Lesson 2.7: Obstetrics & Gynaecology and Paediatrics Frameworks
These two specialty areas require significant adaptations to the standard consultation. Missing the menstrual history in a gynaecological station, or directing questions to the child when you should be asking the parent, are structural errors that cost marks across the entire station.
Obstetrics and Gynaecology — Menstrual History
Ask in every gynaecological station. Takes under 60 seconds and must not be omitted.
| Element | What to Ask |
|---|---|
| LMP | "When was the first day of your last period?" |
| Cycle | "How regular are your periods? How many days from the start of one to the start of the next?" |
| Flow | "How long does it last? Light, moderate, or heavy? Any flooding, clots, or need to change pads every two hours?" |
| Intermenstrual / post-coital bleeding | "Any bleeding between periods, or after sex?" |
| Dysmenorrhoea | "Do you get painful periods? Does the pain stop your normal activities?" |
| Perimenopause (over 45) | "Have your periods changed recently? Any hot flushes, night sweats, or vaginal dryness?" |
Obstetric History — GPAL
| Letter | Term | Meaning |
|---|---|---|
| G | Gravida | Total number of pregnancies including current. |
| P | Para | Deliveries at or after 24 weeks, regardless of outcome. |
| A | Abortus | All pregnancy losses before 24 weeks — spontaneous and induced. |
| L | Living children | Number of currently living children. |
Also ask about delivery mode, complications, and gestational age. For a current pregnancy: gestational age, scans, fetal movements, any bleeding or pain. Always ask about contraception, cervical screening status, and (normalising first) sexual health.
Always consider pregnancy in any woman of reproductive age presenting with abdominal pain, nausea, or vomiting — even if she does not mention it.
Paediatrics — The Age-Adapted Consultation
| Age | Primary Focus | How to Adapt |
|---|---|---|
| Under 5 | Parent / carer | History from parent. Interact warmly with child. |
| 5–11 | Both | Involve child directly with simple language alongside parent. |
| 12–16 | Young person first | Address young person first. Check if they want a parent present. Gillick competence applies. |
| Over 16 | Young person | Treat as an adult. Adult rights apply. |
- Birth history (under 2 or developmental concern): gestational age, delivery mode, neonatal unit admission.
- Feeding, immunisations, school or nursery attendance.
Developmental Milestones
| Age | Gross Motor | Speech & Language | Social |
|---|---|---|---|
| 6 weeks | Lifts head briefly | Startles to sound, coos | Social smile |
| 6 months | Sits with support | Babbles, turns to voice | Smiles at mirror |
| 12 months | Stands with support | 1–2 specific words | Waves, points |
| 18 months | Walks independently | 6–10 words | Imitates household activities |
| 2 years | Runs, climbs stairs | 50+ words, 2–3 word sentences | Parallel play |
| 3 years | Pedals tricycle | Understood by strangers | Takes turns, group play |
Does the history fit the presentation? Does the story change? Any unexplained delay in seeking care? Unusual fearfulness? → Gather carefully, document, escalate to senior. Full detail in Module 4.