Obstetrics
Encyclopedia
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy
(prenatal period), childbirth
and the postnatal
period. Veterinary obstetrics
is the same concept for veterinary medicine
although theriogenology
is more commonly used term that includes obstetrics, gynecology, and andrology
. Almost all modern obstetricians are also gynaecologists
.
genetic screening for downs syndrome (trisomy 21) and trisomy 18
the national standard in the United States is rapidly evolving away from the AFP-Quad screen for downs syndrome- done typically in the second trimester at 16–18 weeks. The newer integrated screen (formerly called F.A.S.T.E.R for First And Second Trimester Early Results) can be done at 10 plus weeks to 13 plus weeks with an ultrasound of the fetal neck (thick skin is bad) and two chemicals (analytes) Papp-a and bhcg (pregnancy hormone level itself). It gives an accurate risk profile very early. There is a second blood screen at 15 to 20 weeks which refines the risk more accurately. The cost is higher than an "AFP-quad" screen due to the ultrasound and second blood test but it is quoted to have a 93% pick up rate as opposed to 88% for the standard AFP/QS. This is an evolving standard of care in the United States.
Most doctors do a sugar load in a drink form of 50 grams of glucose in cola, lime or orange and draw blood an hour later (plus or minus 5 minutes) ; the standard modified criteria have been lowered to 135 since the late 1980s
and physical examination
. On subsequent visits, the gestational age
(GA) is rechecked with each visit.
Symphysis-fundal height (SFH; in cm) should equal gestational age after 20 weeks of gestation, and the fetal growth should be plotted on a curve during the antenatal visits. The fetus is palpated by the midwife or obstetrician using Leopold maneuver to determine the position of the baby. Blood pressure
should also be monitored, and may be up to 140/90 in normal pregnancies. High blood pressure indicates hypertension
and possibly pre-eclampsia
, if severe swelling (edema
) and spilled protein in the urine are also present.
Fetal screening is also used to help assess the viability of the fetus, as well as congenital problems. Genetic counseling
is often offered for families who may be at an increased risk to have a child with a genetic condition.
Amniocentesis
at around the 20th week is sometimes done for women 35 or older to check for Down's Syndrome and other chromosome
abnormalities in the fetus.
Even earlier than amniocentesis is performed, the mother may undergo the triple test
, nuchal screening, nasal bone
, alpha-fetoprotein
screening and Chorionic villus sampling
, also to check for disorders such as Down Syndrome. Amniocentesis is a prenatal genetic screening of the fetus, which involves inserting a needle through the mother's abdominal wall and uterine wall, to extract fetal DNA from the amniotic fluid. There is a risk of miscarriage and fetal injury with amniocentesis because it involves penetrating the uterus with the baby still in utero.
Imaging is another important way to monitor a pregnancy. The mother and fetus
are also usually imaged in the first trimester of pregnancy. This is done to predict problems with the mother; confirm that a pregnancy is present inside the uterus
; estimate the gestational age
; determine the number of fetuses and placenta
e; evaluate for an ectopic pregnancy
and first trimester bleeding; and assess for early signs of anomalies.
X-ray
s and computerized tomography (CT) are not used, especially in the first trimester, due to the ionizing radiation
, which has teratogenic effects on the fetus. No effects of magnetic resonance imaging
(MRI) on the fetus have been demonstrated, but this technique is too expensive for routine observation. Instead, ultrasound
is the imaging method of choice in the first trimester and throughout the pregnancy, because it emits no radiation
, is portable, and allows for realtime imaging.
Ultrasound imaging may be done at any time throughout the pregnancy, but usually happens at the 12th week (dating scan) and the 20th week (detailed scan).
A normal gestation would reveal a gestational sac
, yolk sac
, and fetal pole
. The gestational age
can be assessed by evaluating the mean gestational sac diameter (MGD) before week 6, and the crown-rump length after week 6. Multiple gestation is evaluated by the number of placenta
e and amniotic sac
s present.
is routinely used for dating the gestational age of a pregnancy from the size of the fetus, the most accurate dating being in first trimester before the growth of the fetus has been significantly influenced by other factors. Ultrasound is also used for detecting congenital anomalies (or other fetal anomalies) and determining the biophysical profile
s (BPP), which are generally easier to detect in the second trimester when the fetal structures are larger and more developed. Specialised ultrasound equipment can also evaluate the blood flow velocity in the umbilical cord
, looking to detect a decrease/absence/reversal or diastolic blood flow in the umbilical artery.
