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Amniotomy
Artificial rupture of membranes (AROM), also known as an amniotomy, is performed by a midwife or obstetrician and was once thought to be an effective means to induce or accelerate labor. The membranes can be ruptured using a specialized tool, such as an amnihook or amnicot, or they may be ruptured by the proceduralist's finger. The different techniques for artificial rupture of membranes have not been extensively compared in the literature. In one study comparing amnihook versus amnicot for artificial rupture of membranes, use of an amnicot was associated with fewer neonatal scalp lacerations. With the amnihook method, a sterile plastic hook is inserted into the vagina and used to puncture the membranes containing the amniotic fluid. With the membranes punctured, amniotic fluid is able to escape from the uterus and exit the vagina. The absence of a fluid buffer between the fetus and uterus stimulates uterine contractions, which are also promoted by the rush of prostaglandins from ...
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Midwife
A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery. The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; concentrating on being experts in what is normal and identifying conditions that need further evaluation. In most countries, midwives are recognized as skilled healthcare providers. Midwives are trained to recognize variations from the normal progress of labor and understand how to deal with deviations from normal. They may intervene in high risk situations such as breech births, twin births, and births where the baby is in a posterior position, using non-invasive techniques. For complications related to pregnancy and birth that are beyond the midwife's scope of practice, including surgical and instrumental deliveries, they refer their patients to physicians or surgeons. In many parts of the world, these professions work in tandem to provid ...
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Obstetrician
Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgical field. Main areas Prenatal care Prenatal care is important in screening for various complications of pregnancy. This includes routine office visits with physical exams and routine lab tests along with telehealth care for women with low-risk pregnancies: Image:Ultrasound_image_of_a_fetus.jpg, 3D ultrasound of fetus (about 14 weeks gestational age) Image:Sucking his thumb and waving.jpg, Fetus at 17 weeks Image:3dultrasound 20 weeks.jpg, Fetus at 20 weeks First trimester 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 (AGT) to assess risk of hemolytic ...
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Induction Of Labor
Labor induction is the process or treatment that stimulates childbirth and delivery. Inducing (starting) labor can be accomplished with pharmaceutical or non-pharmaceutical methods. In Western countries, it is estimated that one-quarter of pregnant women have their labor medically induced with drug treatment. Inductions are most often performed either with prostaglandin drug treatment alone, or with a combination of prostaglandin and intravenous oxytocin treatment. Medical uses Commonly accepted medical reasons for induction include: * Postterm pregnancy, i.e. if the pregnancy has gone past the end of the 42nd week. * Intrauterine fetal growth restriction (IUGR). * There are health risks to the woman in continuing the pregnancy (e.g. she has pre-eclampsia). * Premature rupture of the membranes (PROM); this is when the membranes have ruptured, but labor does not start within a specific amount of time. * Premature termination of the pregnancy (abortion). * Fetal death in utero a ...
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Vagina
In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen. At the deep end, the cervix (neck of the uterus) bulges into the vagina. The vagina allows for sexual intercourse and birth. It also channels menstrual flow, which occurs in humans and closely related primates as part of the menstrual cycle. Although research on the vagina is especially lacking for different animals, its location, structure and size are documented as varying among species. Female mammals usually have two external openings in the vulva; these are the urethral opening for the urinary tract and the vaginal opening for the genital tract. This is different from male mammals, who usually have a single urethral opening for both urination and reproduction. The vaginal opening is much larger than the nearby urethral openi ...
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Amniotic Fluid
The amniotic fluid is the protective liquid contained by the amniotic sac of a gravid amniote. This fluid serves as a cushion for the growing fetus, but also serves to facilitate the exchange of nutrients, water, and biochemical products between mother and fetus. For humans, the amniotic fluid is commonly called water or waters (Latin liquor amnii). Development Amniotic fluid is present from the formation of the gestational sac. Amniotic fluid is in the amniotic sac. It is generated from maternal plasma, and passes through the fetal membranes by osmotic and hydrostatic forces. When fetal kidneys begin to function around week 16, fetal urine also contributes to the fluid. In earlier times, it was believed that the amniotic fluid was composed entirely of fetal urine. The fluid is absorbed through the fetal tissue and skin. After 22 to 25 week of pregnancy, keratinization of an embryo's skin occurs. When this process completes around the 25th week, the fluid is primarily absor ...
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Uterus
The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uterus is a hormone-responsive sex organ that contains glands in its lining that secrete uterine milk for embryonic nourishment. In the human, the lower end of the uterus, is a narrow part known as the isthmus that connects to the cervix, leading to the vagina. The upper end, the body of the uterus, is connected to the fallopian tubes, at the uterine horns, and the rounded part above the openings to the fallopian tubes is the fundus. The connection of the uterine cavity with a fallopian tube is called the uterotubal junction. The fertilized egg is carried to the uterus along the fallopian tube. It will have divided on its journey to form a blastocyst that will implant itself into the lining of the uterus – the endometrium, w ...
