Full obstetric history with examples and explanations smart

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The library doesn't have a dedicated "obstetric history" heading, but I have the Creasy & Resnik's Maternal-Fetal Medicine and Berek & Novak's Gynecology available. I'll now compile a comprehensive, well-structured obstetric history from authoritative knowledge, referencing these sources.

Full Obstetric History — Comprehensive Guide with Examples

A complete obstetric history is the systematic collection of all pregnancy-related information about a patient. It forms the backbone of antenatal care and risk stratification.

1. IDENTIFICATION DATA

Element	Example
Name	Mrs. Amina Hassan
Age	28 years
Parity / Gravidity	G3P2 (see below)
Marital status	Married
Occupation	Teacher
Last Menstrual Period (LMP)	14 August 2025
Expected Date of Delivery (EDD)	21 May 2026

2. GRAVIDITY & PARITY — The G/P System

Definitions

Term	Definition
Gravida (G)	Total number of pregnancies, regardless of outcome (includes current pregnancy)
Para (P)	Number of pregnancies delivered at ≥20 weeks gestation (or ≥500g), regardless of whether the baby was alive or dead
Nulligravida	Never been pregnant
Primigravida	Currently in first pregnancy
Multigravida	Has been pregnant more than once
Nullipara	Never delivered a viable pregnancy
Primipara	Delivered once
Multipara	Delivered twice or more
Grand multipara	Delivered 5 or more times

The TPAL System (more detailed)

Used in North America. Breaks parity into 4 digits: T-P-A-L

Letter	Meaning
T	Term deliveries (≥37 weeks)
P	Preterm deliveries (20–36+6 weeks)
A	Abortions (spontaneous or induced, <20 weeks)
L	Living children

Examples

Scenario	G	P	TPAL
Never pregnant	G0	P0	—
Currently 1st pregnancy, no prior births	G1P0	P0	0-0-0-0
One full-term delivery, now pregnant again	G2P1	P1	1-0-0-1
2 term births, 1 miscarriage, now pregnant	G4P2	P2	2-0-1-2
3 term births, 1 preterm, 1 miscarriage, 1 abortion, 4 living children	G6P4	P4	3-1-2-4

Important rule: Twins count as one pregnancy but one para (if delivered ≥20 wks). If the woman had twins at 38 weeks, she is G1P1 — not P2.

3. LAST MENSTRUAL PERIOD (LMP) & GESTATIONAL AGE

Nägele's Rule for EDD

EDD = LMP + 9 months + 7 days (or LMP + 280 days)

Example:

LMP = 14 August 2025
Add 9 months → 14 May 2026
Add 7 days → EDD = 21 May 2026
Gestational age at booking = counted from LMP

Gestational Age Classification

Term	Weeks
Early preterm	20–31+6 wks
Preterm	32–36+6 wks
Term	37–41+6 wks
Post-term	≥42 wks

4. CURRENT PREGNANCY HISTORY

Elicit the following:

a) Presenting complaint

Why has she come today? Routine ANC visit, reduced fetal movements, pain, bleeding, discharge?

Example: "I've had heavy bleeding for 2 hours since this morning." → Leads to investigation for placenta praevia or abruption.

b) Booking visit details

Was this pregnancy planned/unplanned?
When did she first attend antenatal clinic?
Booking gestational age (ideally <12 weeks)
Was a dating ultrasound done?

c) Symptoms throughout pregnancy

Trimester	Key symptoms to ask about
1st (0–13 wks)	Nausea/vomiting, bleeding (threatened miscarriage), spotting
2nd (14–27 wks)	Fetal movements (felt from ~18–20 wks in primigravida, ~16–18 wks in multigravida), mid-trimester bleeding
3rd (28+ wks)	Fetal movement counting, contractions, headache, visual changes, epigastric pain (pre-eclampsia), leaking of liquor, bleeding

d) Antenatal investigations done

Blood group and Rhesus status
Full blood count (anaemia screen)
Urine culture (asymptomatic bacteriuria)
VDRL/RPR (syphilis)
HIV status and PMTCT (Prevention of Mother-to-Child Transmission)
Hepatitis B surface antigen
Rubella immunity
Oral glucose tolerance test (if gestational diabetes risk factors)
Nuchal translucency / anomaly scan (18–20 wks)

5. PREVIOUS OBSTETRIC HISTORY

For each prior pregnancy, record in chronological order:

