Obstetrics

OBSTETRICS STUDY GUIDE A. OBSTETRICS IN BROAD PERSPECTIVE 1. OBSTETRICS - Branch of medicine that deals with parturition, its antecedents and each sequel. AIMS: 1. That every pregnancy be wanted and culminate in a healthy mother and healthy baby. 2. Minimize maternal and infant mortality rate. 3. concerned with the number and spacing of children so that mother and offspring may enjoy optimal physical and emotional well-being. 2. BIRTH = complete expulsion from a mother of a fetus irrespective of weather or not the umbilical has been cut or placenta is attached. 3. BIRTH RATE = NUMBER OF LIVE BIRTH PER 1,000 population. 4. FERTILITY RATE = number of live birth per 1,000 female population aged 15-44 yrs old. 5. LIVE BIRTH = an infant or after breath spontaneously or show any signs of life such as heart beat definite spontaneous movement. 6. NEONATAL DEATH = refers to the death of live born infant during the 1st 7 days of life, late neonatal death infants per 1,000 infants born. 7. STILL BIRTH RATE = number of stillborn infants per 1,000 infants born. 8. FETAL DEATH = synonymous with still birth. 9. NEONATAL MORTALITY RATE = number of neonatal deaths per 1,000 live births. 10 .PERINATAL MORTALITY RATE = number of fetal death (stillbirth) plus neonatal deaths per 1,000 total births. 11. LOW BIRTH WEIGHT = FIRST weight obtained after birth is 2,500 or less. 12. TERM INFANT= Infant born anytime after 37 completed weeks of gestation through 41 completed weeks of gestation . 13. PRE TERM OR PRE MATURE = infant born before 37 completed weeks. 14. POST TERM INFANT = infants born at 42 weeks gestation age or more. 15. ABORTUS = fetus or embryo expelled from the uterus during the 1st half of pregnancy (20 wks or less) or weighing less than 500g or measuring less than 25 cm. 16. DIRECT MATERNAL DEATH= death of the mother resulting from obstetrics complication pregnancy state labor or puerperium. 17. INDIRECT MATERNAL DEATH = death directly due to obstetrics causes but resulting from previously existing disease that developed during pregnancy, labor and puerperium. 18. NON MATERNAL DEATH = death of the mother resulting from accidental or incidental causes not related to pregnancy. 19. MATERNAL DEATH RATE OR MORTALITY= number of maternal that occurs as the result of the reproductive process per 100,000 live birth. 20. REPRODUCTIVE MORTALITY = resulting from the use of contraceptive technique to avoid pregnancy express as a number of deaths per 100,000 woman.

B. HUMAN PREGNANCY , LABOR AND PUERPERIUM: 1. ABORTION= termination by means before the fetus is sufficiently developed to survive. CATEGORIES OF SPONTANEOUS ABORTION: 1. THREATENED ABORTION= any vaginal bleeding during 1st half of pregnancy may or may not be accompanied by mild cramping pain. 2. INEVITABLE ABORTION= there is gross rupture of the membranes with cervical dilatation. 3. INCOMPLETE ABORTION= fetus expelled before the 10th weeks but placenta in whole or part is retained. 4. HABITUAL ABORTION= 3 or more consecutive spontaneous abortion. 2. ABRUPTIO PLACENTA= premature separation of normally implanted /sited placenta. 3. ACME= highest intensity of a uterine contraction 4. AMNIOCENTESIS= removal of a liquor or tapping the amniotic sac through the needle inserted at the anterior abdominal and uterine walls. 5. AMNION= smooth tough inner membrane containing the amniotic fluid. 6. ATTITUDE= relation of the fetal limbs and head to its trunk usually one of flexion. 7. BALLOTMENT= rebound of the fetus to its original position with the tap tells by the examining hand. 8. BANDL’S RING= marked ridge between the upper and lower uterine segment noted in obstructed labor. 9. BARTHOLOMEW’S RULE= estimate of the duration of pregnancy by noting the fundic height in relation to the three anatomical landmark. 10. BATTLEDORE PLACENTA= umbilical cord(funis) inserted to the placental edge. 11. ELASTOCYST= the fertilized ovum ready for implantation about 10 days after fertilization. 12. BRACHT MANEUVER= the breech delivered spontaneously to the umbilical and the baby’s body held against the symphysis pubis with the moderate supra pubic pressure. 13. BRAXTON HICKS = palpable but ordinarily painless uterine contractions at irregular intervals from stage of gestations. 14. BREECH DELIVERY=three general methods on breech delivery through the vagina: 1. spontaneous=infants expelled entirely spontaneously without any traction other than support of the infant. 2. partial= infant is delivered spontaneously up to the navel but the remainder of the body is extracted 3. total= the entire body of the infant is extracted by the obstetrician. 15. CALKIN’S SIGN=change in the shape and consistency of the uterus from a flattened discoid body to a form globular mass. 16. CARDINAL MOVEMENT OF LABOR=process of adaptation and accommodation of the head to the various segments of the pelvis.