Other tools used for assessment include:
, placental malfunction, intrauterine growth retardation, and other various general medical conditions, such as renal disease. Induction may occur any time after 34 weeks of gestation if the risk to the fetus or mother is greater than the risk of delivering a premature fetus regardless of lung maturity.
Induction may be achieved via several methods:
may leave the hospital as soon as she is medically stable and chooses to leave, which can be as early as a few hours postpartum, though the average for spontaneous vaginal delivery
(SVD) is 1–2 days, and the average caesarean section
postnatal stay is 3–4 days.
During this time the mother is monitored for bleeding
, bowel and bladder
function, and baby care. The infant
's health is also monitored.
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
(prenatal period), childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
and the postnatal
Postnatal
Postnatal is the period beginning immediately after the birth of a child and extending for about six weeks. Another term would be postpartum period, as it refers to the mother...
period. Veterinary obstetrics
Veterinary obstetrics
Veterinary obstetrics are the obstetrical methods used in veterinary medicine, which are quite different from the ones of human medicine....
is the same concept for veterinary medicine
Veterinary medicine
Veterinary Medicine is the branch of science that deals with the prevention, diagnosis and treatment of disease, disorder and injury in non-human animals...
although theriogenology
Theriogenology
Theriogenology is the branch of veterinary medicine concerned with reproduction, including the physiology and pathology of male and female reproductive systems of animals and the clinical practice of veterinary obstetrics, gynecology, and andrology. Theriogenologists are veterinarians with advanced...
is more commonly used term that includes obstetrics, gynecology, and andrology
Andrology
Andrology is the medical specialty that deals with male health, particularly relating to the problems of the male reproductive system and urological problems that are unique to men. It is the counterpart to gynaecology, which deals with medical issues which are specific to the female reproductive...
. Almost all modern obstetricians are also gynaecologists
Gynaecology
Gynaecology or gynecology is the medical practice dealing with the health of the female reproductive system . Literally, outside medicine, it means "the science of women"...
.
Prenatal care
Prenatal care is important in screening for various complications of pregnancy. This includes routine office visits with physical exams and routine lab tests:First trimester
- Complete blood countComplete blood countA complete blood count , also known as full blood count or full blood exam or blood panel, is a test panel requested by a doctor or other medical professional that gives information about the cells in a patient's blood...
(CBC) - Blood typeBlood typeA blood type is a classification of blood based on the presence or absence of inherited antigenic substances on the surface of red blood cells . These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system...
- General antibodyAntibodyAn antibody, also known as an immunoglobulin, is a large Y-shaped protein used by the immune system to identify and neutralize foreign objects such as bacteria and viruses. The antibody recognizes a unique part of the foreign target, termed an antigen...
screen (indirect Coombs test) for HDNHDNHDN may refer to* Yampa Valley Airport * Haemorrhagic disease of the newborn, a vitamin K deficiency in babies* Hemolytic disease of the newborn, an alloimmune illness of babies...
- Rh D negative antenatal patients should receive RhoGam at 28 weeks to prevent Rh disease.
- Rapid plasma reagent (RPR) which screens for syphilisSyphilisSyphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
- RubellaRubellaRubella, commonly known as German measles, is a disease caused by the rubella virus. The name "rubella" is derived from the Latin, meaning little red. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is...
antibody screen - Hepatitis B surface antigen
- GonorrheaGonorrheaGonorrhea is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain...
and ChlamydiaChlamydia (bacterium)Chlamydia is a genus of bacteria that are obligate intracellular parasites. Chlamydia infections are the most common bacterial sexually transmitted infections in humans and are the leading cause of infectious blindness worldwide....
culture - PPDMantoux testThe Mantoux test is a diagnostic tool for tuberculosis. It is one of the two major tuberculin skin tests used in the world, largely replacing multiple-puncture tests such as the Tine test...
for tuberculosisTuberculosisTuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body... - Pap smearPap smearThe Papanicolaou test is a screening test used in to detect pre-cancerous and cancerous processes in the endocervical canal of the female reproductive system. Changes can be treated, thus preventing cervical cancer...
