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Encyclopedia > Obstetrics

Obstetrics (from the Latin obstare, "to stand by") is the surgical specialty dealing with the care of a woman and her offspring during pregnancy, childbirth and the puerperium (the period shortly after birth). Most obstetricians are also gynaecologists. See Obstetrics and gynaecology. Image File history File links Broom_icon. ... A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ... A pregnant woman near the end of her term Pregnancy is the carrying of one or more embryos or fetuses by female mammals, including humans, inside their bodies. ... Childbirth (also called labour, birth, partus or parturition) is the culmination of a human pregnancy with the emergence of a newborn infant/s from the mothers uterus. ... Postnatal (Latin for after birth) is the period beginning immediately after the birth of a child and extending for about six weeks. ... The shamefulness associated with the examination of female genitalia has long inhibited the science of gynaecology. ... The current version of the article or section is written like a magazine article instead of the formal tone expected of an encyclopedia. ...


The average gestational period for humans is 40 weeks.[citation needed] This is divided into three trimesters. The human gestation period of approximately 40 weeks between the time of the last menstrual cycle and delivery is traditionally divided into three periods of three months, or trimesters. ...

Contents

Antenatal care

In obstetric practice, an obstetrician or midwife will see a pregnant woman on a regular basis to check the progress of the pregnancy. An individual woman's schedule of antenatal appointment varies depending on local resources and her risk factors, such as diabetes. This article is about the disease that features high blood sugar. ...


The main rationale for these visits is surveillance for diseases of pregnancy which are detectable. Some examples are:

  1. pre-eclampsia. The blood-pressure and urine of a pregnant woman is checked at every opportunity to check for this.
  2. placenta praevia. On ultrasound, the placenta is visible obstructing the birth canal
  3. unusual presentation (late pregnancy only). The fetus may be feet-first or buttocks-first(breech), side-on (transverse), or at an angle (oblique presentation)
  4. IUGR (Intrauterine Growth Restriction), this is a general designation, where the fetus is too small for its gestational age. Causes can be intrinsic (in the fetus) or extrinsic (usually placental problems). IUGR refers to fetal growth that is less than 10% of what is expected at that gestational age.

Pre-eclampsia (US: preeclampsia) is said to be present when hypertension arises in pregnancy (pregnancy-induced hypertension) in association with significant protein in the urine. ... Obstetric sonogram of a fetus at 16 weeks. ... Breech, by W.Smellie, 1792 A breech birth (also known as breech presentation) refers to the position of the baby in the uterus such that it will be delivered buttocks first as opposed to the normal head first position. ... Intrauterine growth retardation or Intrauterine growth restriction (IUGR) refers to the condition during pregnancy where a fetus is considered to be too small for its gestational age (generally in the 10th percentile). ...

Signs

Anatomical model of a human pregnancy
Anatomical model of a human pregnancy

Download high resolution version (1280x960, 172 KB)Anatomical model of a pregnancy Source: image*after This image has been released into the public domain by the copyright holder, its copyright has expired, or it is ineligible for copyright. ... Download high resolution version (1280x960, 172 KB)Anatomical model of a pregnancy Source: image*after This image has been released into the public domain by the copyright holder, its copyright has expired, or it is ineligible for copyright. ...

Trimesters

First trimester: elevated β-hCG (human chorionic gonadotrophin) of up to 100,000 mIU/mL by 10 weeks GA can cause morning sickness, fatigue, mood swings and food cravings. The symptoms can last through 12 to 16 weeks of gestation. Morning sickness, also called nausea and vomiting of pregnancy (NVP) or pregnancy sickness, affects between 50 and 95 percent of all pregnant women as well as some women who take birth control pills or hormone replacement therapy. ... A mood swing is an extreme or rapid change in mood. ...


Second trimester: The abdomen shows an obvious swelling arising from the pelvis, starting the "obvious phase" of pregnancy. Hyperpigmentation, including linea nigra, may appear. In dermatology, hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin. ... Linea Nigra from pubis to navel. ...


