History: First century a Greek text on Obstetrics Pregnancy, - PDF document

Pregnancy, Chidlbirth, Puerpurum 7/24/2010 History: • First century a Greek text on Obstetrics Pregnancy, Childbirth and the • 1513 • 1595 ‐ Puerpurium p • 1668 Midwifery Text Fernando Vega, MD • New Orleans first to license midwives in1772 Puerperal Fever • Mercurialsi (1530 ‐ 1606) named it “Milk • Obstetrical Forcepts Fever” Used in 11 th and 12 th Centuries to extract • • Lying ‐ In Hospitals – epidemics of 1 out of dead fetuses every five patients • 1795 – Alexander Gordon noticed it occurred • 1795 Alexander Gordon noticed it occurred • Chamberlen Family passed on the secret h b l il d h with patients who had practitioners who for three generations over 100 years. previously attended other patients with Puerperal fever • 1843 – Oliver Wendell Holmes(34yo) wrote about others’ observations and was attacked by colleauges Puerperal Fever Puerperal Fever • 1854 – Meig’s advocated copious blood • May 15, 1847 Semmelweis made all his staff letting as treatment and medical students wash their hands. The mortality rate plummeted to 3%. He was not • 1846 – Ignaz Philipp Semmelweis, in given a reappointment. Died 1865, mentally given a reappointment Died 1865 mentally charge of a division of a lying in hospital charge of a division of a lying ‐ in hospital disturbed, emotionally unstable. observed that puerperal fever was negligible in women who delivered before arriving at his • 1897 Lous Pasteur identified the hemolytic wing. His friend had later died from a knife streptococcus scratch with changes in his body similar to that of those that died with puerperal fever Fernando Vega, MD 1

Pregnancy, Chidlbirth, Puerpurum 7/24/2010 Gynecologic Endocrinology Gynecologic Endocrinology • ‐ See Handout. • ‐ What is left behind becomes a corpus luteum which has a 14 day life span and • ‐ FSH (Follicle Stimulating Hormone) from produces progesterone for 14 days the pituitary to induce the ovaries to make follicles and estrogen follicles and estrogen • • ‐ The progesterone develops and supports The progesterone develops and supports the endometrium so the fertilized egg can • ‐ One of the follicles ruptures on day 14 implant. and produces an egg (ovulation) to go into the fallopian tubes awaiting fertilization. Gynecologic Endocrinology Pregnancy • What happens in pregnancy • Naegles rule for predincting EDC: Add three months and subtract 7 days from LMP • What happens with taking oral contraceptives Pregnancy Pregnancy • Subjective Symptoms: • Objective symptoms • Cessation of Menses • Goodell’s sign – beginning of second month • Morning Sickness • Hegar’s sign – softening of the lower ’ i f i f h l • Breast Changes segment • Enlargement of abdomen • Quickening – 18 weeks Fernando Vega, MD 2

Pregnancy, Chidlbirth, Puerpurum 7/24/2010 Pregnancy Pregnancy • Breast signs • Abnormal pregnancy • • Spontaneous abortion Auscutation – 18 th week • • Ectopic pregnancy • • Hemolytic disease of the Newborn • Uterine size at pubis, umbilicus, xyphoid • Bleeding in pregnancy • Placenta previa • Abruption placenta • Rupture of the uterus Preeclampsia ‐ eclampsia • Pregnancy Pregnancy • Preeclampsia ‐ eclampsia • Normal labor • Pelvimetry • Stages of Labor • Fetal monitoring Complications of Labor The Puerpurium • Premature labor • Flowing delivery of placenta to resumption of ovulatory menstrual cycles (6 ‐ 8weeks) • Dystocia • • Cord accidents, knots, coils, shortening • Post partum bleeding bl di • Usually 60 cm (30 ‐ 120cm) • Uterine atony, Lacerations • Twins • Fever, infections • Cesarean secton • Endometritis, mastitis, UTI’s Fernando Vega, MD 3

Pregnancy, Chidlbirth, Puerpurum 7/24/2010 Evaluation of Fetal Status The Infant • Evaluation of the Fetal Status • Physiology of the Fetus • Amniocentesis • Lung maturity • Urinary estriol • Circulation • Ultransonography • Assessment of maturity • Nonstress test. • Tone • Skin • Ear folds • Genitalia Plantar Creases • Fernando Vega, MD 4