OB/GYN EMR: antenatal, partogram and fertility workflows

An OB/GYN EMR should hold each pregnancy as one record across visits, calculate gestational age from a single agreed EDD, keep an antenatal flowsheet, support an electronic partogram on labor admissions, and track fertility cycles from stimulation to outcome. Gynecology, postpartum and menopause care need their own structured sections in the same chart.

This guide is for obstetricians, gynecologists, fertility specialists and women's health clinic managers. Our worked example is Helix's OB/GYN EMR, the Woman's-Health Canvas, which is part of the Helix EMR.

The pregnancy is the record, not the visit

In most EMRs every visit opens a blank note. For obstetrics that is the wrong unit. The dating, scans, risk factors and antenatal readings all belong to the pregnancy, and each visit should add to it.

Helix treats a pregnancy, and a fertility cycle, as a patient-level episode. Open the chart at the second antenatal visit and the whole pregnancy is there: dating, flowsheet, scans and risk board. Ending the pregnancy asks for the outcome and date, files a row in the obstetric history and updates GTPAL. Each patient can have one open pregnancy and one open cycle at a time.

Dating: one working EDD, everything derived

Gestational age errors spread. If GA is typed by hand in five places, one of them will eventually be wrong. The safer design:

1. Record the LMP. The software calculates menstrual dating using Naegele's rule, adjusted for cycle length.
2. Enter the ultrasound estimate, usually from crown-rump length in the first trimester.
3. The software shows whether the two agree, against the redating rule your unit uses.
4. The clinician sets the working EDD, and every gestational age and centile is recalculated from it.
5. Later edits to the LMP never silently move a confirmed EDD.

Helix follows this model and shows the gestational age in the chart's top rail, so everyone in the room works from the same number.

Antenatal visits and risk

The antenatal flowsheet is the backbone of routine care: blood pressure, weight, urine, fundal height, fetal heart and presentation, with the ability to add rows and copy forward. Growth and weight gain should chart over time. Risk factors and screening results should sit on one board that follows the pregnancy.

GTPAL deserves a special mention. It is often retyped on several screens and ends up inconsistent. Keep it in one place, the obstetric history, and derive every other display from it. Also check for:

• Blood group and antibody status recorded once.
• Previous pregnancies with outcomes, including those recorded in a previous system.
• VBAC planning where there is a prior cesarean section.

Scans and fetal growth

Ultrasound findings are some of the most valuable data in antenatal care and some of the worst stored. They often arrive as a scanned report attached to the visit, with the estimated fetal weight and centile visible only to whoever opens the file.

Record the key measurements on the pregnancy record instead: the scan date, gestational age at the scan, biometry, estimated fetal weight, liquor and placental position. When growth is plotted against the working EDD, a falling centile is visible at a glance. When a sonographer's centile differs from the chart's, the difference is usually the reference chart or the dating, and both should be visible so the clinician can reconcile them. Helix keeps scans on the pregnancy record and shows them on a pregnancy timeline alongside visits and milestones.

The electronic partogram

Paper partograms still dominate labor wards, partly because many electronic versions are harder to use than a pen. A good electronic partogram:

• Plots cervical dilatation and descent over time, with fetal heart, liquor, contractions, drugs and maternal observations in their own lanes.
• Lets the midwife add a vaginal examination by clicking on the cervicogram.
• Shows alert and action lines, with a choice between the traditional thresholds and the WHO Labour Care Guide approach.
• Treats line crossings as advisory. The clinician records a crossing and the response; the software does not decide management.
• Records the Bishop score and CTG classification as the clinician assessed them.

Helix's partogram appears on delivery and surgical admissions with these lanes, and offers both Philpott-style alert and action lines and the WHO 2020 Labour Care Guide view.

Delivery and the newborn

The delivery record closes the pregnancy episode: mode of delivery, indication, the stages of labor with their durations, third-stage management, blood loss and any complications. The newborn's details, including sex, weight and Apgar scores, should be recorded once and flow to the pediatric record rather than being copied by hand.

Where there is a previous cesarean, the VBAC discussion and decision should be documented before labor, not reconstructed afterwards. And when the pregnancy ends for any reason, the outcome should update the obstetric history automatically, so the next pregnancy starts with correct GTPAL counts.

Fertility cycles

Fertility work generates dense, time-critical data. Each treatment cycle has a protocol and a sequence: baseline, stimulation, trigger, retrieval, transfer, the two-week wait and the outcome. The chart should:

• Track stimulation medications by drug, dose, route and cycle day.
• Hold folliculometry, with follicle sizes per ovary and hormone levels (estradiol, LH and progesterone) plotted by cycle day.
• Record male-factor results, including semen analysis against current WHO reference limits.
• Cancel cycles rather than delete them, so the history stays honest.
• Build a trying-to-conceive timeline from prior pregnancies and cycles automatically.

Helix's fertility mode covers each of these, including a follicle view that reads out the lead follicle and how many follicles have reached a given size.

Gynecology, postpartum and menopause

The same chart should serve the rest of the specialty without switching systems: cycle history and contraception, examination findings, POP-Q staging for prolapse, colposcopy, the postpartum course and plan, and menopausal transition staging. Helix's canvas has five modes: obstetric, gynecologic, fertility, postpartum and menopause. Switching mode never deletes data; it only changes which sections are shown.

Bilingual consultations and patient instructions

Many consultations in the GCC move between Arabic and English, sometimes with a spouse or family member in the room. Documentation should not slow that down. Helix's Verto AI scribe follows Arabic and English in the same visit and writes the clinical note in English. It can then turn the plan into Arabic patient instructions, which the doctor can edit, with a check that doses and units were preserved in translation. We explore this in our guide to the Arabic–English AI medical scribe.

Patients can also receive booking links, e-consent forms and lab results through the patient portal, without installing an app or remembering a password.

Where OB/GYN meets the rest of the clinic

Women's health services rarely stand alone. They share laboratory and ultrasound services, pediatrics for the newborn, and often a day-surgery unit. How one record works across these departments is covered in running a multi-specialty clinic on one EMR.