Template per pregnancy

Element	What to Ask
Year	Year of delivery or loss
Gestation at outcome	How many weeks?
Mode of delivery	SVD, instrumental (forceps/ventouse), LSCS
Place of delivery	Hospital, home
Outcome	Live birth, stillbirth, neonatal death, miscarriage, ectopic, TOP
Baby's weight	Birthweight
Baby's sex	Male/female
Complications	APH, PPH, pre-eclampsia, obstructed labour, shoulder dystocia, perineal tears
Puerperium	Any postnatal complications, breastfeeding

Example — Previous Obstetric History of G3P2

Pregnancy 1 (2019):

39 weeks, SVD, boy, 3.2 kg, live birth, no complications
Puerperium: uneventful, breastfed for 6 months

Pregnancy 2 (2021):

34 weeks, emergency LSCS (for fetal distress), girl, 2.1 kg, admitted to NICU for 2 weeks, survived
Complication: postpartum haemorrhage, 900 mL blood loss, received oxytocin + ergometrine

Current Pregnancy 3 (2025–26):

Now 32 weeks, attending routine ANC, this case

6. GYNAECOLOGICAL HISTORY

Element	Example
Age at menarche	13 years
Cycle regularity	Regular, 28/5 (every 28 days, lasting 5 days)
Dysmenorrhoea	Mild cramps, no dyspareunia
Last Pap smear	2023, normal
Sexually transmitted infections	VDRL negative in current pregnancy
Uterine pathology	Uterine fibroids detected on USS in 2020
Previous gynaecological surgery	D&C after incomplete miscarriage in 2018
Contraception	OCP prior to this pregnancy

7. PAST MEDICAL & SURGICAL HISTORY

Critical co-morbidities affecting pregnancy:

Condition	Why it matters
Hypertension	Risk of superimposed pre-eclampsia, IUGR
Diabetes mellitus	Gestational DM, macrosomia, shoulder dystocia
Epilepsy	Drug teratogenicity (valproate → neural tube defects)
Cardiac disease	Heart failure in pregnancy
Thyroid disease	Hypothyroidism → cretinism; hyperthyroidism → neonatal thyrotoxicosis
HIV	PMTCT, ARV regimen, mode of delivery
SLE	Lupus flare, neonatal lupus, anti-Ro antibodies
Sickle cell disease	Sickle cell crisis, anaemia, IUGR
Asthma	Drug safety (steroids), respiratory compromise
Previous abdominal/uterine surgery	Risk of uterine rupture (scar)

Example: "I had a LSCS in 2021. This pregnancy I have a previous uterine scar — risk of uterine rupture, plan for elective LSCS vs trial of VBAC."

8. DRUG HISTORY & ALLERGIES

Category	Considerations
Current medications	Note all — OTC, herbal, prescription
Teratogens to screen for	ACE inhibitors (renal agenesis), warfarin (embryopathy), retinoids (craniofacial defects), valproate (NTD)
Supplements	Folic acid (400 mcg, ideally pre-conception to 12 wks), iron, calcium
Allergies	Drug, latex, food — and type of reaction

Example: "She is on metformin for pre-gestational T2DM, and was counselled to switch to insulin post-conception — but is still taking metformin."

9. FAMILY HISTORY

Condition	Relevance
Hypertension / Pre-eclampsia	Strong family history increases risk
Diabetes mellitus	Gestational DM risk
Multiple pregnancies (twins)	Dizygotic twins are hereditary
Congenital anomalies	Chromosomal disorders, neural tube defects
Bleeding disorders	Haemophilia, von Willebrand disease
Thalassaemia / sickle cell	Screen partner, genetic counselling

10. SOCIAL HISTORY

Element	Why it matters
Marital status / support	Domestic violence screening (ask SAFE questions)
Occupation	Heavy lifting, chemical exposure, stress
Smoking	IUGR, placental abruption, SIDS
Alcohol	Fetal alcohol syndrome (no safe level in pregnancy)
Illicit drugs	Neonatal abstinence syndrome (heroin, cocaine)
Diet & nutrition	Anaemia, neural tube defect prevention
Housing	Overcrowding, indoor air pollution
Financial situation	Social support, compliance with ANC

Example: "She smokes 5 cigarettes/day. Counselled on smoking cessation — risk of IUGR and placental abruption explained."

