Editing Obstetrics (section)

==Diseases in pregnancy==
{{Further|Pre-existing disease in pregnancy}}
A pregnant woman may have a [[pre-existing disease in pregnancy|pre-existing disease]], that may become worse or become a risk to the pregnancy, or to [[Postnatal|postnatal development]] of the offspring<ref>{{Cite web | vauthors = Dunkin MA |title=High-Risk Pregnancies: Symptoms, Doctors, Support, and More |url=https://www.webmd.com/baby/managing-a-high-risk-pregnancy |access-date=2022-04-29 |website=WebMD |language=en}}</ref>
* [[Diabetes mellitus and pregnancy]] deals with the interactions of [[diabetes mellitus]] (not restricted to [[gestational diabetes]]) and pregnancy.<ref>{{Cite journal | vauthors = Moore T |date=2022-04-06 | veditors = Griffing GT |title=Diabetes Mellitus and Pregnancy: Practice Essentials, Gestational Diabetes, Maternal-Fetal Metabolism in Normal Pregnancy |url=https://emedicine.medscape.com/article/127547-overview | journal = Medscape }}</ref> Risks for the child include miscarriage, growth restriction, growth acceleration, foetal obesity (macrosomia), polyhydramnios and birth defects.
* [[Lupus and pregnancy]] confers an increased rate of foetal death ''in utero'' and [[spontaneous abortion]] (miscarriage), as well as of [[neonatal lupus]].<ref>{{Cite journal|date=2021-10-16 | vauthors = Khurana R, Wolf RE | veditors = Talavera F, Singh AK |title=Systemic Lupus Erythematosus and Pregnancy: Practice Essentials, Pathophysiology, Epidemiology |url=https://emedicine.medscape.com/article/335055-overview | journal = Medscape }}</ref>
* [[Thyroid disease in pregnancy]] can, if uncorrected, cause adverse effects on foetal and maternal well-being.<ref>{{Cite web | vauthors = Friel LA  |title=Thyroid Disorders in Pregnancy - Gynecology and Obstetrics |url=https://www.msdmanuals.com/professional/gynecology-and-obstetrics/pregnancy-complicated-by-disease/thyroid-disorders-in-pregnancy |access-date=2022-04-29 |website=MSD Manual Professional Edition |language=en}}</ref> The deleterious effects of thyroid dysfunction can also extend beyond pregnancy and delivery to affect neurointellectual development in the early life of the child.<ref>{{cite journal | vauthors = Alemu A, Terefe B, Abebe M, Biadgo B | title = Thyroid hormone dysfunction during pregnancy: A review | journal = International Journal of Reproductive Biomedicine | volume = 14 | issue = 11 | pages = 677–686 | date = November 2016 | pmid = 27981252 | pmc = 5153572 }}</ref> Demand for thyroid hormones is increased during pregnancy, and may cause a previously unnoticed thyroid disorder to worsen.{{cn|date=August 2023}}
* [[Hypercoagulability in pregnancy]] is the propensity of pregnant women to develop [[thrombosis]] (blood <ref>{{cite journal | vauthors = Nichols KM, Henkin S, Creager MA | title = Venous Thromboembolism Associated With Pregnancy: JACC Focus Seminar | journal = Journal of the American College of Cardiology | volume = 76 | issue = 18 | pages = 2128–2141 | date = November 2020 | pmid = 33121721 | doi = 10.1016/j.jacc.2020.06.090 | s2cid = 226205234 | doi-access = free }}</ref> clots). Pregnancy itself is a factor of [[hypercoagulability]] (pregnancy-induced hypercoagulability), as a physiologically adaptive mechanism to prevent [[postpartum hemorrhage|''post partum'' bleeding]].<ref name=gresele/> However, when combined with an additional underlying hypercoagulable states, the risk of thrombosis or embolism may become substantial.<ref name=gresele>Page 264 in: {{cite book | vauthors = Gresele P |title=Platelets in haematologic and cardiovascular disorders: a clinical handbook |publisher=Cambridge University Press |location=Cambridge, UK |year=2008 |isbn=978-0-521-88115-9 }}</ref>
* [[Hyperemesis gravidarum|Hyperemesis]] gravidarum in pregnancy occurs due to extreme, persistent nausea and vomiting during pregnancy.<ref>{{Cite web |title=Hyperemesis Gravidarum: Symptoms & Treatment |url=https://my.clevelandclinic.org/health/diseases/12232-hyperemesis-gravidarum-severe-nausea--vomiting-during-pregnancy |access-date=2022-04-30 |website=Cleveland Clinic}}</ref> If untreated, can lead to [[dehydration]], weight loss, and electrolyte imbalances. Most women develop nausea and vomiting during the first trimester.<ref>{{Cite web |title=Morning sickness - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/morning-sickness/symptoms-causes/syc-20375254 |access-date=2022-04-30 |website=Mayo Clinic |language=en}}</ref> The cause of hyperemesis gravidarum is not known. However, it is believed to be caused by a rapidly rising blood level of a hormone, human chorionic gonadotropin (HCG), which is released by the placenta.
* [[Pre-eclampsia|Preeclampsia]] is a condition that causes high blood pressure during pregnancy. If left untreated, it can be life-threatening.<ref>{{Cite web | vauthors = Gaither K | date = 13 December 2019 |title=Preeclampsia |url=https://www.webmd.com/baby/preeclampsia-eclampsia |access-date=2022-04-29 |website=WebMD |language=en}}</ref> In pregnant women, preeclampsia may occur after 20 weeks of pregnancy, often in women who have no history of high blood pressure. Symptoms of preeclampsia may include severe headache, vision changes and pain under the ribs.<ref>{{Cite web |title=Preeclampsia - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745 |access-date=2022-04-29 |website=Mayo Clinic |language=en}}</ref> However, in some women, symptoms may not occur, until they go for a routine prenatal visit.<ref>{{Cite web |date=2021-08-08 |title=4 Common Pregnancy Complications |url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/staying-healthy-during-pregnancy/4-common-pregnancy-complications |access-date=2022-04-28 |website=www.hopkinsmedicine.org |language=en}}</ref>

