Chapter 2 Clinical Approach to the Patient
Obstetric and Gynecologic Evaluation
In few areas of medicine is it necessary to be more sensitive to the emotional and psychological needs of the patient than in obstetrics and gynecology. By their very nature, the history and physical examination may cause embarrassment to some patients. The members of the medical care team are individually and collectively responsible for ensuring that each patient’s privacy and modesty are respected while providing the highest level of medical care. Box 2-1 lists the appropriate steps for the clinical approach to the patient.
Obstetric History
A complete history must be recorded at the time of the prepregnancy evaluation or at the initial antenatal visit. Several detailed standardized forms are available, but this should not negate the need for a detailed chronologic history taken personally by the physician who will be caring for the patient throughout her pregnancy. While taking the history, major opportunities will usually arise to provide counseling and explanations that serve to establish rapport and a supportive patient–physician encounter.
PREVIOUS PREGNANCIES
Each prior pregnancy should be reviewed in chronologic order and the following information recorded:
Diagnosis of Pregnancy
The diagnosis of pregnancy and its location, based on physical signs and examination alone, may be quite challenging during the early weeks of amenorrhea. Urine pregnancy tests done in the office are reliable a few days after the first missed period, and office ultrasonography is used increasingly as a routine.
SIGNS OF PREGNANCY
The signs of pregnancy may be divided into presumptive, probable, and positive.