Obstetrics History and Pending Births

Selecting the Obstetric Hx tab within the Clinical Window will present you with the Obstetric History window. This window allows you to enter past antenatal records or create a new pregnancy record for the patient.

Smoking/ Alcohol - The patient's smoking status and alcohol intake will automatically populate from the Summary/Main tab of the clinical window

Folate - Folate reduces the risk of neural tube defects in babies and is recommended to be taken in early stages of pregnancy.

The Last Pap field will be populated automatically if you download electronic results. Alternatively it can be filled in manually to stop warnings for overdue smears appearing and to mark correctly the patient on the Overdue Smears list in the Patients menu. If the patient is not a regular of the practice or is no longer required to be recalled for smears (eg. due to hysterectomy), you can tick the Don't Recall for Pap tickbox which will prevent them from appearing on the Overdue Smears recall list.

Left clicking in the blank fields beneath last pap allows you to add a pap smear result from the Result drop down list which is generated in Open > Pathology and Radiology in the Action List. Free text can also be typed into this field.

Last HPV- the Last HPV field behaves in the same way as the Last Pap field above it, but for HPV results instead

Parity GxPx refers to Gravida and Parity

To ensure the correct calculation of parity, there are several factors:

• The Result field needs to be completed in the Current Pregnancy or the Obstetric History
• The text in the Result field needs to be either 'Miscarriage', 'Stillborn', 'TOP' or 'Live' ('Live' can be followed by any text e.g. Live Birth)

A Miscarriage result in a Current Pregnancy or Obstetric History will produce an M

A TOP result will produce a T if it was before 20 weeks and a P if it was after 20 weeks. Both Stillborn and Live results will produce a P

Obstetric History - To enter general details about any past pregnancies that have not been previously entered in Genie (through the Current Pregnancy window), choose the blue plus icon . Enter in the relevant details in the fields provided. Information for multiple babies born within this pregnancy can be added under the Baby 1, 2, etc. tabs in the top right hand corner of this window. The Parity will automatically be generated by the outcomes added in the Result field. Automated calculation of parity recognises the results: Live, TOP (Termination of Pregnancy), Stillborn, Miscarriage.

Items added to the obstetric history tab can be deleted by highlighting them and using the trash can icon. 

To create or open a current pregnancy click the Open Current Pregnancy button in the Obstetric Hx tab.

If no current pregnancy record exists, you will receive the following prompt:

Select Yes.

The pregnancy window will now appear. Three tabs will be visible along the top of this window; Current Pregnancy, Antenatal Visits, Birth & Postnatal.

To enter details about the current pregnancy for this patient, you must first enter the LMP (Last Menstrual Period) date.

Once you have added the LMP date, Genie will automatically calculate the EDD (Estimated Date of Delivery), Gestation and the Agreed EDD dates.

To find out a patient's gestation on any date within the pregnancy, click on the down arrow next to gestation to be presented with the below window:

If you wish to change the Agreed EDD for accuracy after the first ultrasound, you can override this date at any time. The Agreed EDD field can also be used if the patient's cycle is irregular or their LMP not known for any reason.

All pregnancy-related calculations - e.g. gestation, 20/30 week invoicing, scheduled investigations, etc. - are based on the Agreed EDD. As the Agreed EDD is generally based on the doctor's observations, such as the 12 week ultrasound, it is considered to be the most accurate estimated date of delivery.

You can also choose the Provider and Hospital from the drop down lists provided (rooms are pulled from Appts > Appt Preferences > Column Order and Rooms, while the Providers are those listed in File > All User Preferences.)

Please note: The Agreed EDD and Provider fields are required for the pregnancy to correctly populate into the Pending Births window. These should be considered the "essential" fields when creating a pregnancy record, along with the Hospital.

The Partner field will only populate if a Next of Kin record has been created and marked as Partner in the Secondary tab of the Patient's Demographic window. The record can only be edited from this window, as shown below:

Once the first section of the current pregnancy window has been populated, the remaining fields can be entered. Information can be added via free text, or by selecting an option from the drop down list where applicable.

The patient's blood type information will not carry over from a previous pregnancy record. It must be entered with each new pregnancy that is opened for the patient.

Entering a blood type, including the rhesus factor, into the Blood Gp field will determine whether the Anti-D checkboxes appear under the 28 and 36 week investigations, and whether the appropriate Anti-D injection prompts will appear. If the patient's blood type has a positive rhesus factor, the text in the Blood Gp field will appear in blue, and the Anti-D checkboxes will be hidden. If the patient's blood type is rhesus negative, the text will be red, and the Anti-D checkboxes will appear, as shown below:

For this function to work correctly, a positive rhesus factor must be entered as '+' or 'POS', and a negative rhesus factor as '-' or 'NEG'.

