Obstetrics

Source: Wikipedia, the free encyclopedia.
Obstetrician
Occupation
Names
  • Physician
  • Surgeon
Occupation type
Specialty
Activity sectors
Medicine, surgery
Description
Education required
Fields of
employment
Hospitals, clinics

Obstetrics is the field of study concentrated on

obstetrics and gynecology (OB/GYN), which is a surgical field.[2]

Main areas

Prenatal care

Prenatal care is important in screening for various complications of pregnancy.[3] This includes routine office visits with physical exams and routine lab tests along with telehealth care for women with low-risk pregnancies:[4]

  • 3D ultrasound of 3-inch (76 mm) fetus (about 14 weeks gestational age)
    gestational age
    )
  • Fetus at 17 weeks
    Fetus at 17 weeks
  • Fetus at 20 weeks
    Fetus at 20 weeks

First trimester

Routine tests in the first

trimester
of pregnancy generally include:

Genetic screening for

pregnancy-associated plasma protein A and human chorionic gonadotropin (pregnancy hormone level itself[12]). It gives an accurate risk profile very early. A second blood screen at 15 to 20 weeks refines the risk more accurately.[13] 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.[14][15][16]

Down syndrome karyotype

Second trimester

Third trimester

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.[21]

The result of an ultrasonography: a black and white image that shows a clear view of the interior abdomen

Fetal assessments

A dating scan at 12 weeks

Obstetric ultrasonography is routinely used for dating the gestational age of a pregnancy from the size of the fetus, determine the number of fetuses and placentae, evaluate for an ectopic pregnancy and first trimester bleeding, the most accurate dating being in first trimester before the growth of the foetus has been significantly influenced by other factors.[22] Ultrasound is also used for detecting congenital anomalies (or other foetal anomalies) and determining the biophysical profiles (BPP), which are generally easier to detect in the second trimester when the foetal structures are larger and more developed.[23]

teratogenic effects on the foetus.[24] No effects of magnetic resonance imaging (MRI) on the foetus have been demonstrated,[25] but this technique is too expensive for routine observation. Instead, obstetric ultrasonography 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.[26]

The safety of frequent ultrasound scanning has not been confirmed. Despite this, increasing numbers of women are choosing to have additional scans for no medical purpose, such as gender scans, 3D and 4D scans.[27] A normal gestation would reveal a gestational sac, yolk sac, and fetal pole.[28]

The

Multiple gestation is evaluated by the number of placentae and amniotic sacs present.[29]

Other tools used for assessment include:

Diseases in pregnancy

A pregnant woman may have a

postnatal development of the offspring[35]

  • diabetes mellitus (not restricted to gestational diabetes) and pregnancy.[36]
    Risks for the child include miscarriage, growth restriction, growth acceleration, foetal obesity (macrosomia), polyhydramnios and birth defects.
  • Thyroid disease in pregnancy can, if uncorrected, cause adverse effects on foetal and maternal well-being.[38] The deleterious effects of thyroid dysfunction can also extend beyond pregnancy and delivery to affect neurointellectual development in the early life of the child.[39] Demand for thyroid hormones is increased during pregnancy, and may cause a previously unnoticed thyroid disorder to worsen.[citation needed]
  • post partum bleeding.[41] However, when combined with an additional underlying hypercoagulable states, the risk of thrombosis or embolism may become substantial.[41]
  • Hyperemesis gravidarum in pregnancy occurs due to extreme, persistent nausea and vomiting during pregnancy.[42] If untreated, can lead to dehydration, weight loss, and electrolyte imbalances. Most women develop nausea and vomiting during the first trimester.[43] The cause of hyperemesis gravidarum is not known. However, it is believed to be caused by a rapidly rising blood level of a hormone, human chorionic gonadotropin (HCG), which is released by the placenta.
  • Preeclampsia is a condition that causes high blood pressure during pregnancy. If left untreated, it can be life-threatening.[44] In pregnant women, preeclampsia may occur after 20 weeks of pregnancy, often in women who have no history of high blood pressure. Symptoms of preeclampsia may include severe headache, vision changes and pain under the ribs.[45] However, in some women, symptoms may not occur, until they go for a routine prenatal visit.[46]

