PV bleeding at any point in this pregnancy. There has been no prior episode of fluid loss. Her pregnancy has been uncomplicated to date; her 20-week anomaly scan was normal and placenta was noted to be fundal and posterior. Group B Streptococcus (GBS) swab result at 36 weeks is unknown — she was not tested.

She takes folic acid and ferrous sulphate. No known drug allergies. She is a non-smoker. Her previous delivery was a normal spontaneous vaginal delivery at term.

Example 10: Postdates Pregnancy — Induction of Labour

Patient: Mrs. Ngozi I., 30 years, G2P1+0, presenting at 41 weeks and 3 days gestation. Chief Complaint: Referred for induction of labour — postdates pregnancy.

Mrs. Ngozi I., a 30-year-old woman in her second pregnancy, is admitted to the labour ward for induction of labour following a postdates pregnancy. Her LMP was the 4th August 2025, confirmed by a dating ultrasound at 8 weeks which was consistent with dates (crown-rump length corresponding to 8 weeks and 0 days). Her confirmed EDD is 11th May 2026. She is currently at 41 weeks and 3 days gestation. This is a spontaneous conception.

She has had no spontaneous labour onset despite the pregnancy being postdates. She reports no uterine contractions, no rupture of membranes, and no PV bleeding or spotting. She has had no PV show.

Fetal movements are present and normal — she reports 10–12 perceived movements in the past 12 hours. She performed a kick count chart over the past 2 days as instructed and results were reassuring. A biophysical profile (BPP) performed yesterday scored 8/8, and Doppler studies of the umbilical artery were within normal limits (S/D ratio 2.1, no absent or reversed end-diastolic flow).

She has had no complications throughout the pregnancy. Blood pressure has been consistently normal. There is no proteinuria, no pedal oedema, no headache, or visual disturbance. Her 20-week anomaly scan was entirely normal and placenta was noted to be anterior and upper segment.

She has had a previous uncomplicated spontaneous vaginal delivery at 39 weeks in 2023. She has no uterine scars. She is currently on folic acid and ferrous sulphate, with no known drug allergies. She is a non-smoker. She and her husband have consented to induction of labour and have been counselled on the process.

How the HOPI is Structured in Every Example

Each HOPI follows this consistent skeleton:

Component	What to Include
Patient ID	Age, gravida/para status, gestational age
LMP + EDD + GA	LMP character, cycle regularity, EDD, confirmed GA
Mode of conception	Spontaneous / assisted / planned
Booking & ANC	When booked, number of visits attended
Chief Complaint	The presenting symptom with onset and duration
HPI of complaint	Onset, duration, severity, character, progression, aggravating/relieving factors
Associated symptoms	Related symptoms that support or refine the diagnosis
Relevant negatives	Key symptoms ruled out (bleeding, pain, fetal movements, HTN symptoms)
Fetal movements	Presence, frequency, any change
Antenatal investigations	Scans, blood results, urine results relevant to presentation
Medications	Current medications and compliance
Social history	Smoking, alcohol, occupation, teratogen exposure

Points to ask in obstetrics

Complete Points to Ask in Obstetric History

1. BIODATA

Name, age, occupation
Husband's name, age, occupation
Address, religion, ethnicity
Date of admission / date seen
Parity (Gravida / Para / + abortions)

2. CHIEF COMPLAINT

What brings her in today
Duration of the complaint

3. HISTORY OF PRESENT ILLNESS (HOPI)

A. Menstrual History

LMP — date, was it normal in character, flow, and duration?
Was it heavier/lighter/shorter/longer than usual?
Cycle regularity — regular or irregular? Length of cycle (e.g., 28 days)?
EDD — calculated by Naegele's rule (LMP + 9 months + 7 days)
Is she sure of her dates?

B. Current Pregnancy Details

Gestational age — by dates and/or ultrasound
Mode of conception — spontaneous, IUI, IVF
Planned or unplanned pregnancy
When did she book for antenatal care?
Where has she been receiving ANC?
Number of ANC visits attended
Dating scan — done? Result? Consistent with dates?

4. PRESENTING COMPLAINT IN DETAIL

Ask about the main symptom in full (SOCRATES):

Abbreviation	What to Ask
S — Site	Where exactly is the pain/problem?
O — Onset	When did it start? Was it sudden or gradual?
C — Character	What does it feel like? Cramping, throbbing, sharp, dull?
R — Radiation	Does it spread anywhere (shoulder tip, back, thigh)?
A — Associations	What comes with it? Nausea, vomiting, fever, bleeding?
T — Timing	Constant or intermittent? Getting better or worse?
E — Exacerbating/Relieving	What makes it worse or better?
S — Severity	Score it 1–10. Does it affect daily activities?

