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Common Obstetric Complaints — How to Write the HOPI and Obstetric Part of History
How to Structure an Obstetric History
Before writing each complaint's HOPI, every obstetric history must open with the following identifying obstetric data:
Mrs. [Name], [Age] years old, [Gravida X, Para A+B], [marital status], [occupation], at [gestational age] weeks by [LMP/ultrasound], with an EDD of [date], presenting with…
- Gravida (G) = total number of pregnancies including this one
- Para (P) = A (births ≥24 weeks) + B (losses <24 weeks, miscarriages, TOPs)
- Example: G4P1+2 = 4 pregnancies, 1 live birth, 2 losses before 24 weeks
The Universal Obstetric Section (Written After the HOPI for Every Case)
This must be documented after the presenting complaint's HOPI, regardless of the chief complaint:
1. History of the Current Pregnancy
- 1st Trimester: LMP, method of confirmation (urine/serum βhCG, USS), EDD (Naegele's rule: LMP + 9 months 7 days), nausea/vomiting, bleeding/pain (? ectopic/threatened miscarriage), vaginal discharge, urinary symptoms, first antenatal bloods (blood group, Rh, FBC, VDRL, rubella immunity, HBsAg, HIV)
- 2nd Trimester (14–28 wks): Fetal movements onset (quickening ~18–20 wks), anomaly scan result, OGTT/GDM screen, amniocentesis if applicable, PET screening
- 3rd Trimester (28 wks–delivery): Frequency and pattern of fetal movements, ANC visits, BP readings, glucose tolerance, symphysio-fundal height, presentation/lie, swelling, headaches, visual disturbances
2. Past Obstetric History (For each previous pregnancy)
- Gestational age at delivery
- Mode of delivery (SVD / instrumental / LSCS — indication)
- Birth weight, sex, outcome (alive/stillbirth/neonatal death)
- Any complications: PPH, shoulder dystocia, GDM, PET, IUGR, preterm labour
3. Gynaecological History
- Age of menarche, cycle regularity, dysmenorrhoea
- Contraceptive method prior to conception
- Cervical smear history
- History of STIs, infertility, pelvic surgery, fibroids, ovarian cysts
4. Past Medical & Surgical History
- Hypertension, diabetes, thyroid disease, anaemia, cardiac disease, renal disease, epilepsy
- Previous surgeries (especially abdominal/pelvic)
- Blood transfusions
5. Drug History & Allergies
- Folic acid, iron, aspirin, antihypertensives, insulin, anticonvulsants
- Teratogenic exposures
6. Family History
- Diabetes, hypertension, multiple pregnancy, congenital malformations, thrombophilia
7. Social History
- Smoking, alcohol, recreational drugs
- Occupation, support at home, partner details
- Housing, domestic violence (ask sensitively)
COMPLAINT 1 — Antepartum Haemorrhage (APH) / Vaginal Bleeding in Pregnancy
Chief Complaint
Mrs. X, 28 years, G2P1+0, at 32 weeks gestation by sure LMP (EDD [date]), presented to [facility] with painless/painful per vaginal bleeding of [duration].
HOPI of the Complaint
Characterise the bleeding (SOCRATES-based):
- Onset: When did the bleeding start? Sudden onset (suggestive of placenta previa) vs. progressive
- Amount: How much blood? (Estimate by pads soaked per hour — >1 pad/hour = significant; passage of clots; "flooding")
- Color: Bright red (fresh — previa or local lesion) vs. dark (abruption; concealed)
- Associated pain: Painless bleeding → placenta previa; painful, constant uterine tenderness → placental abruption
- Precipitating factors: Any trauma, coitus, recent cervical examination?
- Passage of tissue/clots: Tissue = possible miscarriage/molar pregnancy
- Associated symptoms: Fetal movements — present, reduced, or absent? (Abruption can cause fetal distress/death)
- Preceding discharge: Mucoid show (early labour) vs. watery loss (PROM)
- Systemic symptoms: Dizziness, fainting, palpitations, syncope (hypovolaemia)
Differentiating features to document:
| Feature | Placenta Previa | Placental Abruption |
|---|---|---|
| Pain | Painless | Painful (constant) |
| Onset | Spontaneous, recurrent | Often follows trauma/hypertension |
| Uterine tone | Soft | Tender, "woody-hard" |
| Fetal movements | Usually normal | Often reduced/absent |
| Revealed bleeding | Yes | May be concealed (20%) |
Obstetric Part (Current Pregnancy)
- Booking ultrasound — was low-lying placenta reported?
- Any prior bleeding episodes in this pregnancy?
- Blood group and Rh type (anti-D prophylaxis if Rh-negative)
- Antenatal visits — BP at each visit (hypertension → abruption risk)
- History of smoking, cocaine use (abruption risk factors)
- Fetal movements history — when last felt
- History of trauma or domestic violence
— Rosen's Emergency Medicine, Chapter on Complications of Late Pregnancy
COMPLAINT 2 — Pre-Eclampsia / Hypertension in Pregnancy
Chief Complaint
Mrs. X, 32 years, G1P0+0, at 36 weeks gestation, presenting with headache, swelling of the face and hands, and blurring of vision of [duration].
HOPI of the Complaint
- Headache: Site (frontal/occipital), severity (grade it 1–10), character (throbbing, pressure), onset, duration, progression, any relieving factors (analgesics), photophobia, phonophobia
- Visual disturbances: Blurring, "flashing lights" (photopsia), scotomata, diplopia — all suggest cerebral vasospasm in severe PET
- Oedema: Distribution — hands, face (facial puffiness), ankles; pitting vs. non-pitting; when it is worst (morning facial oedema = significant; dependent ankle oedema alone = normal pregnancy); sudden rapid onset
- Epigastric/RUQ pain: Burning or tightness under the right ribs → hepatic capsule distension (HELLP syndrome); distinguish from heartburn/reflux (very common in pregnancy)
- Convulsions / loss of consciousness: If present → eclampsia; document sequence, duration, post-ictal state, tongue biting, incontinence
- Nausea and vomiting: Non-specific but can accompany HELLP
- Decreased urine output / dark urine: Suggests renal involvement (oliguria <500 mL/24h = severe PET criterion)
- Fetal movements: Ask carefully — uteroplacental insufficiency reduces fetal movements
Severity markers to elicit:
- Systolic ≥160 or diastolic ≥110 mmHg = severe
- Symptoms of end-organ damage: vision, neurological, liver, renal
- HELLP: haemolysis (jaundice, haematuria), elevated liver enzymes, low platelets (easy bruising, petechiae)
Obstetric Part (Current Pregnancy)
- BP at booking visit and at each antenatal visit — trend is critical (new rise from baseline)
- Proteinuria on urine dipstick at antenatal visits
- Gestational age — PET occurs ≥20 weeks; before 20 weeks consider molar pregnancy
- Primigravida (highest risk), multiple pregnancy, known chronic hypertension/renal disease
- BMI, pre-pregnancy weight
- Family history of pre-eclampsia (mother, sisters)
- Use of low-dose aspirin from 12 weeks (was it given/taken?)
- Investigations done so far: USS for IUGR / oligohydramnios (uteroplacental insufficiency)
— Rosen's Emergency Medicine; Creasy & Resnik's Maternal-Fetal Medicine
COMPLAINT 3 — Preterm Labour (PTL)
Chief Complaint
Mrs. X, 26 years, G2P1+0, at 30 weeks gestation, presenting with painful uterine contractions occurring every [X] minutes since [time/duration].
HOPI of the Complaint
- Contractions: Onset (sudden vs. gradual), frequency (e.g., every 5 minutes), duration per contraction (e.g., 45 seconds), regularity, severity (can she speak through them?), progression (are they getting stronger and more frequent?)
- Associated show: Passage of blood-stained mucoid discharge (cervical show = cervix dilating)
- Membrane status: Has she felt a "gush" or constant trickling of fluid? (PROM/PPROM) — fluid — colour, odour, whether it continues to leak
- Bleeding: Any associated PV bleeding?
- Fetal movements: Present and normal?
- Precipitating factors: UTI (dysuria, frequency), uterine anomaly, polyhydramnios (distension), trauma, intercourse, cervical incompetence (previous LLETZ/cone biopsy, previous second-trimester loss)
- Systemic features: Fever, rigors, offensive discharge (chorioamnionitis); urinary symptoms (UTI is a common trigger)
- Previous similar episode in this pregnancy?
Obstetric Part (Current Pregnancy)
- Gestational age confirmation (USS or reliable LMP)
- Number of fetuses (multiple pregnancy = major risk)
- Cervical length measured on USS (short cervix <25 mm = high risk)
- History of cervical cerclage (in situ?)
- Previous preterm births (strongest predictor of recurrence)
- Antenatal steroids (betamethasone 12 mg × 2 doses): have they been given?
- Group B Streptococcus (GBS) swab status
- Urine culture — UTI excluded?
COMPLAINT 4 — Hyperemesis Gravidarum
Chief Complaint
Mrs. X, 22 years, G1P0+0, at 9 weeks gestation, presenting with persistent nausea and vomiting since [duration], unable to tolerate oral intake.