Induction and labour

Induction is a method of artificially or prematurely stimulating labour in a woman.[47] Reasons to induce can include pre-eclampsia, foetal distress, placental malfunction, intrauterine growth retardation and failure to progress through labour increasing the risk of infection and foetal distresses.[48]

Induction may be achieved via several methods:

During labour, the obstetrician carries out the following tasks:

Complications and emergencies

The main emergencies include:

  • Ectopic pregnancy is when an embryo implants in the uterine (fallopian) tube or (rarely) on the ovary or inside the peritoneal cavity. This may cause massive internal bleeding.[58]
  • seizures occur, which can be fatal.[62] Preeclamptic patients with the HELLP syndrome show liver failure and disseminated intravascular coagulation (DIC).[63] The only treatment is to deliver the foetus. Women may still develop pre-eclampsia following delivery.[64]
  • Placental abruption is where the placenta detaches from the uterus and the woman and foetus can bleed to death if not managed appropriately.[65]
  • foetus is getting compromised in the uterine environment.[66]
  • Shoulder dystocia where one of the foetus' shoulders becomes stuck during vaginal birth. There are many risk factors, including macrosmic (large) foetus, but many are also unexplained.[67]
  • Uterine rupture can occur during obstructed labour and endanger foetal and maternal life.[68]
  • Prolapsed cord can only happen after the membranes have ruptured.[69] The umbilical cord delivers before the presenting part of the foetus. If the foetus is not delivered within minutes, or the pressure taken off the cord, the foetus dies.[70]
  • placenta previa, uterine rupture or tears, uterine atony, retained placenta or placental fragments, or bleeding disorders.[71]
  • Puerperal sepsis is an ascending infection of the genital tract.[72] It may happen during or after labour. Signs to look out for include signs of infection (pyrexia or hypothermia, raised heart rate and respiratory rate, reduced blood pressure), and abdominal pain, offensive lochia (blood loss) increased lochia, clots, diarrhea and vomiting.[citation needed
    ]

Postpartum period

The World Health Organization makes a distinction between the use of postpartum care when it concerns the care of the mother after giving birth, and postnatal care when the care of the newborn is concerned.[73] Postpartum care is provided to the mother following childbirth.

A woman in the Western world who gives birth in a hospital may leave the hospital as soon as she is medically stable, and chooses to leave, which can be as early as a few hours later, but usually averages a stay of one or two days; the average postnatal stay following delivery by caesarean section is three to four days.[74]

During this time the mother is monitored for

bladder function, and baby care. The infant's health is also monitored.[75]

Veterinary obstetrics

History

Eucharius Rößlin

Prior to the 18th century, caring for pregnant women in Europe was

midwives managed all aspects of the labour and delivery.[78] The presence of physicians and surgeons was very rare and only occurred if a serious complication had taken place and the midwife had exhausted all measures at her disposal.[79] Calling a surgeon was very much a last resort and having men deliver women in this era was seen as offending female modesty.[80]: 1050–1051 [81]

Before the 18th century

Prior to the 18th and 19th centuries,

ancient gynecology.[79] Living in the late first century AD and early second century, he studied anatomy and had opinions and techniques on abortion, contraception – most notably coitus interruptus – and birth complications. After his death, techniques and works of gynecology declined; very little of his works were recorded and survived to the late 18th century when gynecology and obstetrics reemerged as a medical specialism.[82]
: 123 

18th century

The 18th century marked the beginning of many advances in European

forceps in childbirth also took place at this time. All these medical advances in obstetrics were a lever for the introduction of men into an arena previously managed and run by women – midwifery.[80]
: 1051–1052 

