Chapter 9: Obstetrics and Neonatology

obstetrics

a branch of medicine that deals with childbirth and the care of the mother before, during, and after birth

neonatology

the branch of medicine that deals with the diagnosis and treatment of disorders of the newborn

gamete

mature germ cell, either sperm (male) or ovum (female)

conception

beginning of pregnancy, when the sperm enters the ovum. Conception normally occurs in the fallopian tubes. (also called fertilization)

zygote

cell formed by the union of the sperm and the ovum

embryo

unborn offspring in the stage of development from implantation of the zygote to the end of the eighth week of pregnancy. This period is characterized by rapid growth of the embryo.

fetus

unborn offspring from the beginning of the ninth week of pregnancy until birth

gestation

development of a new individual from conception to birth (also called pregnancy)

gestation period

duration of pregnancy; normally 38 to 42 weeks, which can be divided into three equal periods, called trimesters

implantation

embedding of the zygote in the uterine lining. The process normally begins about 7 days after fertilization and continues for several days.

placenta

structure that grows on the wall of the uterus during pregnancy and allows for nourishment of the fetus (commonly referred to as afterbirth)

amniotic sac

membranous bag that surrounds the fetus before delivery (also called amnionic sac and commonly referred to as bag of waters)

chorion

outermost layer of the fetal membrane

amnion

innermost later of the fetal membrane

amnionic fluid

fluid within the amniotic sac, which surrounds the fetus (also called amnionic fluid)

umbilicus

navel (belly button); marks the site of attachment of the umbilical cord to the fetus

striae gravidarum

“stretch marks” occuring on the abdomen, breast, buttocks, and thighs from weakening of elastic tissues

linea nigra

dark medial line extending from the pubis upward

chloasma

hyperpigmentation of blotchy brown macules usually evenly distributed over the cheeks and forehead

amni/o

Combining form: amnion, amniotic fluid

amnion/o

Combining form: amnion, amniotic fluid

chori/o

Combining form: chorion

fet/i, fet/o

Combining form: fetus, unborn offspring

gravid/o

Combining form: pregnancy

lact/o

Combining form: milk

nat/o

Combining form: birth

omphal/o

Combining form: umbilicus, navel

par/o

Combining form: bear, give birth to, labor, childbirth

part/o

Combining form: bear, give birth to, labor, childbirth

puerper/o

Combining form: childbirth

amnionitis

inflammation of the amnion

chorioamnionitis

inflammation of the chorion and amnion

choriocarcinoma

cancerous tumor of the chorion

dystocia

difficult labor (obstructed or prolonged; causes may be from maternal factors, such as ineffective uterine contractions and abnormal pelvic shape, or from fetal causes, such as large size and abnormal birth presentation)

hysterorrhexis

rupture of the uterus

oligohydramnios

scanty amnion water (less than the normal amount of amniotic fluid; 500 ml or less)

polyhydramnios

much amnion water (more than the normal amount of amniotic fluid; 2000 ml or more) (also called hydramnios)

pseudocyesis

false pregnancy (a woman who believes she is pregnant—this may be a psychological condition or related to underlying pathology, such as a uterine tumor)

abortion

termination of pregnancy by the expulsion from the uterus of an embryo or fetus before viability, usually before 20 weeks of gestation

spontaneous abortion

the termination of pregnancy that occurs naturally and is commonly referred to as miscarriage

induced abortion

the intentional termination of a pregnancy by surgical or medical intervention

Abbreviation: AB

Abbreviate: abortion

abruptio placentae

premature separation of the placenta from the uterine wall

eclampsia

severe complication and progression of preeclampsia characterized by convulsion; a potentially life-threatening disorder

ectopic pregnancy

pregnancy occuring outside the uterus, commonly in the fallopian tubes

placenta previa

abnormally low implantation of the placenta on the uterine wall completely or partially covering the cervix. Dilation of the cervix can cause separation of the placenta from the uterine wall, resulting in bleeding. White severe hemorrhage, a cesarean section is necessary to save the mother and baby’s life.

preeclampsia

abnormal condition encountered during pregnancy or shortly after delivery characterized by high blood pressure and proteinuria, but with no convulsions. The cause is unknown; if not successfully treated, the condition can progress to eclampsia.

microcephalus

(fetus with a) very small head

omphalitis

inflammation of the umbilical cord

omphalocele

hernia at the umbilicus (a part of the intestine protrudes through the abdominal wall at birth)

pyloric stenosis

narrowing pertaining to the pyloric sphincter

How common is congenital pyloric stenosis?

It occurs in 1 of every 200 newborns.

tracheoesophageal fistula

abnormal passageway pertaining to the trachea and esophagus (between the trachea and esophagus)

cleft lip or palate

congenital split of the lip or roof of the mouth, one or both deformities may be present

cleft

fissure

coarctation of the aorta

congenital stenosis that occurs in the arch of the aorta

stenosis

narrowing

congenital cytomegalovirus infection

infection of a herpes-type virus that crosses the placenta. Symptoms in newborns may include jaundice, microcephaly, developmental delay, and hearing loss; some infants may have no symptoms.