HOPI of the Complaint
- Onset: When did it start? (Nausea of NVP typically 4–8 weeks; hyperemesis more severe and prolonged)
- Frequency of vomiting: How many times per day? (>3–5 = significant; "vomiting after everything I eat or drink")
- Content of vomit: Food, bile, blood (haematemesis — Mallory-Weiss tear)
- Oral intake: Can she keep any fluids down? How long has she been unable to eat or drink?
- Weight loss: Document weight at booking vs. now — weight loss >5% of pre-pregnancy weight is a diagnostic criterion
- Triggers: Smell, food type, movement
- Relieving factors: Any medications tried? (antiemetics, ginger)
- Associated symptoms:
- Dysuria/frequency (exclude UTI as a trigger)
- Diarrhoea
- Headache, confusion (Wernicke's encephalopathy from thiamine deficiency — a serious complication)
- Jaundice (rare liver involvement)
- Signs of dehydration: Thirst, dark urine, dizziness on standing, decreased urine output
- Impact on daily functioning: Work, activity, mood (depression/anxiety common)
Distinguish from:
- Normal NVP (nausea + vomiting, but no weight loss, maintains some oral intake, resolves by 12–14 weeks)
- Molar pregnancy (marked βhCG elevation drives hyperemesis; ask about uterus size larger than dates, no fetal movements, grape-like tissue passed)
- Gastroenteritis, UTI, thyrotoxicosis, hepatitis
Obstetric Part (Current Pregnancy)
- Gestational age (hyperemesis worst at 8–12 weeks, should improve by 20 weeks)
- USS — confirm intrauterine pregnancy, singleton vs. multiple (twins = higher βhCG), exclude molar pregnancy
- βhCG level trend
- TSH (transient gestational hyperthyroidism occurs in ~60% of HEG cases due to βhCG cross-reactivity with TSH receptor)
- Previous pregnancy with same problem (tends to recur)
- Urine dipstick and MSU (exclude UTI, check for ketonuria — indicates starvation)
COMPLAINT 5 — Reduced / Absent Fetal Movements (RFM)
Chief Complaint
Mrs. X, 30 years, G3P2+0, at 38 weeks gestation, presenting with reduced fetal movements since [time].
HOPI of the Complaint
- Baseline fetal movements: How many movements per hour/day has she been used to? When did she first feel movements (quickening)?
- Change: Since when has she noticed a reduction? Any complete cessation?
- Nature of the change: Reduced in frequency, reduced in strength, or completely absent
- Kick counts: Has she been monitoring? What is the count today vs. usual? (A count of <10 movements in 2 hours = concerning)
- Associated features:
- Any vaginal bleeding?
- Any abdominal pain or uterine tightening?
- Fever (intrauterine infection)?
- Any fall or trauma?
- Polyhydramnios (excessive fluid "cushions" movements, making them harder to feel)
- Anterior placenta (attenuates sensation)
- Last time she was certain baby moved?
- Maternal wellbeing: Any dizziness, decreased activity (sedatives/alcohol can reduce FMs)
Obstetric Part (Current Pregnancy)
- Gestational age and placental location (anterior placenta = reduced sensation — reassure; does not reduce actual movement)
- Known IUGR or SGA on previous scans
- History of pre-eclampsia/gestational hypertension (uteroplacental insufficiency)
- Gestational diabetes (macrosomia, polyhydramnios)
- Maternal medications (opiates, sedatives reduce perceived FMs)
- Results of previous growth scans, Doppler studies
- Prior episodes of RFM in this pregnancy
- Obstetric history of previous stillbirth (highest-risk group)
COMPLAINT 6 — Prelabour Rupture of Membranes (PROM / PPROM)
Chief Complaint
Mrs. X, 24 years, G1P0+0, at 28 weeks gestation, presenting with a sudden gush of watery fluid per vaginum since [time].
HOPI of the Complaint
- Onset: Sudden gush (classic PROM) vs. slow continuous trickle (high leak)
- Amount: Large gush soaking through clothes vs. mild dampness
- Colour of fluid: Clear/straw-coloured (normal), green/meconium-stained (fetal distress), blood-stained, offensive smell (chorioamnionitis)
- Odour: Offensive odour → infection
- Continued leaking: Is fluid still leaking? Does she still feel wet?
- Distinguish from: Urinary incontinence (common in pregnancy — ask if she can stop the flow voluntarily, whether it smells like urine), increased vaginal discharge, show
- Contractions: Any associated uterine contractions? (If yes, in labour)
- Fetal movements: Present and normal?
- Signs of infection (chorioamnionitis): Fever, rigors, tachycardia, abdominal tenderness, offensive discharge — if present, this is a medical emergency
- Time since rupture: Latency period → risk of infection increases with time
Obstetric Part (Current Pregnancy)
- Gestational age — determines management (conservative vs. delivery)
- Presentation and lie of the fetus (USS) — cord prolapse risk with non-cephalic presentation
- Group B Streptococcus (GBS) status
- Antenatal steroid status (given for lung maturity if <34 weeks?)
- Cervical cerclage in situ? (Must be removed if PROM occurs)
- History of cervical procedure (LLETZ, cone biopsy)
- Recent PV examination or intercourse
- Urine culture (UTI as precipitant)
- Previous PPROM (recurrence risk ~16%)
COMPLAINT 7 — Gestational Diabetes (GDM) — Antenatal Visit Complaint
Chief Complaint
Mrs. X, 35 years, G2P1+0, at 26 weeks gestation, referred with elevated blood glucose on routine OGTT screening.
HOPI of the Complaint
- Symptoms of hyperglycaemia: Polyuria, polydipsia, polyphagia, unexplained fatigue — though most GDM is asymptomatic and found on screening
- Timing of diagnosis: Routine screen (24–28 weeks) vs. early screen (first trimester if high risk)
- Blood glucose values: Fasting and 2-hour post-load values on OGTT
- Dietary history: Sugar intake, carbohydrate load, junk food, soft drinks
- Home glucose monitoring: Is she doing it? Values?
- Medications taken: Metformin, insulin — response and adherence
- Hypoglycaemic episodes: Shakiness, sweating, dizziness, palpitations after medication
- Symptoms of complications: Excessive thirst despite treatment, recurrent thrush (Candida — common with high glucose), blurred vision
- Known pre-gestational diabetes? (Different diagnosis — document duration, type, complications)
Obstetric Part (Current Pregnancy)
- USS for fetal growth — macrosomia (abdominal circumference > 95th centile), polyhydramnios (AFI)
- Fundal height — uterus larger than dates (polyhydramnios/macrosomia)
- BP and urinalysis (GDM increases risk of PET)
- Family history of DM type 2
- Previous GDM (50–70% recurrence risk)
- Previous macrosomic baby (>4 kg), previous stillbirth, previous shoulder dystocia
- BMI, weight gain in pregnancy
- Ethnicity (South Asian, African, Middle Eastern = high risk)
- Antenatal clinic referrals: dietician, diabetic team, ophthalmology
— Creasy & Resnik's Maternal-Fetal Medicine; Textbook of Family Medicine, 9e
Quick Reference Summary Table
| Complaint | Key Hallmark in HOPI | Critical Obstetric Data Needed |
|---|---|---|
| APH / Vaginal Bleeding | Painless (previa) vs. painful (abruption); amount; fetal movements | Placental site on USS; Rh type; BP trend |
| Pre-eclampsia | Headache + visual changes + oedema ≥20 wks; RUQ pain; urine output | BP trend; proteinuria; USS for IUGR |
| Preterm Labour | Contraction frequency/duration; show; membrane status | Gestational age; cervical length; steroid status |
| Hyperemesis | Frequency/content of vomiting; weight loss; oral intake; ketonuria | Gestational age; molar pregnancy excluded; βhCG; TSH |
| Reduced Fetal Movements | Baseline vs. current count; cessation time; anterior placenta | Growth scans; Doppler; previous stillbirth |
| PROM / PPROM | Gush vs. trickle; colour/odour; contractions; signs of infection | Gestational age; GBS status; steroid given? |
| Gestational Diabetes | Often asymptomatic; polyuria/polydipsia; OGTT values | Macrosomia/polyhydramnios on USS; weight gain; family Hx |
Sources:
- Rosen's Emergency Medicine: Concepts and Clinical Practice — Complications of Late Pregnancy
- Creasy & Resnik's Maternal-Fetal Medicine: Principles and Practice
- Textbook of Family Medicine, 9e
- University of Queensland / Qatar University — History & Clinical Examination in Obstetrics (academic reference)
Now write each complaints in their description examples using their format
Here are all 7 complaints written out as full, realistic clinical history examples — exactly as you would write them in a case sheet or present them in a clinical setting.
COMPLAINT 1 — Antepartum Haemorrhage (Placenta Previa)
Mrs. Amina Hassan, 28 years old, Muslim, married, housewife. G3P2+0, at 34 weeks gestation by sure LMP (EDD: 20/07/2026). She was booked at [facility] at 10 weeks.
Chief Complaint (C/O)
- Per vaginal bleeding × 3 hours
History of Presenting Illness (HOPI)
Mrs. Amina Hassan, a 28-year-old G3P2+0 at 34 weeks gestation, presented to the labor ward with a 3-hour history of per vaginal bleeding. She reports that the bleeding started suddenly and without warning at approximately 6:00 AM while she was sleeping. She denies any preceding trauma, coitus, or strenuous activity prior to the onset.