The addition of the male-midwife (or man-midwife) is historically a significant change to the profession of obstetrics.[86] In the 18th century medical men began to train in area of childbirth and believed with their advanced knowledge in anatomy that childbirth could be improved.[87] In France these male-midwives were referred to as accoucheurs, a title later used all over Europe. The founding of lying-in hospitals also contributed to the medicalization and male-dominance of obstetrics.[88] These early maternity hospitals were establishments where women would come to have their babies delivered, as opposed to the practice since time immemorial of the midwife attending the home of the woman in labour.[89] This institution provided male-midwives with endless patients to practice their techniques on and was a way for these men to demonstrate their knowledge.[90]

Many midwives of the time bitterly opposed the involvement of men in childbirth. Some male practitioners also opposed the involvement of medical men like themselves in midwifery and even went as far as to say that male-midwives only undertook midwifery solely for perverse erotic satisfaction. The accoucheurs argued that their involvement in midwifery was to improve the process of childbirth. These men also believed that obstetrics would forge ahead and continue to strengthen.[80]: 1050–1051 

19th century

18th-century physicians expected that obstetrics would continue to grow, but the opposite happened. Obstetrics entered a stage of stagnation in the 19th century, which lasted until about the 1880s.[77]: 96–98  The central explanation for the lack of advancement during this time was the rejection of obstetrics by the medical community.[91] The 19th century marked an era of medical reform in Europe and increased regulation over the profession. Major European institutions such as The College of Physicians and Surgeons[where?] considered delivering babies ungentlemanly work and refused to have anything to do with childbirth as a whole. Even when Medical Act 1858 was introduced, which stated that medical students could qualify as doctors, midwifery was entirely ignored.[92] This made it nearly impossible to pursue an education in midwifery and also have the recognition of being a doctor or surgeon. Obstetrics was pushed to the side.[80]: 1053–1055 

By the late 19th century, the foundation of modern-day obstetrics and midwifery began developing. Delivery of babies by doctors became popular and readily accepted, but midwives continued to play a role in childbirth.[87] Midwifery also changed during this era due to increased regulation and the eventual need for midwives to become certified.[93] Many European countries by the late 19th century were monitoring the training of midwives and issued certification based on competency. Midwives were no longer uneducated in the formal sense.[94]

As midwifery began to develop, so did the profession of obstetrics near the end of the century.

anaesthesia, which paved the way for the mainstream introduction and later success of the Caesarean section.[94][96]

Before the 1880s mortality rates in lying-hospitals would reach unacceptably high levels and became an area of public concern. Much of these maternal deaths were due to

maternal mortality rates among many populations.[citation needed
]

History of obstetrics in America

The development of obstetrics as a practice for accredited doctors happened at the turn of the 18th century and thus was very differently developed in Europe and in the Americas due to the independence of many countries in the Americas from European powers. "Unlike in Europe and the British Isles, where midwifery laws were national, in America, midwifery laws were local and varied widely".[98]

Gynaecology and Obstetrics gained attention in the American medical field at the end of the nineteenth century through the development of such procedures as the ovariotomy.[99] These procedures then were shared with European surgeons who replicated the surgeries. This was a period when antiseptic, aseptic or anaesthetic measures were just being introduced to surgical and observational procedures and without these procedures surgeries were dangerous and often fatal.[100] Following are two surgeons noted for their contributions to these fields include Ephraim McDowell and J. Marion Sims.[101]

Ephraim McDowell developed a surgical practice in 1795 and performed the first ovariotomy in 1809 on a 47-year-old widow who then lived on for 31 more years.[102] He had attempted to share this with John Bell whom he had practiced under who had retired to Italy. Bell was said to have died without seeing the document but it was published by an associate in Extractions of Diseased Ovaria in 1825.[103] By the mid-century the surgery was both successfully and unsuccessfully being performed. Pennsylvanian surgeons the Attlee brothers made this procedure very routine for a total of 465 surgeries – John Attlee performed 64 successfully of 78 while his brother William reported 387 – between the years of 1843 and 1883.[104] By the middle of the nineteenth century this procedure was successfully performed in Europe by English surgeons Sir Spencer Wells and Charles Clay as well as French surgeons Eugène Koeberlé, Auguste Nélaton and Jules Péan.[82]: 125 