11. SYSTEMIC ENQUIRY (Review of Systems in Pregnancy)

System	Key questions
CNS	Headache, visual disturbances, seizures (→ eclampsia)
CVS	Palpitations, chest pain, oedema (physiological vs pathological)
Respiratory	Dyspnoea (physiological in late pregnancy vs cardiac/pulmonary)
GIT	Nausea, vomiting, heartburn (GERD common in pregnancy), constipation
Urinary	Frequency (normal), dysuria, haematuria (UTI/pyelonephritis)
MSK	Back pain, pelvic girdle pain, leg cramps
Skin	Striae gravidarum, pruritus (→ obstetric cholestasis if severe)
Fetal	Fetal movements: normal ≥10 movements in 2 hrs in third trimester

12. SUMMARY STATEMENT (Presenting the Case)

A well-structured summary after taking the history:

"Mrs. Amina Hassan is a 28-year-old teacher, G3P2, at 32 weeks gestation by LMP (EDD 21/05/2026), who presents for a routine antenatal visit. Her first pregnancy in 2019 resulted in an uncomplicated term SVD. Her second pregnancy in 2021 was complicated by preterm labour at 34 weeks requiring emergency LSCS for fetal distress, with a subsequent PPH of 900 mL. She has no significant medical history, is on folic acid and iron supplementation, is a non-smoker, and her booking investigations were all within normal limits. She reports good fetal movements and no symptoms of pre-eclampsia."

Quick Reference: High-Risk Features to Flag

Red Flag	Implication
Previous LSCS	Risk of uterine rupture, placenta praevia accreta
Grand multiparity (≥P5)	Uterine atony, abnormal placentation, malpresentation
Previous PPH	Anticipate, have oxytocics ready
Previous pre-eclampsia	Aspirin 75–150 mg/day from <16 weeks
Previous preterm birth	Cervical length scan, progesterone
Previous stillbirth	Intensified fetal surveillance
Maternal age ≥35	Aneuploidy screening, gestational DM, hypertension
Short inter-pregnancy interval (<18 months)	Preterm birth, uterine rupture (if scarred uterus)
Previous shoulder dystocia	Plan for senior obstetrician at delivery

Sources

This guide is grounded in principles from:

Creasy & Resnik's Maternal-Fetal Medicine: Principles and Practice (8th ed.)
Berek & Novak's Gynecology (16th ed.)
Standard clinical obstetrics teaching (Williams Obstetrics framework)

I need examples of cases written comprehensibly and using table in obstetric part

Full Obstetric History — Case Examples with Tables

📋 CASE 1: Low-Risk Primigravida

Identification


Name	Mrs. Sarah Okonkwo
Age	24 years
Occupation	Nurse
Marital status	Married, 2 years
LMP	10 September 2025
EDD	17 June 2026 (by Nägele's rule)
GA at booking	10 weeks

Gravida/Parity


Gravida	G1
Para	P0
TPAL	0-0-0-0
Status	Primigravida, Nullipara

Previous Obstetric History

#	Year	GA	Mode	Sex	Weight	Outcome	Complications
—	—	—	—	—	—	No prior pregnancies	—

Current Pregnancy History

Element	Details
Planned/unplanned	Planned
Booking visit	10 weeks at district hospital
Dating scan	Confirmed 10 weeks, single live fetus
Nausea/vomiting	Moderate 1st trimester, resolved at 14 weeks
Fetal movements	Felt since 20 weeks, good
Bleeding	None
Headache/visual changes	None
Ankle swelling	Mild, bilateral, worse in evenings (physiological)
ANC visits to date	5 visits, all uneventful

Antenatal Investigations

Investigation	Result
Blood group	O+ (Rh positive)
FBC	Hb 11.8 g/dL (mild anaemia — on iron)
HIV	Negative
VDRL	Non-reactive
HBsAg	Negative
Urine C&S	No growth
OGTT (28 wks)	Normal
Anomaly scan (20 wks)	No fetal anomaly detected
Nuchal translucency	1.2 mm (normal)

Past Medical/Surgical History


Medical	Nil significant
Surgical	Appendicectomy at age 16, uncomplicated
Allergies	Penicillin (rash)

Drug History

Drug	Dose	Indication
Ferrous sulphate	200 mg BD	Iron-deficiency anaemia
Folic acid	400 mcg OD	Neural tube defect prevention

Social History


Smoking	Non-smoker
Alcohol	None since conception
Illicit drugs	None
Housing	Lives with husband, stable home
Support	Strong family support

Summary Statement

Mrs. Sarah Okonkwo is a 24-year-old nurse, G1P0, at 34 weeks gestation (EDD 17/06/2026), attending for routine ANC. This is a planned, singleton pregnancy with no prior obstetric history. The pregnancy has been uneventful apart from mild first-trimester nausea and mild iron-deficiency anaemia, now on supplementation. Fetal movements are normal. All booking investigations were reassuring. No medical or social risk factors identified. Plan: continue routine ANC, growth scan at 36 weeks, counsel on labour signs.

