Obstetric and gynecologic history are often considered a distinct part of the medical history. This history includes past medical history related to reproductive and overall gynecologic health, including pregnancies, medical conditions, medications, and procedures.
Obstetric History
Taking an obstetric history usually begins with asking about previous pregnancies, including dates, outcomes, and complications.
For pregnant patients, a more detailed obstetric history is taken regarding prior pregnancies and the current pregnancy.
Gravidity and parity
The basic obstetric history is documented in a specific format, noting gravidity and parity.
Gravidity (G) is the number of confirmed pregnancies; a gravida is a term for a person who has had at least one pregnancy.
Parity (P) is the number of deliveries at ≥ 20 weeks of gestation. The numbers for parity are recorded along with other pregnancy outcomes:
Term deliveries (≥ 37 weeks)
Preterm deliveries (≥ 20 and < 37 weeks)
Abortions (including spontaneous pregnancy losses at < 20 weeks, induced abortions, ectopic pregnancies, or molar pregnancies)
Living children
Multifetal pregnancy is counted as 1 pregnancy in terms of gravidity and for all parity numbers, with the exception of living children (eg, for a woman who has had a singleton pregnancy and a twins pregnancy and all children are living, this is noted as 3).
In this documentation format, the numbers are recorded as:
G (gravidity number) P (parity number, noted as 4 numbers for term pregnancies, preterm pregnancies, abortions, and living children)
For example, the history of a patient who has had 1 term delivery, 1 set of twins born at 32 weeks, 1 spontaneous abortion, and 1 ectopic pregnancy is documented as G4 P1-1-2-3.
Obstetric outcomes and complications
In addition to gravidity and parity, taking an obstetric history in a nonpregnant patient usually focuses on prior obstetric complications that may impact future pregnancies or reproductive or general health.
Past obstetric history that may impact future pregnancies includes
Gestational age at delivery
Spontaneous labor or induction
Length of labor
Mode of delivery (vaginal, operative, cesarean)
Birth weight and sex of newborn
Complications that require further evaluation to determine etiology (eg, stillbirth, congenital anomaly)
Complications that tend to recur (eg, gestational diabetes, preeclampsia, preterm delivery, fetal growth restriction, shoulder dystocia, postpartum hemorrhage, neonatal group B strep infection)
Complications that require additional treatment or monitoring in future pregnancies (eg, cervical insufficiency)
Past obstetric history that may impact future reproductive or general health includes
Injury during vaginal delivery or surgical complications
Thromboembolism
Peripartum cardiomyopathy
Intensive care unit admission
Complications that may persist as chronic disease or are risk factors for future chronic disease (eg, gestational diabetes [1], gestational hypertension or severe preeclampsia [2], postpartum depression [3], postpartum psychosis)
Obstetric history references
1. Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ. 2020;369:m1361. Published 2020 May 13. doi:10.1136/bmj.m1361
2. Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the american heart association [published correction appears in Circulation. 2011 Jun 7;123(22):e624] [published correction appears in Circulation. 2011 Oct 18;124(16):e427]. Circulation. 2011;123(11):1243-1262. doi:10.1161/CIR.0b013e31820faaf8
3. Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet. 2014;384(9956):1775-1788. doi:10.1016/S0140-6736(14)61276-9
Gynecologic History
Taking a gynecologic history consists of asking patients about any symptoms or concerns that prompted the visit. The history should include a menstrual history, sexual history, urinary tract symptoms or history, and previous or current gynecologic conditions and treatments.
