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Obstetrician
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  • Physician
  • Surgeon
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Hospitals, clinics

Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period.[1] As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgical field.[2]

Main areas

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Prenatal care

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Prenatal care is important in screening for various complications of pregnancy.[3] This includes routine office visits with physical exams and routine lab tests along with telehealth care for women with low-risk pregnancies:[4]

First trimester

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Routine tests in the first trimester of pregnancy generally include:

Genetic screening for Down syndrome (trisomy 21) and Edwards syndrome (trisomy 18), the national standard in the United States, is rapidly evolving away from the AFP-quad screen, done typically in the second trimester at 16–18 weeks.[11] The newer integrated screen (formerly called F.A.S.T.E.R for First And Second Trimester Early Results) 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 and human chorionic gonadotropin (pregnancy hormone level itself[12]). It gives an accurate risk profile very early. A second blood screen at 15 to 20 weeks refines the risk more accurately.[13] The cost is higher than an "AFP-quad" screen due to the ultrasound and second blood test, but it is quoted to have a 93% pick up rate as opposed to 88% for the standard AFP/QS. This is an evolving standard of care in the United States.[14][15][16]

Down syndrome karyotype

Second trimester

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  • MSAFP/quad. screen (four simultaneous blood tests) (maternal serum AFP, inhibin A, estriol, and βHCG) – elevations, low numbers or odd patterns correlate with neural tube defect risk and increased risks of trisomy 18 or trisomy 21[17]
  • Ultrasound either abdominal or transvaginal to assess cervix, placenta, fluid and baby[18]
  • Amniocentesis is the national standard for women over 35 or who reach 35 by mid pregnancy or who are at increased risk by family history or prior birth history.[16]

Third trimester

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  • Hematocrit (if low, the mother receives iron supplements)[19]
  • Group B Streptococcus screen. If positive, the woman receives IV penicillin or ampicillin while in labor—or, if she is allergic to penicillin, an alternative therapy, such as IV clindamycin or IV vancomycin.[16]
  • Glucose loading test (GLT) – screens for gestational diabetes; if > 140 mg/dL, a glucose tolerance test (GTT) is administered; a fasting glucose > 105 mg/dL suggests gestational diabetes.[20]

Most doctors do a sugar load in a drink form of 50 grams of glucose in cola, lime or orange and draw blood an hour later (plus or minus 5 minutes). The standard modified criteria have been lowered to 135 since the late 1980s.[21]

The result of an ultrasonography: a black and white image that shows a clear view of the interior abdomen

Fetal assessments

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A dating scan at 12 weeks

Obstetric ultrasonography is routinely used for dating the gestational age of a pregnancy from the size of the fetus, determine the number of fetuses and placentae, 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.[22] 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.[23]

X-rays and computerized tomography (CT) are not used, especially in the first trimester, due to the ionizing radiation, which has teratogenic effects on the foetus.[24] No effects of magnetic resonance imaging (MRI) on the foetus have been demonstrated,[25] but this technique is too expensive for routine observation. Instead, obstetric ultrasonography is the imaging method of choice in the first trimester and throughout the pregnancy, because it emits no radiation, is portable, and allows for realtime imaging.[26]

The safety of frequent ultrasound scanning has not been confirmed. Despite this, increasing numbers of women are choosing to have additional scans for no medical purpose, such as gender scans, 3D and 4D scans.[27] A normal gestation would reveal a gestational sac, yolk sac, and fetal pole.[28]

The gestational age can be assessed by evaluating the mean gestational sac diameter (MGD) before week 6, and the crown-rump length after week 6. Multiple gestation is evaluated by the number of placentae and amniotic sacs present.[29]

Other tools used for assessment include:

Diseases in pregnancy

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Further information: Pre-existing disease in pregnancy

A pregnant woman may have a pre-existing disease, that may become worse or become a risk to the pregnancy, or to postnatal development of the offspring[35]

  • Diabetes mellitus and pregnancy deals with the interactions of diabetes mellitus (not restricted to gestational diabetes) and pregnancy.[36] 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.[37]
  • Thyroid disease in pregnancy can, if uncorrected, cause adverse effects on foetal and maternal well-being.[38] The deleterious effects of thyroid dysfunction can also extend beyond pregnancy and delivery to affect neurointellectual development in the early life of the child.[39] Demand for thyroid hormones is increased during pregnancy, and may cause a previously unnoticed thyroid disorder to worsen.[citation needed]
  • Hypercoagulability in pregnancy is the propensity of pregnant women to develop thrombosis (blood [40] clots). Pregnancy itself is a factor of hypercoagulability (pregnancy-induced hypercoagulability), as a physiologically adaptive mechanism to prevent post partum bleeding.[41] However, when combined with an additional underlying hypercoagulable states, the risk of thrombosis or embolism may become substantial.[41]
  • Hyperemesis gravidarum in pregnancy occurs due to extreme, persistent nausea and vomiting during pregnancy.[42] If untreated, can lead to dehydration, weight loss, and electrolyte imbalances. Most women develop nausea and vomiting during the first trimester.[43] 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.
  • Preeclampsia is a condition that causes high blood pressure during pregnancy. If left untreated, it can be life-threatening.[44] 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.[45] However, in some women, symptoms may not occur, until they go for a routine prenatal visit.[46]

Induction and labour

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Main articles: Induction (birth) and Childbirth
Further information: Pain management during childbirth

Induction is a method of artificially or prematurely stimulating labour in a woman.[47] 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.[48]

Induction may be achieved via several methods:

During labour, the obstetrician carries out the following tasks:

Complications and emergencies

[edit]
Main article: 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.[58]
  • Pre-eclampsia is a disease defined by a combination of signs and symptoms that are related to maternal hypertension.[59] The cause is unknown, and markers are being sought to predict its development from the earliest stages of pregnancy.[60] Some unknown factors cause vascular damage in the endothelium, causing hypertension.[61] If severe, it progresses to eclampsia, where seizures occur, which can be fatal.[62] Preeclamptic patients with the HELLP syndrome show liver failure and disseminated intravascular coagulation (DIC).[63] The only treatment is to deliver the foetus. Women may still develop pre-eclampsia following delivery.[64]
  • Placental abruption is where the placenta detaches from the uterus and the woman and foetus can bleed to death if not managed appropriately.[65]
  • Foetal distress where the foetus is getting compromised in the uterine environment.[66]
  • 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.[67]
  • Uterine rupture can occur during obstructed labour and endanger foetal and maternal life.[68]
  • Prolapsed cord can only happen after the membranes have ruptured.[69] 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.[70]
  • 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.[71]
  • Puerperal sepsis is an ascending infection of the genital tract.[72] 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.[citation needed]

Postpartum period

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Further information: 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.[73] 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.[74]

During this time the mother is monitored for bleeding, bowel and bladder function, and baby care. The infant's health is also monitored.[75]

Veterinary obstetrics

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Main article: Veterinary obstetrics

History

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Two midwives assisting a woman in labour on a birthing chair in the 16th century, from a work by Eucharius Rößlin

Prior to the 18th century, caring for pregnant women in Europe was confined exclusively to women, and rigorously excluded men.[76] The expectant mother would invite close female friends and family members to her home to keep her company during childbirth.[77]: 96–98  Skilled midwives managed all aspects of the labour and delivery.[78] The presence of physicians and surgeons was very rare and only occurred if a serious complication had taken place and the midwife had exhausted all measures at her disposal.[79] Calling a surgeon was very much a last resort and having men deliver women in this era was seen as offending female modesty.[80]: 1050–1051 [81]

Before the 18th century

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See also: Women's medicine in antiquity

Prior to the 18th and 19th centuries, midwifery was well established but obstetrics was not recognized as a specific medical specialty. However, the subject matter and interest in the female reproductive system and sexual practice can be traced back to Ancient Egypt[82]: 122  and Ancient Greece.[83]: 11  Soranus of Ephesus sometimes is called the most important figure in ancient gynecology.[79] Living in the late first century AD and early second century, he studied anatomy and had opinions and techniques on abortion, contraception – most notably coitus interruptus – and birth complications. After his death, techniques and works of gynecology declined; very little of his works were recorded and survived to the late 18th century when gynecology and obstetrics reemerged as a medical specialism.[82]: 123 

18th century

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The 18th century marked the beginning of many advances in European midwifery, based on better knowledge of the physiology of pregnancy and labour.[84] By the end of the century, medical professionals began to understand the anatomy of the uterus and the physiological changes that take place during labour.[85] The introduction of forceps in childbirth also took place at this time. All these medical advances in obstetrics were a lever for the introduction of men into an arena previously managed and run by women – midwifery.[80]: 1051–1052 

The addition of the male-midwife (or man-midwife) is historically a significant change to the profession of obstetrics.[86] In the 18th century medical men began to train in area of childbirth and believed with their advanced knowledge in anatomy that childbirth could be improved.[87] In France these male-midwives were referred to as accoucheurs, a title later used all over Europe. The founding of lying-in hospitals also contributed to the medicalization and male-dominance of obstetrics.[88] These early maternity hospitals were establishments where women would come to have their babies delivered, as opposed to the practice since time immemorial of the midwife attending the home of the woman in labour.[89] This institution provided male-midwives with endless patients to practice their techniques on and was a way for these men to demonstrate their knowledge.[90]

Many midwives of the time bitterly opposed the involvement of men in childbirth. Some male practitioners also opposed the involvement of medical men like themselves in midwifery and even went as far as to say that male-midwives only undertook midwifery solely for perverse erotic satisfaction. The accoucheurs argued that their involvement in midwifery was to improve the process of childbirth. These men also believed that obstetrics would forge ahead and continue to strengthen.[80]: 1050–1051 

