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Maternity Ward: Comprehensive History Taking & Common Complaints

Overview of the 3 Sections

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1. LABOUR ROOM

History Taking Framework

Presenting Complaint

• Why is she here? "I'm having contractions", "My water broke", "I'm bleeding"

History of Presenting Complaint (HPC)

• Contractions: onset, frequency, duration, regularity, severity (e.g., "contractions every 5 minutes, lasting 45 seconds, for 2 hours")
• Rupture of membranes (ROM): time of rupture, colour of fluid (clear, green/meconium-stained, blood-stained), amount, smell (offensive = infection)
• Show: blood-stained mucus plug — normal sign of cervical ripening
• Fetal movements: felt today? reduced? (last felt when?)
• Bleeding: amount, colour, with/without pain (painless = placenta praevia; painful = abruption)
• Leaking urine vs liquor — can be confused

Obstetric History (ALWAYS take fully)

• G_P_ — Gravida and Para status (e.g., G3P2 = 3rd pregnancy, 2 previous deliveries)
• Previous deliveries: SVD or C-section, gestational age, complications, birth weight
• Previous C-sections: number, type of uterine incision (LSCS — lower segment; classical)
• Previous complications: PPH, shoulder dystocia, retained placenta, perineal tears
• Miscarriages/terminations: how many, how managed

Current Pregnancy History

• Gestational age: LMP, EDD, confirmed by dating scan
• Antenatal care: booked? where? how many visits?
• Anomaly scan findings: any abnormalities?
• Complications this pregnancy: GDM, pre-eclampsia, anaemia, placenta praevia, IUGR, polyhydramnios
• Medications: iron, folic acid, antihypertensives, insulin, heparin
• GBS status (Group B Strep): positive/negative/unknown

Gynaecological History

• Last cervical smear, fibroids, previous uterine surgery

Medical History

• Hypertension, diabetes, asthma, epilepsy, cardiac disease, thyroid disorders, HIV/syphilis status
• Blood group and Rhesus status (e.g., O+, B-)

Allergies, Medications, Social History (AMSOC)

• Allergies (especially penicillin — relevant for GBS prophylaxis)
• Smoking, alcohol, substance use
• Support at home, domestic safety

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Common Complaints in Labour Room & Examples

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2. POST C-SECTION (Post-operative)

History Taking Framework

Establish the Operation First

• Date and time of surgery
• Indication for LSCS: elective (planned) vs emergency, and reason (e.g., previous LSCS, fetal distress, malpresentation, failed induction)
• Type of anaesthesia: spinal, epidural, or general anaesthetic (GA)
• Any intraoperative complications: excessive bleeding, uterine extension, bladder injury, blood transfusion needed

Post-op Complaints Systematic Review

• Pain: site (wound vs uterine vs shoulder-tip), severity, what helps, current analgesia
• Lochia: amount, colour, clots, offensive smell
• Urinary: catheter in situ? output adequate (>0.5 mL/kg/hr)? dysuria after catheter removal?
• Bowels: flatus passed? bowels opened? (ileus risk post-op)
• Wound: pain, swelling, discharge, bleeding, opening
• Fever/chills: suggestive of wound infection, endometritis, UTI, DVT
• Legs: calf pain, swelling, redness → DVT (significant risk post-LSCS)
• Breathing difficulty: PE risk
• Headache: post-dural puncture headache (if spinal used), worse on sitting/standing, relieved lying flat
• Nausea/vomiting: common post-spinal, post-opiate
• Breastfeeding: initiated? difficulty? pain?

Baby Status

• Baby in NICU? skin-to-skin achieved? feeding type?

