On this page you can find interesting topics in the field of Obstetrics.

HISTORY OF CESAREAN DELIVERY

Terms

The origin of the term cesarean section is likely the product of two separate reports in 1581 and 1598, the former making reference to Cesarean and the second to Sections. The origin of the term cesarean is somewhat uncertain. The hypothesis that Julius Caesar was the product of a cesarean birth is unlikely to be true in view of the probability of fatality associated with the procedure in ancient times and the observation that his mother, Aurelia, corresponded with him during his campaigns in Europe many years later. The term may have as its origin in the Latin verb cadere, to cut; the children of such births were referred to as caesones. It is also possible that the term stems from the Roman law known as Lex Regis, which mandated postmortemoperative delivery so that the mother and child could be buried separately; the specific law is referred to historically as Lex Cesare. >>more

Recurrent miscarriage

Recurrent miscarriage (RM), traditionally defined as three or more consecutive first-trimester spontaneous losses, affects up to 1% of couples. Primary recurrent miscarriage is diagnosed in women who have never had a successful pregnancy, and secondary recurrent miscarriage in those whose repetitive losses follow a live birth. There is no specific classification for women who have multiple miscarriages interspersed with normal pregnancies. >>more

Ectopic Pregnancy – Risk factors

Ectopic pregnancy most often is associated with risk factors leading to tubal epithelial damage, which alters gamete and embryo transport.  Documented tubal pathology carries a 3.5-fold common adjusted odds ratio for ectopic pregnancy. Patients with a previous ectopic pregnancy are 6 to 8 times more likely to experience another ectopic pregnancy, and 8% to 14% of patients experience more than one ectopic pregnancy. Patients with a history of tubal surgery have a 21-fold common adjusted odds ratio of ectopic pregnancy. >> more

Prolonged Pregnancy - Menagement

 A prolonged pregnancy, also commonly called postterm pregnancy, is one that has lasted longer than 42 weeks or 294 days beyond the first day of the last menstrual period.  Postdatism implies pregnancy lasting beyond the estimated due date at 40 weeks. The term “postmature” is reserved for the pathologic syndrome in which the fetus experiences placental insufficiency and resultant intrauterine growth restriction. Prolonged pregnancies have been recognized since antiquity. Hadrian, emperor of Rome from 117 to 138 A.D., decreed that a child born 11 months after the death of a husband was illegitimate. >> more

Premature Rupture of the Membranes – Treatment consideration

Premature rupture of the fetal membranes (PROM) is one of the most common problems in obstetrics, complicating approximately 5% to 10% of term pregnancies and up to 30% of preterm deliveries. Although the etiology of premature rupture of the membranes is often not clinically evident, a degree of consensus has arisen regarding management options. Indeed, the problem is intricate. Considerations in selecting management in a particular patient are gestational age and patient demographics. The clinician is confronted by a complex set of options including use of corticosteroids, tocolytics, more potent antibiotics, and innovative approaches using various tests (such as amniocentesis, ultrasound, and biophysical testing). Of major importance is the marked improvement in survival of low–birth-weight infants. >> more

PHYSIOLOGIC SKIN CHANGES DURING PREGNANCY

Hypermelanosis

Hypermelanosis, or darker than constitutive skin color, occurs in 90 percent of pregnancies. Darkly complected women are more likely to manifest hypermelanosis during pregnancy. The hypermelanosis may be generalized or localized to areas of increased melanocyte density. The areolae, umbilicus, vulva, and perianal skin may darken as early as the first trimester. The linea alba often becomes the hyperpigmented linea nigra. Pigmented nevi, freckles, and recent scars may also deepen in color. >>more

DETERMINANTS OF NORMAL AND ABERRANT PLACENTAL GROWTH

Approximately 10% of the almost 4 million infants born each year in the United States are classified as low birth weight (LBW). Terminology used to describe the small fetus/newborn can be confusing. The term LBW is used clinically by pediatricians postnatally and is defined strictly as a birth weight less than 2500g with no regard for gestational age. The term “small for gestational age” (SGA) was originally defined by pediatricians as a newborn with a birth weight less than expected given gestational age and which can occur in a term or a preterm neonate. However, use of the term SGA subsequently expanded from the postnatal period to the antenatal period and is currently used interchangeably with intrauterine growth restriction (IUGR). For the purposes of this chapter, the use of the term SGA will be reserved for the newborn and IUGR, as implied by the name, will be restricted to the fetus. IUGR is more specifically defined later in the chapter. >>more

Recurrent Early Pregnancy Losses
Immunologic Problems

Autoimmunity (Self Antigens)

In autoimmunity, a humoral or cellular response is directed against a specific component of the host. The lupus anticoagulant and anticardiolipin antibodies are antiphospholipid antibodies, which arise as the result of an autoimmune disease. The lupus anticoagulant is present in a variety of clinical conditions, not just with lupus erythematosus. The antiphospholipid antibodies are directed against platelets and the vascular endothelium and cause thrombosis, spontaneous miscarriage, and fetal wastage. These antibodies block prostacyclin formation, which results in unbalanced thromboxane activity, leading to vasoconstriction and thrombosis. In several series, 10–16% of women with recurrent miscarriages have had antiphospholipid antibodies.  These antibodies are also associated with fetal growth retardation and fetal death in addition to recurrent miscarriages, and when present, there is a high rate of second-trimester fetal deaths. The mechanism of pregnancy loss is probably decidual and placental insufficiency due to the thrombotic tendency. Annexin-V is a phospholipid-binding protein that inhibits coagulation; the levels of annexin-V on trophoblasts and endothelial cells are reduced in the presence of antiphospholipid antibodies. >>more