Transcript Chapter 9

CHAPTER 9
Obstetrics and
Neonatology
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
CHAPTER 9
Lesson 9.1
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
2
OBJECTIVES
 Identify organs and structures related to pregnancy.
 Define and spell word parts related to obstetrics and
neonatology.
 Define, pronounce, and spell disease and disorder terms
related to obstetrics and neonatology.
 Define, pronounce, and spell surgical and diagnostic terms
related to obstetrics and neonatology.
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
3
THREADED CASE STUDY: ALAN & JACKIE
 Let's begin our study of obstetrics and neonatology by returning
to Jackie and Alan from Module 8, who, after successful in vitro
fertilization (IVF), are expecting their first child. IVF is a method
of fertilizing human ova outside the woman's body and then
placing the zygote into the uterus.
 Today Jackie and Alan are having their first meeting with
their obstetrician (OB), Dr. Kwan. An obstetrician is a physician
who specializes in obstetrics (also abbreviated OB). Obstetrics is
a branch of surgery dealing with pregnancy, childbirth,
and puerperium, which is the period from delivery until the
reproductive organs return to normal, usually about 6 weeks.
Jackie and Alan could also have chosen to visit a midwife.
Midwifery is the practice of assisting at childbirth; a midwife is a
practitioner.
 Before we go further into Jackie and Alan's case, let's learn
about the process of conception.
4
OBSTETRICS AND NEONATOLOGY
 obstetrics: branch of medicine that deals with childbirth and
the care of the mother before and after birth
 neonatology: branch of medicine that deals with the diagnosis
and treatment of disorders of the newborn
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
5
TERMS RELATING TO PREGNANCY





gamete: mature germ cell
ovulation: expulsion of a mature ovum
conception or fertilization: beginning of pregnancy
zygote: cell formed from the union of the sperm and ovum
embryo: unborn of fspring, from implantation of the zygote to
end of the 8th week
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
6
 https://evolve.elsevier.com/objects/lafleur8e_v1/mod09/me
dia/09s01l0304/09s01l0304p1 .html
7
TERMS RELATING TO
PREGNANCY (CONT’D)
 fetus: unborn of fspring from beginning of the 9th week of
pregnancy until birth
 gestation, pregnancy: development of a new individual from
conception to birth
 implantation: embedding of the zygote in the uterine lining
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
8
CONCEPTION
Once conception occurs, the zygote begins a process of rapid
cell division as it continues its journey through the fallopian
tube (see image). The zygote comes to
rest in the uterine wall 7 to 10 days after
ovulation. This embedding itself into the
uterine lining is called implantation.
(This process is also called nidation,
from the Latin nidus, meaning nest.)
From the fourth day after fertilization
to the end of the eighth week, the zygote is called an embryo.
An embryo cannot survive outside the womb.
9
TERMS RELATING TO
PREGNANCY (CONT’D)
 placenta, or afterbirth:
grows on the wall of the
uterus during pregnancy;
allows for nourishment of
the unborn child
 amniotic sac:
membranous bag that
surrounds the fetus
before delivery
 chorion: outermost layer of
the fetal membrane
 amnion: innermost layer of
the fetal membrane
 amniotic fluid: fluid within
the amniotic sac
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
10
OVULATION, FERTILIZATION,
AND IMPLANTATION
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
11
DEVELOPMENT OF THE FETUS
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
12
HUMAN MALE FETUS AT 68 DAYS
(47 MM)
A . right
B. front
C. left
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
13
COMBINING FORMS OF
OBSTETRICS AND NEONATOLOGY
 amni/o,
amnion/o
 chori/o
 embry/o
 fet/o, fet/i
 gravid/o
 Lact/o




Nat/o
Omphal/o
Par/o, part/o
Puerper/o
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
14
COMBINING FORMS COMMONLY
USED IN OBSTETRICS AND NEONATOLOGY







