Ch.14 Childbirth and Related Terms

Childbirth Stages

• Childbirth occurs in three stages.
  1. Dilation
  2. Delivery of the baby
  3. Expulsion of the afterbirth

Dilation (First Stage)

• The first and longest stage of labor.
• Contractions last 30-70 seconds and occur every 5-10 minutes.
• Contractions: Regular tightening and relaxing of the uterine muscle to push the baby down the birth canal.
• Changes during this stage:
  • Gradual dilation and effacement of the cervix.
  • Rupture of the amniotic sac.
• Effacement: Process where the cervix softens, shortens, and thins in preparation for delivery.
• Fetal monitoring: Use of electronic devices to record fetal heart rate and maternal uterine contractions during labor.

Delivery of the Baby (Second Stage)

• Also known as active labor.
• Begins when the cervix dilates to 10 centimeters.
• Uterine contractions become stronger and more frequent.
• The mother pushes to expel the child through the birth canal (vagina).
• Cephalic Presentation (Crowning): Baby presents head first.

Expulsion of the Afterbirth (Third Stage)

• Expulsion or delivery of the placenta as the afterbirth.
• Umbilical cord blood can be collected for stem cell preservation for potential future medical treatments.

Postpartum Period

• Postpartum: After childbirth.
• Puerperium: Time from placenta delivery through the first six weeks after delivery.
  • Changes in the mother's body due to pregnancy resolve.
  • Reproductive organs return to their non-pregnant state.
• Lochia: Postpartum vaginal discharge lasting up to 4-6 weeks.
  • Consists primarily of blood and mucus.
  • $Loch = childbirth, -ia = pertaining to$
• Uterine Involution: Return of the uterus to its normal size and condition after delivery.
  • Involution: Return of an enlarged organ to its normal size.
• Colostrum: Specialized breast milk providing essential nutrients and antibodies that the newborn can digest.
  • Produced in late pregnancy and the first few days after birth.
• Lactation: Process of forming and secreting milk from the breasts.
  • Breast milk develops a few days after birth, replacing colostrum.

The Newborn (Neonate)

• Neonate: Newborn infant during the first four weeks after birth.
• Vernix: Greasy substance protecting the fetus in utero; may still be present at birth.
  • Made of sebum and discarded epidermal cells.
• Meconium: Greenish material collecting in the fetal intestines and forming the first feces of a newborn.
• Meconium Aspiration Syndrome: Breathing issues occurring when a newborn passes meconium during labor or delivery and then inhales it with amniotic fluid.
• Apgar Score: Scale of 1-10 evaluating a newborn's physical status at 1 and 5 minutes after birth.
  • Named after Virginia Apgar, an obstetrical anesthesiologist.
  • Evaluated based on five criteria, each scored 0, 1, or 2:
    1. Heart Rate
    2. Respiratory Effort
    3. Muscle Tone
    4. Reflexes
    5. Skin Color
  • A score of 8-10 indicates the best possible condition.

Medical Specialties

• Gynecologist: Physician specializing in diagnosing and treating diseases/disorders of the female reproductive system.
  • $Gyn/o = female, -ologist = specialist$
• Obstetrician: Physician specializing in medical care for women during pregnancy, childbirth, and immediately after.
  • Specialty is obstetrics.
  • $Obstetr/o = midwife$
• Certified Midwife (CM):
• Assists in labor and delivery.
• Certified Nurse Midwife (CNM): RN with specialized training in obstetrics and gynecology; provides primary care in normal pregnancies and deliveries.
• Doula: Experienced birth coach (typically without formal obstetric training) providing support and guidance during labor, delivery, and the postpartum period.
• Neonatologist: Physician specializing in diagnosing and treating disorders of the newborn.
  • $Neo = new, nat = birth, -ologist = specialist$
• Neonatal Intensive Care Unit (NICU): Nursery providing specialized care for premature or ill infants.
• Infertility Specialist (Reproductive Endocrinologist): Helps infertile couples by diagnosing and treating problems associated with conception and maintaining pregnancy.