- UrinalysisUrinalysisA urinalysis , also known as Routine and Microscopy , is an array of tests performed on urine, and one of the most common methods of medical diagnosis...
and culture - HIVHIVHuman immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
screen - Group B StreptococcusGroup B StreptococcusInfection with Group B Streptococcus , also known as 'Streptococcus agalactiae' and more colloquially as Strep B and group B Strep, can cause serious illness and sometimes death, especially in newborn infants, the elderly, and patients with compromised immune systems...
screen – will receive IV penicillin or ampicillin (it is much cheaper and has a wider coverage)if positive (if mother is allergic, alternative therapies include IV clindamycin or IV vancomycin)
genetic screening for downs syndrome (trisomy 21) and trisomy 18
the national standard in the United States is rapidly evolving away from the AFP-Quad screen for downs syndrome- done typically in the second trimester at 16–18 weeks. The newer integrated screen (formerly called F.A.S.T.E.R for First And Second Trimester Early Results) can be done at 10 plus weeks to 13 plus weeks with an ultrasound of the fetal neck (thick skin is bad) and two chemicals (analytes) Papp-a and bhcg (pregnancy hormone level itself). It gives an accurate risk profile very early. There is a second blood screen at 15 to 20 weeks which refines the risk more accurately. The cost is higher than an "AFP-quad" screen due to the ultrasound and second blood test but it is quoted to have a 93% pick up rate as opposed to 88% for the standard AFP/QS. This is an evolving standard of care in the United States.
Second trimester
- MSAFP/quad. screen (four simultaneous blood tests) (maternal serum alpha-fetoprotein; inhibin; estriol; bhcg or free bhcg) - elevations, low numbers or odd patterns correlate with neural tube defect risk and increased risks of trisomy 18 or trisomy 21
- Ultrasound either abdominal or trannsvaginal to assess cervix, placenta, fluid and baby
- Amniocentesis is the national standard for women over 35 or who reach 35 by mid pregnancy or who are at increased risk by family history or prior birth history
Third trimester
- Hematocrit (if low, mother will receive iron supplementation)
- Glucose loading test (GLT) - screens for gestational diabetes; if > 140 mg/dL, a glucose tolerance testGlucose tolerance testA glucose tolerance test is a medical test in which glucose is given and blood samples taken afterward to determine how quickly it is cleared from the blood. The test is usually used to test for diabetes, insulin resistance, and sometimes reactive hypoglycemia and acromegaly, or rarer disorders of...
(GTT) is administered; a fasting glucose > 105 mg/dL suggests gestational diabetes.
Most doctors do a sugar load in a drink form of 50 grams of glucose in cola, lime or orange and draw blood an hour later (plus or minus 5 minutes) ; the standard modified criteria have been lowered to 135 since the late 1980s
Antenatal record
On the first visit to her obstetrician or midwife, the pregnant woman is asked to carry out the antenatal record, which constitutes a medical historyMedical history
The medical history or anamnesis of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information , with the aim of obtaining information useful in formulating a diagnosis and providing...
and physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
. On subsequent visits, the gestational age
Gestational age
Gestational age relates to the age of an embryo or fetus . There is some ambiguity in how it is defined:*In embryology, gestational age is the time elapsed since conception. This interval is also termed fertilisation age....
(GA) is rechecked with each visit.
Symphysis-fundal height (SFH; in cm) should equal gestational age after 20 weeks of gestation, and the fetal growth should be plotted on a curve during the antenatal visits. The fetus is palpated by the midwife or obstetrician using Leopold maneuver to determine the position of the baby. Blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
should also be monitored, and may be up to 140/90 in normal pregnancies. High blood pressure indicates hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
and possibly pre-eclampsia
Pre-eclampsia
Pre-eclampsia or preeclampsia is a medical condition in which hypertension arises in pregnancy in association with significant amounts of protein in the urine....
, if severe swelling (edema
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
) and spilled protein in the urine are also present.
Fetal screening is also used to help assess the viability of the fetus, as well as congenital problems. Genetic counseling
Genetic counseling
Genetic counseling or traveling is the process by which patients or relatives, at risk of an inherited disorder, are advised of the consequences and nature of the disorder, the probability of developing or transmitting it, and the options open to them in management and family planning...
is often offered for families who may be at an increased risk to have a child with a genetic condition.