THE 7 CARDINAL MOVEMENTS IN SEQUENCE AND IN ORDERLY FASHION ARE: 1.engagement 2.descent3.flexion 4.internal rotation 5.extension 6.external rotation 7.expulsion 17. CESARIAN SECTION= delivery of the fetus through the incision in the abdominal wall 18. CHADWICKS’ SIGN = characteristics violet color of the vaginal mucosa due to increase vascularly. 19. FERTILIZATION=fusion of ovum and spermatozoa 20. CROWNING=encirclement of the largest diameter of the fetal head by the vulvar ring. 21. DECREMENT=stage of diminishing intensity of a contraction. 22. DENOMINATOR=part of the presentation that determines the position of the fetus , the denominator in vertex presentation is the occiput in breech the sacrum in face the mentum, in shoulder or transverse the acromion process or the scapula. 23. DUNCAN MECHANISM=method of placental extrusion in which separation of placental occurs first at the peripheral and the blood may escape into the vagina even before the placenta is out. 24. ECLAMPSIA=acute disorder of pregnancy characterized by convulsions caused by hypertension induce or aggravated by pregnancy. 25. ECTOPIC PREGNANCY=extra uterine pregnancy where the blastocyst implants anywhere else 95% of ectopic pregnancies involve in the oviducts. 26.EFFACEMENT=shortening of the cervical canal from structure about 2cm in length to one in which the canal is replaced by a mere circular orifice , the degree of effacement is express in terms of the length of the cervical compared to uneffaced cervix. =cervical canal ¾ of original length

= 25%

= cervical canal ½ of the original length =50% =cervical canal ¼ of the original length = 75% =no canal

= 100%

27. EMBRYO=the product of conception from the 3rd to the 7th week. 28. ENGAGEMENT=when the greatest transverse diameter of the fetal head bi parietal passes through the pelvic inlet. 29. EPISIOTOMY=incision of the perineum to substitute a straight near surgical incision of a ragged laceration, it is the most common operation in obstetrics. 30. FETOSCOPY=direct visualization of fetus and placenta through laparoamnioscope.

31 FORAMEN OVALE=the opening between the two atria of the fetal heart that the blood from the right to the left orifice . 32 .GRAVIDA=a woman who is or has been pregnant irrespective of the pregnancy outcome. 33. GOODEL’S SIGN=softening of the cervix similar to the lips of the mouth in primigravida b y 6-8 weeks of gestation. 34. GYNECOLOGY= deals with the physiology and the pathology of the female reproductive organs in the non pregnant state. 35. HAASE RULE= rough estimate of the fetal length in centimeters from crown to heel 36. HEGAR’S SIGN=softening of the isthmus of the uterus at about 6-8 from LMP 37 .HYDATIDIFORM MOLE=chronic villi are converted into a mass of clear vesicles sign are. =persistent uterine bleeding for spotting to profuse hemorrhage. =uterine size growing uterus often enlarge more rapidly than usual. =pregnancy induce hypertension. 38. HYDRAMNIOS=excessive quantity of amniotic fluid of more than 2,000ml 39. HYPEREMESIS GRAVIDARUM=excessive nausea and vomiting in early pregnancy. 40. IMPLANTATION=embedding of the fertilized ovum of the endometrium. 41. INVOLUTION=process by which the reproductive organs return to their normal non pregnant state. 42. LAMAZE NATURAL OR PHYSIOLOGICAL CHILDBIRTH THROUGH=elimination =muscle control =exercise to promote relaxation =ante-partum education 43. LEOPOLD MANEUVER=systemic abdominal palpation and recognition and presentation and position. 44. LIE=relation of long axis of the uterus and long axis of the fetus whether longitudinal or transverse. 45. PLACENTA BIPARIETA=placenta separated into 2 lobes and the umbilical cord. 46. PLACENTA ACCRETA=abnormally adherent to implantation site so that the chronic villi are attached myometrium(accrete) actually invade the myometrium (increta) or even penetrate through the myometrium (peccreta) 47. PARTURITION=an act of giving birth, consist of 3 phases: \=time of uterine preparedness for labor =time of forceful contraction of active labor and delivery. =time of puerperal contraction and involution. 48. PARA= number of deliveries that have reach the acts of viability 49. PAP SMEAR= screening test for cancer