Pathology of the Female Reproductive System

Ovaries, Fallopian Tubes, and Ovulation

• Anovulation: Absence of ovulation when normally expected.
  • $An- = without, ovulation = release of a mature egg$
  • Causes: stress, inadequate nutrition, obesity, or hormonal imbalances.
  • Menstruation may continue even if no ovum is released.
• Dermoid Cyst (Teratoma): Benign tumor containing various tissues (teeth, bone, skin glands, hair).
  • Present at birth; found on the face, inside the skull, lower back, or ovaries.
  • $Derm = skin, -oid = resembling$
  • Large ovarian dermoid cysts may require surgical removal.
• Ovarian Cancer: Originates within the cells of the ovaries; can metastasize to other tissues/organs.
  • Difficult to detect in early stages.
• Ovarian Cysts: Fluid-filled sacs on an ovary; generally harmless unless they rupture.
• Pelvic Inflammatory Disease (PID): Inflammation of female reproductive organs not associated with surgery or pregnancy.
  • Frequently a complication of STDs; can lead to infertility, ectopic pregnancy, and other disorders.
• Polycystic Ovary Syndrome (PCOS): Imbalance of reproductive hormones resulting in irregular menstrual cycles, hirsutism, and acne.
  • High insulin levels and increased androgen (male hormone) levels are often present.
• Pyosalpinx: Accumulation of pus in a fallopian tube; sometimes a result of PID.
  • $Pyo- = pus, salpinx = fallopian tube$
• Salpingitis: Inflammation of a fallopian tube caused by bacterial infection (usually an STD).
  • $Salping- = fallopian tube, -itis = inflammation$

The Uterus

• Endometriosis: Endometrial tissue escapes the uterus and attaches to other pelvic structures.
  • $Endo- = within, metri- = uterus, -osis = abnormal condition$
  • Cause unknown; painful condition.
• Endometrial Cancer: Cancerous growth in the uterine lining that can spread to the ovaries and fallopian tubes.
  • Symptoms: vaginal bleeding after menopause, bleeding between menstrual periods, and pelvic pain.
• Uterine Fibroids (Leiomyomas): Benign tumors composed of muscle and fibrous tissue in the uterine wall.
  • Not associated with increased risk of uterine cancer.
• Uterine Prolapse (Pelvic Floor Hernia): Weakening of pelvic muscles and tissues causing the uterus to sag into the vagina.
  • Prolapse: Falling or dropping down of an organ or internal part.

The Cervix

• Cervical Cancer: Slow-growing squamous cell cancer caused by HPV (spread through sexual contact).
  • HPV vaccine available for prevention, most effective at ages 11-12.
  • Precancerous changes detectable through routine Pap smear screening.
• Cervical Dysplasia: Precancerous changes in the cells lining the cervix.
  • Can become malignant without early detection and treatment.
• Cervical Insufficiency (Incompetent Cervix): Weakened tissue in the cervix; can cause premature opening during pregnancy, leading to late miscarriage or premature birth.
• Cervicitis: Inflammation of the cervix, usually caused by infection, irritation, or allergies.
  • $Cervic- = cervix, -itis = inflammation$

Vagina

• Dyspareunia: Pain during sexual intercourse.
  • $Dys- = painful, pareunia = sexual intercourse$
• Leukorrhea: Whitish mucus discharge from the uterus and vagina.
  • $Leuk/o = white, -rrhea = flow or discharge$
  • Change and increase in discharge may be due to infection or hormonal imbalance.
• Vaginal Atrophy (Genitourinary Syndrome of Menopause): Thinning, drying, and inflammation of vaginal walls due to hormonal changes.
  • Treated with vaginal moisturizers, lubricants, or estrogen therapy.
• Vaginal Candidiasis: Yeast infection caused by Candida albicans.
  • Symptoms: burning, itching, and cottage cheese-like vaginal discharge.
• Vaginismus: Involuntary spasm of pelvic floor muscles closing off the vagina.
  • Causes dyspareunia and difficulty tolerating insertion of tampons or speculum.
  • $Vagin- = vagina, -ismus = spasm or contraction$
• Vaginitis: Inflammation of the lining of the vagina.
  • Common causes: bacterial vaginosis, trichomoniasis, and vaginal candidiasis.
  • $Vagin- = vagina, -itis = inflammation$

