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ObstetricsObstetrics is the surgical specialty dealing with the care of a woman and her offspring during pregnancy, childbirth and the puerperium (the period shortly after birth).
The main rationale for these visits is surveillance for diseases of pregnancy which are detectable. Some examples are:
InductionAn obstetrician may recommend a woman have her labour induced if it is felt that continuation would be more dangerous to her, the foetus, or both. Reasons to induce include:
If a woman does not eventually labour by 41-42 weeks, induction is performed, as the placenta becomes unstable after this date.
Induction is achieved by 3 methods:
LabourDuring labour itself, the obstetrician may be called on to do a number of things:
Emergencies in obstetricsTwo main emergencies are eclampsia and ectopic pregnancy.
Ectopic pregnancy is when an embryo implants in the Fallopian tube or (rarely) on the ovary or inside the peritoneal cavity. Tubal pregnancies are very dangerous, as at about 4-10 weeks the tube bursts, causing massive internal bleeding.
Ectopic pregnancy must be considered in any woman with abdominal pain who has the slightest chance of being pregnant. Diagnosis is by a positive pregnancy test and a uterus empty on ultrasound. Treatment is by laparoscopy, and the tube is incised and excavated.
Pre-eclampsia is a disease caused by mysterious toxins secreted by the placenta. These toxins act on the vascular endothelium, causing hypertension and proteinuria. If severe, it progresses to fulminant pre-eclampsia, with headaches and visual disturbances.
This is a prelude to eclampsia, where a convulsion occurs, which is often fatal.
The only treatment for eclampsia, or advancing pre-eclampsia is delivery, either by induction or Caesarean section. Women can be stabilised temporarily with magnesium sulphate. Delivery as early as 28 weeks is not unknown.
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