Amniocentesis
Amniocentesis
Amniocentesis is a medical procedure used in prenatal diagnosis of chromosomal abnormalities and fetal infections, in which a small amount of amniotic fluid, which contains fetal tissues, is sampled from the amnion or amniotic sac surrounding a developing fetus, and the fetal DNA is examined for...
at around the 20th week is sometimes done for women 35 or older to check for Down's Syndrome and other chromosome
Chromosome
A chromosome is an organized structure of DNA and protein found in cells. It is a single piece of coiled DNA containing many genes, regulatory elements and other nucleotide sequences. Chromosomes also contain DNA-bound proteins, which serve to package the DNA and control its functions.Chromosomes...
abnormalities in the fetus.
Even earlier than amniocentesis is performed, the mother may undergo the triple test
Triple test
The triple test, also called triple screen, the Kettering test or the Bart's test, is an investigation performed during pregnancy in the second trimester to classify a patient as either high-risk or low-risk for chromosomal abnormalities .The term "multiple-marker screening test" is sometimes used...
, nuchal screening, nasal bone
Nasal bone
The nasal bones are two small oblong bones, varying in size and form in different individuals; they are placed side by side at the middle and upper part of the face, and form, by their junction, "the bridge" of the nose.Each has two surfaces and four borders....
, alpha-fetoprotein
Alpha-fetoprotein
Alpha-fetoprotein is a protein that in humans is encoded by the AFP gene....
screening and Chorionic villus sampling
Chorionic villus sampling
Chorionic villus sampling , sometimes misspelled "chorionic villous sampling", is a form of prenatal diagnosis to determine chromosomal or genetic disorders in the fetus. It entails sampling of the chorionic villus and testing it...
, also to check for disorders such as Down Syndrome. Amniocentesis is a prenatal genetic screening of the fetus, which involves inserting a needle through the mother's abdominal wall and uterine wall, to extract fetal DNA from the amniotic fluid. There is a risk of miscarriage and fetal injury with amniocentesis because it involves penetrating the uterus with the baby still in utero.
Imaging
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...
are also usually imaged in the first trimester of pregnancy. This is done to predict problems with the mother; confirm that a pregnancy is present inside the uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
; estimate the gestational age
Gestational age
Gestational age relates to the age of an embryo or fetus . There is some ambiguity in how it is defined:*In embryology, gestational age is the time elapsed since conception. This interval is also termed fertilisation age....
; determine the number of fetuses and placenta
Placenta
The placenta is an organ that connects the developing fetus to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. "True" placentas are a defining characteristic of eutherian or "placental" mammals, but are also found in some snakes and...
e; evaluate for an ectopic pregnancy
Ectopic pregnancy
An ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
and first trimester bleeding; and assess for early signs of anomalies.
X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
s and computerized tomography (CT) are not used, especially in the first trimester, due to the ionizing radiation
Ionizing radiation
Ionizing radiation is radiation composed of particles that individually have sufficient energy to remove an electron from an atom or molecule. This ionization produces free radicals, which are atoms or molecules containing unpaired electrons...
, which has teratogenic effects on the fetus. No effects of magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
(MRI) on the fetus have been demonstrated, but this technique is too expensive for routine observation. Instead, ultrasound
Obstetric ultrasonography
Obstetric sonography is the application of medical ultrasonography to obstetrics, in which sonography is used to visualize the embryo or foetus in its mother's uterus...
is the imaging method of choice in the first trimester and throughout the pregnancy, because it emits no radiation
Radiation
In physics, radiation is a process in which energetic particles or energetic waves travel through a medium or space. There are two distinct types of radiation; ionizing and non-ionizing...
, is portable, and allows for realtime imaging.
Ultrasound imaging may be done at any time throughout the pregnancy, but usually happens at the 12th week (dating scan) and the 20th week (detailed scan).
A normal gestation would reveal a gestational sac
Gestational sac
The gestational sac is the only available intrauterine structure that can be used to determine if an intrauterine pregnancy exists, until the embryo is identified....
, yolk sac
Yolk sac
The yolk sac is a membranous sac attached to an embryo, providing early nourishment in the form of yolk in bony fishes, sharks, reptiles, birds, and primitive mammals...
, and fetal pole
Fetal pole
The fetal pole is a thickening on the margin of the yolk sac of a fetus during pregnancy.It is usually identified at 6.5 weeks with abdominal ultrasound imaging, and 6 weeks with vaginal ultrasound imaging. However it is quite normal for the fetal pole to not be visible until about 9 weeks...