J. Marion Sims was the surgeon responsible for being the first treating a vesicovaginal fistula[82]: 125  – a condition linked to many caused mainly by prolonged pressing of the foetus against the pelvis or other causes such as rape, hysterectomy, or other operations – and also having been doctor to many European royals and the 20th President of the United States James A. Garfield after he had been shot. Sims does have a controversial medical past. Under the beliefs at the time about pain and the prejudice towards African people, he had practiced his surgical skills and developed skills on slaves.[105] These women were the first patients of modern gynecology. One of the women he operated on was named Anarcha Westcott, the woman he first treated for a fistula.[105]

Historical role of gender

Women and men inhabited very different roles in natal care up to the 18th century.

Midwives, meaning "with woman", were those who assisted in the birth and care of both born and unborn children, a position historically held mainly by women.[107]

During the birth of a child, men were rarely present. Women from the neighbourhood or family would join in on the process of birth and assist in many different ways.[108] The one position where men would help with the birth of a child would be in the sitting position, usually when performed on the side of a bed to support the mother.[77]: 130 

Men were introduced into the field of obstetrics in the nineteenth century and resulted in a change of the focus of this profession.[109] Gynaecology directly resulted as a new and separate field of study from obstetrics and focused on the curing of illness and indispositions of female sexual organs.[110] This had some relevance to some conditions as menopause, uterine and cervical problems, and childbirth could leave the mother in need of extensive surgery to repair tissue.[111] But, there was also a large blame of the uterus for completely unrelated conditions. This led to many social consequences of the nineteenth century.[82]: 123–125 