Third trimester: The mother may experience backaches due to increased strain. Typically, the curvature of the spine is changed as pregnancy evolves in order to counteract the change in weight distribution. The mother may also suffer mild urinary incontinence due to pressure on the bladder by the pregnant uterus, as well as heartburn(due to compression of the stomach). It has been suggested that this article or section be merged with Low back pain. ... This article or section is not written in the formal tone expected of an encyclopedia article. ...


Overall

A pregnant womans breasts. ... Linea Nigra from pubis to navel. ... Telangiectasias (tee-LAN-jek-TAY-ja) are small enlarged blood vessels near the surface of the skin, usually they measure only a few millimetres. ... Palmar erythema is reddening of the palms at the thenar and hypothenar eminences. ... Amenorrhoea (BE) or amenorrhea (AmE) is the absence of a menstrual period in a woman of reproductive age. ... For the Beck song, see Nausea (song). ... Vomiting (or emesis) is the forceful expulsion of the contents of ones stomach through the mouth. ... Sciatica is pain caused by general compression and/or irritation of one of five nerve roots that are branches of the sciatic nerve. ... This article or section may be confusing or unclear for some readers, and should be edited to rectify this. ...

Maternal physiology

During pregnancy, the woman undergoes many physiological changes, which are entirely normal, including cardiovascular, hematologic, metabolic, renal and respiratory changes that become very important in the event of complications. Leonardo da Vincis Vitruvian Man, an important early achievement in the study of physiology. ... The circulatory system or cardiovascular system is the organ system which circulates blood around the body of most animals. ... Hematology is the branch of medicine that is concerned with blood and its disorders. ... A few of the metabolic pathways in a cell. ... Kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... // In animal physiology, respiration is the transport of oxygen from the ambient air to the tissue cells and the transport of carbon dioxide in the opposite direction. ...


Cardiovascular

The woman is the sole provider of nourishment for the embryo and later, the fetus, and so her plasma and blood volume slowly increase by 40-50% over the course of the pregnancy to accommodate the changes. This results in overall vasodilation, an increase in heart rate (15 beats/min more than usual), stroke volume, and cardiac output. Cardiac output increases by about 50%, mostly during the first trimester. The systemic vascular resistance also drops due to the smooth muscle relaxation caused by elevated progesterone, leading to a fall in blood pressure. Diastolic blood pressure consequently decreases between 12-26 weeks, and increases again to prepregnancy levels by 36 weeks. If the blood pressure remains abnormal beyond 36 weeks, the woman should be investigated for pre-eclampsia, a condition that precedes eclampsia. It has been suggested that embryology be merged into this article or section. ... Human fetus at eight weeks. ... Blood plasma is the liquid component of blood, in which the blood cells are suspended. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... Heart Rate is a term used to describe the frequency of the cardiac cycle. ... Cardiac output is the volume of blood being pumped by the heart, in particular a ventricle in a minute. ... A sphygmomanometer, a device used for measuring blood pressure. ... Pre-eclampsia (US: preeclampsia) is said to be present when hypertension arises in pregnancy (pregnancy-induced hypertension) in association with significant protein in the urine. ...


Hematology

  • The plasma volume increases by 50% and the red blood cell volume increases only by 20-30%.
  • Consequently, the hematocrit decreases.
  • White blood cell count increases and may peak at over 20 mil/mL in stressful conditions.
  • Decrease in platelet concentration to a minimal normal values of 100-150 mil/mL
  • The pregnant woman also becomes hypercoagulable due to increased liver production of coagulation factors, mainly fibrinogen and factor VIII.

Blood plasma is the liquid component of blood, in which the blood cells are suspended. ... The hematocrit (Ht or HCT) and packed cell volume (PCV) are measures of the proportion of blood volume that is occupied by red blood cells. ... The liver is an organ present in vertebrates and some other animals. ... Fibrin is a protein involved in the clotting of blood. ... Factor VIII (FVIII) is an essential clotting factor. ...