19th century

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18th-century physicians expected that obstetrics would continue to grow, but the opposite happened. Obstetrics entered a stage of stagnation in the 19th century, which lasted until about the 1880s.[77]: 96–98  The central explanation for the lack of advancement during this time was the rejection of obstetrics by the medical community.[91] The 19th century marked an era of medical reform in Europe and increased regulation over the profession. Major European institutions such as The College of Physicians and Surgeons[where?] considered delivering babies ungentlemanly work and refused to have anything to do with childbirth as a whole. Even when Medical Act 1858 was introduced, which stated that medical students could qualify as doctors, midwifery was entirely ignored.[92] This made it nearly impossible to pursue an education in midwifery and also have the recognition of being a doctor or surgeon. Obstetrics was pushed to the side.[80]: 1053–1055 

By the late 19th century, the foundation of modern-day obstetrics and midwifery began developing. Delivery of babies by doctors became popular and readily accepted, but midwives continued to play a role in childbirth.[87] Midwifery also changed during this era due to increased regulation and the eventual need for midwives to become certified.[93] Many European countries by the late 19th century were monitoring the training of midwives and issued certification based on competency. Midwives were no longer uneducated in the formal sense.[94]

As midwifery began to develop, so did the profession of obstetrics near the end of the century.[95] Childbirth was no longer unjustifiably despised by the medical community as it once had been at the beginning of the century. But obstetrics was underdeveloped compared to other medical specialities. Many male physicians would deliver children but very few would have referred to themselves as obstetricians. The end of the 19th century did mark a significant accomplishment in the profession with the advancements in asepsis and anaesthesia, which paved the way for the mainstream introduction and later success of the Caesarean section.[94][96]

Before the 1880s mortality rates in lying-hospitals would reach unacceptably high levels and became an area of public concern. Much of these maternal deaths were due to puerperal fever, then known as childbed fever. In the 1800s Ignaz Semmelweis noticed that women giving birth at home had a much lower incidence of childbed fever than those giving birth by physicians in lying-hospitals. His investigation discovered that washing hands with an antiseptic solution before a delivery reduced childbed fever fatalities by 90%.[97] So it was concluded that it was physicians who had been spreading disease from one labouring mother to the next. Despite the publication of this information, doctors still would not wash. It was not until the 20th century when advancements in aseptic technique and the understanding of disease would play a significant role in the decrease of maternal mortality rates among many populations.[citation needed]

History of obstetrics in America

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The development of obstetrics as a practice for accredited doctors happened at the turn of the 18th century and thus was very differently developed in Europe and in the Americas due to the independence of many countries in the Americas from European powers. "Unlike in Europe and the British Isles, where midwifery laws were national, in America, midwifery laws were local and varied widely".[98]

Gynaecology and Obstetrics gained attention in the American medical field at the end of the nineteenth century through the development of such procedures as the ovariotomy.[99] These procedures then were shared with European surgeons who replicated the surgeries. This was a period when antiseptic, aseptic or anaesthetic measures were just being introduced to surgical and observational procedures and without these procedures surgeries were dangerous and often fatal.[100] Following are two surgeons noted for their contributions to these fields include Ephraim McDowell and J. Marion Sims.[101]

Ephraim McDowell developed a surgical practice in 1795 and performed the first ovariotomy in 1809 on a 47-year-old widow who then lived on for 31 more years.[102] He had attempted to share this with John Bell whom he had practiced under who had retired to Italy. Bell was said to have died without seeing the document but it was published by an associate in Extractions of Diseased Ovaria in 1825.[103] By the mid-century the surgery was both successfully and unsuccessfully being performed. Pennsylvanian surgeons the Attlee brothers made this procedure very routine for a total of 465 surgeries – John Attlee performed 64 successfully of 78 while his brother William reported 387 – between the years of 1843 and 1883.[104] By the middle of the nineteenth century this procedure was successfully performed in Europe by English surgeons Sir Spencer Wells and Charles Clay as well as French surgeons Eugène Koeberlé, Auguste Nélaton and Jules Péan.[82]: 125 

J. Marion Sims was the surgeon responsible for being the first treating a vesicovaginal fistula[82]: 125  – a condition linked to many caused mainly by prolonged pressing of the foetus against the pelvis or other causes such as rape, hysterectomy, or other operations – and also having been doctor to many European royals and the 20th President of the United States James A. Garfield after he had been shot. Sims does have a controversial medical past. Under the beliefs at the time about pain and the prejudice towards African people, he had practiced his surgical skills and developed skills on slaves.[105] These women were the first patients of modern gynecology. One of the women he operated on was named Anarcha Westcott, the woman he first treated for a fistula.[105]

Historical role of gender

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Women and men inhabited very different roles in natal care up to the 18th century.[106] The role of a physician was exclusively held by men who went to university, an overly male institution, who would theorize anatomy and the process of reproduction based on theological teaching and philosophy. Many beliefs about the female body and menstruation in the 17th and 18th centuries were inaccurate; clearly resulting from the lack of literature about the practice.[82]: 123–125  Many of the theories of what caused menstruation prevailed from Hippocratic philosophy.[83]: 16  Midwives, meaning "with woman", were those who assisted in the birth and care of both born and unborn children, a position historically held mainly by women.[107]

During the birth of a child, men were rarely present. Women from the neighbourhood or family would join in on the process of birth and assist in many different ways.[108] The one position where men would help with the birth of a child would be in the sitting position, usually when performed on the side of a bed to support the mother.[77]: 130 

Men entered the field of obstetrics in the nineteenth century, resulting in a change of focus within the profession.[109] Gynecology developed as a new and separate field of study from obstetrics, focusing on the curing of illness and indispositions of female sexual organs,[110] encompassing conditions such as menopause, uterine and cervical problems, and tissue damage as a result of childbirth.[111]

See also

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Wikimedia Commons has media related to Obstetrics.
Wikisource has the text of the 1911 Encyclopædia Britannica article "Obstetrics".

References

[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Obstetrics

View on Grokipedia
from Grokipedia
Obstetrics is the branch of that involves caring for patients who are or are in labor. This specialty focuses on the and of women during , , and the , as well as the care of the and newborn. Obstetric care aims to prevent and manage complications, promote normal physiological processes, and optimize outcomes for both mother and child through evidence-based practices. The scope of obstetrics encompasses several key phases of reproductive care. , also known as antenatal care, involves regular medical visits starting early in to monitor fetal development, , and risk factors such as or , often including ultrasounds, screenings, and lifestyle counseling. During labor and delivery, obstetricians manage the stages of , assessing progress, providing pain relief options like epidurals, and intervening when necessary with techniques such as forceps-assisted delivery or cesarean section to address dystocia or fetal distress. Postpartum care extends into the "fourth trimester," offering ongoing support for physical recovery, screening for conditions like , guidance, and contraception planning, with recommendations for contact within the first three weeks after birth followed by comprehensive evaluation by 12 weeks. Obstetrics is typically practiced by obstetrician-gynecologists (ob-gyns), who undergo specialized residency training in both obstetrics and gynecology, though certified nurse-midwives and family physicians with additional maternal care expertise also contribute. The field emphasizes interdisciplinary collaboration, including with neonatologists for high-risk cases, and advancements have led to dramatic reductions in global maternal and neonatal mortality rates, such as a 40% decline in the maternal mortality ratio from 2000 to 2023; in the United States, standardized levels of maternal care from basic to regional centers for complex needs aim to address persistent challenges and disparities. Historically, obstetrics evolved from ancient traditions, where non-physician practitioners handled most births, to a formalized medical discipline in the 18th and 19th centuries with innovations such as the invention of by the Chamberlen family and the introduction of antisepsis by to combat puerperal fever. The brought further progress, including the widespread use of antibiotics, electronic fetal monitoring, and safe cesarean deliveries, transforming from a high-risk event to a generally manageable medical process under professional oversight. Today, obstetrics continues to advance with telemedicine for prenatal monitoring and personalized care models to address disparities in outcomes.

Definition and Fundamentals

Scope and Importance

Obstetrics is the branch of and that specializes in the care of women during , , and the , focusing on the of both the mother and . This field encompasses preventive care, diagnosis, and management of complications to ensure safe outcomes for maternal and fetal well-being. Obstetrics is distinct from gynecology, which addresses the reproductive of women outside of , including conditions affecting the female reproductive organs such as menstrual disorders and cancers. It also differs from , a of dedicated to the medical care of newborns, particularly those who are premature or ill, typically beginning immediately after birth. The importance of obstetrics lies in its direct impact on reducing maternal mortality, a persistent crisis where approximately 260,000 women died from preventable causes related to and in 2023, equating to about 712 deaths daily. Advances in obstetric care have contributed to a 40% decline in the global since 2000, dropping to 197 deaths per 100,000 live births by 2023, though disparities persist in low-resource settings. On a societal level, obstetrics plays a vital role in lowering rates, supporting initiatives, and advancing , which aims to ensure healthy lives and promote well-being for all, including targets to reduce maternal deaths to under 70 per 100,000 live births and end preventable newborn deaths by 2030. Obstetrics is inherently multidisciplinary, involving collaboration among obstetricians, who lead medical and surgical interventions; midwives, who provide holistic support during labor and delivery; nurses, who handle routine monitoring and patient education; and anesthesiologists, who manage pain relief and emergencies. This team-based approach enhances care coordination and improves outcomes in complex cases.