. The gestational age
Gestational age
Gestational age relates to the age of an embryo or fetus . There is some ambiguity in how it is defined:*In embryology, gestational age is the time elapsed since conception. This interval is also termed fertilisation age....
can be assessed by evaluating the mean gestational sac diameter (MGD) before week 6, and the crown-rump length after week 6. Multiple gestation is evaluated by the number of placenta
Placenta
The placenta is an organ that connects the developing fetus to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. "True" placentas are a defining characteristic of eutherian or "placental" mammals, but are also found in some snakes and...
e and amniotic sac
Amniotic sac
The amniotic sac is the sac in which the fetus develops in amniotes. It is a tough but thin transparent pair of membranes, which hold a developing embryo until shortly before birth. The inner membrane, the amnion, contains the amniotic fluid and the fetus. The outer membrane, the Chorion,...
s present.
Complications and emergencies
The main emergencies include:- Ectopic pregnancyEctopic pregnancyAn ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
is when an embryo implants in the Fallopian tube or (rarely) on the ovary or inside the peritoneal cavity. This may cause massive internal bleeding. - Pre-eclampsiaPre-eclampsiaPre-eclampsia or preeclampsia is a medical condition in which hypertension arises in pregnancy in association with significant amounts of protein in the urine....
is a disease which is defined by a combination of signs and symptoms that are related to maternal hypertension. The cause is unknown, and markers are being sought to predict its development from the earliest stages of pregnancy. Some unknown factors cause vascular damage in the endotheliumEndotheliumThe endothelium is the thin layer of cells that lines the interior surface of blood vessels, forming an interface between circulating blood in the lumen and the rest of the vessel wall. These cells are called endothelial cells. Endothelial cells line the entire circulatory system, from the heart...
, causing hypertensionHypertensionHypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
. If severe, it progresses to eclampsiaEclampsiaEclampsia , an acute and life-threatening complication of pregnancy, is characterized by the appearance of tonic-clonic seizures, usually in a patient who had developed pre-eclampsia...
, where a convulsions occur, which can be fatal. Preeclamptic patients with the HELLP syndromeHELLP syndromeHELLP syndrome is a life-threatening obstetric complication usually considered to be a variant of pre-eclampsia. Both conditions usually occur during the later stages of pregnancy, or sometimes after childbirth.HELLP is an abbreviation of the main findings:...
show liver failure and Disseminated intravascular coagulationDisseminated intravascular coagulationDisseminated intravascular coagulation , also known as disseminated intravascular coagulopathy or consumptive coagulopathy, is a pathological activation of coagulation mechanisms that happens in response to a variety of diseases. DIC leads to the formation of small blood clots inside the blood...
(DIC). - Placental abruptionPlacental abruptionPlacental abruption is a complication of pregnancy, wherein the placental lining has separated from the uterus of the mother. It is the most common pathological cause of late pregnancy bleeding. In humans, it refers to the abnormal separation after 20 weeks of gestation and prior to birth...
where the patient can bleed to death if not managed appropriately. - Fetal distressFetal distressIn medicine , the term fetal distress refers to the presence of signs in a pregnant woman—before or during childbirth—that suggest that the fetus may not be well...
where the fetusFetusA fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...
is getting compromised in the uterine environment. - Shoulder dystociaShoulder dystociaShoulder dystocia is a specific case of dystocia whereby after the delivery of the head, the anterior shoulder of the infant cannot pass below the pubic symphysis, or requires significant manipulation to pass below the pubic symphysis. It is diagnosed when the shoulders fail to deliver shortly...
where one of the fetus' shoulders becomes stuck during vaginal birth, especially in macrosomic babies of diabetic mothers. - Uterine ruptureUterine ruptureUterine rupture is a potentially catastrophic event during childbirth by which the integrity of the myometrial wall is breached. In an incomplete rupture the peritoneum is still intact. With a complete rupture the contents of the uterus may spill into the peritoneal cavity or the broad ligament...
can occur during obstructed labor and endangered fetal and maternal life. - Prolapsed cord refers to the prolapse of the fetal cord during labor with the risk of fetal suffocation.
- Obstetrical hemorrhageObstetrical hemorrhageObstetrical hemorrhage refers to heavy bleeding during pregnancy, labor, or the puerperium. Bleeding may be vaginal and external, or, less commonly but more dangerously, internal, into the abdominal cavity...
may be due to a number of factors such as placenta previa, uterine rupture of tears, uterine atonyUterine atonyUterine atony is a loss of tone in the uterine musculature. Normally, contraction of the uterine muscle compresses the vessels and reduces flow. This increases the likelihood of coagulation and prevents bleeds. Thus, lack of uterine muscle contraction can cause an acute hemorrhage...
