Talk:Obstetrics

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References[edit]

This article needs one or more references to cover the content, added the tag. --FloNight 04:13, 23 November 2005 (UTC)


Cleanup request[edit]

For for such an important topic. Perhaps some parts of it should be split into other sections (antenatal care and induction, for example). If not, then the sections need quite a bit of work to flesh them out. violet/riga (t) 22 July 2005

This is a poorly written article. I concur it needs major rewrite and restructuring. Mirasmus 03:35, 3 May 2006 (UTC)
Still.  :( violet/riga (t) 21:12, 5 June 2006 (UTC)

Minor Cleaning[edit]

Added a few links in the Trimesters section. What does β-hCG mean? I know it has something to do with haemoglobin but a link to exactly what, or some kind of explanation would be helpful.

Also moved the references template from the talk page to the article itself. User:SaintedLegion

It has nothing to do with Hemoglobin (perhaps you're thinking of Hgb-A1C? which is form of hemoglobin measured to assess the long term level of a diabetic's blood sugar status). beta HCG is produced by the placenta and is only found in the blood (and urine) of pregnant women and rarely those with certain types of tumors. I plan on cleaning this article up a bit when I can.

Human Chorionic Gonadotrophin, I think.

Minor Comment[edit]

Human Chorionic Gonadotropin is correct.

The HCG tests used by physicians to determine if a woman is pregnant - to confirm a pregnancy, or to elimunate the possibilty of pregnacy in a woman of child bearing years who, for example, is starting a medication contraindicated by pregnancy, or who requires an X-ray - are the Beta HCG, determined by analysis of blood, and the urinary HCG, which is sold for home use,yielding a rapid result, but is less specific and less sensitive than Beta HCG... if you understand the probability associated with virtually all medical testing: A sensitive test is one which will identify the occurance or presence of an abnormality or disease substrate - such as chemical or cellular components of blood indicative of a disease state - e.g., the glucose level in diabetes; "drop out" of visible heart muscle in nuclear stress testing - indicating a diminished blood supply to that region of the heart and disease in the artery which supplies it; MRI imaging of the brain which will establish or rule out an intracranial blled- is so sensitive that it will rarely fail to confirm an abnomality, but not infrequently yield a "false positive" result - the test may indicate that a condition is present when, in fact, it isn't.A highly specific test is at the opposite end of the spectrum - if it is postive, it is very likely that the disease state exists; however, a negative result does not conclusively rule out the disease, but merely diminishes the physician's index of suspicion, as the test is so specific for a particular disease substrate that it might miss low-grade, incipient indicators of an illness...producing a "false negative" test. When an emergent answer is necessary regarding the possibility of pregnacy - say, with regard to a young woman involved in a motor vehicle accident with a suspected collapsed lung, who thus needs an X-ray - the urinary HCG will have to do. When time isn't of the essence, a Beta HCG is obtained - it is, again , far more specific for the presence of a pregnacy than the urinary HCG, as well as more sensitive. As an aside, the take home message is : Don't relie on a negative urinary HCG to establish the absence of pregnacy. The urinary test is so inferior to the Beta,and is so temporally dependent on the moment of implantation, that serial home testing, over a several days after insemination or a missed menstrual cycle ( the specifics are recommended by the manufacturer) should be considered. No references are cited - I was an emergency room doctor for three years before establishing a viable cardiology practice, and I'm certified in Internal Medicine and Cardiovacular Disease...and have practiced for more decades than I want to remember.

Mitral valve stenosis risk[edit]

I'd like to add to the article - if there is a concensus among the community - one of the more dire risk factors in maternal/fetal morbidity and mortality: Mitral Valvular Stenosis. Mitral stenosis used to be primarily the result of rhematic heart disease, a sequel to rheumatic fever associated with beta hemolytic strep infections - such as "strep throat". Despite the concerted effort of our younger doctors to create antibiotic resistence in every known bacterium ( in contraversion to the fact that most upper respiratory infections are viral), RF still occurs, and an associated stenosis of the mutral valve may result, progressing over time. Endocarditis, due to poor dentition, IV drug use, or sepsis arising elsewhere which seeds the valve, is an important cause. The leading cause of mitral valve replacement is mitral valve prolapse -significant prolapse, confirmed by imaging, with very "floppy" and redundent valve leaflets ( as opposed to the universal MVP with which every woman with a vague chest complaint is told they are afflicted). This usually causes back flow of blood through the valve ( mitral regurgitation), but as it constitutes a risk factor for endocarditis, and patients at risk may not have been diagnosed and undergo a procedure - a simple visit to the dentist for a filling, which floods the circulation with pathogens - usually without any harm, just as brushing your teeth releases a considerable number of pathogens ( don't worry about it - the body sweeps these up in immune competant individuals - poor dental hygeine is far worse ); but in the presence of significant MVP may lead to endocarditis, and in turn , MS. A women with moderate to severe MS should not conceive until a ( rather complex)strategy has been developed to releive the narrowing of the valve. As noted in the article, there is a fifty percent increase in blood volume during pregnacy, and trying to force all that volume through a snall orafice is inviting congestive heart failure and pulmonary hypertention...not an auspicious situation, and a valid reason for terminating the pregnancy if the mother's status deteriorates. This is not to say that every pregnant woman, or those planning to conceive must underco echocariography; but certainly they should expect a careful heart examination, which will reveal the characteristic murmur of MS, and comprehensive questioning by the physician.Skyraderuniform1 (talk) 10:52, 21 March 2009 (UTC)

