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1. Introduction to obstetrics

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Module 1. First lecture in the course

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1. Introduction to obstetrics

  1. 1. Introduction to OB/GYN Department of OB/GYN, DSMA Medvedev M.V., MD, PhD
  2. 2. ContentsSubject of OB/GYNOrganization of OB/GYN serviceShort history of OB/GYNThe principles of preconception and antepartum care
  3. 3. Subject Obstetrics and Gynaecology (often abbreviated to OB/GYN, O&G or Obs & Gynae) are the two surgical specialties dealing with the female reproductive organs, and as such are often combined to form a single medical speciality and postgraduate training program. This combined training prepares the practicing OB/GYN to be adept at the surgical management of the entire scope of clinical pathology involving female reproductive organs, and to provide care for both pregnant and non-pregnant patients.
  4. 4. Organization Examples of subspecialty training available to physicians in the US are:  Maternal-Fetal Medicine - an obstetrical subspecialty that focuses on the medical and surgical management of high-risk pregnancies  Reproductive Endocrinology and Infertility - gynaecologic subspecialty focusing on the medical and surgical evaluation of women with problems related to the menstrual cycle and fertility  Gynaecological Oncology - gynaecologic subspecialty focusing on the medical and surgical treatment of women with cancers of the reproductive organs  Urogynaecology and Pelvic Reconstructive Surgery - gynaecologic subspecialty focusing on the diagnosis and surgical treatment of women with urinary incontinence and prolapse of the pelvic organs. Sometimes referred to (incorrectly) by laypersons as "Female Urology"  Advanced Laparoscopic Surgery  Family Planning - gynaecologic subspecialty offering training in contraception and (sometimes) pregnancy termination (abortion)  Pediatric and Adolescent Gynaecology  Menopausal and Geriatric Gynaecology
  5. 5. Organization In Ukraine we have 3 years of postgraduate training. Some OB/GYN surgeons elect to do further subspecialty training in programs known as fellowships after completing their residency training, although the majority choose to enter private or academic practice as general OB/GYNs. Fellowship training in an obstetric or gynaecologic subspeciality can range from one to four years in duration, and these fellowship programs usually have a research component involved with the clinical and surgical training.
  6. 6. Organization Ambulatory practiceMaternity Gynecologyhouse department(Labor &deliverydepartment)
  7. 7. Levels of OB/GYN care organizationIII II I
  8. 8. History The Kahun Gynaecological Papyrus is the oldest known medical text, (dated to about 1800 BCE) dealing with womens complaints - gynaecological diseases, fertility, pregnancy, contraception etc. Treatments are non surgical, comprising applying medicines to the affected body part or swallowing them. The womb is at times seen as the source of complaints manifesting themselves in other body parts. According to the Suda, the ancient Greek physician Soranus practiced in Alexandria and subsequently Rome. He was the chief representative of the school of physicians known as "Methodists." His treatise Gynaikeia is extant (first published in 1838, later by V. Rose as Gynaecology, in 1882, with a 6th-century Latin translation by Moschio, a physician of the same school). In the United States, J. Marion Sims is considered the father of American gynaecology. In Ukraine and Russia first school for obstetritians and 1st obstetric clinic were founded in 1757 due to order of Kondoidi. 1st professor of obstetrics and author of 1st russian book was Maksimovich-Ambodik (1744-1812)/
  9. 9. PRECONCEPTION COUNSELING AND CARE Family planning and pregnancy spacing Family history Genetic history Medical, surgical, psychiatric, and neurologic histories Current medications Substance use Domestic abuse and violence Nutrition Environmental and occupational exposures Immunity and immunization status Risk factors for sexually transmitted diseases Obstetric and gynecologic history Physical examination Assessment of socioeconomic, education, and culture context
  10. 10. Patients should be counseled regarding the benefits of the following activities: Exercise Reducing weight before pregnancy, if obese; increasing weight, if underweight Avoiding food faddism Avoiding pregnancy within one month of receiving a live attenuated vaccine (e.g., rubella) Preventing HIV infection Determining the time of conception by an accurate menstrual history Abstaining from tobacco, alcohol, and illicit drug use before and during pregnancy Taking 0.4 mg of folic acid daily while attempting pregnancy and during the first trimester of pregnancy Maintaining good control of any preexisting medical conditions (e.g., diabetes, hypertension, asthma, systemic lupus erythematosus, seizures, thyroid disorders, inflammatory bowel disease).
  11. 11. ANTEPARTUM CARE Diagnosing pregnancy and determining gestational age Monitoring the progress of the pregnancy with periodic examinations and appropriate screening tests Assessing the well-being of the woman and her fetus Providing patient education that addresses all aspects of pregnancy Preparing the patient and her family for her management during labor, delivery, and the postpartum interval. Detecting medical and psychosocial complications and instituting indicated interventions
  12. 12. Diagnosis of pregnancySubjective signsPhysical examinationmeasure human chorionic gonadotropin (hCG)Ultrasound examinationDetection of fetal heart activity (“fetal heart tones”)
  13. 13. Estimated Date of DeliveryGestational age is the number of weeks that have elapsed between the first day of the last menstrual period (not the presumed time of conception) and the date of deliveryNaegele’s rule is an easy way to calculate the EDD: add 7 days to the first day of the last normal menstrual flow and subtract 3 monthsObstetric ultrasound
  14. 14. Every prenatal assessment includes the following assessments:Blood pressureWeightUrinalysis for albumin and glucoseFundal height measurementFetal heart rate
  15. 15. Additional tests First trimester screening (10–13 weeks of gestation), which includes serum screening for pregnancy-associated plasma protein A (PPA) and beta-hCG, and an ultrasound assessment of nuchal transparency. Second trimester screening (15–20 weeks of gestation) consisting of triple (maternal serum α-fetal protein [MSAFP], estriol, and hCG) or quadruple (“quad”) (MSAFP, hCG, estriol, and inhibin) screening tests. Ultrasound examination for neural tube defects, in the second trimester
  16. 16. Additional testsGlucose challenge test (GCT) and a glucose tolerance test (GTT)Universal screening for group B streptococcus (GBS)Hemoglobin and hematocrit levels is repeated in the third trimester
  17. 17. Assessment of Fetal Well-BeingIndications for Fetal Testing• Antiphospholipid syndrome• Hyperthyroidism (poorly controlled)• Hemoglobinopathies (hemoglobin SS, SC, or S-thalassemia)• Significant heart disease• Systemic lupus erythematosus• Chronic renal disease• Insulin-treated diabetes mellitus• Hypertensive disorders
  18. 18. Assessment of Fetal Well-Being Pregnancy-related conditions:• Pregnancy-induced hypertension• Decreased fetal movement• Oligohydramnios• Polyhydramnios• Intrauterine growth restriction• Postterm pregnancy• Isoimmunization (moderate to severe)• Previous fetal demise• Multiple gestation (with significant growth discrepancy)
  19. 19. Assessment of Fetal Well-Being NONSTRESS TEST and CONTRACTION STRESS TEST