External Genitalia

• Vulvodynia: Painful syndrome of unknown cause lasting at least three months.
  • $Vulv/o = vulva, -dynia = pain$
  • Characterized by chronic burning, dyspareunia, itching, or stinging irritation of the vulva.
• Vulvitis: Inflammation of the vulva.
  • Causes: fungal or bacterial infections, chafing, skin conditions, or allergies to soaps and bubble bath.
  • $Vulv- = vulva, -itis = inflammation$

Breast Diseases

• Breast Cancer: Discussed separately.
• Fibroadenoma: Round, firm, rubbery mass arising from excess growth of glandular and connective tissue in the breast.
  • Benign and usually painless; common between ages 15-35.
  • Often enlarge during pregnancy and shrinks after menopause.
  • $Fibr/o = fibrous tissue, aden/o = gland, -oma = tumor$
• Fibrocystic Breast: Presence of fibrous tissue and benign cysts; common in premenopausal women.
  • Cyst: Closed sac containing fluid or semisolid material.
• Galactorrhea: Production of breast milk in a woman who is not breastfeeding.
  • Cause: malfunction of the pituitary gland.
  • $Galact/o = milk, -rrhea = flow or discharge$
• Mastalgia: Pain in the breast.
  • $Mast- = breast, -algia = pain$
• Mastitis: Breast infection caused by bacteria entering mammary glands, often during breastfeeding.
  • $Mast- = breast, -itis = inflammation$

Menstrual Disorders

• Amenorrhea: Abnormal absence of menstrual periods for 90 days or more.
  • Normal before puberty, during pregnancy, while breastfeeding, and after menopause.
  • Causes: stress, hormonal problems, inadequate nutrition, or excessive exercise.
  • $A- = without, men/o = menstruation, -rrhea = flow or discharge$
• Dysmenorrhea: Pain caused by uterine contractions during a menstrual period (menstrual cramps).
  • Pain in lower abdomen, sharp, intermittent, dull, or aching.
  • $Dys- = bad, men/o = menstruation, -rrhea = flow or discharge$
• Abnormal Uterine Bleeding (Dysfunctional Uterine Bleeding): Abnormal bleeding during or outside of the menstrual period.
  • Causes: fibroids, hormone problems, or other conditions.
• Menorrhagia: Excessive menstrual flow, sometimes lasting over seven days.
  • $Men/o = menstruation, -rhagia = abnormal bleeding$
• Hypomenorrhea: Unusually small amount of menstrual flow during a shortened regular menstrual period.
  • $Hypo- = deficient, men/o = menstruation, -rrhea = flow or discharge$
• Menometrorrhagia (Intermenstrual Bleeding): Excessive uterine bleeding at both the usual time of menstrual periods and at other irregular intervals.
  • $Men/o = menstruation, metr/o = uterus, -rhagia = abnormal bleeding$
• Oligomenorrhea (Infrequent Menstruation): Irregular or very light menstruation in a woman with previously normal periods.
  • Opposite of polymenorrhea.
  • $Oligo- = scanty, men/o = menstruation, -rrhea = flow or discharge$
• Polymenorrhea: Occurrence of menstrual cycles more frequently than normal.
  • Opposite of oligomenorrhea.
  • $Poly- = many, men/o = menstruation, -rrhea = flow or discharge$
• Premature Menopause: Ovaries cease functioning before age 40 due to disease, hormonal disorder, or surgical removal.
  • Causes infertility and menopausal symptoms.
• Premenstrual Syndrome (PMS): Symptoms experienced by some women within the two-week period before menstruation.
  • Symptoms: bloating, swelling, headaches, mood swings, and breast discomfort.
• Premenstrual Dysphoric Disorder (PMDD): Severe emotional and physical problems closely linked to the menstrual cycle.
  • Symptoms occur regularly in the second half of the cycle and end when menstruation begins or shortly thereafter.