The bleeding is described as bright red in color, moderate in amount — she has soaked through 2 maternity pads within the 3 hours prior to presentation. She denies passage of any clots or tissue. Notably, the bleeding is entirely painless — she reports no abdominal cramps, uterine tightening, or backache accompanying the blood loss.
She denies any associated watery or mucoid vaginal discharge. Fetal movements were last felt approximately 2 hours ago and are reported as normal in frequency and strength by the patient.
She denies any dizziness, pre-syncope, palpitations, or shortness of breath at rest. She has had no fever, chills, or urinary symptoms.
She reports a similar episode of painless PV bleeding at 28 weeks during this pregnancy, for which she was admitted for 2 days, observed, and discharged after USS confirmed low-lying placenta. She was counselled to avoid coitus and heavy lifting.
Obstetric Part (Current Pregnancy)
She was confirmed pregnant by urine pregnancy test at 5 weeks. LMP was 13/10/2025, regular 28-day cycle, certain date. EDD calculated as 20/07/2026. Gestational age = 34 weeks.
1st Trimester: Confirmed intrauterine pregnancy on USS at 8 weeks. No bleeding or pain. Mild nausea managed conservatively. Booking bloods done — blood group O Rh-positive, FBC normal, VDRL non-reactive, rubella immune, HBsAg negative, HIV negative. Folate and iron supplementation started.
2nd Trimester: Quickening felt at 18 weeks. Anomaly scan at 20 weeks — low-lying posterior placenta reported, covering the internal os (Grade III placenta previa). Fetal anatomy normal. Counselled regarding pelvic rest. OGTT at 26 weeks — normal. Episode of painless PV bleeding at 28 weeks, admitted and managed conservatively with bed rest; anti-D not required (Rh-positive).
3rd Trimester: Fetal movements regular and strong. BP at last ANC visit (32 weeks) — 110/70 mmHg, urine dipstick negative. SFH = 32 cm. No oedema documented. Repeat USS at 32 weeks confirmed persistent low-lying placenta, not resolved. No cervical cerclage in situ. Scheduled for repeat USS at 36 weeks and planned elective LSCS.
Past Obstetric History
| Pregnancy | Year | GA at Delivery | Mode | Weight | Sex | Outcome | Complications |
|---|---|---|---|---|---|---|---|
| 1st | 2021 | 39 wks | SVD | 3.2 kg | F | Alive, well | None |
| 2nd | 2023 | 38 wks | SVD | 3.5 kg | M | Alive, well | None |
| 3rd | Current | 34 wks | — | — | — | — | Placenta previa |
Gynaecological History
Regular cycles, 28-day cycle, 5 days flow, moderate — no dysmenorrhoea. No history of STIs, fibroids, or ovarian cysts. Last cervical smear: 2022 — normal. No contraceptive use between pregnancies (natural family planning).
Past Medical / Surgical History
No known hypertension, diabetes, cardiac, renal, or thyroid disease. No previous abdominal or pelvic surgeries.
Drug History & Allergies
Ferrous sulphate 200 mg BD, Folic acid 5 mg OD. No known drug allergies.
Family History
No family history of multiple pregnancy, diabetes, hypertension, or congenital malformations.
Social History
Non-smoker. No alcohol. No recreational drug use. Lives with husband and two children in permanent housing. Good social support.
COMPLAINT 2 — Pre-Eclampsia
Mrs. Fatima Al-Rashid, 32 years old, married, teacher. G1P0+0, at 37 weeks gestation by sure LMP (EDD: 28/05/2026). Booked at 9 weeks.
Chief Complaint (C/O)
- Headache × 2 days
- Blurring of vision × 1 day
- Swelling of face and hands × 3 days
History of Presenting Illness (HOPI)
Mrs. Fatima Al-Rashid, a 32-year-old primigravida at 37 weeks gestation, presented to the antenatal clinic with a 2-day history of progressive headache, a 1-day history of blurring of vision, and a 3-day history of facial and hand swelling.
Headache: The headache is located at the frontal and occipital regions, constant in nature, described as a "heavy pressure" sensation, graded 7/10 in severity. It is persistent, worsening over the 2 days, and poorly relieved by paracetamol 1 g taken yesterday. There is no fever, neck stiffness, vomiting, or photophobia. She has no prior history of migraine or recurrent headaches.
Visual disturbance: Since yesterday, she reports bilateral blurring of vision and "flashing lights" at the periphery of her vision (photopsia). There is no diplopia, total vision loss, or eye pain. She has not had any eye problems previously.
Oedema: She noticed puffiness of the face on waking 3 days ago — involving the periorbital region and cheeks. Her hands have felt tight and swollen, making it difficult to remove her rings. Ankle swelling has been present since 28 weeks but has significantly worsened. The swelling is pitting in nature. It does not improve with leg elevation overnight (facial and hand oedema is non-dependent and therefore more significant).
She also reports mild epigastric discomfort and right upper quadrant heaviness since this morning, which she initially attributed to heartburn. She denies nausea, vomiting, or jaundice.
She denies any convulsions, loss of consciousness, or confusion.
Urine output: She reports her urine has been reduced over the past 24 hours and appears slightly darker than usual. She denies dysuria or haematuria.
Fetal movements are reported as present and normal — last felt 1 hour ago.
Her blood pressure was measured by her community midwife yesterday as 158/104 mmHg — she was sent immediately to hospital. At today's visit, BP is 162/108 mmHg (confirmed on two readings 4 hours apart).
Obstetric Part (Current Pregnancy)
LMP: 21/08/2025, regular 30-day cycle. EDD: 28/05/2026. GA = 37 weeks.
1st Trimester: Confirmed intrauterine singleton pregnancy on USS at 8 weeks. No bleeding or pain. Mild nausea, no vomiting. Booking BP: 118/72 mmHg — normal. Booking bloods: blood group A Rh-negative, FBC normal (Hb 12.8 g/dL), urine dipstick — negative. Anti-D immunoglobulin given. Low-dose aspirin 75 mg OD commenced at 12 weeks (primigravida, BMI 29 — moderate risk for PET).
2nd Trimester: Quickening at 20 weeks. Anomaly scan at 20 weeks — normal fetal anatomy, normal placenta, no uterine artery notching reported. OGTT at 26 weeks — normal (fasting: 4.2 mmol/L; 2-hr: 6.8 mmol/L). BP at 24 weeks: 122/76 mmHg. Urine dipstick at each visit — negative until 32 weeks.
3rd Trimester: At 32 weeks, BP noted to be 130/84 mmHg — monitored closely. Urine dipstick at 34 weeks showed 1+ proteinuria — urine PCR sent, result pending. Growth scan at 34 weeks showed fetal weight on 15th centile, normal Doppler. At 36 weeks, BP 142/90 mmHg — patient advised to attend immediately if headache, visual disturbance, or worsening swelling develop. She presents today with all three symptoms.
Past Obstetric History
No previous pregnancies.
Gynaecological History
Menarche at 13 years. Regular 30-day cycles, 5 days flow. No dysmenorrhoea. No history of infertility. Last cervical smear: 2024 — normal. No STIs. COCP used for 3 years prior to conception, stopped 6 months before.
Past Medical / Surgical History
No known hypertension prior to pregnancy. No diabetes, renal disease, or cardiac disease. No previous surgeries. No blood transfusions.
Drug History & Allergies
Ferrous sulphate 200 mg BD, Folic acid 5 mg OD, Aspirin 75 mg OD (since 12 weeks). No known drug allergies.
Family History
Mother has hypertension — diagnosed at age 40, on antihypertensives. No family history of diabetes, multiple pregnancy, or congenital malformations. No family history of pre-eclampsia (mother's pregnancies uncomplicated).
Social History
Non-smoker. Occasional alcohol before pregnancy — stopped at conception. No recreational drugs. Works as a teacher (currently on leave). Lives with husband in permanent housing. Good social support.
COMPLAINT 3 — Preterm Labour
Mrs. Grace Okonkwo, 26 years old, Christian, married, trader. G2P1+0, at 30 weeks gestation by USS dating (EDD: 19/07/2026). Booked at 12 weeks.
Chief Complaint (C/O)
- Painful uterine contractions × 4 hours
- Watery vaginal discharge × 2 hours
History of Presenting Illness (HOPI)
Mrs. Grace Okonkwo, a 26-year-old G2P1+0 at 30 weeks gestation, presented to the labor ward at 11:00 PM with a 4-hour history of painful uterine contractions and a 2-hour history of watery vaginal discharge.
Contractions: She began experiencing lower abdominal cramps at approximately 7:00 PM. The contractions are rhythmic, occurring every 5–6 minutes, each lasting approximately 40–45 seconds. They are moderate in intensity — she rates the pain as 6/10 and states she is unable to speak through the contractions. They have been progressively worsening in frequency and intensity since onset. The pain radiates from the lower abdomen to the lower back. She denies any precipitating activity, fall, or trauma.