=== Induction and labour ===
{{Main|Induction (birth)|Childbirth}}
{{See|Pain management during childbirth}}
Induction is a method of artificially or prematurely stimulating labour in a woman.<ref>{{Cite web | author = Healthdirect Australia|date=2022-02-08 |title=Induced labour |url=https://www.pregnancybirthbaby.org.au/induced-labour |access-date=2022-04-29 |website=www.pregnancybirthbaby.org.au |language=en-AU}}</ref> Reasons to induce can include [[pre-eclampsia]], foetal distress, placental malfunction, intrauterine growth retardation and failure to progress through labour increasing the risk of infection and foetal distresses.<ref>{{Cite thesis | vauthors = Surányim A | degree = Ph.D. |title=Prenatal and postnatal evaluation of foetal renal hyperechogenicity in pregnancies complicated with pre-eclampsia and intrauterine growth retardation | year = 2000 | doi = 10.14232/phd.2154 |publisher=University of Szeged | doi-access = free }}</ref>

Induction may be achieved via several methods:
* Disturbance of cervical membranes<ref>{{Cite web | vauthors = Moldenhauer JS |title=Prelabor Rupture of the Membranes (PROM) - Women's Health Issues |url=https://www.msdmanuals.com/home/women-s-health-issues/complications-of-labor-and-delivery/prelabor-rupture-of-the-membranes-prom |access-date=2022-04-30 |website=MSD Manual Consumer Version |language=en}}</ref>
* [[Pessary]] of ''Prostin'' cream, [[prostaglandin]] E<sub>2</sub><ref>{{Cite web |title=Prostin E2 Vaginal: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD |url=https://www.webmd.com/drugs/2/drug-14108/prostin-e2-vaginal/details |access-date=2022-04-30 |website=www.webmd.com |language=en}}</ref>
* Intravaginal or oral administration of [[misoprostol]]<ref>{{cite journal | vauthors = Ho PC, Ngai SW, Liu KL, Wong GC, Lee SW | title = Vaginal misoprostol compared with oral misoprostol in termination of second-trimester pregnancy | journal = Obstetrics and Gynecology | volume = 90 | issue = 5 | pages = 735–738 | date = November 1997 | pmid = 9351755 | doi = 10.1016/S0029-7844(97)00419-5 | s2cid = 21261210 }}</ref>
* Cervical insertion of a 30-mL [[Foley catheter]]<ref>{{cite journal | vauthors = Adeniji OA, Oladokun A, Olayemi O, Adeniji OI, Odukogbe AA, Ogunbode O, Aimakhu CO, Omigbodun AO, Ilesanmi AO | display-authors = 6 | title = Pre-induction cervical ripening: transcervical foley catheter versus intravaginal misoprostol | journal = Journal of Obstetrics and Gynaecology | volume = 25 | issue = 2 | pages = 134–139 | date = February 2005 | pmid = 15814391 | doi = 10.1080/01443610500040737 | s2cid = 24250115 }}</ref>
* Rupturing the amniotic membranes<ref>{{Cite encyclopedia |title=Premature rupture of membranes | location = Bethesda (MD) | encyclopedia = MedlinePlus Medical Encyclopedia | publisher = U.S. National Library of Medicine |url=https://medlineplus.gov/ency/patientinstructions/000512.htm |access-date=2022-04-30 |language=en}}</ref>
* Intravenous infusion of synthetic [[oxytocin]] (Pitocin or Syntocinon)<ref>{{Cite web |title=Oxytocin 10 IU/ml Solution for infusion - Summary of Product Characteristics (SmPC) - (emc) |url=https://www.medicines.org.uk/emc/medicine/30427#gref |access-date=2022-04-30 |website=www.medicines.org.uk}}</ref>