5. SYSTEMIC REVIEW OF PREGNANCY SYMPTOMS

These must be asked in every obstetric patient, regardless of complaint:

A. Per Vaginal (PV) Bleeding

Any bleeding at any point in this pregnancy?
If yes: when, how much (number of pads/hour), colour (bright red / dark / old blood)
Painless or painful?
Any passage of clots or tissue?
Any bleeding after intercourse (post-coital bleeding)?
Any prior episodes earlier in pregnancy?

B. Abdominal Pain

Any abdominal pain?
Location — central, lower, right iliac fossa, epigastric, right upper quadrant?
Character — cramping (labour-like), sharp, constant, colicky?
Onset — sudden or gradual?
Relationship to contractions?
Any pain at rest vs. on movement?

C. Fetal Movements

When did she first feel movements (quickening)?
- Primigravida: usually 18–20 weeks
- Multigravida: usually 16–18 weeks
Frequency per day (normal: ≥10 movements in 12 hours)
Any change in frequency — increased, reduced, absent?
How does it compare to her usual pattern?
When were movements last felt?

D. Uterine Contractions / Labour Symptoms

Any tightening of the abdomen?
Frequency (how many per hour / per 10 minutes)?
Duration of each contraction?
Regularity — are they becoming more frequent and stronger?
Any show (blood-stained mucus plug)?
Any rupture of membranes (sudden gush or trickle of fluid per vaginum)?
- If yes: time it occurred, colour of fluid (clear / blood-stained / green / foul-smelling), amount

E. Symptoms of Pre-eclampsia / Hypertension

Headache — location, severity, duration, response to analgesia?
Visual disturbance — blurring, flashing lights, spots, double vision?
Epigastric / right upper quadrant pain — any liver capsule tenderness?
Facial puffiness or swelling of hands on waking?
Leg swelling — how high, pitting, how long?
Known history of high blood pressure before pregnancy?

F. Urinary Symptoms

Dysuria (painful urination)?
Increased urinary frequency (distinguish from normal pregnancy frequency)?
Haematuria (blood in urine)?
Loin pain or fever (pyelonephritis)?
Reduced urine output / oliguria?

G. Vaginal Discharge

Any abnormal vaginal discharge?
Colour — white, yellow, green, grey?
Smell — offensive odour?
Itch or vulval soreness?
Any sores or ulcers around the vulva?

H. Gastrointestinal Symptoms

Nausea — when, how often, how severe?
Vomiting — frequency per day, able to tolerate fluids?
Haematemesis?
Heartburn / reflux (very common in pregnancy)
Constipation or diarrhoea?
Any change in bowel habit?

I. Respiratory Symptoms

Cough — productive or dry?
Shortness of breath — at rest or on exertion?
Orthopnoea (unable to lie flat)?
Chest pain?

J. Symptoms of Anaemia

Dizziness, lightheadedness?
Palpitations?
Easily fatigued / breathless on minimal exertion?
Pallor (self-noticed)?

6. INVESTIGATIONS DONE IN THIS PREGNANCY

Ask about results of:

Ultrasound scans — dating scan (GA, singleton/twins), anomaly scan (20 weeks), growth scans, placental location
Blood tests — blood group and Rh factor, full blood count (anaemia), HIV, VDRL/RPR (syphilis), hepatitis B, haemoglobin electrophoresis (sickle cell)
Urine tests — urinalysis, midstream urine culture
OGTT — result if done (screen at 24–28 weeks, earlier if risk factors)
Cervical length — if measured
Pap smear — if done recently
Group B Streptococcus (GBS) swab — result if done (35–37 weeks)

7. MEDICATIONS IN THIS PREGNANCY

Folic acid — dose, when started (ideally pre-conception)
Ferrous sulphate / iron supplement
Calcium
Progesterone (vaginal or IM — indication?)
Antihypertensives (methyldopa, nifedipine, labetalol)
Insulin or metformin (if GDM)
Antiretrovirals (if HIV positive)
Antibiotics (any recent course — indication?)
Aspirin (if high risk for pre-eclampsia — started at ≤16 weeks?)
Any herbal remedies, traditional medicines, or supplements?
Compliance with medications?