📋 CASE 2: High-Risk Multigravida (Previous LSCS + Pre-eclampsia)

Identification


Name	Mrs. Fatima Al-Rashidi
Age	35 years
Occupation	Accountant
Marital status	Married, 10 years
LMP	1 August 2025
EDD	8 May 2026
GA at booking	9 weeks

Gravida/Parity


Gravida	G4
Para	P2
TPAL	1-1-1-2
Status	Multigravida

TPAL breakdown: 1 term delivery + 1 preterm delivery + 1 abortion (miscarriage) + 2 living children

Previous Obstetric History (presented in chronological table)

Preg #	Year	GA at Delivery	Mode of Delivery	Sex	Birthweight	Outcome	Maternal Complications	Fetal/Neonatal Complications
1	2016	39 wks	SVD	Female	3.4 kg	Live birth	Nil	Nil
2	2019	34 wks	Emergency LSCS	Male	2.0 kg	Live birth	Pre-eclampsia, PPH (1.2 L)	NICU admission 10 days (RDS)
3	2022	8 wks	— (medical management)	—	—	Miscarriage (incomplete)	D&C performed	—
4 (current)	2025–26	30 wks (ongoing)	—	—	—	Ongoing	—	—

Current Pregnancy History

Element	Details
Planned	Yes, after 1 year of trying
Booking visit	9 weeks
Dating scan	Confirmed 9+2 weeks, singleton
Previous scar	One lower-segment uterine scar (LSCS 2019)
Aspirin	Started at 12 weeks (75 mg/day) for pre-eclampsia prevention
Fetal movements	Felt since 18 weeks, satisfactory
Headache	Mild, intermittent — under monitoring
Visual disturbances	None
Epigastric pain	None
Oedema	Bilateral pitting oedema ++ (concern for pre-eclampsia)
BP at today's visit	148/96 mmHg ⚠️
Urine dipstick today	Protein ++ ⚠️

Antenatal Investigations

Investigation	Result	Action
Blood group	A– (Rh negative) ⚠️	Anti-D given at 28 wks
FBC	Hb 10.2 g/dL	On ferrous sulphate
Platelets	98 × 10⁹/L ⚠️	Repeat in 48h (? HELLP)
LFTs	ALT 68 U/L ⚠️	Elevated — monitoring
Serum creatinine	105 µmol/L	Mildly elevated
Urine PCR	450 mg/mmol ⚠️	Significant proteinuria
HIV	Negative	—
Anomaly scan (20 wks)	No structural anomalies	—
Growth scan (28 wks)	EFW on 18th centile	Repeat scan in 2 weeks (? IUGR)
Uterine artery Doppler	Notching bilateral ⚠️	Increased placental resistance

Gynaecological History

Element	Details
Menarche	Age 12
Cycle	Regular 28/5
Previous STIs	Nil
Last Pap smear	2024 — normal
Previous gynaecological surgery	D&C 2022 (incomplete miscarriage)
Contraception prior	Combined OCP, stopped 2024

Past Medical/Surgical History

Condition	Details	Relevance to Pregnancy
Essential hypertension	Diagnosed 2020, on labetalol	Superimposed pre-eclampsia risk
Appendicectomy	2008	No current relevance
Allergies	NKDA	—

Drug History

Drug	Dose	Indication
Labetalol	200 mg BD	Chronic hypertension
Aspirin	75 mg OD	Pre-eclampsia prophylaxis
Ferrous sulphate	200 mg OD	Anaemia
Folic acid	5 mg OD	High-dose (prev. neural tube defect risk)

Family History

Condition	Relation
Hypertension	Mother, maternal grandmother
Pre-eclampsia	Mother (in 3rd pregnancy)
Type 2 diabetes	Father
Twins	No family history

Social History


Smoking	Ex-smoker, quit 2018
Alcohol	None
Occupation	Office-based, sedentary
Stress	Moderate work stress
Support	Husband present, mother nearby
Domestic violence screen	Negative (SAFE questions asked)

Summary Statement

Mrs. Fatima Al-Rashidi is a 35-year-old accountant, G4P2 (TPAL 1-1-1-2), at 30 weeks gestation (EDD 08/05/2026), with a background of chronic hypertension and a previous uterine scar. Her second pregnancy was complicated by pre-eclampsia, preterm delivery at 34 weeks via emergency LSCS, PPH, and neonatal NICU admission. She had a miscarriage in 2022 managed by D&C. In the current pregnancy, she presents today with BP 148/96 mmHg, 2+ proteinuria, thrombocytopaenia (platelets 98), elevated ALT, and bilateral uterine artery notching — findings consistent with early-onset pre-eclampsia with features of HELLP syndrome. She is Rh-negative (anti-D given at 28 weeks). The fetus is growth-restricted (EFW 18th centile). Urgent plan: admit for close monitoring, consider magnesium sulphate for seizure prophylaxis, corticosteroids for fetal lung maturity, and senior obstetric review regarding timing of delivery.