Current symptoms are explored using open-ended questions followed by specific questions about the following:
Pelvic pain (location, duration, character, quality, triggering and relieving factors)
Abnormal vaginal bleeding (quantity, duration, relation to the menstrual cycle)
Vaginal discharge (color, odor, consistency)
Vulvovaginal discomfort or pain (location, duration, character, quality, triggering and relieving factors)
Menstrual history includes the following:
Age at menarche or menopause
Number of days of menses
Length and regularity of the interval between cycles
Start date of the last menstrual period (LMP)
Dates of the preceding period (previous menstrual period [PMP])
Volume of menses
Passage of blood clots: Any history of passage of clots warrants further evaluation and referral to a gynecologist
Any symptoms that occur with menses (eg, pain, cramping, migraine headaches)
The individual patient's menstrual history is compared with the normal ranges for characteristics of the menstrual cycle (frequency, regularity, duration, and volume of bleeding) (see table Normal Menstrual Parameters). If there are menstrual abnormalities, the patient is evaluated for the type and etiology of abnormal uterine bleeding.
Usually, menstrual bleeding lasts for ≤ 8 days, with 24 to 38 days between menses; average blood loss is 30 mL (range, 13 to 80 mL), with the most bleeding on the second day. A saturated pad or tampon absorbs 5 to 15 mL. Objective measurement of menstrual volume is done only in research studies, so clinicians should ask the patient about use of pads and tampons and passage of blood clots from the vagina. Descriptions that suggest heavy uterine blood flow include:
Saturating ≥ 1 pad or tampon within 3 hours or less
Saturating > 21 pads or tampons per cycle
Frequently needing to change pad or tampon during the night to avoid leakage of blood on clothing or bedding
Passing blood clots ≥ 1 inch in diameter
Cramping is common on the day before and on the first day of menses. Vaginal bleeding that is irregular, painless, scant, and abnormally brief or prolonged suggests ovulatory dysfunction.
Any postmenopausal vaginal bleeding (any volume, including spotting or pink or brown staining) requires further evaluation for endometrial hyperplasia or cancer. Menopause is diagnosed 12 months after cessation of menses. However, perimenopausal women may have irregular bleeding, or postmenopausal bleeding may be misinterpreted as menses. Thus, any heavy, irregular, or prolonged bleeding in women age ≥ 45 years should be further evaluated by endometrial biopsy irrespective of the etiology.
Past gynecologic history includes history of
Sexually transmitted infection (STI) or pelvic inflammatory disease (including diagnosis, frequency, and treatment)
Vulval/vaginal lesions, ovarian cysts, uterine fibroids, infertility, endometriosis, polycystic ovary syndrome, pelvic organ prolapse, or urine/stool incontinence (including mode of diagnosis and treatment received)
Pap smear (normal or abnormal), colposcopy (including date, results, and treatment)
Gynecologic procedures such as cervical/endometrial/vulval/vaginal biopsy, hysteroscopy, laparoscopy, hysterectomy (including date, indications, and complications)
Sexual history should be obtained in a professional and nonjudgmental way and includes the following (see CDC: A Guide to Taking a Sexual History):
Gender of partners
Sexual risk behaviors (eg, multiple partners, risk or history of sexual violence)
Use of contraception (especially use of condoms)
Concerns about sexual function (eg, dyspareunia, sexual interest, arousal, orgasm)
Medical history
Social history includes social stressors, exercise patterns, and substance misuse (including smoking) and completion of a drug and alcohol questionnaire. In adolescents, social history includes athletic participation, school absence rate, and decreased participation in hobbies/sports, especially if related to menstrual cycles.
Family history includes history of malignancy, bleeding disorders, infertility, menstrual disorders, fibroids, endometriosis, and thyroid diseases in first-degree and second-degree relatives. Family history of diabetes mellitus or disorders of lipids or triglycerides should be noted and may suggest polycystic ovary syndrome.
Review of systems should include any weight changes, fatigue, hirsutism, acne, vision changes, headaches, galactorrhea, changes in bowel habits, abdominal pain, heat/cold intolerance, and urinary and gastrointestinal symptoms. In adolescents, history of self-induced vomiting, eating disorders, undernutrition, easy bleeding/bruising (epistaxis, bleeding gums) is important.
