medical student under supervision may be called on to do a number of tasks. These tasks can include:
Monitor the progress of labor, by reviewing the nursing chart, performing vaginal examination, and assessing the trace produced by a fetal monitoring device (the cardiotocograph)

Accelerate the progress of labor by infusion of the hormone oxytocin

Provide pain relief, either by nitrous oxide, opiates, or by epidural anesthesia done by anaesthestists, an anesthesiologist, or a nurse anesthetist.

Surgically assisting labor, by forceps or the Ventouse (a suction cap applied to the fetus' head)

Caesarean section, if there is an associated risk with vaginal delivery, as such fetal or maternal compromise supported by evidence and literature. Caesarean section can either be elective, that is, arranged before labor, or decided during labor as an alternative to hours of waiting. True "emergency" Cesarean sections include abruptio placenta, and are more common in multigravid patients, or patients attempting a Vaginal Birth After Caeserean section (VBAC).

[edit]Postnatal
Main article: Postnatal
A woman in the Western world who is delivering in a hospital may leave the hospital as soon as she is medically stable and chooses to leave, which can be as early as a few hours postpartum, though the average for spontaneous vaginal delivery (SVD) is 1–2 days, and the average caesarean section postnatal stay is 3–4 days. During this time the mother is monitored for bleeding, bowel and bladder function, and baby care. The infant's health is also monitored.^[2]
[edit]Salary
The salary of a obstetrician varies by country. In the United States, the salary ranges from $200,000 to $339,738.

Country

Annual salary (US$)

United Kingdom 187,771^[3]

United Arab Emirates 231,809^[4]

United States 236,411

Country	Annual salary (US$)
United Kingdom	187,771^[3]
United Arab Emirates	231,809^[4]
United States	236,411

Obstetric ultrasonography

Obstetric sonography (ultrasonography) is the application of medical ultrasonography to obstetrics, in which sonography is used to visualize the embryoor foetus in its mother's uterus (womb). The procedure is often a standard part ofprenatal care, as it yields a variety of information regarding the health of the mother and of the fetus, as well as regarding the progress of the pregnancy.

Obstetric sonogram of a fetus at 16 weeks. The bright white circle center-right is the head, which faces to the left. Features include the forehead at 10 o'clock, the left ear toward the center at 7 o'clock and the right hand covering the eyes at 9:00.