8. PAST OBSTETRIC HISTORY

Record each prior pregnancy chronologically. For each, ask:

Point	What to Ask
Year	Year of delivery or loss
Gestational age	How many weeks at delivery / termination
Conception	Spontaneous or assisted
ANC	Was she booked, where
Complications	Any problem during pregnancy (HTN, GDM, bleeding, infections)
Labour	Spontaneous onset or induced — if induced, why?
Mode of delivery	SVD / forceps / vacuum / LSCS
LSCS details	Emergency or elective? Indication? Type of incision (lower segment vs. classical)?
Baby details	Male/female, birthweight, APGAR scores
Baby outcome	Alive and well / NICU admission / neonatal death / stillbirth
Puerperium	Smooth recovery / PPH / infection / wound breakdown / DVT
Breastfeeding	Breastfed? For how long?

Special questions for previous losses:

Miscarriage — gestational age, spontaneous or managed, surgical / medical / expectant?
Recurrent miscarriage — how many? Any investigations done?
Ectopic pregnancy — which tube? Managed surgically or medically?
Stillbirth — gestation, cause identified? Autopsy done?
Neonatal death — age at death, cause?

9. PAST MEDICAL HISTORY

Hypertension (pre-existing)
Diabetes mellitus (Type 1 or 2)
Cardiac disease (rheumatic heart disease, congenital)
Renal disease (chronic kidney disease, nephrotic syndrome)
Thyroid disease (hypothyroidism / hyperthyroidism)
Sickle cell disease or trait
Epilepsy
Asthma
Autoimmune disease (SLE, antiphospholipid syndrome)
HIV / TB / hepatitis B
Previous abdominal or pelvic surgeries (myomectomy, cervical surgery, appendicectomy)
History of deep vein thrombosis (DVT) or pulmonary embolism (PE)
Any blood transfusions — when, why?
Any hospital admissions — reason?

10. PAST SURGICAL HISTORY

Any previous operations?
Type of anaesthesia — general, spinal, epidural?
Any complications from surgery or anaesthesia?
Specifically: previous uterine surgery (LSCS type, myomectomy, hysterotomy) — scar status matters for current delivery planning

11. FAMILY HISTORY

Hypertension in parents or siblings
Diabetes mellitus
Multiple pregnancies (twins run in families — maternal side)
Pre-eclampsia in mother or sisters
Sickle cell disease or trait (both parents' status)
Congenital abnormalities in family
Hereditary bleeding disorders
Genetic conditions (Down syndrome, cystic fibrosis, thalassaemia)

12. SOCIAL HISTORY

Marital status — married, single, separated
Support at home — husband/partner, family support?
Occupation — current work status; any exposure to chemicals, radiation, heavy lifting?
Smoking — current smoker? How many cigarettes/day? For how long? Does partner smoke?
Alcohol — any consumption during pregnancy? Amount? Frequency?
Illicit drugs — current or past use? Type?
Diet — balanced? Any food aversions or cravings (especially pica — eating soil, chalk)?
Exercise — any activity or bed-rest advised?
Housing — living conditions, any overcrowding (TB risk)?
Travel — any recent travel to malaria-endemic area?
Financial/psychosocial — any stress, domestic violence concerns, or mental health issues?

13. DRUG AND ALLERGY HISTORY

Any known drug allergies?
Nature of reaction — rash, anaphylaxis, intolerance?
Any food allergies?
Previous adverse reactions to anaesthesia?

QUICK REFERENCE SUMMARY

BIODATA → CHIEF COMPLAINT → HOPI
  ├── LMP / EDD / GA / Mode of conception / Booking
  ├── Presenting complaint (SOCRATES)
  ├── PV bleeding
  ├── Abdominal pain
  ├── Fetal movements
  ├── Contractions / Show / ROM
  ├── Pre-eclampsia symptoms
  ├── Urinary symptoms
  ├── Vaginal discharge
  ├── GI symptoms
  └── Anaemia symptoms
INVESTIGATIONS IN THIS PREGNANCY
MEDICATIONS
PAST OBSTETRIC HISTORY (each pregnancy, chronological)
PAST MEDICAL HISTORY
PAST SURGICAL HISTORY
FAMILY HISTORY
SOCIAL HISTORY
DRUG & ALLERGY HISTORY

This is the complete framework for any obstetric patient — whether at booking, a routine visit, or emergency presentation. You use the same skeleton every time, then expand or abbreviate based on what's relevant to the case.

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