, retained placentaRetained placentaRetained placenta is a condition where all or part of the placenta or membranes are left behind in the uterus during the third stage of labour.-In humans:...
or placental fragments, or bleeding disorders. - Puerperal sepsis is a progressed infection of the uterus during or after labor.
Fetal assessments
UltrasoundObstetric ultrasonography
Obstetric sonography is the application of medical ultrasonography to obstetrics, in which sonography is used to visualize the embryo or foetus in its mother's uterus...
is routinely used for dating the gestational age of a pregnancy from the size of the fetus, the most accurate dating being in first trimester before the growth of the fetus has been significantly influenced by other factors. Ultrasound is also used for detecting congenital anomalies (or other fetal anomalies) and determining the biophysical profile
Biophysical profile
A biophysical profile is a prenatal ultrasound evaluation of fetal well-being, involving a scoring system. It is often done when a non-stress test is non reactive, or for other obstetrical indications.-The test:...
s (BPP), which are generally easier to detect in the second trimester when the fetal structures are larger and more developed. Specialised ultrasound equipment can also evaluate the blood flow velocity in the umbilical cord
Umbilical cord
In placental mammals, the umbilical cord is the connecting cord from the developing embryo or fetus to the placenta...
, looking to detect a decrease/absence/reversal or diastolic blood flow in the umbilical artery.
Other tools used for assessment include:
- Fetal karyotypeKaryotypeA karyotype is the number and appearance of chromosomes in the nucleus of an eukaryotic cell. The term is also used for the complete set of chromosomes in a species, or an individual organism.p28...
can be used for the screening of genetic diseases. This can be obtained via amniocentesisAmniocentesisAmniocentesis is a medical procedure used in prenatal diagnosis of chromosomal abnormalities and fetal infections, in which a small amount of amniotic fluid, which contains fetal tissues, is sampled from the amnion or amniotic sac surrounding a developing fetus, and the fetal DNA is examined for...
or chorionic villus samplingChorionic villus samplingChorionic villus sampling , sometimes misspelled "chorionic villous sampling", is a form of prenatal diagnosis to determine chromosomal or genetic disorders in the fetus. It entails sampling of the chorionic villus and testing it...
(CVS) - Fetal hematocritHematocritThe hematocrit or packed cell volume or erythrocyte volume fraction is the percentage of the concentration of red blood cells in blood. It is normally about 45% for men and 40% for women...
for the assessment of fetal anemiaAnemiaAnemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
, Rh isoimmunization, or hydropsHydrops-Medicine:* In general, hydrops is another name for edema.** Endolymphatic hydrops - a pathological feature present in Ménière's disease.** Hydrops fetalis is edema in a fetus.-Zoology:* Hydrops, a colubrid snake genus....
can be determined by percutaneous umbilical blood sampling (PUBS) which is done by placing a needle through the abdomen into the uterusUterusThe uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
and taking a portion of the umbilical cordUmbilical cordIn placental mammals, the umbilical cord is the connecting cord from the developing embryo or fetus to the placenta...
. - Fetal lung maturity is associated with how much surfactantSurfactantSurfactants are compounds that lower the surface tension of a liquid, the interfacial tension between two liquids, or that between a liquid and a solid...
the fetus is producing. Reduced production of surfactant indicates decreased lung maturity and is a high risk factor for infant respiratory distress syndromeInfant respiratory distress syndromeInfant respiratory distress syndrome , also called neonatal respiratory distress syndrome or respiratory distress syndrome of newborn, previously called hyaline membrane disease, is a syndrome in premature infants caused by developmental insufficiency of surfactant production and structural...
. Typically a lecithinLecithinLecithin is a generic term to designate any group of yellow-brownish fatty substances occurring in animal and plant tissues, and in egg yolk, composed of phosphoric acid, choline, fatty acids, glycerol, glycolipids, triglycerides, and phospholipids .The word lecithin was originally coined in 1847 by...