Metabolism

During pregnancy, both protein metabolism and carbohydrate metabolism are affected. One kilogram of extra protein is deposited, with half going to the fetus and placenta, and another half going to uterine contractile proteins, breast glandular tissue, plasma protein, and hemoglobin. Protein metabolism denotes the various biochemical processes responsible for the synthesis of proteins and amino acids, and the breakdown of proteins (catabolism). ... The smooth endoplasmic reticulum is responsible for some carbohydrate metabolism. ... The U.S. National Prototype Kilogram, which currently serves as the primary standard for measuring mass in the U.S. It was assigned to the United States in 1889 and is periodically recertified and traceable to the primary international standard, The Kilogram, held at the Bureau International des Poids et... A representation of the 3D structure of myoglobin, showing coloured alpha helices. ... Human fetus at eight weeks. ... The placenta is an ephemeral (temporary) organ present in female placental vertebrates during gestation (pregnancy), but a placenta has evolved independently also in other animals as well, for instance scorpions and velvet worms. ... The uterus or womb is the major female reproductive organ of most mammals, including humans. ... In both males and females, the breasts are composed of adipose tissue and mammary glands. ... 3-dimensional structure of hemoglobin. ...


Nutrition

  • Increased caloric requirement by 300 kcal/day
  • Gain of 20 to 30 lb (10 to 15 kg)
  • Increased protein requirement to 70 or 75 g/day
  • Increased folate requirement from 0.4 to 0.8 mg/day (important in preventing neural tube defects)

All patients are advised to take prenatal vitamins to compensate for the increased nutritional requirements. The use of Omega 3 fatty acids supports mental and visual development of infants source Choline supplementation of research mammals supports mental development that lasts throughout life source Folic acid (the anion form is called folate) is a B-complex vitamin (once called vitamin M) that is important in preventing neural tube defects (NTDs) in the developing human fetus. ... The neural tube is the embryonal structure that gives rise to the brain and spinal cord. ... Retinol (Vitamin A) For the record label, see Vitamin Records Vitamins are nutrients required in tiny amounts for essential metabolic reactions in the body. ...


Gastrointestinal

  • nausea and vomiting ("morning sickness") due to elevated B-hCG, which should resolve by 14 to 16 weeks
  • prolonged gastric empty time
  • decreased gastroesophageal sphincter tone, which can lead to acid reflux
  • decreased colonic motility, which leads to increased water absorption and constipation

Morning sickness, also called nausea and vomiting of pregnancy (NVP) or pregnancy sickness, affects between 50 and 95 percent of all pregnant women as well as some women who take birth control pills or hormone replacement therapy. ... Gastroesophageal Reflux Disease (GERD, or GORD when -oesophageal, the BE form, is substituted) is injury to the esophagus that develops from chronic exposure of the esophagus to acid coming up from the stomach (reflux). ... Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. ...

Renal

Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal glomerular capillaries into Bowmans capsule per unit time. ... Postnatal (Latin for after birth) is the period beginning immediately after the birth of a child and extending for about six weeks. ... The blood urea nitrogen (BUN) test is a measure of the amount of nitrogen in the blood that comes from urea. ... Chemical structure of creatinine. ... Gestational diabetes is a form of diabetes found in pregnant women. ... Schematic depicting how the RAAS works. ... Aldosterone is a steroid hormone synthesized from cholesterol by the enzyme aldosterone synthase. ... General Name, Symbol, Number sodium, Na, 11 Chemical series alkali metals Group, Period, Block 1, 3, s Appearance silvery white Standard atomic weight 22. ...

