User:Alejandra Navarro Rosado/Obstetrics

Obstetrics is the field of study concentrated on pregnancy, childbirth, and the postpartum period. As a medical specialty, obstetrics is combined with gynaecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgical field. An obstetrician/gynecology is the one who monitors all stages of pregnancy including the part of the labor. The OB/GYN does all the types of examinations on the pregnancy also is the one who does the ultrasound and finds the gender of the baby. Also, they specialized in treating women not only on their pregnancy but also with their reproductive systems, disease, etc.

Prenatal care[edit]

Prenatal care is important in screening for various complications of pregnancy. Most of the women that are pregnant don't do their prenatal care which can which can cause complications and high risk when left untreated. Normally the women that don't do their prenatal care mostly are immigrants, black, Asian, poor and other causes that leave them to the decision of not having their prenatal care. These situations have normally been tried to be evaluated, but since they are not always concurrent situations, we could not have exact data. Despite this, they take them to evaluation and divide the cases into internal and external barriers.This includes routine office visits with physical exams and routine lab tests:

First trimester[edit]

Routine tests in the first trimester of pregnancy generally include:

• Complete blood count
• Blood type
• Rh-negative antenatal patients should receive RhoGAM at 28 weeks to prevent Rh disease.
• Indirect Coombs test) to assess risk of hemolytic disease of the newborn
• Rapid plasma reagin test to screen for syphilis
• Rubella antibody screen
• HBsAg test to screen for hepatitis B
• Testing for chlamydia (and gonorrhea when indicated)
• Mantoux test for tuberculosis
• Urinalysis and culture
• HIV screen

Down syndrome karyotype

Genetic screening for Down syndrome (trisomy 21) and Edwards syndrome (trisomy 18), the national standard in the United States, is rapidly evolving away from the AFP-quad screen, done typically in the second trimester at 16–18 weeks.Studies have shown that the free hCG, which is a second trimester marker, is one of the detection markers that are productive to down syndrome on the first trimester. The newer integrated screen (formerly called F.A.S.T.E.R for First And Second Trimester Early Results) can be done at 10 plus weeks to 13 plus weeks with an ultrasound of the fetal neck (thicker nuchal skin correlates with higher risk of down syndrome being present) and two chemicals (analytes), pregnancy-associated plasma protein Aand human chorionic gonadotropin (pregnancy hormone level itself). It gives an accurate risk profile very early. A second blood screen at 15 to 20 weeks refines the risk more accurately. The cost is higher than an "AFP-quad" screen due to the ultrasound and second blood test, but it is quoted to have a 93% pick up rate as opposed to 88% for the standard AFP/QS. This is an evolving standard of care in the United States.^{[citation needed]}

Second trimester[edit]

• MSAFP/quad. screen (four simultaneous blood tests) (maternal serum AFP, inhibit A, estriol, & βHCG) – elevations, low numbers or odd patterns correlate with neural tube defect risk and increased risks of trisomy 18 or trisomy 21.
• Ultrasound either abdominal or transvaginal to assess cervix, placenta, fluid and baby.
• Amniocentesis is the national standard (in what country) for women over 35 or who reach 35 by mid pregnancy or who are at increased risk by family history or prior birth history.

The liver disease is a very rare one, a pregnancy that can have this is not said that is no healthy since most of them are. There are liver disease states but the one on the second trimester is call ICP, intrahepatic cholestasis of pregnancy. The ICP is pruritus and elevated levels of bile acid that is found in the second half of the pregnancy, which is not found after the delivery.

Third trimester[edit]

• Hematocrit (if low, the mother receives iron supplements)
• Group B Streptococcus screen. If positive, the woman receives IV penicillin or ampicillin while in labor—or, if she is allergic to penicillin, an alternative therapy, such as IV clindamycin or IV vancomycin.
• Glucose loading test (GLT) – screens for gestational diabetes; if > 140 mg/dL, a glucose tolerance test (GTT) is administered; a fasting glucose > 105 mg/dL suggests gestational diabetes.