Types
Traditional obstetric sonograms are done by placing a transducer (a device that converts one type of energy into another) on the abdomen of the pregnant woman. One variant is a transvaginal sonography is done with a probe placed in the woman's vagina. Transvaginal scans usually provide clearer pictures during early pregnancy and in obese women. Also used is Doppler sonography which detects the heartbeat of the fetus. Doppler sonography can be used to evaluate the pulsations in the fetal heart and bloods vessels for signs of abnormalities.^[1]
[edit]Early pregnancy
The gestational sac can sometimes be visualized as early as four and a half weeks of gestation (approximately two and a half weeks after ovulation) and the yolk sac at about five weeks gestation. The embryo can be observed and measured by about five and a half weeks. Theheartbeat may be seen as early as 6 weeks, and is usually visible by 7 weeks gestation.^[1]^[2]
[edit]Dating and growth monitoring
Gestational age is usually determined by the date of the woman's last menstrual period, and assuming ovulation occurred on day fourteen of the menstrual cycle. Sometimes a woman may be uncertain of the date of her last menstrual period, or there may be reason to suspect ovulation occurred significantly earlier or later than the fourteenth day of her cycle. Ultrasound scans offer an alternative method of estimating gestational age. The most accurate measurement for dating is the crown-rump length of the fetus, which can be done between 7 and 13 weeks of gestation. After 13 weeks gestation, the fetal age may be estimated by the biparietal diameter (the transverse diameter of the head), the head circumference, the length of the femur (the longest bone in the body), and the many more fetal parameters that have been measured and correlated with age over the last 30 years. Dating is more accurate when done earlier in the pregnancy; if a later scan gives a different estimate of gestational age, the estimated age is not normally changed but rather it is assumed the fetus is not growing at the expected rate.^[1]
Not useful for dating, the abdominal circumference of the fetus may also be measured. This gives an estimate of the weight and size of the fetus and is important when doing serial ultrasounds to monitor fetal growth.^[1]
[edit]Fetal sex determination
Sonogram of male fetus, with scrotum and penis in center of image
The sex of the baby can usually be determined by ultrasound at any time after 16 weeks, often at the dating scan around 20 weeks into the pregnancy depending upon the quality of the sonographic machine and skill of the operator. This is also the best time to have an ultrasound done as most infants are the same size at this stage of development. Depending on the skill of the sonographer, ultrasound may suffer from a high rate of false negatives and false positives. This means care has to be taken in interpreting the accuracy of the scan.
[edit]Ultrasonography of the cervix
Fetus at 14 weeks (profile)
Obstetric sonography has become useful in the assessment of the cervix in women at risk forpremature birth. A short cervix preterm is undesirable: At 24 weeks gestation a cervix length of less than 25 mm defines a risk group for preterm birth, further, the shorter the cervix the greater the risk.^[3] It also has been helpful to use ultrasonography in women with preterm contractions, as those whose cervix length exceed 30 mm are unlikely to deliver within the next week.^[4]
[edit]Abnormality screening
In some countries, routine pregnancy sonographic scans are performed to detect developmental defects before birth. This includes checking the status of the limbs and vital organs, as well as (sometimes) specific tests for abnormalities. Some abnormalities detected by ultrasound can be addressed by medical treatment in utero or by perinatal care, though indications of other abnormalities can lead to a decision regarding abortion.
Perhaps the most common such test uses a measurement of the nuchal translucency thickness ("NT-test", or "Nuchal Scan"). Although 91% of fetuses affected by Down syndrome exhibit this defect, 5% of fetuses flagged by the test do not have Down syndrome.
Ultrasound may also detect fetal organ anomaly. Usually scans for this type of detection are done around 18 to 20 weeks of gestational age.
[edit]History
Scottish physician Ian Donald was one of the pioneers of medical use of ultrasound. His article "Investigation of Abdominal Masses by Pulsed Ultrasound" was published in The Lancet in 1958. Donald was Regius Professor of Midwifery at the University of Glasgow.^[5]
In 1962, after about two years of work, Joseph Holmes, William Wright, and Ralph Meyerdirk developed the first compound contact B-mode scanner. Their work had been supported by U.S. Public Health Services and the University of Colorado. Wright and Meyerdirk left the university to form Physionic Engineering Inc., which launched the first commercial hand-held articulated arm compound contact B-mode scanner in 1963.^[6] This was the start of the most popular design in the history of ultrasound scanners.
Obstetric ultrasound has played a significant role in the development of diagnostic ultrasound technology in general. Much of the technological advances in diagnostic ultrasound technology are due to the drive to create better obstetric ultrasound equipment. Acuson Corporation's pioneering work on the development of Coherent Image Formation helped shape the development of diagnostic ultrasound equipment as a whole.
[edit]Safety issues
Current evidence indicates that diagnostic ultrasound is safe for the unborn child, unlike radiographs, which employ ionizing radiation. However, no randomized controlled trials have been undertaken to test the safety of the technology, and thus ultrasound procedures are generally not done repeatedly unless medically indicated.
A 2006 study on mice exposed to ultrasound showed neurological changes in the exposed fetuses. Some of the rodent brain cells failed to migrate to their proper position and remained scattered in incorrect parts of the brain.^[7]
It has been shown that Low Intensity Pulsed Ultrasound does have a localized effect on growth in human beings. The 1985 FDA-allowed maximum power of 180 milliwatts per square cm ^[8] is well under the levels used in therapeutic ultrasound, but still higher than the 30-80 milliwatts per square cm range of the Statison V veterinary LIPUS device.^[9] LIPUS has been shown to affect tissue growth in as little as 20 minutes of time with repeated daily applications. Adding to the similarity, LIPUS and medical ultrasound both operate in the 1 to 10MHz range.
While the benefits of medical ultrasound probably outweigh any risks, vanity uses such as making 3D ultrasound movies without a doctors order present an obviously unnecessary but unknown risk to a developing fetus. Clinical guidelines produced by the Society of Obstetricians and Gynaecologists of Canada recommend against the non-medical use of fetal ultrasound.^[10]
List of obstetric topics
Obstetrics is the study of the reproductive process within the female body, including fertilization, pregnancy and childbirth.
Basic obstetric terms
amniocentesis

