Common terminologies of obstetrics
- 1. BASIC TERMINOLOGIES OF OBSTETRICS Presented By: Sehrish Khan Syed Mohammad Baqir
- 2. Obstetrics Obstetrics deals with the care of women's reproductive tracts and their children during pregnancy, childbirth and the postnatal period. A doctor performing such practice is called Obstetrician.
- 3. LMP : Last Menstrual Period. It is the time elapsed since 14 days prior to fertilization
- 4. EDC or EDD : The Due Date. EDC stands for the old-fashioned "estimated date of confinement." EDD is the more modern "Estimated Day of Delivery." The average pregnancy “gestation” is 40 weeks or 280 days from the first day of the last menstrual period (LMP). For a 28 day cycle, EDD is calculated by taking the LMP and adding 9 months and 7 days to it. If the cycle is longer than 28 days, add the difference between cycle length and 28 days. Nagele’s Rule: • Subtract 3 months from the 1st day of the LMP • Add 7 days
- 5. Gravida: It is the number of times the mother has been pregnant, regardless of whether these pregnancies were carried to term. A current pregnancy, if any, is included in this count. A nulligravida or gravida 0 is a woman who has never been pregnant. A primigravida or gravida 1 is a woman who is pregnant for the first time or has been pregnant one time. A multigravida or more specifically a gravida 2 (also secundigravida), gravida 3, and so on, is a woman who has been pregnant more than one time. An elderly primigravida is a woman in her first pregnancy, who is at least 35 years old.
- 6. Parity It is the number of times the woman has delivered after the age of viability. It includes the births after 24 weeks or those having weight of 500 grams. TPAL method Para is often recorded in 4 numbers: • T= the number of term deliveries (after 37 weeks) • P= the number of premature deliveries (> 20 and < 37 wk) • A= the number of abortions (either spontaneous of therapeutic) • L= the number of living children There can be 4 numbers after the "P" for "para." The first number is how many term pregnancies. The second number is how many premature babies. The third number is how many abortions or miscarriages The fourth number is how many living children survive.
- 7. Gestation Gestation is the carrying of an embryo or fetus inside a female viviparous animal. Mammals during pregnancy can have one or more gestations at the same time (multiple gestations). The time interval of a gestation is called the gestation period. In human obstetrics, gestational age refers to the embryonic or fetal age plus two weeks. This is approximately the duration since the woman's last menstrual period (LMP) began.
- 8. Trimester The pregnancy is divided into 3 trimesters. • The first one is from LMP up until 12 or 13 weeks. • The second rimester is from 12-13 weeks until 28 weeks. • The third trimester is from 28 weeks until delivery.
- 9. Preterm Birth It is the birth of a baby between 24 and 37 weeks of gestational age. Premature infants are at greater risk for short and long term complications, including disabilities and impediments in growth and mental development.
- 10. Post term Birth Postmaturity is when a baby has not yet been born after 42 weeks of gestation. Different babies will show different symptoms of postmaturity. The most commons symptoms are dry skin, overgrown nails, creases on the baby's palms and soles of their feet, minimal fat, a lot of hair on their head, and either a brown, green, or yellow discoloration of their skin. Some postmature babies will show no or little sign of postmaturity.
- 11. Presentation It refers to which anatomical part of the fetus is leading, that is, is closest to the pelvic inlet of the birth canal just before the birth. According to the leading part, this is identified as a cephalic, breech, or shoulder presentation. Normal presentation is cephalic. Malpresentation A malpresentation is any other presentation than a vertex presentation (with the top of the head first). It could be breech or shoulder presentation.
- 12. Position It is the relationship of specific fetal denominator to maternal denominator. It includes occipito anterior, occipito posterior, occipito transverse. Normal position is occipito anterior. Malposition It is the abnormal position of the fetus in uterus. Could be occipito posterior or occipito transverse.
- 13. Lie It is the relationship of longitudinal axis of fetus to longitudinal axis of mother’s pelvis. It can be longitudinal, transverse or oblique. Most common is longitudinal.
- 14. Variety The relation of the given portion of the presenting part to the anterior and/or posterior portion of mother’s pelvis.
- 15. Attitude It is the relationship of different parts of fetus to each other. Normal is flexed attitude.
- 16. Engagement Engagement is said to have taken place when the widest part of presenting part of fetus has passed successfully through the pelvic inlet. The number of fifths of the fetal head palpable abdominally s often used to describe whether engagement has taken place. If more than two fifths of fetal head is palpable abdominally, the head is not yet engaged.
- 17. Moulding It is the process which effectively reduces the diameter of fetal skull and encourages progress of delivery through maternal pelvis without harming the fetal brain. It is achieved due to followinf characteristics of fetal skull: • Ununited sutures which help the bones to move together and overlap during delivery. • compressible nature of bones • Anterior and posterior fontanelles
- 18. Effacement It is the process by which the cervix shortens in length as it becomes included in the lower segment of uterus. The cervical os cannot usually begin to dilate until effacement is complete.
