Obstetrics and Neonatology CHAPTER 9 Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Lesson CHAPTER 9 Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 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. 3 OBJECTIVES Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 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 THREADED CASE STUDY: ALAN & JACKIE

 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 5 OBSTETRICS AND NEONATOLOGY Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 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 offspring, from implantation of the zygote to end of the 8th week 6 TERMS RELATING TO PREGNANCY Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 dia/09s01l0304/09s01l0304p1.html dia/09s01l0304/09s01l0304p1.html 7

 fetus: unborn offspring 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 8 TERMS RELATING TO PREGNANCY (CONT’D) Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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 CONCEPTION

 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 10 TERMS RELATING TO PREGNANCY (CONT’D) Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

11 OVULATION, FERTILIZATION, AND IMPLANTATION Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

12 DEVELOPMENT OF THE FETUS Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

13 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.

 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 14 COMBINING FORMS OF OBSTETRICS AND NEONATOLOGY Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 cephal/o  esophag/o  pelvi, pelv/o  prim/i  pseud/o  pylor/o  terat/o 15 COMBINING FORMS COMMONLY USED IN OBSTETRICS AND NEONATOLOGY Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 dia/09s01l0407/09s01l0407p1.html dia/09s01l0407/09s01l0407p1.html 16 FETAL DEVELOPMENT

 001#/content/ ?view= tml 001#/content/ ?view= tml 17 SPEAK AND SPELL

 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 suffix -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 suffix -a denotes a noun. 19 CASE STUDY: JACKIE

 ante-, pre-  micro-  multi-  nulli-  post- 20 PREFIXES Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 -amnios  -cyesis  -e  -is  -partum  -rrhexis  -tocia  -um  -us 21 SUFFIXES Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Word PartMeaning nat/obirth par/o, part/obear, give birth to, labor, childbirth puerper/ochildbirth -partumchildbirth, labor -tociabirth, labor 22 WORD PARTS WITH SIMILAR MEANINGS Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Suffix MeaningChapter -rrhea flow, discharge 4 -rrhagia rapid flow of blood 5 -rrhaphy suturing, repairing 6 -rrhexis rupture 9 23 FOUR “-RRH” SUFFIXES Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Which two of the following word parts mean pregnancy? a) gravid/o and -cyesis b) part/o and -partum 24 CLICKER QUESTION Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 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 delivery 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. THREADED CASE STUDY 25

 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 effaced, 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. THREADED CASE STUDY: STAGES OF BIRTH 26

 001#/content/ ?view= tml 001#/content/ ?view= tml SPEAK AND SPELL 27

 amnionitis  chorioamnionitis  choriocarcinoma  dystocia  hysterorrhexis  oligohydramnios  polyhydramnios 28 OBSTETRIC DISEASE AND DISORDER TERMS BUILT FROM WORD PARTS Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 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. THREADED CASE STUY 29

 abortion  abruptio placentae  eclampsia  ectopic pregnancy  placenta previa  preeclampsia 30 OBSTETRIC DISEASE AND DISORDER TERMS NOT BUILT FROM WORD PARTS Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

31 ABRUPTIO PLACENTAE Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

32 PLACENTA PREVIA Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

VIDEO /09s02l0205p1.html

34 ECTOPIC PREGNANCY Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 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. THREADED CASE STUDY 35

 microcephalus  omphalitis  omphalocele  pyloric stenosis  tracheoesophageal fistula 36 NEONATOLOGY DISEASE AND DISORDER TERMS BUILT FROM WORD PARTS Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

37 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. Pyloric Stenosis

 001#/content/ ?view= tml 001#/content/ ?view= tml SPEAK AND SPELL 38

The correct labeling of the diagram is: a) omphalocele b) omphalcele 39 CLICKER QUESTION Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 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. THREADED CASE STUDY 40

 cleft lip and palate  Down syndrome  erythroblastosis fetalis  fetal alcohol syndrome (FAS)  esophageal atresia  gastroschisis  respiratory distress syndrome (RDS)  spina bifida 41 NEONATOLOGY DISEASE AND DISORDER TERMS NOT BUILT FROM WORD PARTS Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 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 difficult labor. THREADED CASE STUDY 42

43 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.

44 ESOPHAGEAL ATRESIA Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

45 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

46 Gastroschisis

47 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.

 001#/content/ ?view= tml 001#/content/ ?view= tml SPEAK AND SPELL 48

 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. THREADED CASE STUDY 49

 amniotomy  episiotomy 50 OBSTETRIC SURGICAL TERMS BUILT FROM WORD PARTS Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 Diagnostic imaging  pelvic sonography  Other  amniocentesis  amnioscope  amnioscopy 51 OBSTETRIC DIAGNOSTIC TERMS BUILT FROM WORD PARTS Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

52 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.

53 AMNIOCENTESIS Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 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). CESAREAN SECTION 54

55

Lesson CHAPTER 9 Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 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. 57 OBJECTIVES Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 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. THREADED CASE STUDY 58

 amniochorial  amniorrhea  amniorrhexis  antepartum  embryogenic  embryoid  fetal  Gravida  Gravidopuerperal  Intrapartum  Lactic  Lactogenic  Lactorrhea  Multigravida  Multipara (multip)  Natal COMPLEMENTARY TERMS 59 Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 neonate  neonatologist  neonatology  nulligravida  nullipara  para  postnatal  Postpartum  Prenatal  Primigravida  Primipara  Pseudocyesis  Puerpera  Puerperal  Tertogen  Teratogenic  Teratology COMPLEMENTARY TERMS (CONT’D) 60 Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 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 COMPLEMENTARY TERMS NOT BUILT FROM WORD PARTS 61 Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

SPEAK AND SPELL 62 _sjohnson2458_1001#/content/ ?view= %2Fobjects%2Flafleur8e_v1%2Fmod09% 2F09s03l0305.html

Antepartum and postpartum refer to (the): a) birth b) mother CLICKER QUESTION 63 Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

 CS, C-section  DOB  EDD  FAS  LMP  Multip  NB  OB  primip  RDS  VBAC ABBREVIATIONS Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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. READ MEDICAL TERMS IN USE 65 Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

66

67

 001#/content/ ?view= tml 001#/content/ ?view= tml 68