Whilst clearly an issue of Obstetrics#Cardiovascular, that is a section on Obstetrics#Maternal physiology which probably should be more about the normal physiology of pregnancy rather than disease process. Might be better therefore under Obstetrics#Prenatal care, but as a relatively rare issue probably better in the linked main article of Prenatal care ? David Ruben Talk 11:37, 21 March 2009 (UTC)

Rhesus D negative[edit]

This should never be written "Rh-" = WRONG - MAY LEAD TO MISTAKES
It should be always written in full "Rhesus D negataive" = CORRECT - UNLIKELY TO BE MISREAD OR CHANGED
Similarly "Rhesus D positive" should always be written in full.
Accuracy is important in all aspects of blood grouping.

obstetrics or obstetricians[edit]

obstetrics or obstetricians provide complex pregnancy, labour and birth and post natal care for woman who have complications. Obstetricians deal with the abnormal. —The preceding unsigned comment was added by 203.59.126.27 (talk) 07:31, 5 April 2007 (UTC).

This is a misinformed and misleading statement. OB/GYNs will generally either do both obstetrics and gynocology, or restrict themselve to one or the other. While mid-wives have gained popularity in home or hospital delivery, they are not qualified to manage any complications which may crop up. The United States has the highest infant mortality rate of all industrialuzed countries - although we don't really know why. Even so, the majority of deliveries are uncomplicated, and are performed by obstetricians. Just as there are specialized GYNs who restrict themselves to gynocologic maligmancies, there are obstetricians, working in conjunction with neonatologists and other specialists as warranted, who perform high risk deliveries. The average OB is not trained in this manner, and is not resticted to dealing " with the abnormal". Far from it...they refer high risk patients to appropriately trained OB's, usually in tertiary care medical centers. I would suggest eliminating the above remark.Skyraderuniform1 (talk) 10:52, 21 March 2009 (UTC)
But from UK perspective not that far off, for the majority of UK NHS deliveries will be with a midwife and the obstetrician on call might never meet face to face the mother (in other units will do a brief ward round at the start of each rota shift just to "show their faces" adhead of when they might be called in). In such circumstances then yes only the non routine constitutes UK NHS practice (from maternal issues eg asthma, hypertension, gestational diabetes etc to foetal issues or concerns to labour problems). UK private practice probably follows closer the US model, although even with this in recent years private midwives often take the lead as recognised higher intervention rates when delivery lead bu Obs vs midwives. David Ruben Talk 11:29, 21 March 2009 (UTC)


Minor Note[edit]