Key Concepts and Terminology

Obstetrics encompasses the medical care of , , and the , with key concepts rooted in the physiological processes of and fetal development. refers to the period from conception to birth, typically lasting an average of 40 weeks (280 days) in singleton pregnancies, calculated from the first day of the last menstrual period to the . This duration is divided into three trimesters to facilitate clinical monitoring and assessment of developmental milestones: the first trimester spans weeks 1 through 12, marked by ; the second trimester covers weeks 13 through 26, characterized by rapid fetal growth; and the third trimester extends from week 27 to week 40, focusing on maturation and preparation for birth. Central to obstetric physiology is the , a temporary organ that forms after implantation and serves as the primary interface for maternal-fetal exchange. It facilitates the transfer of oxygen and essential nutrients from the maternal bloodstream to the while removing and waste products, ensuring without direct mixing of maternal and fetal blood. Fetal positioning within the is described by terms such as lie, which denotes the relationship between the long axis of the and that of the (typically longitudinal in term pregnancies), and , which indicates the fetal part closest to the cervical os. Common presentations include cephalic (head-down, the most favorable for ) and breech (buttocks or feet first, occurring in about 3-4% of term births). Labor involves coordinated , which are rhythmic tightenings of the driven by oxytocin and other hormones. These contractions are evaluated by frequency (typically 3-5 every 10 minutes in active labor), duration (lasting 45-60 seconds), and intensity (reaching 30-50 mm Hg above baseline tone), progressively dilating the and propelling the downward. Key postpartum terminology includes , the normal consisting of blood, mucus, and uterine tissue that occurs following placental expulsion, initially bright red ( rubra) and decreasing over 3-6 weeks. Newborn assessment immediately after birth relies on the , a standardized tool evaluating five criteria—appearance, pulse, grimace, activity, and respiration—each scored 0-2, for a total of 0-10, at 1 minute and 5 minutes postpartum to gauge the infant's transition to extrauterine life and need for . Developmental milestones during include , the first perceptible fetal movements felt by the mother, usually around 18-20 weeks in primiparous women and slightly earlier in multiparous ones, signaling fetal neuromuscular maturity. Lightening, or the descent of the fetal head into the (), often occurs 2-4 weeks before term in primiparous women, relieving diaphragmatic pressure and easing but potentially increasing pelvic discomfort. These concepts underpin clinical decision-making in obstetrics, guiding interventions to optimize maternal and fetal outcomes.

Prenatal Care

Routine Prenatal Monitoring

Routine prenatal monitoring encompasses standardized assessments to evaluate maternal and fetal well-being throughout , aiming to detect potential complications early and promote healthy outcomes. These protocols, established by professional organizations, guide healthcare providers in scheduling visits and conducting key evaluations to support uncomplicated pregnancies. As of 2025, the American College of Obstetricians and Gynecologists (ACOG) recommends a tailored, patient-centered approach to delivery, including an initial comprehensive ideally before 10 weeks' to identify risks and personalize schedules, modalities (in-person, virtual, or group ), and services. For low-risk pregnancies, this tailored model typically involves 6-10 visits, differing from the traditional schedule of monthly appointments from the first visit until 28 weeks of , biweekly visits from 28 to 36 weeks, and weekly visits thereafter until delivery, which totaled approximately 12-14 visits. This flexible regimen allows for progressive monitoring as advances, with adjustments for higher-risk cases. Essential components of these visits include at every appointment to screen for , a hypertensive disorder affecting about 5-8% of pregnancies. Urine testing for , often via dipstick in traditional protocols, complements this by identifying potential renal involvement in , though recent guidance questions its routine utility in low-risk cases. is tracked regularly, with an ideal total of 11-16 kg recommended for women with a normal pre-pregnancy BMI (18.5-24.9 kg/m²) to optimize maternal and fetal health. status is reviewed and updated, including administration of the Tdap vaccine between 27-36 weeks to protect against pertussis, annual vaccination, and vaccination as recommended to safeguard both mother and newborn. Nutritional and lifestyle counseling forms a core element, emphasizing folic acid supplementation at 400-800 mcg daily from preconception through the first trimester to reduce risk by up to 70%. Screening for occurs via a 50-gram oral glucose challenge test at 24-28 weeks in average-risk women, followed by a diagnostic oral if screening is abnormal, as this condition complicates 6-9% of pregnancies. Providers also offer guidance on balanced diet, exercise, and avoidance of harmful substances like and alcohol. Psychosocial assessments are integrated to address , with routine screening for perinatal depression recommended at least once during using validated tools such as the Postnatal Depression Scale (EPDS), a 10-item questionnaire scoring symptoms over the past week. This screening identifies women at risk for depression, which affects up to 10-15% during , enabling timely interventions like counseling or medication. Adaptations for trimester-specific needs, such as intensified monitoring in the third trimester, build on these routine elements.

Trimester-Specific Guidelines

in obstetrics is structured around the three trimesters to address the evolving physiological changes, fetal development, and maternal risks specific to each stage. Guidelines emphasize tailored interventions based on , integrating routine monitoring with targeted assessments to optimize outcomes. The American College of Obstetricians and Gynecologists (ACOG) recommends initiating care early to confirm viability and screen for anomalies, with adjustments for high-risk factors such as maternal age or . In the first trimester (weeks 1-12), the primary focus is on establishing pregnancy viability and addressing common early symptoms while initiating genetic risk assessment. Transvaginal ultrasound is used to confirm fetal viability through detection of cardiac activity, typically visible around 6 weeks of gestation, helping to differentiate intrauterine pregnancy from ectopic or nonviable cases. Management of nausea and vomiting, affecting up to 80% of pregnancies, involves lifestyle modifications like small frequent meals and ginger supplementation for mild cases, with pharmacologic options such as pyridoxine and doxylamine for more severe symptoms to prevent progression to hyperemesis gravidarum, which requires hospitalization for hydration in 0.3-3% of cases. Genetic screening options include nuchal translucency ultrasound combined with serum markers (pregnancy-associated plasma protein-A and human chorionic gonadotropin) between 11-14 weeks to assess risks for aneuploidies like Down syndrome. As of 2025, cell-free DNA testing (non-invasive prenatal testing, or NIPT) is recommended as the first-line screening for fetal aneuploidy starting from 10 weeks' gestation for all pregnant individuals, regardless of risk, due to its high sensitivity (over 99% for trisomy 21) and low false-positive rate compared to traditional methods. The second trimester (weeks 13-26) shifts toward detailed fetal evaluation and maternal sensitization prevention, as organogenesis completes and risks like congenital anomalies become detectable. A comprehensive anatomy ultrasound at 18-20 weeks examines fetal structures including the brain, heart, spine, limbs, and placenta to identify major anomalies, with detection rates up to 90% for severe defects when performed by certified sonographers. For aneuploidy screening, the quadruple screen—measuring alpha-fetoprotein, human chorionic gonadotropin, estriol, and inhibin A levels between 15-22 weeks—provides risk assessment for Down syndrome and neural tube defects, achieving about 80% detection for trisomy 21 when integrated with prior first-trimester results. Rh-negative mothers receive Rho(D) immune globulin (RhoGAM) prophylaxis at 28 weeks (late second trimester) to prevent alloimmunization, reducing the incidence of hemolytic disease in future pregnancies from approximately 15% to less than 0.1%. During the third trimester (weeks 27-40), care emphasizes infection prevention, preterm birth risk stratification, and labor preparation to support term delivery. Universal screening for Group B Streptococcus via vaginal-rectal culture at 35-37 weeks identifies colonization in 10-30% of women, guiding intrapartum prophylaxis to reduce early-onset neonatal by over 80%. Transvaginal measurement of cervical length, ideally between 16-24 weeks but repeatable if risks emerge, identifies short (<25 mm) in asymptomatic women, prompting interventions like progesterone supplementation to lower risk by 30-50% in singleton pregnancies. Preparation for birth includes discussions on birth plans, covering preferences for pain management, delivery position, and postpartum support, typically initiated around 32-36 weeks to align expectations with evidence-based options. These trimester-specific approaches integrate with overall prenatal monitoring to minimize complications while promoting physiologic labor.

Labor and Delivery

Stages and Physiology of Labor

Labor is a complex physiologic process involving coordinated hormonal, mechanical, and neuromuscular events that facilitate the expulsion of the fetus and placenta from the uterus. Central to this process is the hormone oxytocin, which plays a pivotal role in initiating and sustaining uterine contractions. Oxytocin, released from the posterior pituitary gland, binds to receptors on uterine smooth muscle cells, increasing intracellular calcium and promoting myometrial contractility. This leads to rhythmic contractions that progressively strengthen and coordinate to dilate the cervix and propel the fetus downward. Additionally, oxytocin contributes to cervical ripening by stimulating the production of prostaglandins, such as PGE2 and PGF2α, which soften and efface the cervix through enzymatic remodeling of collagen and increased vascular permeability. The Ferguson reflex, a neuroendocrine feedback mechanism, further amplifies labor progression. As the fetal head descends and exerts pressure on the cervix and lower uterine segment, sensory nerves in the pelvic region transmit signals to the hypothalamus, triggering pulsatile oxytocin release. This reflex creates a positive feedforward loop, intensifying contractions and the urge to push, particularly in the second stage of labor. The cardinal movements of labor describe the adaptive maneuvers the fetus undergoes to navigate the maternal pelvis, assuming a vertex presentation. These include engagement (entry of the fetal head into the pelvic inlet), descent (downward progression through the pelvis driven by contractions), flexion (alignment of the fetal head to present the smallest diameter), internal rotation (alignment of the fetal head with the anteroposterior diameter of the pelvic outlet), extension (unfolding of the head under the pubic symphysis during delivery), external rotation (realignment of the shoulders with the pelvic diameters), and expulsion (complete delivery of the fetus). These movements ensure efficient passage through the curved birth canal. The first stage of labor begins with the onset of regular contractions and ends at full cervical dilation of 10 cm. It is subdivided into the latent phase (cervical dilation from 0 to 6 cm with irregular, mild contractions) and the active phase (dilation from 6 to 10 cm with regular, strong contractions). In nulliparous women (first-time mothers), the latent phase has a median duration of approximately 8 hours, with 95% completing within 20 hours, while the active phase progresses at an overall rate of about 1 cm per hour (slower from 4-6 cm, accelerating later). Multiparous women (those who have previously given birth) experience shorter durations, with the latent phase median around 5 hours and active phase rates exceeding 1.5 cm per hour overall. Common signs heralding this stage include the bloody show—a discharge of blood-tinged mucus from the loss of the cervical mucus plug, indicating effacement and early dilation—and rupture of membranes, or "water breaking," where the amniotic sac tears, releasing fluid that may occur spontaneously before or during contractions. The second stage commences at full cervical dilation and concludes with the birth of the baby, characterized by the maternal bearing-down efforts in response to the Ferguson reflex. This pushing phase typically lasts 1 to 3 hours in nulliparous women without epidural anesthesia (median around 50 minutes) and is shorter in multiparous women (median 20 minutes), allowing for fetal descent, rotation, and expulsion through the vaginal canal. The third stage begins immediately after fetal delivery and ends with the expulsion of the placenta, usually within 30 minutes. Uterine contractions shear the placenta from the decidua, leading to its separation and delivery, often accompanied by a gush of blood. Active management of this stage, recommended by authoritative guidelines, involves prophylactic administration of oxytocin (typically 10 units intramuscularly) to enhance myometrial tone, controlled cord traction, and uterine massage to minimize blood loss and reduce the risk of postpartum hemorrhage by up to 60%. Expectant management without uterotonics is an alternative in low-risk cases but increases hemorrhage risk.