cephal/o
esophag/o
pelvi, pelv/o
prim/i
pseud/o
pylor/o
terat/o
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
15
FETAL DEVELOPMENT
 https://evolve.elsevier.com/objects/lafleur8e_v1/mod09/me
dia/09s01l0407/09s01l0407p1.html
16
SPEAK AND SPELL
 https://evolve.elsevier.com/Courses/14615_sjohnson2458_1
001#/content/463634114?view=https:% 2F%2Fevolve.elsevier
.com%2Fobjects%2Flafleur8e_v1%2Fmod09%2F09s01l0404.h
tml
17
CASE STUDY: JACKIE
 Like most pregnant women, Jackie is absolutely thrilled at the
prospect of first-time motherhood—despite all those big
hormonal fluctuations.
 You will recall that pregnancy is the period of growth and
development from fertilization of the ovum until birth. It may
help you remember a number of pregnancy -related terms if
you know that there are three combining forms that mean
pregnancy: gravid/o, cyes/o, and cyes/i, with gravid/o being
the most commonly seen term. The study of pregnancy is
called cyesiology. Gravid means pregnant. A gravida is either
a pregnant woman, or a woman who has been pregnant,
regardless of pregnancy outcome .
18
CASE STUDY: JACKIE
 The term gravida is represented in more complex terms by the
suf fix -gravida.
 For example, Jackie is gravida. Moreover, she is a
primigravida, meaning this is her first ( primi-) pregnancy. A
multigravida is a woman who has been pregnant two or more
times. (The prefix multi - means many.) A nulligravida is
woman has never been pregnant ( nulli- means none). In these
terms, the suf fix -a denotes a noun.
19
PREFIXES





ante-, premicromultinullipost-
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
20
SUFFIXES









-amnios
-cyesis
-e
-is
-partum
-rrhexis
-tocia
-um
-us
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
21
WORD PARTS WITH SIMILAR MEANINGS
Word Part
nat/o
par/o, part/o
puerper/o
-partum
-tocia
Meaning
birth
bear, give birth to, labor, childbirth
childbirth
childbirth, labor
birth, labor
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
22
FOUR “-RRH” SUFFIXES
Suf fix
-rrhea
-rrhagia
-rrhaphy
-rrhexis
Meaning
flow, discharge
rapid flow of blood
suturing, repairing
rupture
Chapter
4
5
6
9
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
23
CLICKER QUESTION
Which two of the following word parts mean pregnancy?
a) gravid/o and -cyesis
b) part/o and -partum
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
24
THREADED CASE STUDY
 At their next visit to Dr. Kwan, Alan asks, "So how do you know
when our due date is?"
 "Well, babies are never an exact science," Dr. Kwan says, "but
we do have a few tools to help us calculate the expected date
of delivery." The expected date of deliver y is abbreviated EDD.
 Pregnancy or gestation usually lasts about 266 days, or 38
weeks, although this varies. An infant born before completing
37 weeks of gestation is considered a premature infant.
 Dr. Kwan calculates Jackie's due date by counting 280 days
from the first day of her last menstrual period.
25
THREADED CASE STUDY: STAGES OF BIRTH
 Dr. Kwan summarizes what Alan and Jackie might expect
when the time actually comes.
 Labor may be divided into three or four stages. (The fourth
stage is not always recognized as a part of labor because it
occurs after childbirth.) The first stage is cervical dilation,
with the onset of regular contractions of the uterus. When the
cervix opening is completely dilated and ef faced, the second
stage of expulsion begins. During this stage, the infant is
completely expelled from the body.
 The third stage, shown in the illustration, occurs after the
child is born and does not end until the placenta and
membranes are also expelled. This is called the placental
stage. The fourth stage, when considered part of labor, is the
postpartum stage, the hour or two after delivery when muscle
tone is restored to the uterus.
26
SPEAK AND SPELL
 https://evolve.elsevier.com/Courses/14615_sjohnson2458_1
001#/content/463634114?view=https:%2F%2Fevolve.elsevier
.com%2Fobjects%2Flafleur8e_v1%2Fmod09%2F09s01l0504.h
tml
27
OBSTETRIC DISEASE AND DISORDER
TERMS BUILT FROM WORD PARTS







amnionitis
chorioamnionitis
choriocarcinoma
dystocia
hysterorrhexis
oligohydramnios
polyhydramnios
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
28
THREADED CASE STUY
 Jackie and Alan have had a good time remodeling a
guestroom into a nursery. And as for the pregnancy itself? "So
far, so good!" But one thing that continues to weigh a bit on
Jackie and Alan's minds is how to have a safe pregnancy. They
want to stay on top of anything that could go wrong, "while
still enjoying this pregnancy," Alan says. "Having a good
obstetrician helps."
 Several conditions can occur during the course of pregnancy
that can threaten both maternal and fetal health.
29
OBSTETRIC DISEASE AND DISORDER
TERMS NOT BUILT FROM WORD PARTS