Dave,I quite agree that there are vast differences in medical praxis between the UK/NHS and the US health care delivery system.I think,to an extent,that the differences are predicated on the rather unrealistic expectations of Americans-idealistic but not very realistic from a percuniary perspective-that every American is entitled to access to medical care,and that the "care" knows no limits;that is,every testing modality that can be applied will be applied, and each patient seems to expect to walk out the door with a bag of medications,cured and rejuvinated,praising the physician's lovingconcern.Then,too,our system has developed into a paradoxical"privatized NHS",whereby business-as opposed to government-sets the limits on diagnostic and treatment options for the doctor,while the physician bears the responsability of the outcome-and faces tort litigation at the whim of the patient or family.Thus,physicians tend to employ adnvanced diagnostic methods in lieu of a reasonable bedside assessment of the patient by physical examination, to call in consultants needlessly, and to treat aggressively, using the latest and greatest in our armamentarium of surgical and medical therapies and technology.Finally, US doctors often feel compelled to do a great deal of "hand-holding",rather than medicine. Given the patient's expectations, and the pressures on the physician to avoid litigation,to merely "show the flag"-the physician popping in on rounds to show his face-would be unacceptable in the context of an Americann medical practice. In the UK,from what I understand,there is a compelling hierarchy of physicians,the Attending (or Consultant)being shown great deference and respect by the patient and the system alike,such that merely making an appearance satifies the Great Doctor's patients.The NHS doctor does not seem to occupy that exaulted position-he's in the trenches of the city or countryside,more of a technician than clinician,practicing according to the monolithic regulatory NHS.The Attending may have a private,"boutique" practice which resembles the typical US situation-what constraints are placed upon him I don't know, but my impression is that if the wealthy can pay for it,they get it. On the other hand,while economic considerations fuel both systems, US phenomenology would never accept the witholding of life saving technology from any and all comers- the UK, for example, apportioning dialysis on an as needed,and as available basis,while in the US every renal patient can expect dialysis,should it come to that.All of which is a long-winded explanation of why the OB is a part of the American pregnant woman's life from conception to delivery,while midwives are essentially used,at the patient's own discretion, by those people who advocate hoilistic medicine and have disdain for the "establishment".In all,both systems are more or less equally effective in both the delivery and efficacy of health care,just very different in how,and by whom,it is delivered.Then,of course,there is the health insurance crisis over here,the malpractice insurance crisis,the Medicare crisis...I'm sure you're aware of the imminent collapse of our system,and the waning morale of our medical community.And yes, OB's(and neurosurgeons,and others in high risk fields)work a good part of the year to cover their malpractrice costs and other overhead.Best Regards,Skyraderuniform1 (talk) 19:40, 21 March 2009 (UTC)

A reasonable assessment. I think UK consultants are quite independant in clinical decision making, but comparisons with colleagues does somewhat restrain them (eg if post-op stay is significantly longer than for colleagues undertaking the same op). Likewise the relative lack of litigation concerns means we can practice what might be seen as clinically appropriate care, ordering tests only likely to be useful or free of undue side effects, without having to practice defensive medicine (but there is no absolute here and overlap with what may be termed sensible prudent caution for at least patient's sake if not the doctor looking over their shoulder). Whilst before the introduction of the NHS, those that could not afford private medical care would have sought delivery with help of mid-wife or general practitioners (my parents spent much of their younger working time attending home deliveries), there was then a shift to hospitalise labour for being safer (as monitoring and intervention become better understood, along with managed labour - ie. augmentation). I gather there was then a backlash against this medicalising (what in the majority of cases is routine normal) natural life process and so midwifery led care has become the norm - but not primarily out of cost consideration (although I'm sure govbernment looks at that aspect) but from point of view of what thought to be more appropriate. Obs therefore step in for the management of the non-normal pregnancies (but not as if sitting around not doing anything as wil lbe seeing to augmented labour cases, prenatal & postnatal inpatients needing care). Fear not re collapse of your system - since the time I was in training, the death of the NHS has been predicted as healthcare & health-technology have improved and with it extra expense. Hence at start of NHS the routine MI who survived would be initially managed at home (no angiography, no heart bypass nor CABG and what cholesterol testing?), or diabetes defined at higher threshold than now and also being less prevalent with the less overweight population in the post-war years, yet oral agents vs insulin only some years later becoming available. David Ruben Talk 03:25, 22 March 2009 (UTC)

Career[edit]

i need to know more about obstetrics the salary what skill you need the perspectics and much more abot the career —Preceding unsigned comment added by 66.138.72.197 (talk) 21:46, 19 November 2008 (UTC)

What do you want to know, specifically. In terms of what I can understand of your question, OB/GYNs generate well above the average income considering "primary care" and specilized doctors - as a guess ( this is usually published in AMA news periodically, or Medical Economics ), I'd say the median income of an OB is around a half-million, with a range starting in the low six figures to over 1 million dollars. The "skills" you need are the skills all doctors need - competance, a solid university based training, an engaing and empathtic personality, as much experience and continuing education as you can acquire, and a willingness to sacrifice much of your private life in the interest of your patients. You should also be able to go with little or no sleep for a few days, have good manual dexterity required in any surgical field,sound judgement coupled with equanimity; and a tolerance for rediculous malpractice rates. Without intending to sound self-righteous, if your first question is about money...don't go into any medical field. Because if you're already focused on that, the 14 or so years of higher education, the medical school debt of about $100,000, and the emotional demands with which a doctor contends will defeat you...or produce an entreprenurial, uncaring doctor. We've got plenty of those already. As for what they do, the article and my comments above should give you an idea. But, please, consider your motivation.Skyraderuniform1 (talk) 10:52, 21 March 2009 (UTC)
I wonder how much of those pay rates are taken up by malpractice rates, in UK NHS across all specialities of "Consultants can earn between £73,403 to £173,638, dependent on length of service and payment of additional performance related awards"[1] and (as far as I can tell) expect to have medical insurance premium of around £22,300-25,675[2]. Of course private practice earns rather more (and greater insurance premium rates).David Ruben Talk 11:50, 21 March 2009 (UTC)