Induction, Augmentation, and Delivery Methods

Induction of labor refers to the artificial initiation of uterine contractions to stimulate childbirth before it begins naturally, typically when continuing the pregnancy poses risks to the mother or fetus. Common indications include post-term pregnancy, defined as gestation extending beyond 42 weeks, where risks such as placental insufficiency increase. Preeclampsia, a hypertensive disorder characterized by high blood pressure and potential organ damage, is another key indication, often necessitating induction at or after 37 weeks to prevent maternal and fetal complications. Premature rupture of membranes (PROM) at term, where the amniotic sac breaks without onset of labor, also warrants induction to reduce infection risk, with guidelines recommending oxytocin initiation within 12-24 hours. Prior to induction, cervical readiness is assessed using the , a standardized system scoring five factors on a scale of 0-13: cervical dilation (0-10 cm, scored 0-3), effacement (0-100%, scored 0-3), fetal station (-3 to +3, scored 0-3), cervical consistency (firm to soft, scored 0-2), and cervical position (posterior to anterior, scored 0-2). A score of 8 or higher indicates a favorable ("ripe") cervix, predicting higher success rates for vaginal delivery with induction, while scores below 6 often require cervical ripening. Pharmacological methods dominate induction protocols. Prostaglandins, such as misoprostol administered vaginally or orally, promote cervical ripening by softening and dilating the cervix through local prostaglandin E1 effects. For favorable cervices, intravenous oxytocin infusion stimulates contractions by mimicking endogenous oxytocin, with low-dose regimens preferred to minimize hyperstimulation risks. Mechanical methods like membrane stripping or balloon dilation may also be used adjunctively. Labor augmentation enhances ongoing but inadequate contractions, primarily for dystocia—abnormal labor progress due to inefficient uterine activity, malposition, or cephalopelvic disproportion. Amniotomy, the artificial rupture of membranes, is recommended by ACOG to shorten labor duration when combined with augmentation, provided the fetal head is engaged. infusion remains the cornerstone, titrated to achieve regular contractions while monitoring fetal heart rate to avoid tachysystole. Delivery methods vary based on clinical needs during the second stage of labor. Spontaneous vaginal delivery occurs without assistance once full dilation is reached, aligning with natural progression through the three stages. Forceps-assisted delivery uses curved instruments to guide the fetal head through the birth canal, indicated for maternal exhaustion or fetal malposition, with success rates comparable to vacuum when properly selected. Vacuum extraction employs a suction cup on the fetal scalp to facilitate descent, preferred for its lower maternal injury risk but limited to term fetuses in cephalic presentation. Cesarean section, a surgical delivery through abdominal incision, is indicated for conditions like fetal distress or failure to progress, with the U.S. rate reaching 32.3% of all births in 2023 per CDC data. Water immersion during the first stage of labor may reduce pain and epidural use; however, the American College of Obstetricians and Gynecologists (ACOG) recommends delivery on land due to insufficient data on water birth risks, though a 2024 meta-analysis found no increased neonatal complications in low-risk cases. Facilities offering this must ensure infection control and access to land-based care. Pain management during induction, augmentation, and delivery is crucial for maternal comfort. Epidural anesthesia, the most effective regional option, involves injecting local anesthetics and opioids into the epidural space to block sensory nerves from T10 to L1, providing analgesia from the upper abdomen to thighs while preserving motor function in modern low-dose techniques. Nitrous oxide, a 50% inhaled mixture with oxygen, offers rapid-onset anxiolysis and mild analgesia without numbing, self-administered via mask and reversible within minutes, suitable for early labor or as an epidural alternative.

Postpartum Care

Immediate Maternal and Neonatal Care

Immediate postpartum care for the mother emphasizes stabilizing vital signs, preventing hemorrhage, and initiating recovery processes in the first hours after delivery. Uterine massage is routinely performed to promote uterine involution by stimulating contractions, which helps expel remaining placental fragments and minimize blood loss. This intervention is a first-line measure in managing postpartum hemorrhage, defined by the American College of Obstetricians and Gynecologists (ACOG) as cumulative blood loss of at least 1,000 mL or bleeding accompanied by signs of hypovolemia within 24 hours of birth. Concurrently, the uterine fundus is palpated and its height assessed relative to the umbilicus to detect atony or retained products, with any deviation prompting further evaluation and intervention to avert excessive bleeding. If vaginal delivery resulted in perineal lacerations, repair is conducted promptly using absorbable sutures, typically under local anesthesia, to restore anatomy and reduce infection risk; second-degree tears, involving the perineal muscles but sparing the anal sphincter, are closed with continuous suturing for optimal healing. Breastfeeding initiation is encouraged within the first hour postpartum, supported by uninterrupted skin-to-skin contact between mother and newborn, which enhances latch success, stabilizes the infant's temperature and heart rate, and promotes oxytocin release to aid uterine contraction. Neonatal care in the immediate postpartum period prioritizes rapid assessment and prophylactic measures to ensure adaptation to extrauterine life. The Apgar score, developed by Virginia Apgar in 1952, evaluates the newborn at 1 and 5 minutes post-birth across five criteria—appearance (skin color), pulse (heart rate), grimace (reflex irritability), activity (muscle tone), and respiration (breathing effort)—with each scored 0-2; total scores of 7-10 indicate good adaptation, while lower scores guide resuscitation efforts. To prevent vitamin K deficiency bleeding (formerly hemorrhagic disease of the newborn), a single intramuscular dose of 0.5-1 mg phylloquinone is administered within the first hour, as newborns have low vitamin K stores and immature gut flora. Erythromycin 0.5% ophthalmic ointment is applied to both eyes shortly after birth to prophylaxis against gonococcal and chlamydial ophthalmia neonatorum, conditions that can lead to blindness if untreated. Umbilical cord clamping is delayed for at least 30–60 seconds in vigorous term infants to facilitate placental transfusion, increasing neonatal blood volume by up to 30% and enhancing iron stores to reduce anemia risk in the first months of life, as recommended by ACOG. Facilitating early bonding through skin-to-skin contact not only supports breastfeeding but also fosters maternal-infant attachment and reduces newborn stress responses. Initial physical examinations assess for congenital anomalies, with vital signs monitored to confirm stability. Newborn screening for metabolic, endocrine, and genetic disorders—such as , , and sickle cell disease—is performed via heel-prick blood collection onto filter paper, ideally 24-48 hours after birth to avoid false negatives from maternal antibody interference, enabling early intervention as per CDC guidelines.

Long-Term Recovery and Follow-Up

Long-term postpartum recovery involves ongoing monitoring and management to ensure maternal health restoration and prevent complications. The standard timeline includes contact with a maternal care provider within the first 3 weeks postpartum, followed by a comprehensive postpartum visit no later than 12 weeks after delivery, where healthcare providers assess wound healing from cesarean sections or perineal tears, counsel on contraception, and discuss safe return to physical activities such as exercise and sexual intercourse. This visit builds on immediate postpartum care by evaluating overall recovery progress and addressing any lingering issues from the birth process. Maternal recovery encompasses physiological changes like vaginal discharge known as lochia, which progresses through distinct stages: lochia rubra, characterized by bright red blood lasting 1-3 days; lochia serosa, a pinkish-brown discharge from days 4-10; and lochia alba, a yellowish-white mucus phase from days 11-21, though traces may persist up to 6 weeks. Resuming exercise should be gradual, starting with low-impact activities like walking after clearance at the postpartum visit, to avoid strain on healing tissues; pelvic floor therapy is recommended for up to 30% of women experiencing urinary incontinence, involving targeted exercises to strengthen muscles weakened by pregnancy and delivery. Follow-up screenings focus on key health risks during this period. Blood pressure monitoring is essential to detect persistent postpartum hypertension, which affects about 10% of women and requires ongoing evaluation beyond 12 weeks if elevated. Thyroid function tests are advised for women at risk of postpartum thyroiditis, an autoimmune condition occurring in 5-10% of postpartum individuals, typically screened via TSH levels at 6-12 weeks if symptoms like fatigue or weight changes arise. Anemia screening involves hemoglobin checks, with iron supplementation recommended if levels fall below 10 g/dL to address fatigue and support recovery. Screening for perinatal mood and anxiety disorders, such as postpartum depression, is recommended during postpartum visits to identify and address mental health concerns early. Family planning discussions at the postpartum check-up emphasize effective options tailored to breastfeeding status. The lactational amenorrhea method (LAM) offers 98% efficacy in preventing pregnancy when exclusive breastfeeding is maintained for the first 6 months postpartum, without menses returning, serving as a natural interim contraceptive. For longer-term protection, options like intrauterine device (IUD) insertion are safe at 4-6 weeks postpartum, providing immediate reversibility and high effectiveness rates exceeding 99%. In 2025, updates to postpartum care incorporate telemedicine to enhance access, particularly for remote or underserved populations, allowing virtual visits for follow-up screenings and counseling to bridge gaps in traditional in-person care. Studies show telehealth approaches improve adherence to postpartum visits, reducing barriers like transportation and childcare.