50 OVUM= group of cells from fertilization to the first week. 51. OVULATION=rupture of the mature graffian follicle and release of a matured ovum. 52. OXYTOXIC= term use to drugs that stimulate uterine contraction. 53. OLIGOHYDRAMNIOS=deficient quantity of amniotic fluid below 500ml 54. NULLI PARA=a woman who has never completed pregnancy beyond an abortion 55. NULLI GRAVIDA=a woman who is not now and never been pregnant. 56. NUCHAL CORD= cord loops around the fetal neck. 57. LOCHIA=variable amount of uterine discharge early in the puerperium Lochia rubra= first 2 days reddish in color Lochia serosa= 3rd-4th day,pinkish pale lochia Lochia alba=10th day -6 weeks,foul smelling lochia suggest but does not prove infection. 58. MIOSIS= process by which mature ova are produced by reduction and division. 59. LIGHTENING=descent of the fetal head to or through the pelvis with subsequent decrease in fundal height that occur 2weeks before the onset of labor. 60. SPINN BARKEIT= a sign of ovulation where the cervical mucus can be drawn into long threads with considerable elastic recoil. 61. QUICKENING=perception of the slight fluttering movements in the abdomen which gradually increase in intensity between 16-20 wks after onset of the LMP. 62. PLACENTA PREVIA=development of the placenta in part or in the abdomen which gradually increase in intensity between 16-20 weeks after onset of the LMP. 63. PRESENTATION=portion of the fetus that lies of the pelvic brim,cephalic,breech,shoulder. 64 .PRESENTING PART=portion of the fetus felt through the cervix on vaginal examination, senciput. 65 .RITGEN’S MANEUVER=controlled delivery of the fetal head by maintaining flexion and promoting birth of the head gradual extension. 66. STATION =degree of descent of the presenting part in birth canal. =level of the pelvic inlet-minus 3 station. =1/3 the distance from inlet to ischial spine and pelvic outlet –minus 2 station =2/3 the distance from pelvic inlet to ischial spine-minus 1 station. =level of the ischial spine – 0 station =1/3 the distance between the ischial spine and pelvic outlet-plus 1 station =2/3 the distance between the ischial spine and the pelvic outlet –plus 2 station =level of the perineum-plus 3 station 67. SYNCLITISM= when the sagittal suture of the fetal head remains parallel to the transverse axis of the pelvic inlet. 68. POSITIVE SIGN=identification of FHT

=perception of active fetal movement by examiner after 20 weeks of gestation =recognition of the embryo and fetus most anytime in pregnancy by sonography technique or the more mature fetus roentgenographically in the later half of pregnancy. 69. PROBABLE SIGNS= enlargement of the abdomen felt at 12 weeks of gestation. = charges in the size , shape and consistency of the uterus of hegar’s sign. = softening of the cervix of goodel sign at 6-8 weeks gestation. =braxton-hicks contractions palpable painless uterine contractions =ballottment rebound of the fetus to its original position with the tap felt by the examining finger. =outlining of the fetus.