Pulmonary

All of these changes can contribute to the dyspnea (shortness of breath) that a pregnant woman may experience. The average pair of human lungs can hold about 6 litres of air, but only a small amount is used during normal breathing. ... This page may meet Wikipedias criteria for speedy deletion. ... The average pair of human lungs can hold about 6 litres of air, but only a small amount is used during normal breathing. ... Respiratory minute volume (or minute ventilation, or flow of gas) is the volume of air which can be inhaled (inhaled minute volume) or exhaled (exhaled minute volume) from a persons lungs in one minute. ... Alkalosis refers to a condition reducing hydrogen ion concentration of arterial blood plasma. ... Dyspnea (R06. ...


Endocrine

  • Increased estrogen, which is mainly produced in the placenta
    • Fetal well being is associated with maternal estrogen levels
    • Causes an increase in thyroxine-binding globulin (TBG)
  • Increased human chorionic gonadotropin (β-hCG), which is produced by the placenta. This maintains progesterone production by the corpus luteum
  • Human placental lactogen (hPL) is produced by the placenta and ensures nutrient supply to the fetus. It also causes lipolysis and is an insulin antagonist, which is a diabetogenic effect.
  • Increased progesterone production, first by corpus luteum and later by the placenta. Its main course of action is to relax smooth muscle.
  • Increased prolactin
  • Increased alkaline phosphatase

Estriol. ... The placenta is an ephemeral (temporary) organ present in female placental vertebrates during gestation (pregnancy), but a placenta has evolved independently also in other animals as well, for instance scorpions and velvet worms. ... Thyroxine-binding globulin (TBG) or transthyretin is the major binding protein of thyroid hormones in the bloodstream. ... Human chorionic gonadotropin (hCG) is a peptide hormone produced in pregnancy, that is made by the embryo soon after conception and later by the syncytiotrophoblast (part of the placenta). ... Progesterone is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species. ... The corpus luteum (Latin for yellow body) is a small, temporary endocrine structure in animals. ... Human placental lactogen (HPL), also called human chorionic somatomammotropin, is a polypeptide placental hormone. ... Lipolysis is the breakdown of fat stored in fat cells. ... Insulin (from Latin insula, island, as it is produced in the Islets of Langerhans in the pancreas) is a polypeptide hormone that regulates carbohydrate metabolism. ... Prolactin (PRL) is a peptide hormone primarily associated with lactation. ... Ball and stick model of alkaline phosphatase Alkaline phosphatase (ALP) (EC 3. ...

Musculoskeleton and dermatology

  • Lower back pain due to a shift in gravity
  • Increased estrogen can cause spider angiomata and palmar erythema
  • Increase melanocyte-stimulating hormone (MSH) can cause hyperpigmentation of nipples, umbilicus, abdominal midline (linea nigra), perineum, and face (melasma or chloasma)

... Palmar erythema is reddening of the palms at the thenar and hypothenar eminences. ... This article or section does not cite its references or sources. ... Linea Nigra from pubis to navel. ...

Others

  • Edema, or swelling, of the feet is common during pregnancy, partly because the enlarging uterus compresses veins and lymphatic drainage from the legs.

Edema (American English) or oedema (British English), formerly known as dropsy or hydropsy, is swelling of any organ or tissue due to accumulation of excess lymph fluid, without an increase of the number of cells in the affected tissue. ...

Prenatal care

Main article: 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: A doctor performs a prenatal exam. ...


