Ch.14 Pathology of Pregnancy and Childbirth Notes

Pregnancy

  • Abortion: Interruption/termination of pregnancy before the fetus is viable.
    • Spontaneous Abortion (Miscarriage): Occurs early in pregnancy due to abnormality/genetic disorder.
    • Induced Abortion: Caused by human intervention.
      • Therapeutic Abortion: For medical purposes.
      • Methods: Abortive medication (early weeks), suction aspiration (surgical).
  • Ectopic Pregnancy (Extrauterine Pregnancy): Fertilized egg implants outside the uterus.
    • Dangerous condition.
  • Gestational Diabetes Mellitus: Diabetes during pregnancy (refer to Chapter 13).
  • Infertility: Inability to achieve pregnancy after one year of regular unprotected intercourse, or inability to carry a pregnancy to live birth.
  • Abruptio Placentae (Placental Abruption): Placenta separates from uterine wall before birth.
    • Abruption means breaking off.
    • Can cause fetal death or long-term health complications.
  • Placenta Previa: Abnormal placenta implantation in the lower uterus, covering the cervix.
    • Previa means appearing before or in front of.
    • Symptoms: Painless, sudden-onset bleeding during the third trimester, severe bleeding during delivery.
  • Pre-eclampsia (Pregnancy-Induced Hypertension): Pregnancy complication characterized by:
    • Hypertension (high blood pressure).
    • Proteinuria (high protein level in urine).
    • Common cause of preterm birth.
  • Eclampsia: Serious condition with seizures and coma, developed from uncontrolled pre-eclampsia.
  • HELLP Syndrome: Life-threatening pregnancy complication.
    • Hemolysis (breakdown of red blood cells).
    • Elevated Liver Enzymes.
    • Low Platelet Count.
    • Occurs in 10-20% of severe pre-eclampsia cases; damages liver and blood cells.
  • Rh Factor: Presence or absence of Rh antigen on red blood cells (refer to Chapter 5).
    • Rh-negative mother with Rh-positive baby can cause complications.
    • Mother develops antibodies if baby's blood enters her bloodstream (allergic response).
    • Rh-positive man can father either Rh-positive or Rh-negative baby.
    • If both parents are Rh-negative, no incompatibility danger.
    • Antibodies in mother can cause baby anemia/problems; risk to subsequent pregnancies if untreated.
    • Blood tests identify potential problem.
    • Treatment: Rh(D) immunoglobulin (RhoGAM) vaccination for mother.
    • The abbreviation Rh comes from the fact that blood samples from monkeys were used in the experiments that lead to the discovery of the Rh factor in 1940.

Childbirth and Postpartum

  • Breech Presentation: Buttocks or feet positioned to enter birth canal first, instead of head.
  • Premature Infant (Preemie): Born before the 37th week of gestation (preterm birth).
  • Stillbirth: Fetus dies before or during delivery.
  • Postpartum Depression: Mood disorder with sadness and loss of pleasure after giving birth.
    • Cause: Rapid hormone level changes.
    • Treatment: Required if severe/lasts beyond two weeks of normal "baby blues".

Diagnostic Procedures of the Female Reproductive System

  • Colposcopy: Direct visual examination of cervix, vagina, and vulva tissues using a colposcope (binocular magnifier).
    • Culp/o means vagina; scopy means direct visual examination.
  • Endometrial Biopsy: Removal of small tissue amount from uterine lining for microscopic examination.
    • Used to determine the cause of abnormal uterine bleeding.
  • Transvaginal Ultrasound (Endovaginal Ultrasound): Determine the cause of pelvic pain, infertility, or abnormal vaginal bleeding.
    • Trans means through, vagin means vagina, and -al means pertaining to.
    • Ultrasound transducer placed in the vagina to create images of uterus and ovaries.
  • Hysterosalpingography (HSG): X-ray examination of uterus and fallopian tubes.
    • Hyster/o means uterus; salping/o means fallopian tube; graphy means the process of producing a picture or record.
    • Radiopaque contrast material instilled into uterine cavity/fallopian tubes.
    • Instillation means the slow introduction of a liquid into a body part by pouring or injection.
  • Hysteroscopy: Direct visual examination of the interior of the uterus and fallopian tubes.
    • Hyster/o means uterus; scopy means direct visual examination.
    • Used to diagnose/treat abnormal bleeding using a hysteroscope.
  • Pap Smear (Pap Test): Exfoliative biopsy of cervix to detect early indicators of cervical cancer.
    • Developed by Dr. George Papanicolaou.
    • Exfoliative means cells are scraped from the tissue and examined under a microscope.
  • Speculum: Instrument to enlarge vagina opening during cervix/vagina examination.
  • Ultrasound and Laparoscopy: Discussed in Chapter 15.

Diagnostic Procedures Related to Pregnancy and Childbirth

  • Pregnancy Test: Detects high HCG (human chorionic gonadotropin) hormone level in blood/urine, indicating pregnancy.
    • Home test uses urine; doctor's office uses blood (more reliable).
  • Fetal Ultrasound Testing: Discussed in Chapter 15.
  • First Trimester Screening (Combined Screening): Performed between 11-13 weeks of pregnancy; ultrasound and blood test.
    • Detects increased risk for chromosome abnormality (e.g., Down Syndrome).
    • Diagnostic tests (amniocentesis, chorionic villus sampling) recommended for increased risk.
  • Chorionic Villus Sampling (CVS): Examination of cells from chorionic villi (vascular projections on the chorion).
    • Performed between 11th-14th weeks of pregnancy.
    • Searching for genetic abnormalities in the developing fetus.
  • Amniocentesis: Surgical puncture to obtain amniotic fluid.
    • Amni/o means amnion and fetal membrane; centesis means a surgical puncture to remove fluid.
    • Usually after 15th week.
    • Evaluate fetal health and diagnose congenital disorders.