amnion, amniotic sac

amniotic fluid

antenatal care, prenatal care

breastfeeding

cervix

childbirth

chorionic villus sampling

contraception

embryo

embryology

fallopian tube

fetus

gestation

gynecology

hormone

identical twin

In Vitro Fertilization (IVF)

labor, labour - see childbirth

lactation

Lamaze

live birth

menstrual cycle

midwifery

mother

natural childbirth

navel

ovary

ovum or egg

oxytocin or pitocin

pediatrics

pelvic bone width

placenta

pregnancy

sterilization

twin

ultrasound

umbilical cord

umbilicus - see navel

uterus or womb

vagina

womb - see uterus

[edit]Complications of pregnancy and childbirth
Main article: Complications of pregnancy
abortion

abruption

breech birth

cephalo-pelvic disproportion

caesarean section, cesarean section, C-section

dermatoses of pregnancy specific skin conditions during pregnancy

diabetes

eclampsia

ectopic pregnancy

gestational diabetes

Group B Streptococcus infection

HELLP syndrome

hypertension

hysterectomy

Intrauterine Growth Restriction (IUGR)

macrosomia (big baby)

malpractice

miscarriage or stillbirth

obstetric fistula

obstetric hemorrhage

Pelvic girdle pain

placenta praevia

pre-eclampsia

premature birth, preterm labor or prematurity

small for gestational age (SGA)

