Introduction:

Name
Age/ D.O.B
Marital Status (Duration)
Hometown
Gravidity
Parity
LRMP (are they regular? Long or short in duration?) and POA (calculate
from LRMP to now)
EDD (from LRMP and from USS)

Pc: Eg) Abdominal pain, GDM, delivery, as requested for CS, for Ix, due to HTN.
HxPc:
Current Pregnancy:

Single or multiple pregnancy?

How long after marriage did patient become pregnant?
Was the pregnancy planned or unexpected? (not unwanted!)
If planned, was the patient on prenatal supplements (eg. Folate)?
How did the patient find out she was pregnant and at which POA?

Trimester 1: (0-12 weeks)

During booking visit, did patient have FBC, ABO, FBG done? Was BMI
checked? Any murmurs, pallor etc checked?
Dating scan done? At which POA?
Any complications or complaints?
Was patient hospitalised?

Trimester 2: (12-28 weeks)

Tetanus? Deworming? Rubella?

Is patient on supplements? (Folate, Iron, Vit C, Calcium)
Anomaly scan done?
Oral glucose tolerance test done? If so, what were the results?
If Gestational Diabetes Mellitus (GDM) patient, was Blood Sugar Series
(BSS) done? Is patient on metformin and at which POA did she commence
Tx?
Any complications or complaints?
Was the patient hospitalised?

Trimester 3: (28 weeks to term)

Was the growth scan conducted at 37 weeks?

Foetal movements? At which POA did patient first experience it?
Any complications or complaints?
Was the patient hospitalised?
Past Obstetric Hx:

How many past pregnancies? In chronological order mention: the MOD (if
CS, why?), if it was term or pre-term, induced or not, if the baby was
healthy (then and now), and the birth weight.
Current age of child/ children
Any complications? (Pregnancy induced hypertension (PIH), Gestational
Diabetes Mellitus (GDM), Early onset pre-eclampsia, placental abruption,
Foetal growth restriction (FGR) or unexplained stillbirth)
Gap between pregnancies?
Any miscarriages? Recurrent or one-off? Cause (if known)? Ectopic
pregnancies?
Any complications for mother post-partum?
Breastfeeding?
Contraceptive use? Any changes in contraception and if so, why?

Past Gynaecological Hx:

Difficulties in conceiving? Subfertility?

Any infections (sexually transmitted)?
Date of last cervical smear?
Any Tx for cervical changes?
Previous gynaecological surgery?

SI:
PMHx: DM, DL, HTN, thyroid, epilepsy, cardiac/renal/hepatic problems, bronchial
asthma, haematological diseases.
Psychiatric Hx: post-partum depression, depression unrelated to pregnancy,
major psych. illness.
Drug Hx:
Allergies:
PSHx:
Family Hx: Multiple (twin, triplet) pregnancies, congenital conditions, inherited
conditions
Social Hx: Family support, socio-economic status, nearest hospital, diet (?)