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 (the [[cardiotocograph]])<ref>{{cite book | vauthors = Prior T, Lees C | chapter = Control and Monitoring of Fetal Growth. | title = Encyclopedia of Endocrine Diseases | date = 2019 | volume = 5 | pages = 1–9 | doi = 10.1016/B978-0-12-801238-3.65414-4 | isbn = 9780128122006 | s2cid = 81797258 }}</ref>
* Provide pain relief, either by [[nitrous oxide]], [[opiates]], or by [[local anaesthesia|epidural anaesthesia]] done by [[anaesthesiology|anaesthestists]], an anaesthesiologist, or a [[nurse anaesthetist]].<ref name="pmid2405898">{{cite journal | vauthors = Lloyd-Thomas AR | title = Pain management in paediatric patients | journal = British Journal of Anaesthesia | volume = 64 | issue = 1 | pages = 85–104 | date = January 1990 | pmid = 2405898 | doi = 10.1093/bja/64.1.85 | doi-access = free }}</ref>
* [[Caesarean section]], if there is an associated risk with vaginal delivery, as such foetal or maternal compromise.<ref>{{Cite journal | vauthors = Saint Louis H |date=2022-04-14 |title=Cesarean Delivery: Overview, Preparation, Technique |url=https://emedicine.medscape.com/article/263424-overview | journal = Medscape }}</ref>