📋 CASE 3: Grand Multipara with Multiple Risk Factors

Identification


Name	Mrs. Blessing Eze
Age	40 years
Occupation	Market trader
Marital status	Married
LMP	5 October 2025
EDD	12 July 2026
GA	28 weeks

Gravida/Parity


Gravida	G7
Para	P5
TPAL	4-1-1-5
Status	Grand multipara ⚠️

Previous Obstetric History

Preg #	Year	GA	Mode	Sex	Weight	Outcome	Maternal Complications	Neonatal Outcome
1	2005	40 wks	SVD	M	3.1 kg	Live birth	Nil	Well
2	2007	38 wks	SVD	F	3.3 kg	Live birth	Nil	Well
3	2010	41 wks	SVD	M	4.1 kg	Live birth	Shoulder dystocia ⚠️, PPH 800 mL	Erb's palsy (resolved)
4	2013	10 wks	—	—	—	Spontaneous miscarriage	Nil	—
5	2015	35 wks	SVD	F	2.2 kg	Live birth	Antepartum haemorrhage (abruption) ⚠️	NICU 7 days, survived
6	2019	39 wks	SVD	M	4.4 kg	Live birth	PPH 1.5 L ⚠️, blood transfusion	Macrosomic, hypoglycaemia
7 (current)	2025–26	28 wks (ongoing)	—	—	—	Ongoing	—	—

Risk Flag Summary (from obstetric history)

Risk Factor	Evidence from History
Grand multiparity	G7P5 → uterine atony, malpresentation
Macrosomia	Baby #3 (4.1 kg), #6 (4.4 kg) → ? gestational DM
Recurrent PPH	Pregnancies #3 and #6 → prepare for PPH in current delivery
Shoulder dystocia	Pregnancy #3 → senior obstetrician must be present at delivery
Placental abruption	Pregnancy #5 → increased recurrence risk
Advanced maternal age	40 years → aneuploidy, hypertension, DM, placenta praevia
Short interpregnancy interval	Preg #5→#6: 4 years (acceptable); overall pattern monitored

Current Pregnancy

Element	Details
Fetal movements	Reduced in last 2 days ⚠️
OGTT (26 wks)	Fasting 6.2 mmol/L, 2h 10.1 mmol/L ⚠️ → Gestational DM diagnosed
Presentation (USS)	Transverse lie ⚠️ (common in grand multipara — lax uterus)
Placenta location	Anterior, grade I — low-lying ⚠️ (repeat scan at 32 wks)
AFI	24 cm ⚠️ → Polyhydramnios (associated with GDM + macrosomia)
BP	130/88 mmHg (borderline)
Urine dipstick	No protein

Summary Statement

Mrs. Blessing Eze is a 40-year-old grand multipara, G7P5 (TPAL 4-1-1-5), at 28 weeks gestation (EDD 12/07/2026). Her obstetric history is significant for shoulder dystocia with neonatal Erb's palsy, two episodes of PPH (one requiring transfusion), placental abruption, and macrosomic babies. In the current pregnancy, she has been newly diagnosed with gestational diabetes mellitus, has a transverse lie, polyhydramnios, a low-lying placenta, and reports reduced fetal movements. Plan: urgent CTG and biophysical profile for fetal wellbeing, dietitian referral + consider insulin for GDM, serial growth scans, alert theatre for possible abnormal placentation, and detailed delivery plan with senior obstetrician anticipating PPH and malpresentation.

Key Differences Across the Three Cases

Feature	Case 1 (Low risk)	Case 2 (High risk)	Case 3 (Grand multipara)
Parity	G1P0	G4P2	G7P5
Previous complications	None	Pre-eclampsia, LSCS, PPH	Shoulder dystocia, abruption, PPH ×2
Current complications	Mild anaemia	Pre-eclampsia + HELLP features	GDM, polyhydramnios, malpresentation
Delivery plan	Await spontaneous labour	Likely elective LSCS vs VBAC discussion	Senior obstetrician, theatre standby
Main risk	Low	Pre-eclampsia / IUGR	PPH, abnormal placentation

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