:sphingomyelinSphingomyelinSphingomyelin is a type of sphingolipid found in animal cell membranes, especially in the membranous myelin sheath that surrounds some nerve cell axons. It usually consists of phosphorylcholine and ceramide...
ratio greater than 1.5 is associated with increased lung maturity. - Nonstress testNonstress testA nonstress test is a screening test used in pregnancy. A cardiotocograph is used to monitor the fetal heart rate.-Premise:The premise of the NST is that a well-oxygenated, non-acidemic fetus will spontaneously have temporary increases in the fetal heart rate...
(NST) for fetal heart rate - Oxytocin challenge test
Induction
Induction is a method of artificially or prematurely stimulating labour in a woman. Reasons to induce can include pre-eclampsiaPre-eclampsia
Pre-eclampsia or preeclampsia is a medical condition in which hypertension arises in pregnancy in association with significant amounts of protein in the urine....
, placental malfunction, intrauterine growth retardation, and other various general medical conditions, such as renal disease. Induction may occur any time after 34 weeks of gestation if the risk to the fetus or mother is greater than the risk of delivering a premature fetus regardless of lung maturity.
Induction may be achieved via several methods:
- PessaryPessaryA pessary is a small plastic or silicone medical device which is inserted into the vagina or rectum and held in place by the pelvic floor musculature. - Therapeutic pessaries :...
of Prostin cream, prostaglandinProstaglandinA prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the animal body. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring....
E2 - Intravaginal or oral administration of misoprostolMisoprostolMisoprostol is a drug that is used for the prevention of non steroidal anti inflammatory drug induced gastric ulcers, for early abortion, to treat missed miscarriage, and to induce labor. The latter use is controversial in the United States. Misoprostol was invented and marketed by G.D...
- Cervical insertion of a 30-mL Foley catheterFoley catheterA Foley catheter is a flexible tube that is often passed through the urethra and into the bladder. The tube has two separated channels, or lumens, running down its length. One lumen is open at both ends, and allows urine to drain out into a collection bag...
- Rupturing the amniotic membranes
- Intravenous infusion of synthetic oxytocinOxytocinOxytocin is a mammalian hormone that acts primarily as a neuromodulator in the brain.Oxytocin is best known for its roles in sexual reproduction, in particular during and after childbirth...
(Pitocin or Syntocinon)
Labor
During labor itself, the obstetrician/doctor/intern/medical student under supervision may be called on to do a number of tasks. These tasks can include:- Monitor the progress of labor, by reviewing the nursing chart, performing vaginal examination, and assessing the trace produced by a fetal monitoring device (the cardiotocograph)
- Accelerate the progress of labor by infusion of the hormone oxytocinOxytocinOxytocin is a mammalian hormone that acts primarily as a neuromodulator in the brain.Oxytocin is best known for its roles in sexual reproduction, in particular during and after childbirth...
- Provide pain relief, either by nitrous oxideNitrous oxideNitrous oxide, commonly known as laughing gas or sweet air, is a chemical compound with the formula . It is an oxide of nitrogen. At room temperature, it is a colorless non-flammable gas, with a slightly sweet odor and taste. It is used in surgery and dentistry for its anesthetic and analgesic...
, opiates, or by epidural anesthesiaLocal anesthesiaLocal anesthesia is any technique to induce the absence of sensation in part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with...
done by anaesthestists, an anesthesiologist, or a nurse anesthetistNurse anesthetistA nurse anesthetist is a nurse who specializes in the administration of anesthesia.In the United States, a Certified Registered Nurse Anesthetist is an advanced practice registered nurse who has acquired graduate-level education and board certification in anesthesia...
. - Surgically assisting labor, by forceps or the VentouseVentouseVentouse is a vacuum device used to assist the delivery of a baby when the second stage of labour has not progressed adequately. It is an alternative to a forceps delivery and caesarean section. It cannot be used when the baby is in the breech position or for premature births. This technique is...
(a suction cap applied to the fetus' head) - Caesarean sectionCaesarean sectionA Caesarean section, is a surgical procedure in which one or more incisions are made through a mother's abdomen and uterus to deliver one or more babies, or, rarely, to remove a dead fetus...
, if there is an associated risk with vaginal delivery, as such fetal or maternal compromise supported by evidence and literature. Caesarean section can either be elective, that is, arranged before labor, or decided during labor as an alternative to hours of waiting. True "emergency" Cesarean sections include abruptio placenta, and are more common in multigravid patients, or patients attempting a Vaginal Birth After Caeserean section (VBAC).