=== Complications and emergencies ===
{{Main|Complications of pregnancy}}

The main emergencies include:
* [[Ectopic pregnancy]] is 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.<ref>{{Cite web |title=Ectopic pregnancy - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088 |access-date=2022-04-30 |website=Mayo Clinic |language=en}}</ref>
* [[Pre-eclampsia]] is a disease defined by a combination of signs and symptoms that are related to maternal hypertension.<ref>{{Cite journal | vauthors = Lim KH, Steinberg G |date=2022-04-13 |title=Preeclampsia: Practice Essentials, Overview, Pathophysiology |url=https://emedicine.medscape.com/article/1476919-overview | journal = Medscape }}</ref> The cause is unknown, and markers are being sought to predict its development from the earliest stages of pregnancy.<ref>{{Cite web | vauthors = Artal-Mittelmark R |title=Stages of Development of the Fetus - Women's Health Issues |url=https://www.msdmanuals.com/home/women-s-health-issues/normal-pregnancy/stages-of-development-of-the-fetus |access-date=2022-04-30 |website=MSD Manual Consumer Version |language=en}}</ref> Some unknown factors cause vascular damage in the [[endothelium]], causing [[hypertension]].<ref>{{Cite web |date=2021-11-10 |title=Hypertension: Causes, symptoms, and treatments |url=https://www.medicalnewstoday.com/articles/150109 |access-date=2022-04-30 |website=www.medicalnewstoday.com |language=en}}</ref> If severe, it progresses to [[eclampsia]], where [[seizures]] occur, which can be fatal.<ref>{{Cite journal | vauthors = Seppa N |date=2011-01-20 |title=Body & brain: Uncontrolled epilepsy can be fatal: Study finds more deaths in adults whose seizures persist |journal=Science News |volume=179 |issue=3 |pages=8 |doi=10.1002/scin.5591790305 |issn=0036-8423}}</ref> Preeclamptic patients with the [[HELLP syndrome]] show liver failure and [[disseminated intravascular coagulation]] (DIC).<ref>{{cite journal | vauthors = Haram K, Svendsen E, Abildgaard U | title = The HELLP syndrome: clinical issues and management. A Review | journal = BMC Pregnancy and Childbirth | volume = 9 | issue = 1 | pages = 8 | date = February 2009 | pmid = 19245695 | pmc = 2654858 | doi = 10.1186/1471-2393-9-8 | doi-access = free }}</ref> The only treatment is to deliver the foetus. Women may still develop pre-eclampsia following delivery.<ref>{{Cite web |title=Preeclampsia: Symptoms, Causes, Treatments & Prevention |url=https://my.clevelandclinic.org/health/diseases/17952-preeclampsia |access-date=2022-04-30 |website=Cleveland Clinic}}</ref>
* [[Placental abruption]] is where the placenta detaches from the uterus and the woman and foetus can bleed to death if not managed appropriately.<ref>{{Cite web |title=Placental Abruption: Symptoms, Causes & Effects On Baby |url=https://my.clevelandclinic.org/health/diseases/9435-placental-abruption |access-date=2022-04-30 |website=Cleveland Clinic}}</ref>
* [[Foetal distress]] where the [[foetus]] is getting compromised in the uterine environment.<ref>{{Cite web | vauthors = Moldenhauer JS |title=Fetal Distress - Women's Health Issues |url=https://www.msdmanuals.com/home/women-s-health-issues/complications-of-labor-and-delivery/fetal-distress |access-date=2022-04-30 |website=MSD Manual Consumer Version |language=en}}</ref>
* [[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.<ref>{{Cite web |title=Shoulder Dystocia: Signs, Causes, Prevention & Complications |url=https://my.clevelandclinic.org/health/diseases/22311-shoulder-dystocia |access-date=2022-04-30 |website=Cleveland Clinic}}</ref>
* [[Uterine rupture]] can occur during obstructed labour and endanger foetal and maternal life.<ref>{{cite journal | vauthors = Astatikie G, Limenih MA, Kebede M | title = Maternal and fetal outcomes of uterine rupture and factors associated with maternal death secondary to uterine rupture | journal = BMC Pregnancy and Childbirth | volume = 17 | issue = 1 | pages = 117 | date = April 2017 | pmid = 28403833 | pmc = 5389173 | doi = 10.1186/s12884-017-1302-z | doi-access = free }}</ref>
* [[Prolapsed cord]] can only happen after the membranes have ruptured.<ref>{{Cite journal | vauthors = Sims ME |date=2014-01-01 |title=Legal Briefs: Iatrogenesis: Prolapsed Umbilical Cord After Artificial Rupture of the Membranes and Unskilled Stabilization |journal=NeoReviews |volume=15 |issue=1 |pages=e32–e36 |doi=10.1542/neo.15-1-e32 |issn=1526-9906}}</ref> 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.<ref>{{Cite web |title=Umbilical Cord Prolapse: Causes, Diagnosis & Management |url=https://my.clevelandclinic.org/health/diseases/12345-umbilical-cord-prolapse |access-date=2022-04-30 |website=Cleveland Clinic}}</ref>
* [[Obstetrical hemorrhage]] may be due to a number of factors such as [[placenta previa]], uterine rupture or tears, [[uterine atony]], [[retained placenta]] or placental fragments, or bleeding disorders.<ref>{{Cite journal | vauthors = Smith JR |date=2022-04-01 |title=Postpartum Hemorrhage: Practice Essentials, Problem, Epidemiology |url=https://emedicine.medscape.com/article/275038-overview | journal = Medscape }}</ref>
* [[Puerperal sepsis]] is an ascending infection of the genital tract.<ref>{{cite journal | vauthors = Demisse GA, Sifer SD, Kedir B, Fekene DB, Bulto GA | title = Determinants of puerperal sepsis among post partum women at public hospitals in west SHOA zone Oromia regional STATE, Ethiopia (institution BASEDCASE control study) | journal = BMC Pregnancy and Childbirth | volume = 19 | issue = 1 | pages = 95 | date = March 2019 | pmid = 30885159 | pmc = 6423770 | doi = 10.1186/s12884-019-2230-x | doi-access = free }}</ref> 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.{{cn|date=August 2023}}

===Postpartum period===
{{Further|Postpartum period}}
The [[World Health Organization]] makes a distinction between the use of ''postpartum care'' when it concerns the care of the mother after giving birth, and ''postnatal care'' when the care of the newborn is concerned.<ref name="WHO">{{cite web |title=WHO Technical Consultation on Postpartum Care |url=https://www.ncbi.nlm.nih.gov/books/NBK310595/ |publisher=World Health Organization |access-date=30 June 2020 |language=en |date=2010}}</ref>
[[Postpartum period|Postpartum care]] is provided to the mother following childbirth.

A woman in the Western world who gives birth 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 later, but usually averages a stay of one or two days; the average postnatal stay following delivery by [[caesarean section]] is three to four days.<ref name="pmid26857705">{{cite journal | vauthors = Jones E, Taylor B, MacArthur C, Pritchett R, Cummins C | title = The effect of early postnatal discharge from hospital for women and infants: a systematic review protocol | journal = Systematic Reviews | volume = 5 | issue = | pages = 24 | date = February 2016 | pmid = 26857705 | pmc = 4746909 | doi = 10.1186/s13643-016-0193-9 | doi-access = free }}</ref>

During this time the mother is monitored for [[bleeding]], [[bowel]] and [[Urinary bladder|bladder]] function, and baby care. The [[infant]]'s health is also monitored.<ref>{{Cite web |title=Types of Delivery for Pregnancy |url=https://my.clevelandclinic.org/health/articles/9675-pregnancy-types-of-delivery |access-date=2022-04-30 |website=Cleveland Clinic}}</ref>

=== Veterinary obstetrics ===
{{main|Veterinary obstetrics}}