Diagnostics and Assessments

Fetal Monitoring Techniques

Fetal monitoring techniques are essential for evaluating fetal well-being during the antenatal period and intrapartum stage, helping to identify potential hypoxia or distress through assessments of heart rate patterns, movements, and other biophysical parameters. These methods range from non-invasive outpatient tests to continuous electronic monitoring during labor, guiding clinical decisions on intervention timing. The non-stress test (NST) is a common antenatal surveillance method performed in an outpatient setting, typically lasting 20-30 minutes, where fetal heart rate (FHR) is monitored using external Doppler ultrasound while observing for accelerations associated with fetal movement. A reactive NST, indicating normal fetal status, is defined as at least two accelerations of 15 beats per minute (bpm) or more above the baseline FHR, each lasting at least 15 seconds, occurring within a 20-minute window. Non-reactive results may prompt further evaluation but can also reflect fetal sleep cycles rather than pathology. The biophysical profile (BPP) combines the NST with real-time ultrasound to score five parameters: fetal breathing movements (at least one episode lasting 30 seconds), body movements (at least three discrete movements), muscle tone (at least one episode of extension-flexion), amniotic fluid volume (a pocket of at least 2 cm), and the NST result. Each component is scored 0 (absent or abnormal) or 2 (present and normal), yielding a total score from 0 to 10; scores of 8-10 are reassuring, 6 is equivocal requiring repeat testing, and less than 6 suggests fetal compromise necessitating intervention. This scoring system correlates with perinatal outcomes and is particularly useful in high-risk pregnancies after 32 weeks gestation. The contraction stress test (CST), also known as the oxytocin challenge test, evaluates FHR response to induced uterine contractions and is reserved for cases where NST or BPP results are equivocal. It involves intravenous oxytocin administration to achieve three contractions within a 10-minute period, with continuous FHR monitoring to detect late decelerations (indicating uteroplacental insufficiency) or variable decelerations (suggesting cord compression). A negative CST, with no late decelerations, predicts good fetal tolerance of labor, while positive results (late or significant variable decelerations) may warrant delivery planning. During labor, electronic fetal monitoring (EFM) provides continuous assessment of FHR and uterine contractions, typically using external transducers: an ultrasound-based device for FHR and a tocodynamometer for contraction intensity and frequency. If external monitoring is inadequate, internal methods like a fetal scalp electrode for direct FHR recording may be employed, particularly in cases of maternal obesity or excessive fetal movement. Tracings are classified into three categories per National Institute of Child Health and Human Development (NICHD) guidelines, updated in 2008 and reaffirmed in subsequent reviews: Category I (normal, with baseline 110-160 bpm, moderate variability, and no or early decelerations) requires routine care; Category II (indeterminate, including minimal variability or variable decelerations without other abnormalities) prompts conservative measures like maternal repositioning; and Category III (abnormal, characterized by absent variability with recurrent late/variable/prolonged decelerations, bradycardia, or sinusoidal pattern) indicates potential acidosis and mandates immediate delivery. Advanced techniques include fetal pulse oximetry, which measures fetal oxygen saturation via a vaginal probe to supplement EFM in ambiguous cases, though its routine use is not recommended due to limited evidence of improved outcomes. Fetal electrocardiogram (ECG) analysis, such as with the STAN system, analyzes ST-segment changes in the fetal ECG waveform alongside FHR to detect myocardial acidosis risk, but the American College of Obstetricians and Gynecologists advises against its routine intrapartum application pending further validation. These methods integrate with maternal health evaluations to optimize overall pregnancy management.

Maternal Health Evaluations

Maternal health evaluations in obstetrics encompass a range of diagnostic tests and assessments designed to identify and monitor conditions affecting the pregnant individual, ensuring optimal outcomes for both maternal and fetal health. These evaluations typically begin at the first prenatal visit and continue throughout pregnancy, focusing on biomarkers, infections, and physiological changes that could impact gestation. Key components include laboratory analyses for hematological and infectious disease screening, as well as imaging modalities to assess gestational progression and potential complications. Routine laboratory tests form the cornerstone of initial maternal assessments, performed early in pregnancy to detect common conditions. A complete blood count (CBC) is standard to evaluate for anemia, defined as hemoglobin levels below 11 g/dL, which can lead to fatigue, preterm labor risks, and low birth weight if untreated. Screening for rubella immunity via antibody status is essential to confirm protection against congenital rubella syndrome, while HIV and hepatitis B virus testing at the first visit enables early intervention to prevent vertical transmission. These tests, recommended universally, help guide prophylaxis and vaccination where needed. Ultrasound imaging plays a critical role in maternal health evaluations by providing non-invasive visualization of pregnancy parameters. In the first trimester, crown-rump length (CRL) measurement is used for accurate gestational dating, with precision typically within ±5 days when performed between 8 and 13 weeks. Later in pregnancy, growth scans assess fetal biometry to detect intrauterine growth restriction (IUGR), employing metrics such as biparietal diameter (BPD) for head size and femur length for long bone development; deviations below the 10th percentile may indicate IUGR, prompting further maternal vascular or nutritional evaluations. These scans also indirectly inform maternal health by identifying placental issues or hypertension-related growth lags. For higher-risk pregnancies, specialized invasive procedures offer detailed genetic analysis. , typically conducted between 15 and 20 weeks of gestation, involves sampling amniotic fluid to diagnose chromosomal abnormalities, neural tube defects, and infections, with a procedure-related miscarriage risk of 0.1%–0.3%. Similarly, is performed between 10 and 13 weeks to obtain placental tissue for genetic testing, carrying a slightly higher miscarriage risk of approximately 0.2%–0.5%. These tests are reserved for cases with elevated risk based on prior screening, balancing diagnostic yield against procedural hazards. Advancements in non-invasive prenatal testing (NIPT) have revolutionized maternal evaluations for chromosomal risks. NIPT analyzes cell-free fetal DNA in maternal blood, typically after 10 weeks, to screen for aneuploidies such as trisomy 21 (Down syndrome) with sensitivity exceeding 99% and low false-positive rates, as confirmed in 2024 meta-analyses. This blood-based approach reduces the need for invasive procedures in low-risk populations while providing high-accuracy results for common trisomies.

Complications and Emergencies

Common Pregnancy Disorders

Common pregnancy disorders encompass a range of conditions that can arise during gestation, impacting maternal and fetal health, and often require targeted screening, diagnosis, and management to mitigate risks such as preterm birth or neonatal complications. These disorders, including gestational diabetes, preeclampsia, anemia, hyperemesis gravidarum, and venous thromboembolism, are influenced by physiological changes in pregnancy and affect a significant proportion of pregnancies worldwide. Early detection through routine prenatal care is essential, as many can be managed effectively to optimize outcomes. Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first recognition during pregnancy, typically screened for between 24 and 28 weeks of gestation using a 75-gram oral glucose tolerance test (OGTT). Diagnosis is confirmed if the fasting plasma glucose is ≥92 mg/dL, the 1-hour value is ≥180 mg/dL, or the 2-hour value is ≥153 mg/dL. This condition affects approximately 2-10% of pregnancies and increases risks of macrosomia, cesarean delivery, and future type 2 diabetes in the mother. Initial management involves medical nutrition therapy, physical activity, and self-monitoring of blood glucose; if targets (fasting <95 mg/dL, 1-hour postprandial <140 mg/dL, 2-hour postprandial <120 mg/dL) are not met, insulin is the preferred pharmacologic agent, though the 2023 American Diabetes Association (ADA) standards endorse metformin or glyburide as alternatives in select cases under close monitoring. Preeclampsia is a multisystem disorder characterized by new-onset hypertension after 20 weeks of gestation in a previously normotensive woman, defined as blood pressure ≥140/90 mmHg on two occasions at least 4 hours apart, accompanied by proteinuria (≥300 mg in a 24-hour urine collection) or other end-organ dysfunction such as thrombocytopenia or impaired liver function. It complicates 2-8% of pregnancies and can progress to severe features, including eclampsia or stroke if untreated. A severe variant, , involves hemolysis (evidenced by abnormal peripheral blood smear or elevated lactate dehydrogenase), elevated liver enzymes (twice the upper limit of normal), and low platelet count (<100,000/μL), occurring in 10-20% of severe preeclampsia cases and necessitating urgent delivery in many instances. Management focuses on blood pressure control with antihypertensives like labetalol or hydralazine, seizure prophylaxis with magnesium sulfate, and timely delivery, typically after 34 weeks or earlier if severe features emerge. Anemia, most commonly iron-deficiency anemia, affects up to 40% of pregnant individuals due to increased iron demands for fetal growth and expanded maternal blood volume, with hemoglobin levels below 11 g/dL in the first and third trimesters or below 10.5 g/dL in the second trimester indicating anemia. Symptoms include fatigue, pallor, and shortness of breath, potentially leading to preterm delivery or low birth weight if severe. The American College of Obstetricians and Gynecologists (ACOG) recommends routine screening via complete blood count at the first prenatal visit and again at 24–28 weeks of gestation, and universal low-dose iron supplementation of 30 mg elemental iron daily starting in the first trimester for all pregnant individuals, unless contraindicated, to prevent deficiency; higher doses (60-120 mg daily) or intravenous iron may be used for confirmed iron-deficiency anemia. Hyperemesis gravidarum represents the severe end of the nausea and vomiting spectrum in pregnancy, affecting 0.3-3% of cases, characterized by intractable vomiting leading to weight loss (>5% of prepregnancy body weight), , and imbalances, often requiring hospitalization. It typically peaks in the first trimester but can persist, impacting nutritional status and quality of life. First-line treatment includes dietary modifications such as small, frequent meals and ginger, alongside pharmacologic options like (pyridoxine) 10-25 mg combined with doxylamine 12.5 mg up to four times daily; if ineffective, 4-8 mg every 8 hours is recommended as a second-line agent, with monitoring for QT prolongation. In refractory cases, hospitalization for intravenous fluids, supplementation to prevent , and possibly corticosteroids may be necessary. Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, poses a leading cause of maternal morbidity and mortality, with pregnancy conferring a 4-5-fold increased risk due to venous stasis, endothelial injury, and hypercoagulability from elevated clotting factors. The incidence is approximately 1 in 1,000 pregnancies, heightened by factors such as prior VTE, thrombophilia, or obesity. ACOG guidelines advocate for risk assessment at the first prenatal visit and postpartum; antepartum prophylaxis with low-molecular-weight heparin (e.g., enoxaparin 40 mg subcutaneously once daily) is recommended for those with a personal history of VTE or high-risk thrombophilias, while postpartum prophylaxis extends 6 weeks for persistent risks. Diagnosis relies on compression ultrasonography for lower extremity symptoms or ventilation-perfusion scanning for suspected pulmonary embolism, with anticoagulation continued throughout pregnancy and breastfeeding if indicated.