Abbreviation: CMV

Abbreviate: congenital cytomegalovirus

congenital heart disease

heart abnormality present at birth

Down syndrome

genetic condition caused by a chromosomal abnormality characterized by varying degrees of intellectual, developmental, and physical disorders or defects (there is an extra 21st chromosome; hence, it is also called trisomy 21)

erythroblastosis fetalis

condition of the newborn characterized by hemolysis of the erythrocytes. The condition is usually caused by incompatibility of the infant’s and mother’s blood, occurring when the mother’s blood is Rh negative and the infant’s blood is Rh positive

esophageal atresia

congenital absence of part of the esophagus. Food cannot pass from the baby’s mouth to the stomach.

fetal alcohol syndrome

condition caused by excessive alcohol consumption by the mother during pregnancy. Various birth defects may be present, including central nervous system dysfunction and malformations of the skull and face.

Abbreviation: FAS

Abbreviate: fetal alcohol syndrome

gastroschisis

congenital fissure of the abdominal wall that is not at the umbilicus. Enterocele is usually present.

enterocele

protrusion of the intestine

respiratory distress syndrome

respiratory complication in the newborn, especially in premature infants. In premature infants it is caused by normal immaturity of the respiratory system resulting in compromised respiration. (formerly called hyaline membrane disease)

Abbreviation: RDS

Abbreviate: respiratory distress syndrome

spina bifida

congenital defect in the vertebral column caused by the failure of the vertebral arch to close

meningocele

spina bifida with protrusion of the meninges through the opening of the vertebral arch

meningomyelocele

spina bifida with protrusion of both the meninges and spinal cord

neonate

new birth (an infant from birth to 4 weeks of age) (synonymous with newborn)

birthmarks

benign discolorations in the neonate’s skin

congenital dermal melanocytes

common type of birthmark; bluish-black areas of hyperpigmentation often found on the lower back or buttocks of darker-skinned neonates

hemangiomas

common type of birthmark; various benign vascular tumors or stains that cause reddish discoloration and/or malformations of the skin surface

nevus flammeus

also called port-wine stain; a common, often temporary, type of birthmark caused by the dilation of certain blood vessels

amniotomy

incision into the amnion (rupture of the fetal membrane to induce labor; a special hook is generally used to make the incision)

episiotomy

incision into the vulva (perineum) (sometimes performed during delivery to prevent a traumatic tear of the vulva) (also called perineotomy)

cervical cerclage

suturing the cervix closed to prevent dilation and premature delivery

cesarean/caesarean section

birth of a fetus through an incision in the mother’s abdomen and uterus

Abbreviation: CS

Abbreviate: cesarean section

Abbreviation: C-section

Abbreviate: cesarean section

in vitro fertilization

method of fertilizing human ova outside the body and placing the zygote into the uterus; used when infertility is present. Infertility management techniques that artificially combine both the ova and the sperm are called assisted reproductive technology

Abbreviation: IVF

Abbreviate: in vitro fertilization

Abbreviation: ART

Abbreviate: assisted reproductive technology

amniocentesis

surgical puncture to aspirate amniotic fluid

pelvic sonography

pertaining to the pelvis, process of recording sound (also called pelvic ultrasound, pelvic ultrasonography, and obstetric ultrasonography)

nuchal translucency screening

ultrasound test to check the back of the fetal neck for extra fluid or thickening. It is usually performed between 11 and 13 weeks of pregnancy and, when combined with first trimester screening blood tests, may reveal an increased risk for Down syndrome or other congenital disorders

quad screen

blood test performed during the second trimester measuring four hormone levels that can reveal an increased risk of certain disorders in the developing fetus by measuring the levels of alpha-fetoprotein, human chorionic gonadotropin, unconjugated estriol and inhibin

Apgar score

system for rapid neonatal assessment at 1 and 5 minutes after birth. Five vital criteria, including heart rate, respiration, muscle tone, response to stimulation, and color, are assessed and scored on a 0-2 scale, with 7-10 considered normal.

chorionic villus sampling

prenatal test that takes a sample of the area of blood supply in the placenta either through the abdominal wall or the vagina, usually performed between 10 and 13 weeks of pregnancy and tests for chromosome and other genetic problems

Abbreviation: CVS

Abbreviate: chorionic villus sampling

Five vital criterea assessed in the Apgar scoring system

heart rate, respiratory effort, muscle tone, response to catheter in nostril (tested after oropharynx is clear), and color

Apgar score options for heart rate

0 = absent
1 = below 100
2 = over 100

Apgar score options for respiratory effort

0 = absent
1 = slow, irregular
2 = good, crying

Apgar score options for muscle tone

0 = limp
1 = some flexion of extremities
2 = active motion

Apgar score options for response to catheter in nostril

0 = no response
1 = grimace
2 = cough or sneeze

Apgar score options for color

0 = blue, pale
1 = body pink, extremities blue
2 = completely pink

amniorrhea

discharge (escape) of amniotic fluid