Vaginal discharge / membranes: Approximately 2 hours ago, she noticed a sudden gush of clear watery fluid from her vagina, soaking through her underwear. Since then, there has been a continuous slow trickle of clear fluid. She describes the fluid as odourless. She denies any offensive smell or change in colour to yellow/green.
Show: She noticed a small amount of blood-stained mucoid discharge (show) approximately 30 minutes before the contractions began.
Fetal movements: She reports fetal movements are present but feels they may be slightly less frequent than usual today. She is unsure whether to attribute this to her discomfort.
Signs of infection: She denies fever, rigors, or chills. No dysuria or urinary frequency. No offensive vaginal discharge. She was last seen at ANC 2 weeks ago — urine culture was sent and she has not yet received results.
She denies any per vaginal bleeding. No diarrhoea. No trauma.
Obstetric Part (Current Pregnancy)
Pregnancy confirmed by urine pregnancy test at 5 weeks. LMP uncertain (irregular cycles) → USS at 12 weeks dates pregnancy at 12+3 weeks → EDD: 19/07/2026. GA today = 30 weeks.
1st Trimester: USS confirmed singleton intrauterine pregnancy. Mild nausea managed conservatively. No bleeding. Booking bloods: Blood group B Rh-positive, Hb 10.8 g/dL (mild anaemia — iron supplements started), VDRL non-reactive, HIV negative, HBsAg negative. Urine dipstick normal.
2nd Trimester: Quickening at 19 weeks. Anomaly scan at 20 weeks — normal fetal anatomy, normal placenta (fundal), normal AFI. Cervical length on transvaginal USS at 22 weeks: 22 mm (short cervix — patient was counselled on PTL risk; cervical cerclage was not performed as she declined; progesterone pessaries 200 mg ON commenced and continued). OGTT at 26 weeks — normal.
3rd Trimester: At 28 weeks: SFH = 28 cm, fetal movements normal, BP 108/66 mmHg, urine dipstick negative. GBS swab not yet done. Antenatal steroids (betamethasone) have NOT yet been administered prior to this presentation. Urine C&S sent at last visit 2 weeks ago — results pending.
No cervical cerclage in situ. No uterine anomaly documented on USS.
Past Obstetric History
| Pregnancy | Year | GA | Mode | Weight | Sex | Outcome | Complications |
|---|---|---|---|---|---|---|---|
| 1st | 2023 | 36 wks | SVD | 2.4 kg | M | Alive, well | Preterm delivery — admitted in PTL at 35 wks |
| 2nd | Current | 30 wks | — | — | — | — | Preterm labour |
(Previous preterm birth is the single strongest risk factor for recurrent preterm labour)
Gynaecological History
Irregular cycles (28–35 days). Menarche at 14 years. No history of cervical procedures (LLETZ, cone biopsy). No STIs. No infertility. Last cervical smear: 2022 — normal.
Past Medical / Surgical History
No chronic illnesses. No previous pelvic or abdominal surgery. No blood transfusions.
Drug History & Allergies
Ferrous sulphate 200 mg BD, Folic acid 5 mg OD, Progesterone pessaries 200 mg ON. NKDA.
Family History
No family history of multiple pregnancy or congenital malformations. No diabetes or hypertension.
Social History
Non-smoker. No alcohol. No recreational drugs. Works as a trader (on feet for long hours — counselled to reduce activity). Lives with husband. Good social support.
COMPLAINT 4 — Hyperemesis Gravidarum
Miss Zainab Mohammed, 22 years old, single, student. G1P0+0, at 9 weeks gestation by USS (EDD: 07/12/2026). Booked at 7 weeks.
Chief Complaint (C/O)
- Persistent nausea and vomiting × 4 weeks
- Inability to tolerate oral intake × 5 days
- Weight loss
History of Presenting Illness (HOPI)
Miss Zainab Mohammed, a 22-year-old primigravida at 9 weeks gestation, presented to the antenatal day unit with a 4-week history of severe, persistent nausea and vomiting, worsening over the past 5 days to complete inability to tolerate any oral intake.
Onset and progression: Nausea began at approximately 5 weeks gestation, initially in the mornings, consistent with normal NVP. However, by 6 weeks, vomiting had become continuous — occurring throughout the day and night with no predictable pattern. She denies any specific trigger (smell, food, movement) as "everything triggers it."
Frequency and content: She is currently vomiting 10–15 times per day. The vomit initially contained food, then bile, and for the past 2 days she has been vomiting bile only as she can no longer keep any food down. She denies haematemesis (no blood or coffee-ground material in vomit).
Oral intake: She has been completely unable to tolerate any oral intake — including water and oral medications — for the past 5 days. Any attempt to drink results in immediate vomiting within minutes.
Weight loss: She weighed 62 kg at her booking visit 2 weeks ago. Today she weighs 56.5 kg — a loss of 5.5 kg (8.9% of pre-pregnancy body weight) over 2 weeks.
Symptoms of dehydration: She reports intense thirst, decreased and very dark urine output (she estimates she has urinated only twice in the past 24 hours), dizziness and lightheadedness on standing (postural dizziness), and significant weakness. No syncope.
Neurological symptoms: She denies confusion, diplopia, or ataxia. (Absence of Wernicke's features important to document — but thiamine must be given prophylactically before IV dextrose)
Urinary symptoms: She denies dysuria, frequency, or haematuria (excluding UTI as a precipitant).
Other symptoms: No diarrhoea, no fever, no abdominal pain, no jaundice. No history of thyroid disease symptoms prior to pregnancy (though transient gestational hyperthyroidism will be tested).
Previous treatment: She was prescribed metoclopramide 10 mg TDS by her GP one week ago — she was unable to tolerate the tablets as she vomited immediately after every dose.
Psychosocial impact: She has missed 3 weeks of university classes. She reports feeling extremely distressed, helpless, and low in mood. She lives alone in student accommodation and has no one to assist her with daily activities.
Obstetric Part (Current Pregnancy)
Pregnancy confirmed by urine βhCG at 4 weeks (unplanned pregnancy). LMP: 01/03/2026, regular 28-day cycle. EDD: 07/12/2026. GA = 9 weeks.
USS at 7 weeks: Confirmed single intrauterine gestation, fetal pole seen, fetal cardiac activity confirmed. No features of molar pregnancy — no snowstorm appearance, no grape-like vesicles. No corpus luteum cyst. Crown-rump length appropriate for dates.
Booking bloods (7 weeks): Blood group O Rh-positive. FBC: Hb 12.2 g/dL, WCC 9.8 × 10⁹/L (mildly elevated, likely haemoconcentration). U&E: pending today. LFTs: pending today. Urine dipstick at booking: 2+ ketonuria, no protein, no leucocytes. MSU sent — culture pending.
βhCG trend: 7 weeks — 98,000 IU/L (upper limit of normal for singleton at 9 weeks; NOT markedly elevated to suggest molar pregnancy).
TSH: Sent today — awaiting result (transient gestational hyperthyroidism expected).
No multiple pregnancy. No known uterine/ovarian pathology.
Past Obstetric History
No previous pregnancies.
Gynaecological History
Menarche at 13 years. Regular 28-day cycles, 4 days, moderate. No dysmenorrhoea. COCP used for 2 years — stopped 3 months prior to conception. No STIs. No pelvic surgery.
Past Medical / Surgical History
No known medical conditions. No previous surgeries. NKDA.
Drug History & Allergies
Folic acid 400 mcg OD (prior to admission — unable to take now). Metoclopramide 10 mg TDS (prescribed — unable to tolerate). NKDA.
Family History
Mother had NVP in both pregnancies — no hospitalisation. No family history of diabetes, hypertension, or multiple pregnancy.
Social History
Non-smoker. Occasional alcohol prior to pregnancy — stopped at conception. No recreational drug use. University student, lives alone. Limited social support — parents live in another city. Appears distressed and tearful.
COMPLAINT 5 — Reduced Fetal Movements (RFM)
Mrs. Blessing Eze, 30 years old, married, civil servant. G3P2+0, at 38 weeks gestation by sure LMP (EDD: 14/05/2026). Booked at 10 weeks.
Chief Complaint (C/O)
- Reduced fetal movements × 12 hours
History of Presenting Illness (HOPI)
Mrs. Blessing Eze, a 30-year-old G3P2+0 at 38 weeks gestation, presented to the labor ward at 8:00 PM with a 12-hour history of reduced fetal movements.
Baseline fetal movements: She has been actively monitoring fetal movements since 28 weeks as advised by her midwife. She reports that her baby typically moves 10–15 times per 2-hour period, predominantly in the afternoons and evenings. She describes the movements as a combination of kicks, rolls, and punches — strong and regular.
Change noticed: Since this morning at approximately 8:00 AM, she noticed the baby has been "unusually quiet." She waited, changed her position, drank cold water, and lay on her left side — manoeuvres that usually stimulate the baby. Despite these measures, she counted only 3 faint movements over a 2-hour period this afternoon. She has not felt any movement at all in the 2 hours prior to presentation.
Quality of movements: The few movements she did feel were much weaker than usual — she describes them as "flutters" rather than the strong kicks she is accustomed to.
Last certain movement: She is certain she felt a strong kick at approximately 7:00 AM this morning. She is uncertain about movements since then.