- 19. Episiotomy It is a surgically planned incision on the perineum and the posterior vaginal wall during second stage of labor. It is also called perineotomy.
- 20. Crown-to-Rump Length: Measurement from the top of the baby's head to the buttocks of the baby. Chadwick's sign: Dark-blue or purple discoloration of the mucosa of the vagina and cervix during pregnancy.
- 21. NSVD Normal Spontaneous Vaginal Delivery. SVD Spontaneous Vaginal Delivery - same as NSVD. Cesarean section (delivery): Delivery of a baby through an abdominal incision rather than through the vagina. Primary Cesarean Section First time a mother has delivered by Cesarean. Secondary Cesarean Section Mother has already had a previous Cesarean delivery, and this is a repeat Cesarean birth.
- 22. VBAC : Vaginal Birth After Cesarean. The mother has had a previous Cesarean delivery but has now delivered vaginally. There is a small amount of risk (less than 1%) that the old surgical scar on the uterus will rupture when a VBAC is attempted, so mothers who wish to attempt a VBAC must understand the risks and sign an "informed consent" that shows they are aware of the risks/benefits. TOL : Trial of Labor. If a woman has had a previous Cesarean birth and wants to have a VBAC, she is said to be undergoing a "trial of labor" when her contractions start. VAD : Vacuum Assisted Delivery. The doctor applies a suction cup to the baby's head and gently draws it out, when the mother is too tired to push effectively any more but the baby is very low in the pelvis.
- 23. Miscarriage Miscarriage is the spontaneous end of a pregnancy before 24 weeks of gestation. Probable signs include: • Low back pain or abdominal pain that is dull, sharp, or cramping • Tissue or clot-like material that passes from the vagina • Vaginal bleeding, with or without abdominal cramps Cause: Most common cause is chromosomal abnormalities. Other causes include: • progesterone deficiency • malformed uterus • cervical weakness • hormonal disorders • severe infection
- 24. Types: Threatened: Patient is at the risk of miscarriage. Fetus is inside the uterus and the cervical os is closed. Inevitable: Associated with heavy bleeding and severe pain. Cervical os is opening up. May be complete or incomplete. Complete: If cervical os has opened up Incomplete: If cervical os has not opened up completely and some products are still inside the uterus. Missed: Fetus has died in the uterus but has not been expelled out. Septic: Any induced miscarriage, usually done due to social circumstances, done by untrained professional. Recurrent: Three or more miscarriages consecutively.
- 25. Stillbirth It is the birth of a baby after the age of viability when it has no vital functions at birth, ie no heart rate, no umbilical cord pulsation, etc. Causes: • bacterial infection • chromosomal aberrations • maternal diabetes • high blood pressure, including preeclampsia • maternal consumption of recreational drugs • placental abruptions • physical trauma • radiation poisoning
- 26. Ectopic Pregnancy An ectopic pregnancy, or eccysis, is a complication of pregnancy in which the embryo implants outside the uterine cavity. Most ectopic pregnancies occur in the Fallopian tube, so-called tubal pregnancies), but implantation can also occur in the cervix, ovaries, and abdomen. Symptoms include pain in lower abdomen, during micturition, bowel movement, vaginal bleeding. There are four types: Tubal Pregnancy: occurring in fallopian tube Non-tubal Ectopic Pregnancy: occurring in ovary, cervix or are intra-abdominal. Heterotopic Pregnancy: There may be two fertilized eggs, one outside the uterus and the other inside. Persistent Ectopic Pregnancy: continuation of trophoplastic growth after a surgical intervention to remove an ectopic pregnancy.
- 27. Hyperemesis Hyperemesis gravidarum (HG) is a severe form of morning sickness, with "unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids. It may be due to adverse hormonal effects or raised levels of Human Chorionic Gonadotropin (HCG). Pruritis Gravidarum: It is the itching during pregnancy. Postnatal Blues: Mild depression after delivery. Postpartum Depression: Depression after delivery.
- 28. Ante partum Hemorrhage Also called prepartum hemorrhage, it is the bleeding from the vagina during pregnancy from the 24th week gestational age to term. It should be considered a medical emergency and medical attention should be sought immediately. Causes: • Placental abruption - most common pathological cause • Placenta previa - second most common pathological cause • Vasa previa • Uterine rupture • Bleeding from the lower genital tract • Cervical bleeding - cervicitis, cervical neoplasm, cervical polyp • Bleeding from the vagina itself - trauma, neoplasm • Bleeding that may be confused with vaginal bleeding eg GI bleeding, haemorrhoids, inflammatory bowel disease, urinary tract infection
- 29. Postpartum Hemorrhage It is the loss of greater than 500 ml of blood following vaginal delivery, or 1000 ml of blood following cesarean section. Causes: These include uterine atony (inability of the uterus to contract), trauma (tissue tear during delivery), retained placenta, and bleeding coagulopathy, etc. Management: California Maternity Quality Care Collaborative has described a 4 staged protocol for postpartum hemorrhage: Stage 0: normal - treated with fundal massage and oxytocin Stage 1: more than normal bleeding - establish large-bore intravenous access, increase oxytocin, consider use of methergine, perform fundal massage, prepare 2 units of packed red cells. Stage 2: bleeding continues - check coagulation status, place intrauterine balloon, administer additional uterotonics (misoprostol, carboprost tromethamine), consider: uterine artery embolization, dilatation and curettage, and laparotomy with uterine compression stitches or hysterectomy. Stage 3: bleeding continues - activate massive transfusion protocol, recheck laboratory tests, perform laparotomy, consider hysterectomy. A Cochrane review suggests that active management (use of uterotonic drugs, cord clamping and controlled cord traction) of the third stage of labour significantly reduces severe maternal bleeding and anemia compared to expectant management.