Intrapartum and Postpartum Emergencies

Intrapartum emergencies encompass acute, life-threatening events occurring during labor and delivery that demand immediate intervention to safeguard maternal and fetal well-being. These crises, such as and , often arise unpredictably and can lead to severe hemorrhage, fetal distress, or hypoxia if not addressed promptly. Postpartum emergencies, including hemorrhage and , typically manifest shortly after birth and require rapid multidisciplinary responses to prevent maternal mortality or morbidity. Effective management relies on standardized protocols emphasizing team coordination, , and surgical readiness, with recent advancements incorporating simulation-based training to enhance preparedness. Uterine rupture, a rare but catastrophic intrapartum complication, involves the complete or partial tearing of the uterine wall, most commonly in women with a scarred uterus from prior cesarean delivery, where rates reach 0.5% to 0.9% during trials of labor after cesarean. Other risk factors include labor induction, multiparity, obstructed labor, and use of prostaglandins for augmentation. Symptoms manifest suddenly as severe abdominal pain, cessation of uterine contractions, fetal bradycardia indicating distress, and occasionally palpation of extrauterine fetal parts or maternal shock from hemorrhage. Diagnosis is primarily clinical, supported by urgent ultrasound if time permits, but management mandates immediate cesarean delivery via emergency laparotomy to repair the rupture and control bleeding, with maternal stabilization through fluid resuscitation and blood transfusion as needed. Shoulder dystocia occurs when the fetal shoulders fail to deliver after the head, often due to impaction of the anterior shoulder behind the maternal , complicating approximately 0.2% to 3% of vaginal births, particularly in cases of fetal macrosomia, maternal , or prolonged second-stage labor. A hallmark is the "turtle sign," where the fetal head retracts against the due to shoulder . Initial management involves calling for additional help, ceasing maternal pushing, and applying the —hyperflexing the maternal thighs to the abdomen to rotate the cephalad and widen the —which succeeds in up to 42% of cases as a first-line intervention. If unsuccessful, suprapubic pressure is added to dislodge the anterior shoulder by applying firm, downward force above the while avoiding fundal pressure; subsequent maneuvers may include delivery of the posterior arm or rotational techniques if required. Postpartum hemorrhage (PPH) is defined as cumulative blood loss of ≥1,000 mL within 24 hours after birth or blood loss accompanied by signs or symptoms of , regardless of delivery mode, remaining a leading cause of globally despite preventive measures. The primary causes are categorized by the "4 Ts": tone (, accounting for 70-80% of cases due to overdistended or ), trauma (lacerations, hematomas, or ), tissue ( or membranes), and thrombin (coagulopathies like ). Initial management focuses on uterine massage, administration of uterotonics such as oxytocin, and bimanual compression; for persistent bleeding, (TXA) at 1 g intravenously within three hours of onset is recommended by the to reduce mortality by inhibiting . Uterine , involving insertion of a to apply direct pressure, serves as a non-surgical option effective in 80-90% of atony-related cases, particularly in resource-limited settings. Eclampsia represents a severe progression of preeclampsia characterized by new-onset seizures in the intrapartum or postpartum period, often triggered by cerebral vasospasm and endothelial dysfunction, with an incidence of 1 in 2,000 deliveries in high-resource settings. Prophylaxis with magnesium sulfate is standard for women with severe preeclampsia to prevent eclamptic seizures, administered as a loading dose of 4-6 g intravenously over 20-30 minutes, followed by a maintenance infusion of 1-2 g per hour to maintain therapeutic serum levels of 4.8-8.4 mg/dL, as per American College of Obstetricians and Gynecologists guidelines. For active eclampsia, the same regimen is used alongside seizure control, maternal stabilization with antihypertensives like labetalol, and expedited delivery; monitoring for magnesium toxicity includes assessing reflexes and respiratory rate. Amniotic fluid embolism (AFE) is a rare, unpredictable anaphylactoid reaction to entering the maternal circulation, occurring in approximately 1 in 40,000 deliveries and carrying a of up to 60%. It presents abruptly with sudden respiratory distress, , , fetal , and rapid progression to cardiovascular collapse or seizures, often accompanied by resembling . Management is entirely supportive, prioritizing , high-flow oxygen, aggressive fluid resuscitation to maintain above 65 mmHg, vasopressor support for shock, and transfusions to address hemorrhage and , with no specific available. Early recognition and a multidisciplinary team response, including and critical care, are crucial for improving outcomes. As of 2025, updated protocols for intrapartum and postpartum emergencies emphasize training for team-based responses, such as the American College of Obstetricians and Gynecologists' Emergencies in Clinical Obstetrics (ECO) course, which uses hands-on scenarios to drill protocols for hemorrhage and dystocia. The World Health Organization's recent guidelines incorporate modules for PPH management to standardize global responses and reduce delays in care. These emergencies can sometimes be anticipated through preventive screenings for underlying conditions like , as addressed in broader disorder evaluations.

Special Topics

High-Risk and Multiple Pregnancies

High-risk pregnancies are those characterized by an increased likelihood of adverse maternal or fetal outcomes due to maternal, fetal, or placental factors that require specialized management. These pregnancies often involve closer surveillance and interventions to mitigate complications such as preterm birth, gestational diabetes, or preeclampsia. Common risk factors include advanced maternal age, defined as 35 years or older at delivery, which is associated with higher rates of chromosomal abnormalities, miscarriage, and cesarean delivery compared to younger women. Pre-existing conditions such as chronic hypertension or diabetes further elevate risks, with hypertension linked to placental insufficiency and diabetes to macrosomia and congenital anomalies. Maternal obesity, particularly with a body mass index (BMI) greater than 30, independently increases the risk of cesarean delivery by up to twofold due to labor dystocia and comorbidities like sleep apnea. Multiple gestations, including twins and higher-order multiples, represent a significant subset of high-risk pregnancies owing to the amplified physiological demands on the mother and the fetuses. Twins are classified as dichorionic (separate placentas) or monochorionic (shared placenta), with monochorionic pregnancies carrying additional risks such as (TTTS), a condition affecting 10-15% of where unequal blood flow leads to volume imbalance between the fetuses. TTTS is managed through fetoscopic of placental vascular anastomoses, which improves survival rates to over 70% when performed before 26 weeks of . Triplet and higher-order pregnancies are even more precarious, with approximately 90% delivering preterm before 37 weeks due to uterine overdistension and increased risk of preterm labor. Management of high-risk and multiple pregnancies emphasizes intensified antenatal surveillance and targeted interventions. For twin pregnancies, nonstress tests (NSTs) are recommended biweekly starting at 32 weeks' gestation to assess fetal well-being, alongside serial s for growth monitoring every 2-4 weeks. , a amplified in multiples, may be addressed with cerclage placement between 12 and 24 weeks if transvaginal reveals a short (less than 25 mm). In cases of threatened preterm labor, such as , a , are used to delay delivery by 48 hours, allowing time for administration to promote fetal lung maturity; reduces the of delivery before 34 weeks by approximately 23% compared to β-agonists in eligible cases without severe contraindications. Outcomes for high-risk and multiple pregnancies reflect the elevated morbidity, with neonates from twins or facing a 5-10 times higher rate of (NICU) admissions compared to singletons, primarily due to prematurity and . For women with a prior cesarean delivery in a high-risk context, vaginal birth after cesarean (VBAC) may be considered if there is one previous low transverse incision, no prior or classical incision, and no other contraindications such as placenta previa; success rates range from 60-80% under these criteria. In resource-limited settings, ethical dilemmas arise regarding access to advanced interventions like laser for TTTS, often prioritizing maternal stabilization over specialized fetal care.