Associated symptoms:
- She denies any per vaginal bleeding.
- She denies abdominal pain, uterine contractions, or tightening.
- She denies fever, chills, or offensive vaginal discharge.
- She denies any trauma, fall, or road traffic accident.
- She denies taking any medications that could sedate her or the baby (no opiates, no sedatives, no alcohol).
- She reports normal activity levels today — she has not been unusually active or inactive.
Maternal wellbeing: She is anxious but haemodynamically stable. She denies headache, visual disturbance, or oedema (pre-eclampsia screen). No epigastric pain.
Obstetric Part (Current Pregnancy)
LMP: 07/08/2025, regular 28-day cycle. EDD: 14/05/2026. GA = 38 weeks.
1st Trimester: Confirmed intrauterine singleton pregnancy. No complications. Booking bloods normal. Blood group A Rh-positive.
2nd Trimester: Quickening at 18 weeks. Anomaly scan at 20 weeks — normal fetal anatomy, posterior placenta (posterior placenta means fetal movements are felt directly against the uterine wall — not attenuated; this makes the reduced movements more clinically significant). AFI normal. No structural abnormalities.
3rd Trimester: Growth scan at 34 weeks — fetal weight on 10th centile, normal umbilical artery Doppler — classified as SGA (small for gestational age), managed with increased surveillance. Repeat growth scan at 36 weeks — fetal weight now on 7th centile, umbilical artery S/D ratio increased — plan was for delivery at 38 weeks. BP at 36 weeks: 128/80 mmHg. Urine dipstick at 36 weeks: trace protein.
This presentation at 38 weeks is therefore particularly concerning given the background of worsening IUGR and abnormal Doppler trend.
No polyhydramnios or oligohydramnios documented. No GDM. No PET criteria met at last visit, though BP trending up.
Past Obstetric History
| Pregnancy | Year | GA | Mode | Weight | Sex | Outcome | Complications |
|---|---|---|---|---|---|---|---|
| 1st | 2019 | 40 wks | SVD | 3.4 kg | F | Alive, well | None |
| 2nd | 2022 | 38 wks | SVD | 2.8 kg | F | Alive, well | SGA — IUGR noted at 34 wks; induced at 38 wks |
| 3rd | Current | 38 wks | — | — | — | — | SGA/IUGR, RFM |
(Recurrent IUGR — consistent with uteroplacental insufficiency)
Gynaecological History
Regular cycles. No history of uterine or cervical pathology. No STIs.
Past Medical / Surgical History
Mild iron-deficiency anaemia — on iron supplements. No hypertension or diabetes outside of pregnancy. No surgeries.
Drug History & Allergies
Ferrous sulphate 200 mg BD, Folic acid 5 mg OD. NKDA.
Family History
Mother: type 2 diabetes mellitus. No family history of PET or multiple pregnancy.
Social History
Non-smoker. No alcohol. No recreational drugs. Civil servant, currently on maternity leave. Lives with husband and two children. Good support. Visibly anxious.
COMPLAINT 6 — Preterm Prelabour Rupture of Membranes (PPROM)
Mrs. Hauwa Musa, 24 years old, married, tailor. G1P0+0, at 28 weeks gestation by USS (EDD: 11/08/2026). Booked at 10 weeks.
Chief Complaint (C/O)
- Sudden gush of watery fluid per vaginum × 3 hours
History of Presenting Illness (HOPI)
Mrs. Hauwa Musa, a 24-year-old G1P0+0 at 28 weeks gestation, presented to the labor ward at 2:00 AM with a 3-hour history of per vaginal fluid loss.
Onset: At approximately 11:00 PM, while resting in bed, she experienced a sudden large gush of clear watery fluid from her vagina, which immediately soaked through her underwear and onto the mattress. She describes being "completely wet" without any warning or preceding sensation.
Continued leaking: Since the initial gush, there has been a continuous slow trickling of fluid. She has changed 3 pads over the past 3 hours, each moderately wet. The leaking continues.
Characteristics of fluid: The fluid is described as clear, slightly yellowish, and odourless. She denies any offensive or foul smell. She denies green or brown discolouration (no meconium staining). No blood mixed with the fluid.
Distinguishing from urine: She was asked specifically — she reports the fluid does not smell like urine. She is unable to voluntarily stop the leaking by contracting her pelvic floor (unlike urinary incontinence, which stops with voluntary contraction). She had not been incontinent of urine previously during this pregnancy.
Contractions: She denies any associated uterine contractions, cramps, or backache. She is not in labour at presentation.
Show: She denies any blood-stained mucoid discharge.
Fetal movements: Present and normal — last felt approximately 30 minutes ago.
Signs of infection (chorioamnionitis screen):
- She denies fever or feeling hot/cold.
- She denies rigors or chills.
- She denies offensive vaginal discharge prior to this episode.
- She denies abdominal tenderness or uterine pain.
- She denies dysuria or urinary symptoms.
- She has not been unwell in the days preceding this presentation.
Recent PV examination or intercourse: She denies recent sexual intercourse (last coitus was 2 weeks ago). She denies any recent PV examination. No recent cervical procedure.
Duration since rupture: Approximately 3 hours — she noted the time of the initial gush.
Obstetric Part (Current Pregnancy)
Pregnancy confirmed at 6 weeks by urine βhCG. LMP uncertain — USS at 12 weeks dates pregnancy at 12+2 weeks. EDD: 11/08/2026. GA = 28 weeks.
1st Trimester: Confirmed intrauterine singleton pregnancy on USS at 12 weeks. Normal NT scan. Booking bloods: Blood group B Rh-negative (Anti-D immunoglobulin given at booking and will be required again now). FBC: Hb 11.2 g/dL. VDRL non-reactive. HIV negative. HBsAg negative. Rubella immune. Urine dipstick: normal. MSU: no growth.
2nd Trimester: Quickening at 19 weeks. Anomaly scan at 20 weeks — normal fetal anatomy, fundal placenta, normal AFI, normal cervical length (38 mm). No cervical shortening or funnelling noted at that time. OGTT at 26 weeks — normal. No GBS swab yet performed.
3rd Trimester (28 weeks — today's presentation): Last ANC at 26 weeks — BP 104/68 mmHg, urine dipstick negative, SFH = 26 cm. No concerns documented. No antenatal steroids have yet been administered.
No cervical cerclage in situ. No history of cervical procedures (no LLETZ, no cone biopsy). No known uterine anomaly on any scan. No history of prior preterm birth.
No UTI documented in this pregnancy — though last MSU was at 12 weeks.
Past Obstetric History
No previous pregnancies.
Gynaecological History
Menarche at 13 years. Regular 30-day cycles. No STIs documented. No cervical or uterine procedures. Last cervical smear: never done (first time offered at booking).
Past Medical / Surgical History
No chronic medical conditions. No previous surgeries. No blood transfusions.
Drug History & Allergies
Ferrous sulphate 200 mg BD, Folic acid 5 mg OD. NKDA.
Family History
No family history of multiple pregnancy, diabetes, hypertension, or congenital malformations.
Social History
Non-smoker. No alcohol. No recreational drugs. Works as a tailor (sedentary occupation). Lives with husband. Good social support. Anxious about the baby's wellbeing given early gestation.
COMPLAINT 7 — Gestational Diabetes Mellitus (GDM)
Mrs. Priya Sharma, 35 years old, married, accountant. G2P1+0, at 28 weeks gestation by sure LMP (EDD: 08/08/2026). Booked at 8 weeks.
Chief Complaint (C/O)
- Referred from ANC clinic with elevated blood glucose on routine OGTT screening
- Increased thirst and frequency of urination × 3 weeks
History of Presenting Illness (HOPI)
Mrs. Priya Sharma, a 35-year-old G2P1+0 at 28 weeks gestation, was referred to the combined obstetric-diabetic antenatal clinic following an abnormal 75g oral glucose tolerance test (OGTT) performed at her routine 26-week ANC visit. She also reports a 3-week history of increased thirst and urinary frequency.
Abnormal OGTT results: The OGTT performed at 26 weeks showed:
- Fasting glucose: 5.4 mmol/L (normal <5.1 mmol/L — borderline elevated)
- 1-hour glucose: 10.8 mmol/L (normal <10.0 mmol/L — elevated)
- 2-hour glucose: 9.2 mmol/L (normal <8.5 mmol/L — elevated)
- Diagnosis: GDM confirmed (IADPSG criteria — one or more values at or above threshold)
Symptoms:
- Polydipsia: She has noticed increased thirst for approximately 3 weeks — drinking significantly more water than usual (approximately 4–5 litres per day versus her usual 1.5 L).
- Polyuria: Urinary frequency has significantly increased — she is waking 3–4 times per night to urinate (nocturia), and urinating every 45–60 minutes during the day. She denies dysuria, haematuria, or offensive urine (excluding UTI as cause).
- Fatigue: She reports feeling unusually tired and "heavy" — significantly beyond what she attributes to the pregnancy itself.