- 30. Pregnancy Induced Hypertension It is the condition of high blood pressure during pregnancy. It is also called Gestational hypertension. Gestational hypertension can lead to a serious condition called preeclampsia. Types: Chronic Hypertension: Women who have high blood pressure ( over 140/90) before pregnancy, early in pregnancy ( before 20 weeks), or carry it on after delivery. Gestational Hypertension: High blood pressure that develops after week 20 in pregnancy and goes away after delivery. Preeclampsia: Both chronic hypertension and gestational hypertension can lead to this severe condition after week 20 of pregnancy. Symptoms include high blood pressure and protein in the urine and can lead to serious complications for both mom and baby if not treated quickly.
- 31. Pre-eclampsia It is when a pregnant woman develops high blood pressure and protein in the urine after the 20th week of pregnancy. Causes: Blood vessel problems Diet Genes Obesity Being older than age 35 History of diabetes, high blood pressure, or kidney disease Symptoms: Symptoms of preeclampsia can include: Swelling of the hands and face/eyes (edema) Sudden weight gain over 1-2 days, more than 2 pounds a week Headache Belly pain on the right side, below the ribs. Pain may also be felt in the right shoulder Irritability Decreased urine output, not urinating very often Nausea and vomiting Vision changes
- 32. Eclampsia It is an acute and life-threatening complication of pregnancy, is characterized by the appearance of tonic-clonic seizures, which are not due to preexisting or organic brain disorders, usually in a patient who has developed pre-eclampsia. Pre-eclampsia and eclampsia are collectively called Hypertensive disorder of pregnancy and toxemia of pregnancy. Symptoms: Typically patients show signs of pregnancy-induced hypertension and proteinuria prior to the onset of the hallmark of eclampsia, the eclamptic convulsion. Other cerebral signs may precede the convulsion such as nausea, vomiting, headaches, and cortical blindness. In addition, with the advancement of the pathophysiological process, other organ symptoms may be present including abdominal pain, liver failure, signs of the HELLP syndrome, pulmonary oedema, and oliguria. The fetus may already have been compromised by intrauterine growth retardation, and with the toxemic changes during eclampsia may suffer fetal distress. Placental bleeding and placental abruption may occur.
- 33. TORCH Syndrome TORCH complex (also known as STORCH, TORCHES or the TORCH infections) is a medical acronym for a set of perinatal infections. It is spelled as: T – Toxoplasmosis / Toxoplasma gondii O – Other infections (see below) R – Rubella C – Cytomegalovirus H – Herpes simplex virus 2 The "other agents" included under O are Coxsackievirus, Syphilis, Varicella-Zoster Virus, HIV, and Parvovirus B19. Hepatitis B may also be included among "other agents", but the hepatitis B virus is a large virus and does not cross the placenta, hence it cannot infect the fetus. The acronym has also been listed as TORCHES, for TOxoplasmosis, Rubella, Cytomegalovirus, HErpes simplex, Syphilis.
- 34. Maternal Mortality It is the death of a woman while pregnant or within 42 days after termination of pregnancy irrespective of the site and duration. It can be: Direct: death due to pregnancy, labour, puerperium or management of complications Indirect: death due to a pre-existing condition in the pregnant lady that is aggravated by pregnancy. Incidental: death in spite of the lady being normal and healthy Maternal Mortality Rate It is the ratio of the number of maternal deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management, excluding accidental or incidental causes. According to WHO, MMR in world average per 100,000 is 400.
- 35. Neonatal Death Number of deaths during the first 28 completed days of life per 1,000 live births in a given year or period. It is taken per 1000 live births. Neonatal deaths may be subdivided into early neonatal deaths, occurring during the first seven days of life, and late neonatal deaths, occurring after the seventh day but before the 28 completed days of life.
- 36. Perinatal Death It is the death of the baby around birth and includes stillbirth and neonatal death. It includes the time from 24 weeks (before birth) to 28 days after birth. Perinatal Mortality Rate It is the number of perinatal deaths per 1,000 total births. The WHO has not published contemporary data.
- 37. Thank you