First trimester

Schematics of shorthand for complete blood count commonly used by physicians. ... Blood type (or blood group) is determined, in part, by the ABO blood group antigens present on red blood cells. ... Each antibody binds to a specific antigen; an interaction similar to a lock and key. ... Coombs test (also known as Coombs test, antiglobulin test or AGT) refers to two clinical blood tests used in hematology and immunology. ... Hemolytic disease of the newborn, (also known as HDN) is an alloimmune condition that develops in a fetus when the IgG antibodies produced by the mother and passing through the placenta include ones which attack the red blood cells in the fetal circulation. ... This article or section is in need of attention from an expert on the subject. ... Warning: Wikipedia does not give medical advice. ... Hepatitis B is an inflammation of the liver and is caused by the Hepatitis B virus (HBV), a member of the Hepadnavirus family[1] and one of hundreds of unrelated viral species which cause viral hepatitis. ... Gonorrhea (gonorrhoea in British English) is among the most common sexually-transmitted diseases in the world and is caused by Gram-negative bacterium Neisseria gonorrheae. ... Chlamydia is a common term for infection with any bacterium belonging to the phylum Chlamydiae. ... The Mantoux test is a skin test of tuberculosis infection used in the United States and is endorsed by the American Thoracic Society and Centers for Disease Control and Prevention (CDC). ... Tuberculosis (abbreviated as TB for Tubercle Bacillus) is a common and deadly infectious disease that is caused by mycobacteria, primarily Mycobacterium tuberculosis. ... The pap smear as we know it is an invention of Dr. Georgios Papanikolaou (1883-1962), an American of Greek birth, the father of cytopathology. ... A urinalysis (or UA) is an array of tests performed on urine and one of the most common methods of medical diagnosis. ... Species Human immunodeficiency virus 1 Human immunodeficiency virus 2 Human immunodeficiency virus (HIV) is a retrovirus that causes acquired immunodeficiency syndrome (AIDS, a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections). ... Group B Streptococcus (GBS) is a type of bacteria that can cause serious illness and sometimes death, especially in newborn infants and the elderly. ...

Second trimester

  • MSAFP/triple screen (maternal serum alpha-fetoprotein) - elevation correlated with neural tube defects and decrease correlated with Down's syndrome
  • ultrasound
  • amniocentesis in older patients

Alpha-fetoprotein (AFP) is a protein that is normally only produced in the foetus during its development. ...

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 test (GTT) is administered; if fasting glucose > 105 mg/dL, gestational diabetes is suggestive.

A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ...

Complications

See Complications of Pregnancy // Routine Problems of Pregnancy Back Pain Common, particularly in the third trimester when the patients center of gravity has shifted. ...


Fetal assessments

Common
  • ultrasound is used for many functions:
    • Dating the gestational age of a pregnancy, most accurate in first trimester
    • Detecting fetal anomalies in the second trimester
    • biophysical profiles (BPP)
    • Blood flow velocity in umbilical cord -- decrease/absence/reversal or diastolic blood flow in the umbilical artery is worrisome.
    • Congenital anomalies can be diagnosed with second trimester ultrasound
  • Fetal karyotype for the screening of genetic diseases can be obtained via amniocentesis or chorionic villus sampling (CVS)
Uncommon
  • Fetal hematocrit for the assessment of fetal anemia, Rh isoimmunization, or hydrops can be determined by percutaneous umbilical blood sampling (PUBS) which is done by placing a needle through the abdomen into the uterus and taking a portion of the umbilical cord.
  • Fetal lung maturity is associated with how much surfactant the fetus is producing. Reduced production of surfactant indicates decreased lung maturity and is a high risk factor for neonatal respiratory distress syndrome (NRDS). Typically a lecithin:sphingomyelin ratio greater than 1.5 is associated with increased lung maturity.
  • Nonstress test (NST) for fetal heart rate
  • Oxytocin challenge test