- Recurrent vaginal thrush: She has had two episodes of vulvovaginal candidiasis over the past 6 weeks — treated each time with topical clotrimazole. (Recurrent Candida is a red flag for hyperglycaemia)
- Blurred vision: She noticed intermittent blurring of vision over the past 2 weeks — she attributes this to "tiredness" but has not seen an optician. (Fluctuating glucose causes osmotic lens changes — urgent ophthalmology referral needed)
She denies polyuria with pain (UTI excluded), no headache or visual field loss (PET excluded at this point), no nausea/vomiting.
Dietary history: She describes a diet high in refined carbohydrates — white rice, white bread, fruit juices, and frequent sweet snacks. She has not received dietetic counselling yet. She has not commenced home glucose monitoring.
No hypoglycaemic symptoms (not on any pharmacological treatment yet).
Obstetric Part (Current Pregnancy)
LMP: 01/11/2025, regular 28-day cycle. EDD: 08/08/2026. GA = 28 weeks.
1st Trimester: Confirmed intrauterine singleton pregnancy. BMI at booking: 31.2 kg/m² (obese — GDM risk factor). Booking bloods: Blood group O Rh-positive. Fasting glucose at booking: 5.0 mmol/L (borderline — HbA1c was checked: 5.9% — no pre-gestational diabetes, but impaired fasting glucose noted; early OGTT at 16 weeks performed — normal at that time: fasting 4.4 / 2-hr 7.1 mmol/L). FBC: Hb 11.5 g/dL.
2nd Trimester: Quickening at 19 weeks. Anomaly scan at 20 weeks — normal fetal anatomy; note was made of slight increase in abdominal circumference on 60th centile. AFI normal at 20 weeks. OGTT repeated at 26 weeks (routine second screen due to risk factors) — abnormal as above. Weight gain to date: 10 kg (above recommended gain for overweight BMI, target 7–11 kg total).
3rd Trimester (28 weeks — current visit): SFH today = 30 cm at 28 weeks (2 cm larger than dates — suggests macrosomia or polyhydramnios; USS for growth scan ordered today). BP: 118/74 mmHg. Urine dipstick: 2+ glucose, trace protein. No oedema.
Growth USS requested today to assess for macrosomia and polyhydramnios.
Past Obstetric History
| Pregnancy | Year | GA | Mode | Weight | Sex | Outcome | Complications |
|---|---|---|---|---|---|---|---|
| 1st | 2021 | 39 wks | SVD | 4.2 kg (macrosomic) | M | Alive, well | GDM in 1st pregnancy — diet-controlled; shoulder dystocia documented at delivery |
| 2nd | Current | 28 wks | — | — | — | — | GDM recurrence |
(GDM recurrence risk after first GDM pregnancy: 50–70%. History of macrosomia and shoulder dystocia in first pregnancy increases risk of recurrence)
Gynaecological History
Regular cycles. No history of PCOS (asked specifically — irregular cycles? excess hair? — denied). No STIs. No previous pelvic surgery.
Past Medical / Surgical History
No known pre-gestational diabetes. No hypertension. Family history of DM2 noted (see below). BMI pre-pregnancy estimated at 29.5 kg/m². No thyroid disease. No previous surgeries. No blood transfusions.
Drug History & Allergies
Ferrous sulphate 200 mg BD, Folic acid 5 mg OD. Not yet commenced on metformin or insulin — first diabetic clinic visit today. NKDA.
Family History
- Father: Type 2 diabetes mellitus, diagnosed at age 45
- Paternal aunt: Type 2 diabetes mellitus
- No family history of type 1 DM, multiple pregnancy, hypertension, or congenital malformations.
Social History
Non-smoker. No alcohol during pregnancy. No recreational drugs. Accountant — desk-based sedentary occupation (minimal physical activity). Lives with husband and son. Good financial resources and social support. Motivated to comply with dietary changes and monitoring.
Summary of Writing Principles Used Across All Cases
| Element | How It Was Written |
|---|---|
| Opening statement | Name, age, gravida/parity, gestational age, EDD, then the complaint |
| Complaint characterisation | Onset, duration, progression, severity, quality, radiation, associated features, aggravating/relieving factors, effect on function |
| Obstetric-specific symptoms | Fetal movements, bleeding, discharge, contractions addressed in every case |
| Differentials excluded within HOPI | Each case actively excludes competing diagnoses with specific denials |
| Obstetric part structure | 1st / 2nd / 3rd trimester progression, with USS findings, bloods, BP, and relevant risk factors documented |
| Past obstetric history | Table format with GA, mode, weight, outcome, complications — each pregnancy numbered |
| Linking past to present | Past history complications are noted as risk factors for current presentation |
Questions in each part from biodata ?? To ask during clerk using simple word states the questions
Here are all the actual questions you ask the patient during clerking, section by section, in simple everyday language — exactly as you would say them at the bedside.
CLERKING QUESTIONS — OBSTETRICS
From Biodata to the End of History
📋 SECTION 1 — BIODATA
These are the first questions you ask to introduce yourself and identify the patient.
"Good morning/afternoon, my name is Dr. ___. I am going to ask you some questions about yourself and your health. Is that okay?"
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "What is your full name?" | Patient identity |
| 2 | "How old are you?" | Age — risk stratification (<20 = young primigravida risk; >35 = advanced maternal age) |
| 3 | "What is your date of birth?" | Confirm age |
| 4 | "What is your religion?" | Cultural/religious considerations for management (e.g., blood transfusion refusal) |
| 5 | "Are you married, single, or in a relationship?" | Marital/relationship status — social support |
| 6 | "What is your husband's/partner's name and age?" | Partner details |
| 7 | "What do you do for work?" | Occupation — physical activity, stress, exposure risks |
| 8 | "What does your husband/partner do for work?" | Partner occupation — financial support |
| 9 | "Where do you live?" | Address — for records and follow-up |
| 10 | "What is your ethnic background?" | Ethnicity — risk for GDM, sickle cell, thalassaemia, PET |
| 11 | "What is your blood group? Do you know if you are Rhesus positive or negative?" | Blood group and Rh status — anti-D management |
📋 SECTION 2 — CURRENT PREGNANCY DETAILS
(Ask Early — Before the Complaint)
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "Is this your first pregnancy, or have you been pregnant before?" | Gravidity |
| 2 | "How many times have you given birth to a baby?" | Parity (deliveries ≥24 weeks) |
| 3 | "Have you ever had a miscarriage or lost a pregnancy before 6 months?" | Pregnancy losses |
| 4 | "Have you ever had a termination of pregnancy?" | TOPs — ask sensitively, privately |
| 5 | "When did your last period start? Are you sure of that date?" | LMP — to calculate gestational age and EDD |
| 6 | "Are your periods usually regular? How many days between each period?" | Cycle regularity — affects accuracy of EDD |
| 7 | "How many weeks pregnant are you now?" | Gestational age |
| 8 | "Do you know your due date?" | EDD |
| 9 | "Have you done an ultrasound scan? What did it show?" | USS dating and findings |
| 10 | "Where are you attending antenatal care? When did you first register?" | Booking details |
| 11 | "Have you been attending your antenatal visits regularly?" | ANC attendance / compliance |
📋 SECTION 3 — CHIEF COMPLAINT
"Now, can you tell me in your own words — what brought you to the hospital today?"