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Common Complaints Post-C-Section & Examples

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3. POSTNATAL ROOM (Puerperal Ward)

History Taking Framework

Delivery Summary

• Date and time of delivery
• Mode: SVD, instrumental (forceps/ventouse), LSCS
• Any complications: PPH, perineal tears (degree 1–4), shoulder dystocia, manual removal of placenta

Systematic Postnatal Review

• Lochia: character (rubra → serosa → alba over weeks), amount, smell
• Perineum: pain from episiotomy/tears, swelling, suture breakdown, haematoma
• Breasts: engorgement, nipple pain, mastitis (red, hot, painful, systemic symptoms)
• Urinary: stress incontinence, frequency, dysuria, retention
• Bowels: constipation (very common — fear of opening bowels after perineal trauma), haemorrhoids
• Legs/VTE: calf pain, swelling
• Fever: endometritis most common cause of PUO post-delivery
• Mental health: mood, sleep, anxiety, bonding with baby, thoughts of harm
• Baby feeding: breastfeeding or formula? frequency, duration, latch problems, nipple trauma
• Baby wellbeing: feeding, wet nappies, jaundice, weight

Social & Discharge Planning

• Support at home (partner, family)
• Community midwife follow-up arranged?
• Contraception discussed?
• Rhesus negative → anti-D given?
• Rubella immunity → vaccination arranged?

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Common Complaints in Postnatal Room & Examples

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Quick Summary Comparison Table

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Maternity Ward — Clinical Examples by Section

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🏥 SECTION 1: LABOUR ROOM

Patient Example

Mrs. Amina, 28 years old, G2P1, at 39 weeks gestation

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History Taking — With Examples

1. Presenting Complaint

2. Rupture of Membranes

3. Fetal Movements

4. Bleeding

5. Obstetric History

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Common Complaints — Labour Room Examples

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"Doctor, the pain is a 10/10, I can't take it anymore, please give me something!"

• SOCRATES: Suprapubic + lower back, cramping, comes and goes every 3 minutes, radiating to thighs
• Action: Offer Entonox (gas and air), IM pethidine, or epidural (check contraindications first)
• Check: cervical dilation — if 8 cm, likely transition phase → delivery imminent

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"My waters broke and the fluid looked greenish and thick"

• Thick meconium = fetal distress sign
• Action: Continuous CTG, alert neonatology team, prepare for possible instrumental/LSCS delivery
• Key question: "How long ago did your waters break?" (prolonged SROM + meconium = double risk)

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"I have the worst headache of my life and I'm seeing flashing lights"

• Think: Pre-eclampsia / Eclampsia 🚨
• Check: BP (e.g., 168/110), urine dipstick (3+ protein), reflexes (brisk = impending eclampsia)
• Action: IV magnesium sulphate, antihypertensives (labetalol/hydralazine), urgent senior review
• Do NOT leave this patient alone

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"I HAVE to push, I can't stop myself!"

• VE confirms 7 cm — not fully dilated
• Pushing too early → cervical oedema, maternal exhaustion
• Action: Coach breathing (blow through contractions), lateral position, reassess in 30 minutes

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"I did a VE and I can feel something pulsating — it's the cord"

• CORD PROLAPSE 🚨 → obstetric emergency
• Action: Do not remove examining hand, elevate presenting part, call emergency team, category 1 LSCS, position knee-chest or Trendelenburg

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🏥 SECTION 2: POST C-SECTION (Post-operative Recovery)

Patient Example

Mrs. Blessing, 32 years old, G3P2 → now P3, had emergency LSCS 18 hours ago (Indication: fetal distress at 8 cm dilation, under spinal anaesthesia)

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History Taking — With Examples

1. Establish the Operation

2. Systematic Post-op Review

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Common Complaints — Post C-Section Examples

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"The cut is so painful I can't move, turn over, or even cough"

• Expected in first 24–48 hrs
• SOCRATES: Pfannenstiel incision site, constant + sharp on movement, 8/10
• Action: Regular paracetamol + diclofenac (if no contraindications), morphine PCA or IM if severe, support wound with pillow when coughing, early mobilisation

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"I have a severe headache — it started this morning. It's completely gone when I lie down but terrible when I sit up"

• Post-Dural Puncture Headache — classic presentation after spinal anaesthesia
• Mechanism: CSF leak through dural puncture → traction on meninges when upright
• Action: Bed rest, oral/IV caffeine, strong analgesia; if not resolving in 24–48h → blood patch (gold standard)

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"I feel hot, shivery, and my tummy is tender and my discharge smells bad"

• Think: Endometritis (most common post-LSCS infection)
• Fever Day 1: Atelectasis | Day 2–3: UTI, wound | Day 3–5: DVT | Day 5+: wound abscess
• Action: FBC, CRP, blood cultures, urine MC&S, wound swab → IV co-amoxiclav + metronidazole