See also

References

  1. ^ "What Is an Obstetrician? What They Do & When To See One". Cleveland Clinic. Retrieved 2022-04-29.
  2. ^ "Obstetrics and Gynecology Specialty Description". American Medical Association. Retrieved 24 October 2020.
  3. .
  4. .
  5. ^ Rath L. "What Is a Coombs Test?". WebMD. Retrieved 2022-04-29.
  6. ^ Rath L. "Why Do I Need a Rubella Test?". WebMD. Retrieved 2022-04-29.
  7. ^ Mekaroonkamol P, Hashemi N (2021-04-03). Staros EB (ed.). "Hepatitis B Test: Reference Range, Interpretation, Collection and Panels". Medscape.
  8. PMID 24548498
    .
  9. ^ CDCTB (2020-12-16). "Tuberculosis (TB) Fact Sheets- Tuberculin Skin Testing". Centers for Disease Control and Prevention. Retrieved 2022-04-29.
  10. ^ "Urinalysis: What It Is, Purpose, Types & Results". Cleveland Clinic. Retrieved 2022-04-29.
  11. PMID 23088440
    .
  12. .
  13. ^ "Common Tests During Pregnancy". www.hopkinsmedicine.org. 2021-08-08. Retrieved 2022-04-29.
  14. PMID 28499534
    .
  15. .
  16. ^ a b c "Common Tests During Pregnancy". www.hopkinsmedicine.org. 2021-08-08. Retrieved 2022-04-28.
  17. ^ "Quad screen - Mayo Clinic". www.mayoclinic.org. Retrieved 2022-04-29.
  18. ^ "Prenatal Ultrasound Procedure Information". Cleveland Clinic. Retrieved 2022-04-29.
  19. ^ Uscher J. "Anemia in Pregnancy: Causes, Symptoms, and Treatment". WebMD. Retrieved 2022-04-29.
  20. ^ "Glucose challenge test - Mayo Clinic". www.mayoclinic.org. Retrieved 2022-04-29.
  21. ^ "Glucose tolerance test - Mayo Clinic". www.mayoclinic.org. Retrieved 2022-04-29.
  22. ^ Kansky C, Ramus RM (2021-06-15). Pierce Jr JG (ed.). "Basic Obstetric Ultrasound: Background, Indications, Contraindications". Medscape.
  23. .
  24. .
  25. .
  26. . Retrieved 2022-04-29.
  27. .
  28. .
  29. ^ Khan AN, Sabih D, Sabih A (2021-04-26). "Early Pregnancy Loss (Embryonic Demise) Imaging: Practice Essentials, Ultrasonography".
  30. ^ Marino T (2021-06-14). Ramus RM (ed.). "Prenatal Diagnosis for Congenital Malformations and Genetic Disorders: Practice Essentials, Noninvasive Techniques, Invasive Techniques". Medscape.
  31. ^ "Chorionic villus sampling - Mayo Clinic". www.mayoclinic.org. Retrieved 2022-04-29.
  32. ^ Gomella TL, Cunningham MD, Eyal FG, Tuttle DJ (2013). Fetal Assessment (7 ed.). New York, NY: McGraw-Hill Education. Retrieved 2022-04-29. {{cite book}}: |work= ignored (help)
  33. .
  34. ^ "Nonstress test - Mayo Clinic". www.mayoclinic.org. Retrieved 2022-04-29.
  35. ^ Dunkin MA. "High-Risk Pregnancies: Symptoms, Doctors, Support, and More". WebMD. Retrieved 2022-04-29.
  36. ^ Moore T (2022-04-06). Griffing GT (ed.). "Diabetes Mellitus and Pregnancy: Practice Essentials, Gestational Diabetes, Maternal-Fetal Metabolism in Normal Pregnancy". Medscape.
  37. ^ Khurana R, Wolf RE (2021-10-16). Talavera F, Singh AK (eds.). "Systemic Lupus Erythematosus and Pregnancy: Practice Essentials, Pathophysiology, Epidemiology". Medscape.
  38. ^ Friel LA. "Thyroid Disorders in Pregnancy - Gynecology and Obstetrics". MSD Manual Professional Edition. Retrieved 2022-04-29.
  39. PMID 27981252
    .
  40. .
  41. ^ .
  42. ^ "Hyperemesis Gravidarum: Symptoms & Treatment". Cleveland Clinic. Retrieved 2022-04-30.
  43. ^ "Morning sickness - Symptoms and causes". Mayo Clinic. Retrieved 2022-04-30.
  44. ^ Gaither K (13 December 2019). "Preeclampsia". WebMD. Retrieved 2022-04-29.
  45. ^ "Preeclampsia - Symptoms and causes". Mayo Clinic. Retrieved 2022-04-29.
  46. ^ "4 Common Pregnancy Complications". www.hopkinsmedicine.org. 2021-08-08. Retrieved 2022-04-28.
  47. ^ Healthdirect Australia (2022-02-08). "Induced labour". www.pregnancybirthbaby.org.au. Retrieved 2022-04-29.
  48. .
  49. ^ Moldenhauer JS. "Prelabor Rupture of the Membranes (PROM) - Women's Health Issues". MSD Manual Consumer Version. Retrieved 2022-04-30.
  50. ^ "Prostin E2 Vaginal: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD". www.webmd.com. Retrieved 2022-04-30.
  51. S2CID 21261210
    .
  52. .