(Let her speak freely first — do not interrupt)
Then follow with:
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "When exactly did it start?" | Onset |
| 2 | "Did it start suddenly or gradually?" | Mode of onset |
| 3 | "How long has it been going on?" | Duration |
| 4 | "Has it been getting worse, better, or staying the same?" | Progression |
| 5 | "Is there anything that makes it worse?" | Aggravating factors |
| 6 | "Is there anything that makes it better — like lying down, taking a tablet, or resting?" | Relieving factors |
| 7 | "Have you had this same problem before in this pregnancy or a previous one?" | Recurrence / past history relevance |
📋 SECTION 4 — HOPI QUESTIONS BY COMPLAINT
🔴 COMPLAINT 1 — Vaginal Bleeding (APH)
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "When did the bleeding start?" | Onset |
| 2 | "Did it come on suddenly or build up slowly?" | Sudden = placenta previa |
| 3 | "How much blood did you lose? Can you show me on this pad — is it like this much?" | Amount / severity |
| 4 | "What colour was the blood — bright red or dark?" | Bright red = fresh / previa; dark = abruption |
| 5 | "Did you pass any clots or tissue?" | Clots = significant; tissue = possible miscarriage/molar |
| 6 | "Do you have any pain in your belly right now?" | Painless = previa; painful = abruption |
| 7 | "Is the pain constant, or does it come and go?" | Constant pain = abruption; intermittent = contractions |
| 8 | "Is your belly feeling hard or tender when I touch it?" | Wooden/tender uterus = abruption |
| 9 | "What were you doing when the bleeding started — were you sleeping, walking, having sex?" | Precipitating activity |
| 10 | "Did anything happen before — any fall, injury, or accident?" | Trauma as cause |
| 11 | "Have you had sex recently — in the last 24–48 hours?" | Post-coital bleed |
| 12 | "Is the baby still moving? When did you last feel the baby move?" | Fetal wellbeing |
| 13 | "Have the movements changed — less than usual, or the same?" | Reduced FM = fetal distress (abruption) |
| 14 | "Have you had any watery discharge or fluid leaking from your vagina?" | PROM associated |
| 15 | "Do you feel dizzy, faint, or your heart racing?" | Signs of haemorrhagic shock |
| 16 | "Have you had any bleeding earlier in this pregnancy?" | Previous APH = recurrent placenta previa |
| 17 | "Did your scan ever mention a low-lying placenta?" | Placenta previa on USS |
🟠 COMPLAINT 2 — Pre-Eclampsia / Headache + Swelling + High BP
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "Where exactly is the headache — front, back, or all over?" | Location — frontal/occipital common in PET |
| 2 | "How bad is the headache — if 0 is no pain and 10 is the worst, what number?" | Severity |
| 3 | "Is the headache constant or does it come and go?" | Constant = more sinister in PET |
| 4 | "Did you take anything for it? Did it help?" | Response to analgesia |
| 5 | "Is your vision blurred, or do you see flashing lights or spots?" | Visual disturbance = cerebral vasospasm |
| 6 | "Are you seeing double?" | Diplopia |
| 7 | "Have you had any fits, blackouts, or shaking of the body?" | Eclampsia — most important question |
| 8 | "When did you first notice your face was swollen?" | Facial oedema onset |
| 9 | "Is your face puffy when you wake up in the morning?" | Morning facial oedema = significant |
| 10 | "Are your hands swollen? Can you still take off your rings?" | Hand oedema |
| 11 | "Has the swelling in your legs suddenly got much worse?" | Rapidly worsening oedema |
| 12 | "Do you have pain under your right ribs or in your upper stomach?" | RUQ pain = liver capsule / HELLP |
| 13 | "Do you have any pain in the middle of your stomach — like heartburn?" | Epigastric pain — differentiate from reflux |
| 14 | "Is your urine less than usual? Is it dark?" | Oliguria = renal involvement |
| 15 | "Has anyone checked your blood pressure recently? What was it?" | BP trend from community/ANC |
| 16 | "Did your antenatal urine tests ever show protein in your urine?" | Proteinuria history |
| 17 | "Are you still feeling the baby move normally?" | Fetal wellbeing — IUGR risk |
🟡 COMPLAINT 3 — Preterm Labour
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "Are you having pains in your lower belly or back right now?" | Contractions present |
| 2 | "How often do the pains come — how many minutes apart?" | Frequency (every 5 min = active labour) |
| 3 | "How long does each pain last — seconds or minutes?" | Duration per contraction |
| 4 | "Are they getting stronger and more frequent?" | Progression = true labour |
| 5 | "Can you talk or breathe normally during the pain, or does it stop you?" | Severity |
| 6 | "Does the pain go to your back?" | Radiation — true labour often has backache |
| 7 | "Did you notice any blood-stained jelly-like discharge from your vagina before the pains?" | Show |
| 8 | "Did you feel any water or fluid coming out of your vagina?" | PPROM — membranes ruptured |
| 9 | "Was it a big gush or a slow leak?" | Gush = complete PROM; trickle = high leak |
| 10 | "Did you have any bleeding with the pains?" | APH associated with labour |
| 11 | "Is the baby still moving normally?" | Fetal wellbeing |
| 12 | "Do you have any burning when you pass urine, or is it more frequent?" | UTI — common trigger of PTL |
| 13 | "Do you have a fever or feel hot and shivery?" | Chorioamnionitis |
| 14 | "Do you have any bad-smelling discharge from your vagina?" | Infection |
| 15 | "Did anything happen before the pains — a fall, lifting something heavy, or sex?" | Precipitating factor |
| 16 | "Did your scan ever show that your cervix was short?" | Short cervix = PTL risk |
| 17 | "Did you have an early delivery in your last pregnancy?" | Previous PTL = strongest risk factor |
🟢 COMPLAINT 4 — Hyperemesis Gravidarum
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "When did the nausea and vomiting start?" | Onset (NVP starts ~5–6 wks) |
| 2 | "How many times do you vomit in a day?" | Frequency (>5 = significant) |
| 3 | "What does the vomit look like — food, yellow/green liquid, or blood?" | Content — bile = prolonged; blood = Mallory-Weiss |
| 4 | "Are you able to keep anything down at all — water, juice, food?" | Oral intake |
| 5 | "Is there anything that makes it worse — smells, certain foods, movement?" | Triggers |
| 6 | "How much weight have you lost? Do you know your weight before pregnancy?" | Weight loss (>5% = hyperemesis criteria) |
| 7 | "When did you last pass urine? What colour was it?" | Dark urine = dehydration |
| 8 | "Do you feel dizzy when you stand up?" | Postural dizziness = dehydration |
| 9 | "Do you have any pain when you vomit, or pain in your stomach?" | Rule out surgical cause |
| 10 | "Are you confused or is your memory different lately?" | Wernicke's encephalopathy screening |
| 11 | "Is your vision normal?" | Wernicke's — ophthalmoplegia |
| 12 | "Do you have any burning when you pass urine, or need to go more often?" | UTI as precipitant |
| 13 | "Have you had diarrhoea?" | Gastroenteritis vs hyperemesis |
| 14 | "Do you have a fever?" | Infection as a cause |
| 15 | "Did you have this problem in a previous pregnancy?" | Recurrence history |
| 16 | "Have you tried any medication or home remedy for the vomiting?" | Treatment tried |
| 17 | "How has this been affecting your day — work, school, daily life?" | Functional impact |
| 18 | "How are you feeling in your mood — are you coping, or feeling very low?" | Psychological wellbeing |
🔵 COMPLAINT 5 — Reduced Fetal Movements
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "When did you first start feeling the baby move during this pregnancy?" | Quickening onset |
| 2 | "How often does your baby normally move in a day?" | Baseline movement pattern |
| 3 | "When did you first notice the movements had reduced?" | Onset of RFM |
| 4 | "When was the last time you are 100% sure the baby moved?" | Time of last certain movement |
| 5 | "How many times has the baby moved since you noticed the change?" | Kick count |
| 6 | "Did you try drinking cold water or lying on your side to get the baby to move?" | Response to stimulation |
| 7 | "Did the baby move after that, or still nothing?" | Persisting RFM despite stimulation = urgent |
| 8 | "Are the movements weaker than usual, or has the baby completely stopped?" | Quality of remaining movements |
| 9 | "Do you have any pain in your belly?" | Abruption associated |
| 10 | "Have you had any bleeding from your vagina?" | APH — abruption |
| 11 | "Have you had any pains coming and going in your belly?" | Contractions |
| 12 | "Have you taken any tablets, painkillers, or sleeping medicine today?" | Sedatives reduce perceived FM |
| 13 | "Did you eat and drink normally today?" | Hypoglycaemia reduces FM |
| 14 | "Did you have a fall or accident recently?" | Trauma — abruption risk |
| 15 | "Do you have a headache or swelling of your face and hands?" | PET screening — uteroplacental insufficiency |
| 16 | "Did your scan ever say the baby was small for its age?" | IUGR — highest risk for stillbirth |
| 17 | "Have you ever had a stillbirth before?" | Highest risk group — handle sensitively |
🟣 COMPLAINT 6 — PROM / PPROM
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "Can you describe what happened — what exactly did you feel?" | Patient's own account of fluid loss |
| 2 | "Did it come as a big sudden gush, or a slow trickle?" | Gush = complete PROM; trickle = high/partial rupture |
| 3 | "When exactly did it happen?" | Time of rupture → latency period |
| 4 | "Is it still leaking now, or has it stopped?" | Ongoing leakage |
| 5 | "How many pads have you soaked since it started?" | Estimate of volume |
| 6 | "What colour was the fluid — clear, yellow, green, or bloody?" | Clear/straw = normal; green = meconium; offensive = infection |
| 7 | "Did the fluid have a smell — like urine, or a bad smell?" | Offensive odour = chorioamnionitis; urine smell = incontinence |
| 8 | "Are you sure it is not urine — can you squeeze and stop the leaking?" | Distinguish PROM from urinary incontinence |
| 9 | "Is the fluid still coming even when you are sitting or lying still?" | Continuous leak = PROM (urine stops when lying) |
| 10 | "Do you have any pains in your belly or back — coming and going?" | Contractions = labour has started |
| 11 | "Have you noticed any blood-stained jelly coming out?" | Show = cervix dilating |
| 12 | "Is the baby still moving normally?" | Fetal wellbeing |
| 13 | "Do you have a fever, or do you feel hot and shivery?" | Chorioamnionitis |
| 14 | "Does your belly feel tender or painful when I press it?" | Uterine tenderness = chorioamnionitis |
| 15 | "Have you had any bad-smelling discharge from your vagina before today?" | Pre-existing infection |
| 16 | "Did you have sex recently — in the last 48 hours?" | Coitus as precipitant |
| 17 | "Have you had a recent examination in your vagina at the clinic?" | Recent PV exam as precipitant |
| 18 | "Have you ever had an operation on your cervix — like a biopsy or colposcopy?" | Cervical procedure = weakened cervix |
⚪ COMPLAINT 7 — Gestational Diabetes (GDM)
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "Were you told about your sugar test results at your last visit? What did they say?" | Patient's awareness of OGTT result |
| 2 | "Have you been feeling more thirsty than usual — drinking a lot more water?" | Polydipsia |
| 3 | "Are you passing urine much more often than before, even at night?" | Polyuria / nocturia |
| 4 | "How many times do you wake at night to pass urine?" | Nocturia frequency |
| 5 | "Are you feeling unusually tired or heavy all the time?" | Fatigue from hyperglycaemia |
| 6 | "Is your vision blurred at times?" | Osmotic lens changes |
| 7 | "Have you had any itching in your private parts, or repeated thrush infection?" | Recurrent candidiasis = hyperglycaemia |
| 8 | "Have you had any tingling or numbness in your hands or feet?" | Peripheral neuropathy (unlikely in GDM but screen if pre-gestational DM) |
| 9 | "Are you burning when you pass urine?" | UTI — common with GDM; also causes polyuria |
| 10 | "Are you checking your blood sugar at home? What numbers are you getting?" | Home glucose monitoring values |
| 11 | "What kind of food do you eat usually — do you eat a lot of rice, bread, sugar, or sweet drinks?" | Dietary assessment |
| 12 | "Have you been given any medication for your sugar — tablets or injections?" | Treatment compliance |
| 13 | "Did you have sugar problems in your last pregnancy?" | Previous GDM = recurrence risk |
| 14 | "Were any of your previous babies very big at birth — over 4 kg?" | Macrosomia history |
| 15 | "Did you ever have a big baby that got stuck during delivery?" | Previous shoulder dystocia |
| 16 | "Has your belly been measuring bigger than expected at your visits?" | SFH > dates = macrosomia/polyhydramnios |
| 17 | "Is the baby moving normally?" | Fetal wellbeing |
| 18 | "Do you have headache or your face and hands swelling?" | PET screening — GDM increases PET risk |
📋 SECTION 5 — OBSTETRIC HISTORY (PAST PREGNANCIES)
Ask for every previous pregnancy — go through them one by one.