Obstetric sonogram of a fetus at 16 weeks. ... In placental mammals, the umbilical cord is a tube that connects a developing embryo or fetus to its placenta. ... Karyogram of human male using Giemsa staining. ... Amniocentesis, or an Amniotic Fluid Test (AFT), is a medical procedure used for prenatal diagnosis, in which a small amount of amniotic fluid is extracted from the amnion around a developing fetus. ... Chorionic villus sampling (CVS) is a form of prenatal diagnosis to determine genetic abnormalities in the fetus. ... The hematocrit (Ht or HCT) and packed cell volume (PCV) are measures of the proportion of blood volume that is occupied by red blood cells. ... Anemia (AmE) or anaemia (BrE), from the Greek () meaning without blood, is a deficiency of red blood cells (RBCs) and/or hemoglobin. ... Hydrops may refer to: Hydrops fetalis, a medical condition. ... The uterus or womb is the major female reproductive organ of most mammals, including humans. ... In placental mammals, the umbilical cord is a tube that connects a developing embryo or fetus to its placenta. ... Surfactants are wetting agents that lower the surface tension of a liquid, allowing easier spreading, and lower the interfacial tension between two liquids. ... Phosphatidylcholine, a phospholipid in lecithin. ... Sphingomyelin is a type of sphingolipid found in animal cell membranes, especially in the membranous myelin sheath which surrounds some nerve cell axons. ... Part of the formal antenatal test for fetal well being. ... A contraction stress test (CST) is performed near the end of pregnancy to determine how well the fetus will cope with the contractions of childbirth. ...

Induction

Reasons to induce include:

  1. pre-eclampsia
  2. IUGR
  3. diabetes
  4. other general medical condition, such as renal disease

Induction may occur any time after 24 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. Prior to 32 weeks, gestation steroids are given to the mother to help mature the fetus's lungs. Pre-eclampsia (US: preeclampsia) is said to be present when hypertension arises in pregnancy (pregnancy-induced hypertension) in association with significant protein in the urine. ... Kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ...


If a woman does not eventually labour by 41-42 weeks, induction may be performed, as the placenta may become unstable after this date.


Induction may be achieved via several methods:

  1. pessary of Prostin cream, prostaglandin E2
  2. vaginal or oral administration of misoprostol
  3. cervical insertion of a 30-mL Foley catheter
  4. surgical induction, by piercing the amnion
  5. infusion of oxytocin

This article needs cleanup. ... Chemical structure of prostaglandin E1 (PGE1). ... For the alien race in Stephen Donaldsons The Gap Cycle, see Amnion (Gap Cycle). ... Articles with similar titles include OxyContin. ...

Labor

During labor itself, the obstetrician may be called on to do a number of things:

  1. 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)
  2. accelerate the progress of labor by infusion of the hormone oxytocin
  3. provide pain relief, either by nitrous oxide (nowadays uncommon, at least in the U.S.), opiates, or by epidural anesthesia done by anaethestists, an anesthesiologist, or a nurse anesthetist.
  4. surgically assisting labor, by forceps or the Ventouse (a suction cap applied to the fetus' head)
  5. Caesarean section, if vaginal delivery is decided against or appears too difficult. 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 (where minutes count) are a rarity.

The cardiotocograph is more commonly known as Electronic Fetal Monitoring (EFM). ... Articles with similar titles include OxyContin. ... R-phrases S-phrases Supplementary data page Structure and properties n, εr, etc. ... Motto: (Out Of Many, One) (traditional) In God We Trust (1956 to date) Anthem: The Star-Spangled Banner Capital Washington D.C. Largest city New York City None at federal level (English de facto) Government Federal constitutional republic  - President George Walker Bush (R)  - Vice President Dick Cheney (R) Independence from... An opioid is any agent that binds to opioid receptors found principally in the central nervous system and gastrointestinal tract. ... Local anesthesia is any technique to render part of the body insensitive to pain without affecting consciousness. ... Anesthesia (AE), also anaesthesia (BE), is the process of blocking the perception of pain and other sensations. ... A nurse anesthetist (AE) is a registered nurse educated and trained to administer anesthesia. ... // There can be many baby defects within a baby C section. ...

Antenatal

During the time immediately after birth both baby as well as mother are hormonally cued to bond, the mother through the release of oxytocin a hormone also released with breastfeeding. Articles with similar titles include OxyContin. ... Breastfeeding an infant Symbol for breastfeeding (Matt Daigle, Mothering magazine contest winner 2006) Breastfeeding is the feeding of an infant or young child with milk from a womans breasts. ...