Removing Maternal physiological changes in pregnancy[edit]

I removed the introduction to Maternal physiological changes in pregnancy from this article, because it is already found in Pregnancy, and obstetrics on the other hand is primarily to prevent changes that are NOT physiological. Of course it is useful to know what is normal in order to know what is abnormal, but that's what the link to Pregnancy is there for. Mikael Häggström (talk) 05:44, 9 May 2010 (UTC)

Where does this fit?[edit]

I pasted the following section here because it has the following issues which may need to be tended to before any reinsertion:

  • There is already a section on Prenatal care. Where does this fit? Some of it could perhaps fit in complications?
  • It is unreferenced

Mikael Häggström (talk) 05:49, 9 May 2010 (UTC)

Antenatal care[edit]

In obstetric practice, an obstetrician or midwife sees a pregnant woman on a regular basis to check the progress of the pregnancy, to verify the absence of ex-novo disease, to monitor the state of preexisting disease and its possible effect on the ongoing pregnancy. A woman's schedule of antenatal appointment varies according to the presence of risk factors, such as diabetes, and local resources.

Some of the clinically and statistically more important risk factors that must be systematically excluded, especially in advancing pregnancy, are pre-eclampsia, abnormal placentation, abnormal fetal presentation and intrauterine growth restriction. For example, to identify pre-eclampsia, blood-pressure and albuminuria (level of urine protein) are checked at every opportunity.

Placenta praevia must be excluded (PP = low lying placenta that, at least partially, obstructs the birth canal and therefore warrants elective caesarean delivery); this can only be achieved with the use of an ultrasound scan. However, early placenta praevia is not alarming; this is because as the uterus grows along the pregnancy, the placenta may still move away. A placenta praevia is of clinical significance as from the 28th week of gestation. The current management includes a caesarean section. The type of caesarean section is determined by the position (anterior or posterior) of the placenta.

In late pregnancy fetal presentation must be established: cephalic presentation (head first) is the norm but the fetus may present feet-first or buttocks-first (breech), side-on (transverse), or at an angle (oblique presentation).

Intrauterine growth restriction is a general designation where the fetus is smaller than expected when compared to its gestational age (in this case, fetal growth parameters show a tendency to drop off from the 50th percentile eventually falling below the 10th percentile, when plotted on a fetal growth chart).[citation needed] Causes can be intrinsic (to the fetus) or extrinsic (maternal or placental problems).

Obstetrics V Obstetrician[edit]

There is some confusion here between obstetrics and obstetricians A search for obstetrician redirects to this page. This confusion is not helped by the definition used. A more correct and accepted definition would be that obstetrics is the branch of medicine dealing with childbirth and care of the mother. Obstetrics is not a person and cannot have a salary. There should be a separate page for obstetricians, as there is for example for midwives.

The reference to obstetrics being a surgical specialty is also confusing and I suggest incorrect. If surgery is required during pregnancy and childbirth then it would be provided by an obstetrician. However the reverse does not apply and being in obstetric care does not imply that any surgery will be involved. —Preceding unsigned comment added by 125.236.196.95 (talk) 03:19, 14 May 2010 (UTC)

This Article Isn't Helpful[edit]

I came looking for information on what an Obstetrician does... what kind of procedures they might learn to preform, etc. Instead, I feel like I got a bunch of random other information. This is actually, for that one fact, probably the worst article I've ever read on Wikipedia. I've never been motivated to write anything about any other article I've read. I feel like I'm reading more about general pregnancy issues & tests & not how any of these RELATE to obstetrics. There's no discussion about what training is required. This is a pretty long article but most of it is stuff I could find somewhere else under another heading. I understand why some of this info is here, but I just feel like it needs to be cleaned up & more obviously relational to Obstetrics. 65.5.11.253 (talk) 15:39, 15 July 2011 (UTC)

Then fixit. WP:Fixit Gillyweed (talk) 22:32, 15 July 2011 (UTC)

I would if I knew anything about the topic, but I don't, hence my desire to read an article about it. The article on "steampunks" is more complete, organized & sourced than this article.65.5.11.253 (talk) 14:02, 22 July 2011 (UTC)