uterine rupture

Childbirth and obstetrics in antiquity
Traditionally obstetrics is defined as the surgical specialty dealing with the care of a woman and her offspring during pregnancy, childbirth and the puerperium, although in Antiquity surgical intervention did not exist. Without the presence of surgical technology an alternative was necessary. In 2nd century AD, physician Soranus wrote a text on gynecology introducing the occupation of the midwife.
Midwifery and obstetrics are distinctly different but overlap in medical practice that focuses on pregnancy and labor. Midwifery emphasizes the normality of pregnancy along with the reproductive process.
Midwifery
Midwifery flourished in the 2nd century AD, in the beginning of the Hippocratic Corpus. Soranus states that for a woman to be an eligible midwife she must be “A suitable person…must be literate to be able to comprehend the art through theory too. She must have her wits about her so that she may easily follow what is said and what is happening. She must have a good memory to retain the imparted instructions (for knowledge arises from memory of what has been grasped). She must love work, to preserve through all vicissitudes (for a woman who wishes to acquire such vast knowledge needs manly patience).
The most qualified midwife would be trained in all branches of therapy. She should be able to prescribe hygienic regulations for her patients, observe the general and individual features of the case, give advice by recalling from previous knowledge what medical decisions would work in every case and to be reassuring to her patients. It is not necessary for her to have had a child to deliver another woman’s child, but it is good if she has been in labor to enhance sympathy with the mother.
To obtain good midwifery habits, she will be well disciplined and always sober, have a quiet disposition sharing many life secrets, must not be greedy for money, be free of superstition to not overlook salutary measures, keeping her hands soft by staying away from wool-working as this may harden her hands and use ointments to acquire softness. She too needs to be respectable, the people of the household will have to trust her within their household, may not be handicapped in the performance of her work. Long and slim fingers with short nails are necessary to touch deep-lying inflammation without causing too much pain. Midwives that acquire of all these will be the best midwives^[1].
[edit]Labor and delivery
Midwifery and the process of labor and delivery in antiquity go hand in hand. Hospitals did not exist so delivery took place in the home of the expectant mother with a midwife and the presence of other females to aid the midwife.
Superstitions and religion played a major role in antiquity including childbirth. Women in labor called upon the goddess Artemis who had the ability to bring new life into the world and take it away. Though she remained a virgin herself, it was said that she witnessed the pain of her mother during the birth of her brother, Apollo, and immediately assumed the position of midwife. If a woman died while during childbirth, her clothes were taken to the temple of Artemis due to the fact her death was attributed to her^[2]. If the birth was successful, the mother would make a thank-offering of some of her clothes to the goddess as well^[3].
Herbs and plants were used heavily in the delivery process also with strong ties to superstition. For example, a drink sprinkled with powdered sow’s dung was given to relieve labor pain and fumigation with the fat from a hyena was thought to produce immediate delivery^[4]. Most of these practices had little to no medical efficacy, but they did probably provide some placebo effect. These superstitious practices were very common and required little or no medical training.
Significant advances were made in child bearing with the introduction of the Hippocratic Corpus in the 3rd century BCE, though this document still proved to implement many ideas concerning superstitions. Physician, Galen, also provided much advancement in medicine for women in the late 1st century CE, though he focused mostly on specific diseases with only some aspects of labor mentioned. Physician Soranus, who wrote several texts on gynecology in the 2nd century CE, has proven to be the most eminent authority on childbirth and obstetrics in antiquity.
Soranus described three main stages of pregnancy: conception which regarded keeping the male seed within the womb, pica which occurred 40 days into pregnancy and included symptoms of nausea and cravings for extraordinary foods. During this phase women were also instructed to exercise and sleep more to build up strength as preparation for the labor process. Lastly the last stage of pregnancy was described being the labor and the process of delivery. In preparation for labor, the woman was advised to bath in wine and sweet-water baths to calm her mind before delivery. Her belly was then rubbed with oils to decrease the appearance of stretch marks and her genitals were anointed with herbs and injected with softeners such as goose fat^[5].
The role of the midwife was very important during the process of childbirth and Soranus described her role in great detail. For example, the midwife was to have certain tools to ensure a safe delivery including: clean olive oil, sea sponges, pieces of wool bandages to cradle the infant, a pillow, strong smelling herbs in case of fainting, and a birthing stool^[6].
The midwife would ready her supplies as labor began. During the labor process, the mother would lay on her back on a hard, low bed with support under her hips. Her thighs were parted with her feet drawn up. Gentle massage was implemented to ease labor pains as cloths soaked in warm olive oil were laid over her stomach and genital area. Against the woman's sides were placed hot compresses in the form of warm oil-filled bladders^[7].