Emergencies in obstetrics

Two main emergencies are ectopic pregnancy and (pre)eclampsia.

  • Ectopic pregnancy 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-eclampsia is a disease caused by mysterious toxins secreted by the placenta. These toxins act on the vascular endothelium, causing hypertension and proteinuria. If severe, it progresses to fulminant pre-eclampsia, with headaches and visual disturbances. This is a prelude to eclampsia, where a convulsion occurs, which can be fatal.

Pre-eclampsia (US: preeclampsia) is said to be present when hypertension arises in pregnancy (pregnancy-induced hypertension) in association with significant protein in the urine. ... The endothelium is the layer of thin, flat 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. ... This article or section does not cite its references or sources. ... Proteinuria (from protein and urine) means the presence of an excess of serum proteins in the urine. ...

Imaging, monitoring and care

In present society, medical science has developed a number of procedures to monitor pregnancy.


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 history and physical examination. This article needs cleanup. ... Midwifery is a blanket term used to describe a number of different types of health practitioners, other than doctors, who provide prenatal care to expecting mothers, attend the birth of the infant and provide postnatal care to the mother and infant. ... The medical history of a patient (sometimes called anamnesis [1][2] ) 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 (in this case, it is sometimes called heteroanamnesis). ... In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ...


On subsequent visits, the gestational age (GA) is rechecked with each visit. Symphysis-fundal height (dsddsdsddSFH; 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. Gestational age is age of a fetus (or newborn infant) from presumed conception. ... Fundal height, or MacDonalds rule, is a measure of the size of the uterus used to assess fetal growth and development. ... A sphygmomanometer, a device used for measuring blood pressure. ... This article or section does not cite its references or sources. ... Pre-eclampsia (US: preeclampsia) is said to be present when hypertension arises in pregnancy (pregnancy-induced hypertension) in association with significant protein in the urine. ... Edema (American English) or oedema (British English), formerly known as dropsy or hydropsy, is swelling of any organ or tissue due to accumulation of excess lymph fluid, without an increase of the number of cells in the affected tissue. ...


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 since it involves penetrating the uterus with the baby still in utero. Fetal screening refers to any tests that allow a fetus to be tested for certain traits or characteristics. ... Genetic counseling 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 in order to prevent, avoid or... Amniocentesis, or an Amniotic Fluid Test (AFT), is a medical procedure used for prenatal diagnosis, in which a small amount of amniotic fluid is extracted from the amnion around a developing fetus. ... Figure 1: A representation of a condensed eukaryotic chromosome, as seen during cell division. ... The triple test, also called triple screen or the Barts test, is an investigation performed during pregnancy (usually the second trimester) for fetal trisomy 21 (Down syndrome). ... Late in the first trimester, an echolucent area can be identified at the back of the neck of normal fetuses. ... The Nasal Bones (Ossa Faciei & Ossa Nasalia) 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. ... Alpha-fetoprotein (AFP) is a protein that is normally only produced in the foetus during its development. ... Chorionic villus sampling (CVS) is a form of prenatal diagnosis to determine genetic abnormalities in the fetus. ...


Imaging

A dating scan at 12 weeks
A dating scan at 12 weeks

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; guess the gestational age; determine the number of fetuses and placentae; evaluate for an ectopic pregnancy and first trimester bleeding; and assess for early signs of anomalies. Image File history File links Scan12weeks. ... Image File history File links Scan12weeks. ... Obstetric sonogram of a fetus at 16 weeks. ... Human fetus at eight weeks. ... The uterus or womb is the major female reproductive organ of most mammals, including humans. ... Gestational age is age of a fetus (or newborn infant) from presumed conception. ... The placenta is an ephemeral (temporary) organ present in female placental vertebrates during gestation (pregnancy), but a placenta has evolved independently also in other animals as well, for instance scorpions and velvet worms. ...