abortion
abruptio placentae
eclampsia
ectopic pregnancy
placenta previa
preeclampsia
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
30
ABRUPTIO PLACENTAE
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
31
PLACENTA PREVIA
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
32
VIDEO
https://evolve.elsevier.com/objects/lafleur8e_v1/mod09/media/09s02l020
5/09s02l0205p1.html
33
ECTOPIC PREGNANCY
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
34
THREADED CASE STUDY
 In the fifteenth week of pregnancy, Dr. Kwan recommends
that Jackie undergo amniocentesis, a surgical puncture to
aspirate amniotic fluid to assess fetal health (see
illustration).
 If there is a scanty amount of amniotic fluid, the condition is
referred to as oligohydramnios. Olig/o means scanty; hydr/o
means fluid; -amnios means amnion. If there is more than the
normal amount, the condition is called polyhydramnios. Poly means excessive.
35
NEONATOLOGY DISEASE AND DISORDER
TERMS BUILT FROM WORD PARTS





microcephalus
omphalitis
omphalocele
pyloric stenosis
tracheoesophageal fistula
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
36
Pyloric Stenosis
Approximately 1 in 200 newborns is
affected by a disorder of the digestive tract
known as pyloric stenosis. This condition is
characterized by a narrowing of the
muscular ring, the pyloric sphincter that
separates the stomach from the first
portion of the small intestine. Surgical
correction of the disorder may be required.
37
SPEAK AND SPELL
 https://evolve.elsevier.com/Courses/14615_sjohnson2458_1
001#/content/463634114?view=https:%2F%2Fevolve.elsevier
.com%2Fobjects%2Flafleur8e_v1%2Fmod09%2F09s02l0304.h
tml
38
CLICKER QUESTION
The correct labeling of the diagram is:
a)
b)
omphalocele
omphalcele
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
39
THREADED CASE STUDY
 Jackie has developed high blood pressure very quickly and
unexpectedly. Dr. Kwan also notices that her legs and feet look
swollen. He gives her medication to control the high blood
pressure and prescribes that she quit working until after the
baby is born. Her condition is known as preeclampsia.
 Preeclampsia occurs during pregnancy or shortly after delivery.
Its main symptom is the acute onset of high blood pressure. This
disorder is also characterized by large quantities of protein in
the urine and swelling of the legs and feet. Preeclampsia may be
mild or severe. If convulsions occur, the condition has progressed
to a complication known as eclampsia, or toxemia, the gravest
form of pregnancy -induced hypertension. Treatment includes bed
rest and the use of medications to lower the blood pressure and
prevent seizures.
40
NEONATOLOGY DISEASE AND DISORDER
TERMS NOT BUILT FROM WORD PARTS