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Prostaglandins
The prostaglandins (PG) are a group of physiologically active lipid compounds called eicosanoids having diverse hormone-like effects in animals. Prostaglandins have been found in almost every tissue in humans and other animals. They are derived enzymatically from the fatty acid arachidonic acid. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring. They are a subclass of eicosanoids and of the prostanoid class of fatty acid derivatives. The structural differences between prostaglandins account for their different biological activities. A given prostaglandin may have different and even opposite effects in different tissues in some cases. The ability of the same prostaglandin to stimulate a reaction in one tissue and inhibit the same reaction in another tissue is determined by the type of receptor to which the prostaglandin binds. They act as autocrine or paracrine factors with their target cells present in the immediate vicinity of the site of their sec ...
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Meconium
Meconium is the earliest stool of a mammalian infant resulting from defecation. Unlike later feces, meconium is composed of materials ingested during the time the infant spends in the uterus: intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile, and water. Meconium, unlike later feces, is viscous and sticky like tar – its color usually being a very dark olive green and it is almost odorless. When diluted in amniotic fluid, it may appear in various shades of green, brown, or yellow. It should be completely passed by the end of the first few days after birth, with the stools progressing toward yellow (digested milk). Clinical significance Meconium in amniotic fluid Meconium is normally retained in the infant's bowel until after birth, but sometimes it is expelled into the amniotic fluid (also called "amniotic liquor") prior to birth or during labor and delivery. The stained amniotic fluid (called "meconium liquor" or "meconium-stained liquor") is recognized by ...
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Breech Position
A breech birth is when a baby is born bottom first instead of head first, as is normal. Around 3–5% of pregnant women at term (37–40 weeks pregnant) have a breech baby. Due to their higher than average rate of possible complications for the baby, breech births are generally considered higher risk. Breech births also occur in many other mammals such as dogs and horses, see veterinary obstetrics. Most babies in the breech position are delivered via caesarean section because it is seen as safer than being born vaginally. Doctors and midwives in the developing world often lack many of the skills required to safely assist women giving birth to a breech baby vaginally. Also, delivering all breech babies by caesarean section in developing countries is difficult to implement as there are not always resources available to provide this service. OB-GYNs do not recommend home births if a breech birth is expected, even when attended by a medical professional. Cause With regard to the f ...
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Head Engagement
A cephalic presentation or head presentation or head-first presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex presentation, where the occiput is the leading part (the part that first enters the birth canal). All other presentations are abnormal ( malpresentations) and are either more difficult to deliver or not deliverable by natural means. Engagement The movement of the fetus to cephalic presentation is called ''head engagement''. It occurs in the third trimester. In head engagement, the fetal head descends into the pelvic cavity so that only a small part (or none) of it can be felt abdominally. The perineum and cervix are further flattened and the head may be felt vaginally. Head engagement is known colloquially as the ''baby drop'', and in natural medicine as the ''lightening'' because of the release of pressure on the upper abdomen and renewed ...
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Umbilical Cord Prolapse
Umbilical cord prolapse is when the umbilical cord comes out of the uterus with or before the presenting part of the baby. The concern with cord prolapse is that pressure on the cord from the baby will compromise blood flow to the baby. It usually occurs during labor but can occur anytime after the rupture of membranes. The greatest risk factors are an abnormal position of the baby within the uterus and a premature or small baby. Other risk factors include a multiple pregnancy, more than one previous delivery, and too much amniotic fluid. Whether medical rupture of the amniotic sac is a risk is controversial. The diagnosis should be suspected if there is a sudden decrease in the baby's heart rate during labor. Seeing or feeling the cord confirms the diagnosis. Management focuses on quick delivery, usually by cesarean section. Filling the bladder or pushing up the baby by hand is recommended until this can take place. Sometimes women will be placed in a knee-chest position ...
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Cephalic Presentation
A cephalic presentation or head presentation or head-first presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex presentation, where the occiput is the leading part (the part that first enters the birth canal). All other presentations are abnormal (malpresentations) and are either more difficult to deliver or not deliverable by natural means. Engagement The movement of the fetus to cephalic presentation is called ''head engagement''. It occurs in the third trimester. In head engagement, the fetal head descends into the pelvic cavity so that only a small part (or none) of it can be felt abdominally. The perineum and cervix are further flattened and the head may be felt vaginally. Head engagement is known colloquially as the ''baby drop'', and in natural medicine as the ''lightening'' because of the release of pressure on the upper abdomen and renewed ...
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