  53. ^ "Premature rupture of membranes". MedlinePlus Medical Encyclopedia. Bethesda (MD): U.S. National Library of Medicine. Retrieved 2022-04-30.
  54. ^ "Oxytocin 10 IU/ml Solution for infusion - Summary of Product Characteristics (SmPC) - (emc)". www.medicines.org.uk. Retrieved 2022-04-30.
  55. S2CID 81797258
    .
  56. .
  57. ^ Saint Louis H (2022-04-14). "Cesarean Delivery: Overview, Preparation, Technique". Medscape.
  58. ^ "Ectopic pregnancy - Symptoms and causes". Mayo Clinic. Retrieved 2022-04-30.
  59. ^ Lim KH, Steinberg G (2022-04-13). "Preeclampsia: Practice Essentials, Overview, Pathophysiology". Medscape.
  60. ^ Artal-Mittelmark R. "Stages of Development of the Fetus - Women's Health Issues". MSD Manual Consumer Version. Retrieved 2022-04-30.
  61. ^ "Hypertension: Causes, symptoms, and treatments". www.medicalnewstoday.com. 2021-11-10. Retrieved 2022-04-30.
  62. ISSN 0036-8423
    .
  63. .
  64. ^ "Preeclampsia: Symptoms, Causes, Treatments & Prevention". Cleveland Clinic. Retrieved 2022-04-30.
  65. ^ "Placental Abruption: Symptoms, Causes & Effects On Baby". Cleveland Clinic. Retrieved 2022-04-30.
  66. ^ Moldenhauer JS. "Fetal Distress - Women's Health Issues". MSD Manual Consumer Version. Retrieved 2022-04-30.
  67. ^ "Shoulder Dystocia: Signs, Causes, Prevention & Complications". Cleveland Clinic. Retrieved 2022-04-30.
  68. PMID 28403833
    .
  69. .
  70. ^ "Umbilical Cord Prolapse: Causes, Diagnosis & Management". Cleveland Clinic. Retrieved 2022-04-30.
  71. ^ Smith JR (2022-04-01). "Postpartum Hemorrhage: Practice Essentials, Problem, Epidemiology". Medscape.
  72. PMID 30885159
    .
  73. ^ "WHO Technical Consultation on Postpartum Care". World Health Organization. 2010. Retrieved 30 June 2020.
  74. PMID 26857705
    .
  75. ^ "Types of Delivery for Pregnancy". Cleveland Clinic. Retrieved 2022-04-30.
  76. PMID 33461593
    .
  77. ^ a b c Gelis J (1991). History of Childbirth. Boston: Northeastern University Press.
  78. ^ Healthdirect Australia (2021-05-23). "What do midwives do?". www.pregnancybirthbaby.org.au. Retrieved 2022-04-30.
  79. ^
    PMID 33836689
    .
  80. ^ a b c d Bynum WF, Porter R, eds. (1993). Companion Encyclopedia of the History of Medicine. London and New York: Routledge.
  81. ^ Carr I (May 2000). "Some Obstetrical History: Dying to Have a Baby - the History of Childbirth" (PDF). University of Manitoba: Women's Health. Retrieved 20 May 2012.
  82. ^ a b c d e f McGrew RE (1985). Encyclopedia of Medical History. New York: McGraw-Hill Book Company.
  83. ^ a b Hufnagel GL (2012). A History of Women's Menstruation from Ancient Greece to the Twenty-first Century: Psychological, Social, Medical, Religious, and Educational Issues. Lewiston, New York: Edwin Mellen Press.
  84. ^ International Confederation of Midwives (2022-01-31). "The Origins of Midwifery". ICM. Retrieved 2022-04-30.
  85. PMID 32491507
    . Retrieved 2022-04-30.
  86. required.)
  87. ^ .
  88. S2CID 239583227. Retrieved 2022-04-30. {{cite book}}: |work= ignored (help
    )
  89. .
  90. .
  91. .
  92. .
  93. .
  94. ^ ..
  95. .
  96. PMID 20085678. Archived from the original
    (PDF) on January 23, 2013. Retrieved May 20, 2012.
  97. ^ Caplan CE (1995). "The Childbed Fever Mystery and the Meaning of Medical Journalism". McGill Journal of Medicine. 1 (1). Archived from the original on 2012-07-07.
  98. ^ Roth J. Pregnancy & Birth: The History of Childbearing Choices in the United States. Human Service Solutions.
  99. .
  100. . Table 2: Types of procedures and association with surgical site infections (SSI). P-values were obtained from Fisher's Exact test, unless otherwise specified.
  101. .
  102. .
  103. .
  104. .
  105. ^ a b "Dr. J Marion Sims: The Father of Modern Gynecology". International Wellness Foundation. 12 February 2014.
  106. .
  107. .
  108. ^ "Situation of women and children in Nigeria". www.unicef.org. Retrieved 2022-04-30.
  109. .
  110. .
  111. ^ "Uterine Prolapse: Causes, Symptoms, Diagnosis & Treatment". Cleveland Clinic. Retrieved 2022-04-30.