Global Practices and Ethical Considerations

Obstetric practices vary significantly across the globe, influenced by socioeconomic, cultural, and infrastructural factors. In low-income regions, particularly , the (MMR) reached 454 deaths per 100,000 live births as of the latest 2023 estimates, accounting for approximately 70% of global maternal deaths, compared to rates below 10 per 100,000 in high-income European countries. These disparities highlight the critical role of skilled birth attendants—trained health professionals such as midwives, doctors, or nurses—who can detect and manage complications during delivery, potentially averting 13% to 33% of maternal deaths worldwide. Access to such attendants remains limited in rural areas, where only about 50% of births in are attended by skilled personnel, exacerbating outcomes. Cultural traditions further shape obstetric care, with home births predominating in rural communities of low- and middle-income countries, often assisted by traditional birth attendants (TBAs) who rely on indigenous knowledge and remedies. In contrast, urban areas in Western nations emphasize hospital-based deliveries, where over 98% of births occur in facilities equipped for interventions like epidurals and cesareans, reducing perinatal risks for low-risk pregnancies but sometimes increasing intervention rates. Efforts to integrate TBAs into formal systems, such as training programs in Guatemala's rural highlands, aim to bridge these practices while improving safety through referrals to skilled care. However, planned home births in low-risk cases can yield outcomes comparable to hospital births when supported by midwives, though they carry higher risks of neonatal complications without rapid transfer capabilities. Ethical considerations in obstetrics often arise from tensions between maternal and fetal well-being. is foundational, yet conflicts emerge when patients refuse recommended procedures, such as cesareans; for instance, courts have occasionally overridden refusals to prioritize , though professional guidelines stress respecting patient decisions absent imminent harm. Maternal-fetal conflicts intensify in cases of substance use disorders, where forced treatments—like detention for during —have been justified under beneficence and nonmaleficence principles but criticized for violating autonomy and disproportionately affecting marginalized women. During the (2020-2023), posed additional dilemmas, with obstetric protocols prioritizing equitable access to ventilators and intensive care for pregnant patients, balancing maternal and fetal needs amid scarcity. Equity remains a core challenge, as racial and socioeconomic disparities persist in maternal outcomes. , faced a 2023 MMR of 50.3 per 100,000 live births—over three times the rate for women—driven by systemic biases in care quality and access. Globally, postpartum contraception access is uneven, with over two-thirds of women in low-income countries desiring spacing or limiting future pregnancies yet lacking effective methods due to supply shortages and counseling gaps. Initiatives to promote immediately postpartum aim to enhance equity, particularly for underserved populations. As of 2025, emerging technologies offer pathways to address these issues in underserved areas. models, such as algorithms analyzing electronic fetal monitoring data, have demonstrated high accuracy in predicting high-risk pregnancies and complications like postpartum hemorrhage, enabling earlier interventions. Telemedicine integration has expanded in rural and remote regions, with programs like those at the providing virtual consultations that improve outcomes for high-risk patients by overcoming geographic barriers. These tools, when equitably deployed, hold potential to reduce global disparities by facilitating timely and follow-up.

Veterinary Obstetrics

Core Principles in Animals

Veterinary obstetrics, a specialized subset of —the branch of dedicated to animal reproduction—primarily addresses the reproductive health and parturition processes in domestic mammals such as , horses, and dogs. Unlike obstetrics, which often emphasizes elective interventions and long-term maternal-fetal monitoring, veterinary obstetrics centers on practical management to ensure the viability of and companion animals, with a key focus on dystocia, defined as a difficult or prolonged birth requiring assistance to prevent maternal or fetal loss. In , for example, dystocia affects approximately 5% of calvings, particularly in primiparous cows (heifers), highlighting its economic and welfare implications in agricultural settings. Physiological differences between animal and human reproduction significantly shape obstetric principles in veterinary practice. Animal gestations are typically shorter than the human 280 days, such as 63 days in dogs and around 340 days in , allowing for more rapid reproductive cycles but demanding precise timing in interventions. Litter-bearing species like dogs and cats often involve polyovulation, where multiple oocytes are released and fertilized, resulting in simultaneous or sequential deliveries that contrast with human singleton pregnancies and reduce risks associated with . Moreover, the lack of an upright bipedal posture in animals enables more flexible birthing positions—such as lateral recumbency in cows—facilitating natural expulsion without the gravitational and pelvic constraints seen in humans. Basic interventions in animal obstetrics prioritize minimally invasive techniques to resolve common issues like fetal malpresentation or uterine inertia, differing from the more surgical-oriented approaches in human care. Manual correction, involving gentle repositioning of the via vaginal access, is a first-line method for malpresentations in species like horses and dogs, often succeeding without further escalation. For uterine inertia—characterized by weak contractions—oxytocin administration (e.g., 2–5 IU intramuscularly or intravenously in dogs, with doses adjusted based on and size) stimulates labor progression, mimicking natural hormonal surges but requiring caution to avoid over-stimulation. Episiotomy analogs, such as controlled incisions in the , are employed in large animals like cows to enlarge the birth canal during obstructed deliveries, serving as a preventive measure against perineal tears while preserving future . Recent advances as of 2025 include AI integration in for early prediction of dystocia risks in large animals. Monitoring techniques in veterinary obstetrics emphasize non-invasive diagnostics adapted to animal anatomy and farm environments, contrasting with the continuous electronic fetal heart rate tracking common in human labor. Ultrasonography provides real-time assessment of fetal viability, position, and viability through transrectal or transabdominal probes, enabling early detection of distress in species across sizes. In large animals like cattle and horses, rectal palpation remains a cornerstone for evaluating cervical dilation and fetal presentation, offering a cost-effective, hands-on method that informs timely interventions without sedation. These approaches underscore the balance between efficiency and animal welfare in veterinary settings.

Species-Specific Applications

In veterinary obstetrics, practices are adapted to the anatomical and physiological differences among species, particularly in large and small animals. For bovine species, dystocia management often involves the use of for calf extraction during difficult deliveries, where the instrument aids in applying controlled traction to reposition and deliver the calf while minimizing trauma to the and . Cesarean sections in are frequently performed under field conditions to address severe dystocias, utilizing and standing restraint to facilitate on-farm intervention without the need for specialized facilities. In equine obstetrics, dystocia occurs in approximately 5% of pregnancies, a relatively low incidence compared to other species, often due to fetal malposition rather than maternal factors. The normal fetal in mares at term is dorsosacral, with the forelimbs extended and the soles of the hooves facing ventrally toward the ground, facilitating passage through the birth canal. For small companion animals, obstetric interventions are tailored to breed-specific challenges. In canines, cesarean sections are commonly performed in brachycephalic breeds such as English bulldogs, where the disproportionately large relative to the maternal increases dystocia risk, often necessitating elective procedures to ensure safe delivery. Feline litters typically consist of 3 to 5 kittens, reflecting the species' reproductive , with dystocia managed primarily through supportive care rather than routine intervention. Tocolytic agents, such as or beta-agonists, are rarely used in cats due to limited evidence of efficacy and potential risks to neonatal viability during premature labor. Distinctions between farm and companion animal highlight practical adaptations in obstetric care. In farm settings, such as bovine herds, estrus protocols using prostaglandins and progestins are employed to align calving seasons, enabling concentrated monitoring and during peak parturition periods. Conversely, in companion animals like dogs, elective cesarean sections are increasingly scheduled for high-risk breeds to mitigate dystocia, prioritizing individual over herd-level efficiency. Recent advances in veterinary obstetrics have enhanced species-specific applications, particularly in . techniques allow for the rapid dissemination of desirable by flushing embryos from elite donor cows and implanting them into recipient , accelerating improvement without multiple pregnancies in valuable animals. Progesterone assays, measured via or plasma samples around 21-24 days post-breeding, provide a reliable early in , with levels above 1 ng/mL indicating luteal activity and non-pregnancy confirmed by concentrations below 0.5 ng/mL.

History of Obstetrics

Pre-Modern Developments

Obstetrics in ancient civilizations relied heavily on empirical observations and traditional remedies, with early documented practices appearing in Egyptian medical texts. The , dating to approximately 1550 BCE, describes the use of birth stools to facilitate labor by supporting the mother in a semi-reclined position during delivery, a method that reduced strain and aided expulsion of the . This papyrus also details herbal emmenagogues, such as mixtures of honey, dates, and plants like , intended to induce or in cases of unwanted , reflecting an understanding of reproductive through trial-based . In , the , compiled around the 5th century BCE, introduced as a manual technique for breech presentations, involving internal manipulation to turn the feet-first for extraction, marking one of the earliest recorded interventions to manage difficult labors. During the medieval period, obstetrics remained largely in the hands of female midwives across , who dominated practice through apprenticeships and community knowledge, performing the majority of deliveries without formal male physician involvement until the . In Islamic scholarship, Avicenna's (completed around 1025 CE) advanced understanding of fetal positioning, classifying presentations such as vertex, breech, and transverse, and recommending manual versions or aids to correct malpositions during labor. Asian traditions, particularly in , incorporated —a technique burning dried near the BL67 acupoint on the little toe—to stimulate and encourage cephalic version in breech cases, a practice rooted in ancient texts like the (circa 200 BCE) and used for millennia in . Key figures emerged in this era, notably Trotula of Salerno in the 12th century, whose compendium The Trotula addressed comprehensively, including obstetric topics like managing postpartum hemorrhage with herbal poultices and advising on hygienic practices during birth to prevent infection, influencing European for centuries. Another pivotal development was the invention of the obstetric forceps by Peter Chamberlen around 1630, a locked, blade-like instrument designed to grasp and extract the in obstructed labors; kept as a family secret by the Chamberlen dynasty, it was not publicly revealed until the 1730s, limiting its early impact. Pre-modern obstetrics carried significant s, with maternal mortality rates estimated at 1-2% per birth due to uncontrolled infections, postpartum hemorrhage, and , exacerbated by the absence of antisepsis and surgical interventions; for instance, medieval English indicate a 1.2% per delivery among aristocratic women, compounded over multiple pregnancies. These high rates underscored the era's reliance on non-invasive, community-based care, where outcomes depended heavily on the midwife's and environmental factors.