The Out of Pocket Expense field allows Genie to generate the 20 and 30 week invoices for the patient automatically through the Pending Births List. See The Pending Births List for more information.

Once all applicable fields have been updated, ensure you select Save before exiting.

Please note: no pathology results will be automatically populated into the Current Pregnancy window. All results will need to be manually entered according to the results you have received either electronically through Genie or paper copies you have received from pathology companies themselves.

The below buttons will be visible in all three tabs of the pregnancy record in the bottom right-hand corner. 

Printer:  This will allow you to print a summary of what is displayed on the screen. If you print from the current pregnancy tab, you will also be prompted to print any antenatal visits. 

Pathology: Will allow you to order Pathology for this patient. See Ordering Pathology for more information. 

Radiology: Will allow you to order Radiology for this patient. See Ordering Radiology for more information.

Red Quill:   Will allow you to create a referral and reply letter for this patient. See Referral/Reply Letters for more information.

Add Script: This will allow you to prescribe directly from the patient's current pregnancy record. This feature is available if you are running Genie v9.3.5 or above.

Delete Record: This will delete the entire pregnancy record. You will be prompted to confirm the deletion before continuing. This action is irreversible.

Selecting the Antenatal Visit tab will allow you to record information regarding each visit the patient makes. The table in this tab is equivalent to a printed antenatal card that a patient would take with them to every antenatal visit throughout their pregnancy.

The window will appear as below:

Select New Visit to add a record.

The Antenatal Record window will appear.

Choose a Provider from the drop down list, and fill in the remaining fields as appropriate.

Select Save to exit.

Once you have saved the Antenatal Record, it will appear in the table as below:

A saved Antenatal Record can be deleted by highlighting it and clicking the Delete button.

Highlighting an item from this table will show the full context of the notes in the Antenatal Notes area. You can add any extra notes in the Additional Notes box.

Once an Antenatal Visit has been saved to the patient's record, it will appear in the Antenatal Visits tab of the Contacts list of that patient's Clinical window, as shown below:

Selecting the Birth & Postnatal tab will present you with the window designed to record information regarding the birth for this pregnancy record.

The window will appear as below:

Within this window you will need to record the details of the birth of the child, as well as any postnatal checks. The provider may also wish to use the Item to Charge drop-down menu to select the appropriate item, depending on the circumstances of the delivery. 

In order to select the Accoucher, Paediatrician, and/or Anaesthetist who assisted with the delivery, the assisting party must have a record in the Address Book, and must have the appropriate specialty specified in their record. 

To finalise or 'end' a pregnancy you will need to assign a Date and record a Result in the corresponding field.

As soon as the date field has been populated, the Add this Pregnancy to Past Obs Hx button at the bottom of this window will become active.

After selecting this button, you will receiving the following prompt. Select Proceed to continue.

Saving the final pregnancy result to the patient's Past Obstetric History will allow Genie to update the patient's parity score accurately, and removes the pregnancy from the Pending Births list. Once it has been saved, postnatal information can only be accessed by opening the record from the patient's Obstetrics History table. Unlike Antenatal visits, postnatal information is not recorded in the patient's contact list.

Please note: you will not be able to create a new pregnancy record until you have finalised the current pregnancy and added the current record to the Past Obstetric History area.

This window can be accessed via Patients > Pending Births or Appts > Pending Births. The Pending Births window shows all pending births by month, based on the Agreed EDD of current pregnancy records. These can be shown for one or all providers in the practice.

The list will populate with details of all births due for that month, including the patient and their preferred hospital. Double-click a patient's name in this list to open their current pregnancy record.

The number shown in red at the top of the window indicates the number of births due for the displayed month. This provides an at-a-glance idea of the projected workload for that month, for a single provider, or the practice as a whole. Click the Select radio button to choose an individual provider to display births for, or All to show the pending births for all providers in the practice.

Use the  and  buttons or the month/year drop-down menus to navigate through the months.

The 20 wks Due and 30 wks Due buttons are used to generate the 20/30 week invoices for the applicable patients for that month. For 20 week invoicing, this includes all patients who are 18 to 22 weeks pregnant in that month. For 30 week invoicing, this includes all patients who are 28 to 32 weeks pregnant in that month.

For more information about generating the 20 & 30 week invoices, please see our 20 & 30 Week Invoicing article.