During the actual birth, the mother would be moved to the birthing stool where she was seated with a midwife in front of her and female aids standing at her sides. In a normal headfirst delivery, the cervical opening was stretched slightly, and the rest of the body was pulled out. Soranus instructed the midwife to wrap her hands in pieces of cloth or thin papyrus so that the slippery newborn did not slide out of her grasp^[8].
[edit]Caesarian sections
The word “caesarian” possibly derives from the ancient Roman ruler Julius Caesar, because it was believed that Caesar was delivered through this procedure ^[9]. However, this is probably based more on tradition and myth than historical accuracies. Another possibility for the etymology of the word “caesarian” is the Latin word caedere, meaning “to cut”^[10].
This practice is probably much older than Caesar, but C-sections as performed by the Romans were to rescue the baby from a dying or already dead mother (performed post-mortem)^[11].
Evidence suggests that Jews in ancient Rome practiced C-sections on living mothers who were not in danger of dying^[12]. Evidence of these procedures is found in several collections of ancient Roman Rabbis (the most famous of which is called the Mishnah^[13]).
Greeks and Egyptians did not perform C-sections post-mortem or on living mothers. However, Greeks would have had at least some knowledge of the caesarian operation/ procedure. The Greek god Aesclepius was fabled to have been extracted from his mother’s womb through this process^[14].
Other than the evidence of Jews practicing C-sections in antiquity (very little in ancient Rome, even less in ancient Greece), not much more evidence exists regarding caesarian-operation birth. One reason could have been that C-sections were not performed very often because of medical complications or superstitions surrounding C-sections.
In early Christian Rome, C-sections were almost non-existent^[15]. Loss of skill is a possibility for the lack of C-sections. Infant mortality rates were high in antiquity, so C-sections certainly could have been useful. However, early Christian doctors could have disregarded C-sections as a socially acceptable surgery because of religious beliefs^[16].
The lack of education for women (who would have been the most knowledgeable about childbirth procedures) and the social norm that women remained in the private sphere of life (as opposed to public) could also have contributed to a shortage of C-sections^[17]. Midwives were the primary persons involved in the childbirth process. Midwives were women, and were not actually physicians. They did not record their medical practices in writing like Soranus or Galen. Thus, C-sections could have potentially occurred on a fairly regular basis, accounts were just not recorded.
Disease, need for secrecy, and social discouragement could also have been factors that lead to the decline in C-sections among early Christians in Rome (for almost no evidence exists for C-sections in the Christian world until the 10th c.)^[18].
[edit]Death and childbirth
Mortality is considered to have been quite high in antiquity, due to a few factors: a lack of sanitation and hygienic awareness, no understanding of micro-organisms, and a dearth of effective drugs all contributed. In the context of childbirth, however, maternal and infant mortality were seriously raised by modern standards. This inflation resulted from the toll childbirth took on women, and the increased risk of infection following labor. Infants in the modern era are fragile compared to adults, and the lack of sanitation mentioned above contributed further to this fragility.
Maternal
Maternal mortality figures are available only through comparison. While well-attested in the sense that sources are not lacking, all evidence is anecdotal and difficult to extrapolate valid statistics from. Therefore, maternal mortality is thought to be comparable with figures for similar, but much later, societies with more surviving records, such as eighteenth-century rural England, where maternal mortality averaged 25 per 1000 births^[19].
Infant
The question of infant mortality in antiquity is complicated by infanticide and exposure, neither of which reflect on medical ability during the period, though both remove children from family records. The former does this through intentional death of the child, and the latter through abandonment, and possible death. These reflect instead on social conditions and norms. While valuable, this is not the information sought, and scholars having painstakingly attempted to eliminate the noise from their inquiries^[20].
While it is difficult to construct actual figures of the infant mortality rate in antiquity, comparisons have been made between ancient societies and modern non-industrialized societies. The figures suggested for these are then compared with those of modern industrialized societies to put them in perspective. While infant mortality is less than 10 per 1000 in modern industrialized societies, non-industrialized societies display rates from 50 to 200+ per 1000. Scholarship using model life tables and assuming life expectancy at birth of 25 years produces the figure of 300 per 1000 for Roman society^[21

RADIOLOGY, PREGNANCY, INFECTION AND TREATMENT

Friday, July 23, 2010

Obstetrics

Prenatal care

[edit]First trimester

[edit]Second trimester

[edit]Third trimester

[edit]Antenatal record

[edit]Imaging

[edit]Complications and emergencies

[edit]Fetal assessments

[edit]Childbirth

[edit]Induction

[edit]Labor

[edit]Postnatal

[edit]Salary

Obstetric ultrasonography

Types

[edit]Early pregnancy

[edit]Dating and growth monitoring

[edit]Fetal sex determination

[edit]Ultrasonography of the cervix

[edit]Abnormality screening

[edit]History

[edit]Safety issues

List of obstetric topics

Basic obstetric terms

[edit]Complications of pregnancy and childbirth

Childbirth and obstetrics in antiquity

Midwifery

[edit]Labor and delivery

[edit]Caesarian sections

[edit]Death and childbirth

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