cleft lip and palate
Down syndrome
erythroblastosis fetalis
fetal alcohol syndrome (FAS)
esophageal atresia
gastroschisis
respiratory distress syndrome (RDS)
spina bifida
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
41
THREADED CASE STUDY
 With her preeclampsia under control, no further symptoms
develop, and finally, Jackie and Alan are about to have their
baby. Labor pains begin while they are at their favorite
restaurant, and soon Jackie's water breaks. Alan takes her
straight to the hospital. She seems to be experiencing labor
pains that are quite strong. Alan asks Dr. Kwan if these are
"normal." Dr. Kwan checks the perineum and assesses the
baby's position.
 What constitutes normal pain in labor and delivery? What
kinds of problems can arise? Unfortunately, things can go
wrong during labor and delivery. Dystocia describes any
dif ficult labor.
42
Spina bifida (Fig. B) is a congenital
defect in the vertebral column caused
by the failure of the vertebral arch to
fuse. The name spina bifida means
divided spine.
43
ESOPHAGEAL ATRESIA
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
44
Cleft lip and palate.
Cleft lip and cleft palate
(Fig. A) involve a
congenital split of the lip
and roof of the mouth,
respectively. The word cleft
means gap
45
Gastroschisis
46
Down syndrome.
Down syndrome, is an inherited, or
genetic, chromosomal abnormality.
Infants with this syndrome are often
identifiable by a distinct set of physical
characteristics including slanted eyes,
flattened nose, enlarged tongue, and
short stubby hands and feet. A
hallmark feature of Down syndrome is
mental retardation, which may vary
from moderate to severe.
47
SPEAK AND SPELL
 https://evolve.elsevier.com/Courses/14615_sjohnson2458_1
001#/content/463634114?view=https:%2F%2Fevolve.elsevier
.com%2Fobjects%2Flafleur8e_v1%2Fmod09%2F09s02l0411 .h
tml
48
THREADED CASE STUDY
 Let's turn our attention now to common
diagnostic procedures. You may recall
that in the fifteenth week of pregnancy,
Dr. Kwan had Jackie undergo a procedure
called amniocentesis, which, you'll
remember, is a surgical puncture done to
aspirate amniotic fluid to assess fetal
health.
 In a second procedure called
amnioscopy, an instrument called an
amnioscope is used for visual
examination of both the amniotic fluid
and the fetus.
49
OBSTETRIC SURGICAL TERMS
BUILT FROM WORD PARTS
 amniotomy
 episiotomy
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
50
OBSTETRIC DIAGNOSTIC TERMS
BUILT FROM WORD PARTS
Diagnostic imaging
pelvic sonography
Other
amniocentesis
amnioscope
amnioscopy
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
51
ULTRASOUND IMAGE SHOWING
THE FOREARM OF THE FETUS
s, skinline; m, muscle; w, wrist; h, hand.
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
52
AMNIOCENTESIS
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
53
CESAREAN SECTION
 You may recall from the previous
section the discussion of abruptio
placentae and placenta previa. In
these and other conditions, if
severe hemorrhaging occurs, an
immediate cesarean section (C/S,
C-section) may be necessary to
save the mother's life.
 A cesarean section is the removal
of the fetus through an incision in
the abdomen and uterus. A woman
can often still have a vaginal birth
on subsequent pregnancies after
having had a C-section. This is
referred to as a VBAC (vaginal
birth after cesarean section).
54
55
CHAPTER 9
Lesson 9.2
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
56
OBJECTIVES
 Define, pronounce, and spell complementary terms related to
the female reproductive system.
 Interpret the meaning of abbreviations related to obstetrics
and neonatology.
 Interpret, read, and comprehend medical language in
simulated medical statements and documents.
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
57
THREADED CASE STUDY
 At last! Jackie and Alan have a healthy looking baby girl named Iris. One of the
first things Dr. Kwan will do in the
delivery room is check to make sure
that the infant is breathing and has
good circulation. The best way to do
this is through the Apgar score system
(see image), which rates the physical
health of the neonate 1 and 5 minutes
after birth. The rating system evaluates
the infant's heart rate, respiration,
muscle tone, color, and response to
skin stimulation.
 Iris is finally here—on her way to a
healthy new life in the outside world,
with parents who are eager to join her.
58
COMPLEMENTARY TERMS
 amniochorial
 amniorrhea
 amniorrhexis
 antepartum
 embryogenic
 embryoid
 fetal
 Gravida
 Gravidopuerperal
 Intrapartum
 Lactic
 Lactogenic
 Lactorrhea
 Multigravida
 Multipara (multip)
 Natal
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
59
COMPLEMENTARY TERMS (CONT’D)
 neonate
 neonatologist
 neonatology
 nulligravida
 nullipara
 para
 postnatal
 Postpartum
 Prenatal
 Primigravida
 Primipara
 Pseudocyesis
 Puerpera
 Puerperal
 Tertogen
 Teratogenic
 Teratology
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
60
COMPLEMENTARY TERMS
NOT BUILT FROM WORD PARTS
 breech presentation
 cephalic presentation
 cesarean section (C/S,
C-section)
 colostrum
 congenital anomaly

in vitro fertilization (INF)
 lactation
 lochia
 Meconium
 Midwife
 Midwifery
 Obstetrician
 Obstetrics (OB)
 Parturition
 Premature infant
 Puerperium
 Quickening
 Stillborn
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
61
SPEAK AND SPELL
https://evolve.elsevier.com/Courses/14615
_sjohnson2458_1001#/content/463634114
?view=https:%2F%2Fevolve.elsevier.com
%2Fobjects%2Flafleur8e_v1%2Fmod09%
2F09s03l0305.html
62
CLICKER QUESTION
Antepartum and postpartum refer to (the):
a)
birth
b)
mother
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
63
ABBREVIATIONS











CS, C-section
DOB
EDD
FAS
LMP
Multip
NB
OB
primip
RDS
VBAC
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
READ MEDICAL TERMS IN USE
Jane Anne is a 34-year-old gravida 2 para 1 woman. Her LMP
was April 20, 20xx. The EDD is January 2, 20xx. The obstetrician
prescribed folic acid to prevent spina bifida. The patient’s first
pregnancy was complicated by preeclampsia and a breech
presentation, which required a cesarean section. Pelvic
sonography showed a single female fetus with normal
development. She went on to deliver a healthy baby by VBAC 3
days before her expected delivery date .
Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
65
66
67
 https://evolve.elsevier.com/Courses/14615_sjohnson2458_1
001#/content/463634114?view=https:%2F%2Fevolve.elsevier
.com%2Fobjects%2Flafleur8e_v1%2Fmod09%2F09s04l0105.h
tml
68