X-rays and computerized tomography (CT) are not used, especially in the first trimester, due to the ionizing radiation, which has teratogenic effects on the fetus. Instead, ultrasound is the imaging method of choice in the first trimester and throughout the pregnancy, since 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). In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... Radiation hazard symbol. ... Teratogenesis is a medical term from the Greek, literally meaning monster making. ... Obstetric sonogram of a fetus at 16 weeks. ... Radiation as used in physics, is energy in the form of waves or particles. ...


A normal gestation would reveal a gestational sac, yolk sac, and fetal pole. The gestational age can be assessed by evaluating the mean gestation sac diameter (MGD) before week 6, and the crown-rump length after week 6. Multiple gestation is evaluated by the number of placentae and amniotic sacs present. The gestational sac is the only available intrauterine structure that can be used to determine if an intrauterine pregnancy (IUP) exists, until the embryo is identified. ... The yolk sac is the first element seen in the gestational sac during pregnancy, usually at 5 weeks gestation. ... The fetal pole is a thickening on the margin of the yolk sac of a fetus during pregnancy. ... Gestational age is age of a fetus (or newborn infant) from presumed conception. ... The placenta is an ephemeral (temporary) organ present in female placental vertebrates during gestation (pregnancy), but a placenta has evolved independently also in other animals as well, for instance scorpions and velvet worms. ... A drawing of the amniotic sac from Grays Anatomy. ...


Pregnancy has different cultural aspects related to the perception of the body, the relationship with partner and to the meaning of the event.


Terms and definitions

  • embryo - conceptus between time of fertilization to 10 weeks of gestation
  • fetus - from 10 weeks of gestation to time of birth
  • infant - time of birth to 1 year of age
  • gestational age - time from last menstrual period (LMP) up to present
  • first trimester - up to 14 weeks of gestation
  • second trimester - 14 to 28 weeks of gestation
  • third trimester - 28 weeks to delivery
  • viability - minimum age for fetus survival, ca. third trimester
  • previable infant - delivered prior to 24 weeks
  • preterm infant - delivered between 24-37 weeks
  • term infant - delivered between 37-42 weeks
  • gravidity (G) - number of times a woman has been pregnant
  • parity (P) - number of pregnancies with a birth beyond 20 weeks GA or an infant weighing more than 500 g
  • Ga Pw-x-y-z - a = number of pregnancies, w = number of term births, x = number of preterm births, y = number of miscarriages, z = number of living children; for example, G4P1-2-1-3 means the woman had a total of 4 pregnancies, of which 1 is of term, 2 are preterm, 1 miscarriage, and 3 total living children (1 term + 2 preterm).

References

Further reading

  • J Lane (July 1987). "A provincial surgeon and his obstetric practice: Thomas W. Jones of Henley-in-Arden, 1764–1846". Medical History 31 (3): 333–348. 

External links

  • OBGYN.net resource portal on Obstetrics and Gynecology for patients and medical professionals
  • Prenatal Choline improves research mammals lifetime mental ability
  • Omega 3 fatty acid supports mental and visual development of infants
  • Obstetrics Forums
  • Ingenious: archive of historical images related to obstetrics, gynaecology, and contraception.
  • OBGYNHealth.net

See also


  Results from FactBites:
 
Obstetric ultrasound -- a comprehensive guide to ultrasound scans in pregnancy (3712 words)
Obstetric Ultrasound is the use of ultrasound scans in pregnancy.
In both these situations, careful ultrasound examination should be made to exclude intraulterine growth retardation and congenital malformation in the fetus such as intestinal atresia, hydrops fetalis or renal dysplasia.
Further developments in doppler ultrasound technology in recent years have enabled a great expansion in its application in Obstetrics, particularly in the area of assessing and monitoring the well-being of the fetus, its progression in the face of intrauterine growth restriction, and the diagnosis of cardiac malformations.
  More results at FactBites »

 
 

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