Postnatal
A woman in the Western world who is delivering in a hospitalHospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
may leave the hospital as soon as she is medically stable and chooses to leave, which can be as early as a few hours postpartum, though the average for spontaneous vaginal delivery
Spontaneous vaginal delivery
A vaginal delivery is the birth of offspring in mammals through the vagina. It is the natural method of birth for all mammals except monotremes, which lay eggs into the external environment...
(SVD) is 1–2 days, and the average caesarean section
Caesarean section
A Caesarean section, is a surgical procedure in which one or more incisions are made through a mother's abdomen and uterus to deliver one or more babies, or, rarely, to remove a dead fetus...
postnatal stay is 3–4 days.
During this time the mother is monitored for bleeding
Bleeding
Bleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system...
, bowel and bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
function, and baby care. The infant
Infant
A newborn or baby is the very young offspring of a human or other mammal. A newborn is an infant who is within hours, days, or up to a few weeks from birth. In medical contexts, newborn or neonate refers to an infant in the first 28 days after birth...
's health is also monitored.
Post-Natal Care
• Care provided to the mother following parturition. Certain things must be kept in mind as the physician proceeds with the post-natal care.- General Condition of the patient.
- Check for Vital Signs (Pulse, Blood Pressure, Temperature, Respiratory Rate, (Pain) at times)
- Palor?
- Edema?
- Dehydration?
- Fundus (height following parturition, and the feel of the fundus) (Per Abdominal Examination)
- If an Episiotomy or a C-Section was performed, check for the dressing. Intact, pus, oozing, haematomas?
- Lochia (colour, amount, odour)?
- Bladder (keep the patient catheterized for 12 hours following local anaesthesia and 24–48 hours after general anaesthesia) ? (check for bladder function)
- Bowel Movements?
- Follow up with the neonate to check if they’re healthy.
Salary
The salary of an obstetrician varies by country. In the United States, the salary ranges from $200,000 to $339,738.| Country | Annual salary (US$) |
|---|---|
| United Kingdom United Kingdom The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages... |
187,771 |
| United Arab Emirates United Arab Emirates The United Arab Emirates, abbreviated as the UAE, or shortened to "the Emirates", is a state situated in the southeast of the Arabian Peninsula in Western Asia on the Persian Gulf, bordering Oman, and Saudi Arabia, and sharing sea borders with Iraq, Kuwait, Bahrain, Qatar, and Iran.The UAE is a... |
231,809 |
| United States United States The United States of America is a federal constitutional republic comprising fifty states and a federal district... |
236,411 |
See also
- Childbirth and obstetrics in antiquityChildbirth and Obstetrics in AntiquityTraditionally obstetrics is defined as the surgical specialty dealing with the care of a woman and her offspring during pregnancy, childbirth and the puerperium, although in Antiquity surgical intervention did not exist. Without the presence of surgical technology an alternative was necessary...
- Henry Jacques Garrigues, who introduced antiseptic obstetrics to North AmericaHenry Jacques GarriguesHenry Jacques Garrigues was an American doctor who is considered to have introduced antiseptic obstetrics to America. Born in Copenhagen, Denmark, he was graduated from medical school there in 1869...
- List of obstetric topics
- Maternal-fetal medicineMaternal-fetal medicineMaternal-Fetal medicine is the branch of obstetrics that focuses on the medical and surgical management of high-risk pregnancies. Management includes monitoring and treatment including comprehensive ultrasound, chorionic villus sampling, genetic amniocentesis, and fetal surgery or treatment....
- Obstetric ultrasonographyObstetric ultrasonographyObstetric sonography is the application of medical ultrasonography to obstetrics, in which sonography is used to visualize the embryo or foetus in its mother's uterus...
- Puerperum
Further reading
- Stockham, Alice BAlice Bunker Stockhamthumb|right|Dr Alice Bunker StockhamAlice Bunker Stockham was an obstetrician and gynecologist from Chicago, and the fifth woman to be made a doctor in the United States...
. Tokology. A Book for Every Woman. o.O., (Kessinger Publishing) o.J. Reprint of Revised Edition Chicago, Alice B. Stockham & Co. 1891 (first edition 1886). ISBN 1-4179-4001-8
External links
- Ingenious - Archive of historical images related to obstetrics, gynaecology, and contraception.
- World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI)
- Seven Hills Women's Health Centers - Leaders in Women's Health and a helpful women's health library section