Pregnancy & Delivery

Obstetrics is the field concentrated on welfare and care of pregnancy, childbirth and postpartum period.

Main area of services provided under this are:

Prenatal care (care during pregnancy), Fetal assessments, Intercurrent diseases in pregnancy, Induction and labour, Complications and emergencies, Postnatal care

• OUR OBSTETRICS SERVICES INCLUDE:
• PRECONCEPTION CARE
• HIGH RISK PREGNANCY
• RECURRENT PREGNANCY LOSS
• PAINLESS NORMALDELIVERY
• ALL TYPE OF INVESTIGATIONS RELATED TO PREGNANCY

Prenatal care (care during pregnancy),

Prenatal care is screening and taking care of various complications of pregnancy and to identify and manage high risk pregnancy. This includes routine office visit with physical examinations and routine lab test.

FIRST TRIMESTER (1^st three months of pregnancy)

Routine test in first trimester of pregnancy generally include:

• Complete blood count
• Blood group typing

Rh-negative mothers should receive RhoGAM at 28 weeks to prevent Rh disease, indirect coombs test to access risk of hemolytic disease of newborn.

• Screening of HIV, Hepatitis B, Syphillis
• Urinalysis and culture
• Genetic screening for Down Syndrome  (trisomy 21) and  Edward Syndrome(trisomy 18), can be done at 10 plus weeks to 13 plus weeks with an ultrasound of the fetal neck (thicker nuchal skin correlates with higher risk of Down syndrome being present) and two chemicals (analytes), pregnancy-associated plasma protein A (PAPP-A) and human chorionic gonadotropins (HCG-pregnancy hormone level itself). It gives an accurate risk profile very early. This is an evolving standard of care.

 

SECOND TRIMESTER

• Level II ultrasound to access all the pregnancy details and anatomical development of fetus.
• ·         QUAD TEST(four simultaneous blood tests) (maternal serum AFP, inhibin A, Estriol&β-HCG – elevations, low numbers or odd patterns correlate with neural tube defect risk and increased risks of trisomy 18 or trisomy 21.
• ·         Amniocentesis in patients who are at increased risk by family history or prior birth history.
• ·         Hematocrit, iron, calcium supplements to be started
• ·         Glucose loading test (GLT) – screens for gestational diabetes; if > 140 mg/dL, a glucose tolerance test is administered; to diagnose gestational diabetes.

THIRD TRIMESTER

• Lab test and ultrasound follow up for wellbeing of mother and fetus depending on the high risk factors present in pregnancy.

 

Fetal assessments

Obstetric ultrasound sonography is routinely used for dating the gestational age of a pregnancy from the size of the fetus, determine the number of fetuses and placenta, evaluate for an ectopic pregnancy and first trimester bleeding, the most accurate dating being in first trimester before the growth of the foetus has been significantly influenced by other factors. Ultrasound is also used for detecting congenital anomalies (or other foetal anomalies) and determining the biophysical profiles (BPP), which are generally easier to detect in the second trimester when the foetal structures are larger and more developed. Specialised ultrasound equipment can also evaluate the blood flow velocity in the umbilical cord, looking to detect a decrease/absence/reversal or diastolic blood flow in the umbilical artery.

 

Intercurrent diseases in pregnancy

A pregnant woman may have medical or surgical condition that is, other diseases or conditions (not directly caused by the pregnancy) that may become worse or be a potential risk to the pregnancy.

• Diabetes mellitus and pregnancy deals with the interactions of diabetes mellitus (not restricted to gestational diabetes) and pregnancy. Risks for the child include miscarriage, growth restriction, growth acceleration, foetal obesity (macrosomia), polyhydramnios and birth defects.
• Systemic lupus erythematosus and pregnancy confers an increased rate of foetal death in uteroand spontaneous abortion (miscarriage) and recurrent pregnancy loss, as well as of neonatal lupus.
• Thyroid disease in pregnancy can, if uncorrected, cause adverse effects on foetal and maternal well-being. The deleterious effects of thyroid dysfunction can also extend beyond pregnancy and delivery to affect neurointellectual development in the early life of the child. Demand for thyroid hormones is increased during pregnancy, and may cause a previously unnoticed thyroid disorder to worsen.
• Hypercoagulability in pregnancy is the propensity of pregnant women to develop thrombosis (blood clots). Pregnancy itself is a factor of hypercoagulability (pregnancy-induced hypercoagulability), as a physiologically adaptive mechanism to prevent postpartum bleeding. However, when combined with an additional underlying hypercoagulable states, the risk of thrombosis or embolism may become substantial.

 

Induction and labour

Induction is a method of artificially or prematurely stimulating labour in a woman. Reasons to induce can include preeclmpsia, foetal distress, placental malfunction, intrauterine growth retardation and failure to progress through labour increasing the risk of infection and foetal distresses.

During labour, the obstetrician carries out the following tasks:

• Monitor the progress of labour, by reviewing the nursing chart, performing vaginal examination, and assessing the trace produced by a foetal monitoring device (thecardiotocograph CTG)
• Provide pain relief, either by opiates  or by epidural anaesthesia done byanaesthesiologist.
• Caesarean section, if there is an associated risk with vaginal delivery, as such foetal or maternal compromise

 

Complications and emergencies

The main emergencies include:

• Ectopic pregnancyis when an embryo implants in the uterine (Fallopian) tube or (rarely) on the ovary or inside the peritoneal cavity. This may cause massive internal bleeding.
• Pre eclampsiais a disease defined by a combination of signs and symptoms that are related to maternal hypertension. The cause is unknown, and markers are being sought to predict its development from the earliest stages of pregnancy. Some unknown factors cause vascular damage in the endothelium, causing hypertension. If severe, it progresses to eclampsia, where seizuresoccur, which can be fatal. Preeclamptic patients with the HELLP syndrome show liver failure and Disseminated intravascular coagulation (DIC). The only treatment is to deliver the foetus. Women may still develop pre-eclampsia following delivery.
• Placental abruption is where the placenta detaches from the uterus and the woman and foetus can bleed to death if not managed appropriately.
• Foetal distresswhere the foetus is getting compromised in the uterine environment.
• Shoulder dystocia where one of the foetus’ shoulders becomes stuck during vaginal birth. There are many risk factors, including macrosmic (large) foetus, but many are also unexplained.
• Uterine rupturecan occur during obstructed labour and endanger foetal and maternal life.
• Prolapsed cord can only happen after the membranes have ruptured. The umbilical cord delivers before the presenting part of the foetus. If the foetus is not delivered within minutes, or the pressure taken off the cord, the foetus dies.
• Obstetrical hemorrhage may be due to a number of factors such as placenta previa, uterine rupture or tears, uterine atony, retained placentaor placental fragments, or bleeding disorders.
• Puerperal sepsisis an ascending infection of the genital tract. It may happen during or after labour. Signs to look out for include signs of infection (pyrexia or hypothermia, raised heart rate and respiratory rate, reduced blood pressure), and abdominal pain, offensive lochia (blood loss) increased lochia, clots, diarrhea and vomiting.

 

Postnatal care

Postnatal care is care provided to the mother following parturition.

A woman who is delivering in a hospital may leave the hospital as soon as she is medically stable and chooses to leave, which can be as early as a few hours postpartum, though the average for spontaneous vaginal delivery (SVD) is 1–2 days, and the average caesarean section postnatal stay is 3–4 days.

During this time the mother is monitored for bleeding, bowel and bladder function, and baby care. The infant’s health is also monitored.