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"It's been 6 hours since they removed the catheter and I still can't pass urine, I feel so full"

• Action: Bladder scan — if >400 mL retained → re-catheterise
• Causes: spinal anaesthesia effect, pain inhibiting voiding, perineal swelling
• Reassess in 24–48 hrs before further trial of void

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"My right leg has been swollen and painful since yesterday, much worse than the left"

• Think: Deep Vein Thrombosis (DVT) — C-section doubles VTE risk
• Action: Wells score, urgent Doppler USS, start therapeutic LMWH if confirmed
• Ensure thromboprophylaxis was prescribed post-op (enoxaparin 40 mg daily)

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"Why does my shoulder hurt? I didn't injure it"

• Referred pain from diaphragmatic irritation (residual blood/gas in peritoneum post-surgery)
• Reassure: self-limiting, resolves in 24–48 hrs. Regular analgesia.

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🏥 SECTION 3: POSTNATAL ROOM

Patient Example

Mrs. Fatima, 25 years old, G1P1, Day 2 post normal vaginal delivery (2nd degree perineal tear, sutured; baby girl 3.1 kg, breastfeeding)

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History Taking — With Examples

1. Delivery Summary

2. Systematic Postnatal Review

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Common Complaints — Postnatal Room Examples

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"My stitches are absolutely killing me, I can't sit, walk, or go to the toilet"

• Action: Ice pack first 24 hrs, paracetamol + ibuprofen regular, topical lidocaine gel
• Inspect: is swelling normal? Any haematoma (tense, painful swelling = blood collection → surgical review)?
• "The area is swelling up rapidly like a balloon" → Perineal haematoma 🚨 → urgent review

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"Both my breasts are rock hard, burning hot and so painful I can't lift my arms"

• Normal Day 2–4 as milk comes in (transitional milk)
• Action: Frequent feeding (8–12 times/day), warm compress before feed to help letdown, cold cabbage leaves/cold pack between feeds for comfort, gentle massage
• If one breast becomes red, hot, wedge-shaped area with flu symptoms → Mastitis → flucloxacillin 500 mg QDS x 10 days, continue breastfeeding

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"I suddenly passed a huge clot and soaked through 3 pads in one hour — this is Day 6"

• Secondary PPH: excessive bleeding >24 hours after delivery (primary = within 24 hrs)
• Causes: retained products of conception (RPOC), endometritis, uterine subinvolution
• Action: IV access, FBC, group & save, pelvic USS → if RPOC → surgical evacuation (ERPC); if infection → antibiotics

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"I haven't opened my bowels in 4 days. I'm terrified of pushing because of my stitches"

• Extremely common, especially after perineal trauma
• Action: Reassure — stitches will NOT burst; prescribe lactulose 15 mL BD + movicol; high fibre diet, adequate fluids; stool softener pre-emptively on Day 1

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"My baby looks yellow today — the nurse said it's normal but I'm worried"

• "The baby went yellow within 6 hours of birth" → Pathological jaundice 🚨 → urgent workup

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"The baby cries constantly, won't latch, and I think my milk isn't enough. I want to give up"

• Common cause of early breastfeeding cessation
• Assess: latch technique (mouth wide open, more areola than nipple), positioning (cradle, cross-cradle, football hold), feeding frequency
• Action: Lactation consultant referral, hand expressing to stimulate supply, reassure that colostrum is enough in Day 1–2 before milk comes in
• Check baby: adequate wet nappies (>6/day by Day 4), regained birth weight by Day 10–14

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Master Summary — One-Page Reference

LABOUR ROOM          POST C-SECTION         POSTNATAL ROOM
─────────────────    ──────────────────     ──────────────────────
Pain → analgesia     Wound pain             Perineal pain
APH → praevia/abruption  PDPH (postural)   Breast engorgement/mastitis
ROM → colour, time   Fever (Day rule)       Baby blues / PPD
Reduced FM → CTG     Urinary retention      Secondary PPH
Hypertension → PET   DVT → calf pain        Constipation
Cord prolapse 🚨     Shoulder-tip pain      Neonatal jaundice