Treatment Procedures of the Female Reproductive System

  • Medications
    • Contraceptive: Measure to lessen pregnancy likelihood.
      • Birth control pills (oral contraceptive).
      • Other forms: Injection, skin patch, arm implant, vaginally inserted ring.
      • Diaphragm: Barrier contraceptive, blocking sperm from reaching the egg.
      • Spermicide: Gel, lube, or foam to kill/stop sperm movement.
      • Intrauterine Device (IUD): Plastic contraceptive inserted into the uterus; long-term, reversible.
        • Intra means within, and uterine means uterus.
      • Condom: Prevents pregnancy and STDs.
      • Hormone Replacement Therapy (HRT): Estrogen and progesterone to replace hormones during/after perimenopause.
        • Relieves menopausal symptoms (hot flashes, vaginal dryness).
        • Estradiol/progestin: Synthetic estrogen/progesterone.
  • The Ovaries and Fallopian Tubes
    • Oophorectomy: Surgical removal of one or both ovaries.
      • Oophor/o means ovary; -ectomy means surgical removal.
      • Bilateral oophorectomy in premenopausal women induces surgical menopause.
      • Salpingectomy: Surgical removal of one or both fallopian tubes.
        • Salping means fallopian tube; ectomy means surgical removal.
      • Salpingo-oophorectomy (SO): Surgical removal of a fallopian tube and ovary.
        • Salping/o means fallopian tube, oophorectomy means ovary, and ectomy means surgical removal.
      • Bilateral salpingo-oophorectomy: Removal of both fallopian tubes and ovaries.
        • Used to treat/reduce risk of ovarian cancer.
      • Tubal Ligation: Surgical sterilization, fallopian tubes sealed/cut.
  • The Uterus, Cervix, and Vagina
    • Sacrocolpopexy: Surgical fixation of prolapsed vagina to sacrum.
      • Sacr/o means sacrum; Culp/o means vagina; pexy means surgical fixation in place.
      • Conization (Cone Biopsy): Surgical removal of cone-shaped tissue specimen from cervix.
      • Diagnostic or to remove abnormal tissue.
      • Colporrhaphy: Surgical suturing a tear in the vaginal wall.
        • Culp/o means vagina; Rupi means surgical suturing.
      • Dilation and Curettage (D&C): Cervix dilated and endometrium scraped away.
        • Diagnostic (abnormal bleeding) or treatment (miscarriage, abortion, childbirth).
        • Dilation means the expansion of an opening.
        • Curettage is the removal of material from the surface by scraping with an instrument known as a curette.
      • Myomectomy: Surgical removal of uterine fibroids.
        • Myome means muscle tumor; ectomy means surgical removal.
      • Hysterectomy: Surgical removal of the uterus.
        • Hyster means uterus; ectomy means surgical removal.
        • Due to fibroids, gynecological cancer, endometriosis, or uterine prolapse.
      • Partial Hysterectomy: Uterus removed, cervix remains.
      • Radical Hysterectomy: Removal of uterus, ligaments, cervix, and part of the vagina (for cervical cancer).
      • Total Hysterectomy (Complete Hysterectomy): Uterus and cervix removed (vaginally or laparoscopically).
      • Bilateral Salpingo-oophorectomy (BSO): Surgical removal of both ovaries and fallopian tubes (usually during hysterectomy).
        • Induces surgical menopause if done before natural menopause.
      • Mammoplasty: Cosmetic operation on the breast.
        • Mammo/o means breast; plasty means surgical repair.
        • Breast Augmentation: Increase breast size.
        • Augmentation means the process of adding to make larger.
        • Breast Reduction: Decrease/reshape large breasts.
        • Mastopexy (Breast Lift): Surgery to affix sagging breast in elevated position.
          • Mass/o means breast; pexi means surgical fixation.
          • Breast reconstruction following a mastectomy is discussed in chapter six.

Treatment Procedures Related to Pregnancy and Childbirth

  • Cesarean Section (C-Section): Delivery through incision in maternal abdominal/uterine walls.
    • Performed when vaginal birth is unsafe for mother/baby.
    • VBAC: Vaginal Birth After Cesarean.
  • Episiotomy: Surgical incision in perineum to enlarge vaginal orifice.
    • Episi means vulva, and odomy means a surgical incision.
    • Prevents tissue tearing.
  • Incubator: Apparatus for controlled temperature, humidity, and oxygen concentration for premature/ill newborn.
  • Assisted Reproduction
    • Aiding infertile couples/individuals to achieve pregnancy.
    • Assisted Reproductive Technology (ART): Techniques where eggs/embryos are treated outside the woman's body.
      • Medication stimulates egg production before retrieval.
      • Artificial Insemination (Intrauterine Insemination - IUI): Sperm from partner/donor introduced into vagina/uterus during ovulation.
      • In Vitro Fertilization (IVF): Mature ova removed, fertilized, and healthy embryos transferred into uterus.
        • In vitro means in an artificial environment such as a test tube.
      • Intracytoplasmic Sperm Injection (ICSI): Single sperm injected into mature ovum (used for low sperm count).
      • Surrogate: Woman agrees to become pregnant/give birth on behalf of another.

Gender Reassignment

  • Transgender: Gender identity does not match sex assigned at birth.
  • Cisgender: Gender identity does match sex assigned at birth.
  • Medical treatment alters physical characteristics.
  • Gender reassignment surgery and hormone therapy used.