Most doctors do a sugar load in a drink form of 50 grams of glucose in cola, lime or orange and draw blood an hour later (plus or minus 5 minutes). The standard modified criteria have been lowered to 135 since the late 1980s.

The result of an Ultrasonography: a black and white image that shows a clear view of the interior abdomen.

Fetal assessments[edit]

A dating scan at 12 weeks.

A fetal 3D-Sonography

Obstetric ultrasonography is routinely used for dating the gestational age of a pregnancy from the size of the fetus, determine the number of fetuses and placentae, evaluate for an ectopic pregnancy and first trimester bleeding, the most accurate dating being in first trimester before the growth of the foetus has been significantly influenced by other factors. Ultrasound is also used for detecting congenital anomalies (or other foetal anomalies) and determining the biophysical profiles (BPP), which are generally easier to detect in the second trimester when the foetal structures are larger and more developed. Specialized ultrasound equipment can also evaluate the blood flow velocity in the umbilical cord, looking to detect a decrease/absence/reversal or diastolic blood flow in the umbilical artery. If we have an umbilical artery with a pH lower than 7.00 it means that there is an increase in multi-organ morbidity.

X-rays and computerized tomography (CT) are not used, especially in the first trimester, due to the ionizing radiation, which has teratogenic effects on the foetus. No effects of magnetic resonance imaging (MRI) on the foetus have been demonstrated, but this technique is too expensive for routine observation. Instead, obstetric ultrasonography is the imaging method of choice in the first trimester and throughout the pregnancy, because it emits no radiation, is portable, and allows for realtime imaging.

Ultrasound scan

The safety of frequent ultrasound scanning has not been confirmed. Despite this, increasing numbers of women are choosing to have additional scans for no medical purpose, such as gender scans, 3D and 4D scans. A normal gestation would reveal a gestational sac, yolk sac, and fetal pole. The gestational age can be assessed by evaluating the mean gestational sac diameter (MGD) before week 6, and the crown-rump length after week 6. Multiple gestation is evaluated by the number of placentae and amniotic sacs present.

Other tools used for assessment include:

• Fetal screening is used to help assess the viability of the fetus, as well as congenital abnormalities.
• Fetal karyotype can be used for the screening of genetic diseases. This can be obtained via amniocentesis or chorionic villus sampling (CVS)
• Foetal haematocrit for the assessment of foetal anemia, Rh isoimmunization, or hydrops can be determined by percutaneous umbilical blood sampling(PUBS), which is done by placing a needle through the abdomen into the uterus and taking a portion of the umbilical cord.
• Fetal lung maturity is associated with how much surfactant the fetus is producing. Reduced production of surfactant indicates decreased lung maturity and is a high risk factor for infant respiratory distress syndrome. Typically a lecithin:sphingomyelin ratio greater than 1.5 is associated with increased lung maturity.
• Nonstress test (NST) for fetal heart rate
• Oxytocin challenge test

Exercise during pregnancy

Benefits (potential benefits):

• Same benefits as a non pregnant women.
• Good cardiorespiratory resistance, muscular strength and endurance, flexibility, and body composition.
• Maintenance and/or best agility, coordination, equilibrium, energy, reaction time and velocity.
• Prevent excessive gestational weight gain.
• Preclusion or reduction of orthopedic symptoms.
• Prevention of urinary incontinence - pelvic floor muscle exercise can help but this hasn't been established for a long-term benefit.
• Reduction risk of delivery an macrosomic or large for gestational age newborn.
• Potencial decrease in risk of developing diabetes gestacional.
• Possible reduction in risk of developing pre-eclampsia .
• Possible reduction in the duration of the first stage of labour but no reduction in the second stage.
• Possible reduction in risk of cesarean delivery.

Risks (potential risks):

• Maternal trauma (can lead to an obstetric complication).
• Hyperthermia - having a maternal core temperature of 102.2°F (39°C) can increased the risk for neural tube defects. It is unlikely that during exercise the body's core will reach teratogenic levels while doing normal exercise.
• Reduction in uteroplacental blood flow
• Impaired fetal growth
• Light exercise or physical activity probably does not increase risk of miscarriage or premature delivery in women uncomplicated pregnancies.