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "How many times have you been pregnant before — including this one?" | Total gravidity |
| 2 | "Let's start from your first pregnancy — what year was that?" | Timeline |
| 3 | "How many months pregnant were you when you delivered?" | Gestational age at delivery |
| 4 | "Did you deliver normally through the vagina, or was it a caesarean section?" | Mode of delivery |
| 5 | "If caesarean — why was it done? Was it planned or an emergency?" | Indication for LSCS |
| 6 | "How much did the baby weigh?" | Birth weight |
| 7 | "Was it a boy or a girl?" | Sex of infant |
| 8 | "Is the baby alive and well today?" | Neonatal outcome |
| 9 | "Were there any problems during the pregnancy, labour, or after delivery?" | Complications |
| 10 | "Did you have a lot of bleeding after the baby was born?" | Previous PPH |
| 11 | "Did you have high blood pressure, swelling, or fits during that pregnancy?" | Previous PET/eclampsia |
| 12 | "Were you told you had sugar problems in that pregnancy?" | Previous GDM |
| 13 | "Was the baby premature — born before 9 months?" | Previous preterm delivery |
| 14 | "Were any of the babies small or not growing well inside the womb?" | Previous IUGR/SGA |
| 15 | "Have you ever lost a pregnancy before — a stillbirth or a baby that died after birth?" | Stillbirth / neonatal death — ask very sensitively |
| 16 | "Have you ever had a miscarriage — lost a pregnancy in the early months?" | Early pregnancy loss |
📋 SECTION 6 — GYNAECOLOGICAL HISTORY
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "How old were you when your periods first started?" | Age of menarche |
| 2 | "Are your periods usually regular?" | Cycle regularity |
| 3 | "How many days is your cycle — from the first day of one period to the next?" | Cycle length |
| 4 | "How many days does the bleeding last?" | Duration of flow |
| 5 | "Is the flow heavy, moderate, or light?" | Amount of flow |
| 6 | "Do you have pain during your periods?" | Dysmenorrhoea |
| 7 | "Have you ever had a smear test? When was the last one, and what was the result?" | Cervical smear history |
| 8 | "Have you ever been told you have fibroids, ovarian cysts, or polyps?" | Uterine/ovarian pathology |
| 9 | "Have you ever had an operation on your cervix or womb?" | Previous cervical/uterine surgery |
| 10 | "Have you ever had any infections 'down there' — sexually transmitted infections?" | STI history |
| 11 | "Have you ever had problems falling pregnant — did it take a long time?" | Fertility history |
| 12 | "What contraceptive method were you using before this pregnancy?" | Contraception history |
📋 SECTION 7 — PAST MEDICAL & SURGICAL HISTORY
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "Do you have high blood pressure?" | Chronic hypertension |
| 2 | "Do you have diabetes — sugar in your blood?" | Pre-gestational diabetes |
| 3 | "Do you have any problems with your kidneys?" | Renal disease — PET risk |
| 4 | "Do you have any heart problems?" | Cardiac disease |
| 5 | "Do you have any thyroid problems — has your thyroid been checked?" | Thyroid disease |
| 6 | "Do you have anaemia — low blood?" | Chronic anaemia |
| 7 | "Have you ever had fits or epilepsy?" | Epilepsy — drug-drug interaction, teratogenicity |
| 8 | "Have you ever had asthma or breathing problems?" | Asthma |
| 9 | "Have you ever had malaria during this pregnancy?" | Malaria — common in endemic areas, causes anaemia/preterm labour |
| 10 | "Have you ever been in hospital before, not for pregnancy?" | Previous admissions |
| 11 | "Have you ever had an operation? What was it for, and were there any problems?" | Surgical history |
| 12 | "Have you ever had a blood transfusion?" | Blood transfusion history — infections, antibodies |
| 13 | "Have you ever had tuberculosis — TB — or been treated for it?" | TB history |
| 14 | "Have you ever been told you have HIV? Are you on treatment?" | HIV status — PMTCT |
| 15 | "Do you have sickle cell disease or sickle cell trait?" | Haemoglobinopathy |
📋 SECTION 8 — DRUG HISTORY & ALLERGIES
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "Are you taking any medicines right now — tablets, injections, or supplements?" | Current medications |
| 2 | "Are you taking your folic acid and iron tablets regularly?" | Compliance with antenatal supplements |
| 3 | "Are you taking aspirin — was it prescribed to you?" | Aspirin for PET prevention |
| 4 | "Are you on any blood pressure medicines?" | Antihypertensives |
| 5 | "Are you on insulin or any diabetes tablets?" | Diabetic medications |
| 6 | "Are you taking any herbal medicines, local herbs, or traditional remedies?" | Herbal/traditional medicine — teratogen risk |
| 7 | "Do you have any allergies to any medicine — did any medicine ever give you a rash, swelling, or difficulty breathing?" | Drug allergies |
📋 SECTION 9 — FAMILY HISTORY
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "Does anyone in your family have diabetes — your parents, brothers, sisters?" | Family DM → GDM risk |
| 2 | "Does anyone in your family have high blood pressure?" | Family hypertension → PET risk |
| 3 | "Did your mother or sister ever have high blood pressure during their own pregnancy?" | Family PET history |
| 4 | "Are there any twins or triplets in your family?" | Multiple pregnancy tendency |
| 5 | "Is there any hereditary illness in the family — sickle cell, thalassaemia, chromosomal problems?" | Genetic conditions |
| 6 | "Has any baby in the family been born with a defect?" | Congenital malformations |
| 7 | "Is there a history of blood clots — DVT or PE — in the family?" | Thrombophilia family history |
📋 SECTION 10 — SOCIAL HISTORY
| # | Question to Ask | What You Are Finding Out |
|---|---|---|
| 1 | "Do you smoke cigarettes?" | Smoking — IUGR, preterm, abruption risk |
| 2 | "If yes — how many do you smoke per day, and for how many years?" | Pack-year history |
| 3 | "Do you drink alcohol?" | Alcohol — fetal alcohol syndrome |
| 4 | "If yes — how much do you drink and how often?" | Quantity and frequency |
| 5 | "Do you use any other substances — cannabis, cocaine, or anything else?" | Recreational drugs — abruption (cocaine), IUGR |
| 6 | "Is your relationship with your husband or partner good? Do you feel safe at home?" | Domestic violence screening — ask alone, sensitively |
| 7 | "Do you have family or friends around to help you at home?" | Social support network |
| 8 | "Do you have any financial worries or problems caring for yourself?" | Socioeconomic status |
| 9 | "Are you still working? Is the work physically demanding?" | Occupational risks |
| 10 | "Who will be with you during labour and after delivery?" | Birth partner / postnatal support |
| 11 | "Is this pregnancy planned, or was it a surprise?" | Planned vs unplanned — affects engagement with care |
| 12 | "How are you feeling in yourself emotionally — are you coping with the pregnancy?" | Mental health / antenatal depression screening |
Quick Memory Aid — Order of Sections
B → Biodata
C → Current pregnancy (GA, EDD, G/P)
C → Chief complaint
H → HOPI (complaint-specific questions above)
O → Obstetric history (past pregnancies)
G → Gynaecological history
M → Medical and surgical history
D → Drug history and allergies
F → Family history
S → Social history
Tip: In obstetrics, always establish gestational age and parity before exploring the complaint — it changes everything about which conditions are possible and how urgently you need to act.
Now common complaints symptoms with their diagnosis smart memory aid
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