18th to 20th Century Advances

In the , significant advancements in obstetrical instrumentation emerged, particularly through the work of Scottish physician William Smellie. In his 1752 publication, A Treatise on the Theory and Practice of Midwifery, Smellie publicized and refined the use of , modifying earlier designs to enable safer extraction of the during difficult deliveries. He was the first to apply for rotating the fetal head and for assisting in breech presentations, establishing guidelines that reduced maternal and fetal trauma compared to prior invasive methods. These innovations built on empirical practices but introduced more systematic anatomical understanding to forceps application, marking a shift toward evidence-based intervention in labor. Another 18th-century procedure for addressing was , which involved surgically dividing the to enlarge the and facilitate . First described in the late but increasingly performed in the 1700s, it was employed in cases of obstructed labor where the could not pass through the maternal , offering an alternative to destructive fetal operations. By the late , from 1777 to 1804, approximately 40 such operations were documented in , with survival rates improving due to better surgical techniques, though it remained controversial owing to risks of long-term pelvic instability. The brought transformative insights into infection control and in obstetrics. Hungarian physician , observing higher puerperal fever mortality in hospital wards attended by medical students versus midwives, instituted handwashing with chlorinated lime solution in 1847 at Vienna General Hospital's First Obstetrical Clinic. This intervention dramatically reduced mortality from 18.3% in April 1847 to 2.2% in June and 1.2% in July, attributing the fever to contamination transferred via unwashed hands. Semmelweis's findings, published in 1861, laid foundational principles for in maternity care, though initially met with resistance. Concurrently, Scottish obstetrician advanced pain relief during labor. In November 1847, Simpson first administered to women in , transitioning from earlier that year to this more potent for alleviating and delivery pain. This innovation challenged prevailing views that labor pain was divinely ordained, enabling safer operative interventions and gaining royal endorsement when used it in 1853, thereby accelerating its adoption across and . Building on antisepsis, British surgeon extended carbolic acid (phenol) techniques to surgical practice, including obstetrics, from 1867 onward. Inspired by Louis Pasteur's germ theory, Lister applied carbolic acid dressings and sprays to wounds and operative sites, significantly lowering postoperative rates in procedures like cesarean sections and repairs of perineal tears. In maternity settings, these methods reduced in puerperal cases, with hospital mortality from surgical interventions dropping from over 45% pre-1867 to under 15% within a decade in adopting centers. Early 20th-century progress enhanced transfusion safety critical for managing obstetric hemorrhage. Austrian immunologist discovered the in 1901 by identifying agglutination reactions between human sera and erythrocytes, classifying into A, B, AB, and O types. This breakthrough prevented hemolytic reactions in transfusions, enabling reliable replacement during postpartum bleeding, which had previously caused up to 25% of maternal deaths. The 1930s introduction of sulfa drugs revolutionized treatment of puerperal infections. Discovered by in 1932 and first used clinically in 1935, sulfonamides like effectively combated bacterial following delivery, reducing maternal mortality from puerperal fever from 4-5 per 1,000 births before 1935 to under 1 per 1,000 by the early in the United States. These antibiotics allowed safer hospital-based interventions, such as cesareans, previously deterred by risks. In the , the vacuum extractor provided a less traumatic alternative to for assisted vaginal deliveries. Swedish physician Tage Malmström developed the ventouse device, which was refined and popularized in Britain by obstetrician James Alexander Chalmers, applying suction to the fetal for traction during prolonged second-stage labor. Clinical adoption demonstrated reduced maternal perineal injury compared to , with success rates exceeding 80% in cephalic presentations, contributing to lower cesarean rates. In the American context, formal obstetrical education advanced with the establishment of dedicated academic positions. The first chair of obstetrics in a U.S. was created in the 1790s at the , where William Shippen Jr. lectured on from the 1760s, formalizing the role by 1792 amid growing emphasis on physician-led training over traditional . This institutionalization paralleled the shift toward hospital births, which rose from fewer than 5% of U.S. deliveries in 1900—mostly home-based with midwives or family physicians—to over 90% by 1950, driven by , medical specialization, and campaigns promoting aseptic hospital environments.

Contemporary Milestones

In the late , obstetrics saw transformative technological advancements that enhanced fetal assessment and reproductive options. imaging was first applied to obstetrics in 1958 through the pioneering work of Ian Donald and colleagues, who published their findings in , demonstrating its potential for visualizing fetal . By the , became routine for dating and anatomical surveys, revolutionizing prenatal diagnosis and reducing reliance on invasive procedures. Concurrently, electronic fetal monitoring emerged in the 1960s, with commercial systems available by 1968, enabling continuous assessment of fetal heart rate during labor to detect distress early and inform timely interventions. The 1978 birth of , the first baby conceived via fertilization (IVF), marked a milestone in , though IVF pregnancies often carry higher risks of complications such as and hypertensive disorders, thereby influencing protocols for high-risk obstetrics. Entering the 21st century, evidence-based practices and innovative screening methods further refined obstetric care. The American College of Obstetricians and Gynecologists (ACOG) issued guidelines in 2010 supporting vaginal birth after cesarean (VBAC) for most women with a prior low transverse incision, emphasizing trial of labor after cesarean (TOLAC) to reduce repeat cesarean rates, with updates in 2019 and 2020 reinforcing shared decision-making and tools. Non-invasive prenatal testing (NIPT), leveraging in maternal blood, began development in 2007 and became clinically available in 2011, offering high-accuracy screening for aneuploidies like with detection rates exceeding 99% and low false-positive rates, thus minimizing the need for invasive . In the 2010s, robotic-assisted surgery expanded in obstetrics, including applications for cesarean deliveries and scar defect repairs, providing enhanced precision, reduced blood loss, and shorter recovery times compared to traditional , as evidenced by early case series on cesarean scar pregnancies. The from 2020 prompted rapid adaptations in obstetric care, including widespread adoption of for prenatal visits to minimize viral exposure while maintaining continuity. Studies confirmed the safety of mRNA vaccines in , showing no increased risk of , with spontaneous abortion rates aligning with background population levels of 10-15%. By 2024-2025, (AI) and models emerged for prediction, achieving accuracies over 85% using routine clinical data like and biomarkers, enabling earlier interventions to mitigate maternal and fetal risks. Gender dynamics in obstetrics evolved significantly, with women comprising over 85% of U.S. obstetrics and gynecology residency applicants in 2023, surpassing 50% in active residencies and addressing the field's historical dominance to promote diverse perspectives in care. Ongoing initiatives aim to curb rising cesarean rates, which exceed 30% in many regions; the 2018 ARRIVE trial demonstrated that elective at 39 weeks in low-risk nulliparous women reduced cesarean deliveries by 16% without increasing adverse perinatal outcomes, informing guidelines to optimize term births.

References

  1. https://www.acog.org/womens-health/dictionary
  2. https://www.acog.org/about
  3. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth
  4. https://www.acog.org/womens-health/faqs/prenatal-care
  5. https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2024/01/first-and-second-stage-labor-management
  6. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care
  7. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
  8. https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2019/08/levels-of-maternal-care
  9. https://pmc.ncbi.nlm.nih.gov/articles/PMC2586862/
  10. https://pmc.ncbi.nlm.nih.gov/articles/PMC11568873/
  11. https://evidencebasedbirth.com/fetal-monitoring/
  12. https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2025/04/tailored-prenatal-care-delivery-for-pregnant-individuals
  13. https://www.ncbi.nlm.nih.gov/books/NBK607441/
  14. https://medical.rossu.edu/about/blog/what-is-an-ob-gyn
  15. https://www.unfpa.org/publications/trends-maternal-mortality-2000-2023
  16. https://data.unicef.org/topic/maternal-health/maternal-mortality/
  17. https://www.un.org/sustainabledevelopment/health/
  18. https://www.rcog.org.uk/guidance/patient-safety/maternity-safety/multi-disciplinary-team-working/
  19. https://www.nice.org.uk/guidance/qs192/chapter/Quality-statement-2-Composition-of-the-multidisciplinary-team
  20. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/11/definition-of-term-pregnancy
  21. https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo
  22. https://www.ncbi.nlm.nih.gov/books/NBK551634/
  23. https://www.acog.org/womens-health/faqs/if-your-baby-is-breech
  24. https://www.ncbi.nlm.nih.gov/books/NBK448063/
  25. https://www.ncbi.nlm.nih.gov/books/NBK532927/
  26. https://www.ncbi.nlm.nih.gov/books/NBK564403/
  27. https://www.acog.org/womens-health/experts-and-stories/the-latest/3-conditions-to-watch-for-after-childbirth
  28. https://www.ncbi.nlm.nih.gov/books/NBK565875/
  29. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/10/the-apgar-score
  30. https://www.nlm.nih.gov/medlineplus/ency/article/003402.htm
  31. https://www.ncbi.nlm.nih.gov/books/NBK470566/
  32. https://www.nichd.nih.gov/health/topics/factsheets/labor-delivery
  33. https://www.acog.org/womens-health/faqs/preeclampsia-and-high-blood-pressure-during-pregnancy
  34. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/01/weight-gain-during-pregnancy
  35. https://www.acog.org/programs/immunization-infectious-disease-public-health/maternal-immunization-task-force/immunization-for-pregnant-women-a-call-to-action
  36. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/folic-acid-for-the-prevention-of-neural-tube-defects-preventive-medication
  37. https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/06/screening-and-diagnosis-of-mental-health-conditions-during-pregnancy-and-postpartum
  38. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2016/12/ultrasound-in-pregnancy
  39. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/01/nausea-and-vomiting-of-pregnancy
  40. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/10/screening-for-fetal-chromosomal-abnormalities
  41. https://www.natera.com/wp-content/uploads/2021/04/ACOG-PB-226.pdf
  42. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/08/prevention-of-rh-d-alloimmunization
  43. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/02/prevention-of-group-b-streptococcal-early-onset-disease-in-newborns
  44. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2021/08/prediction-and-prevention-of-spontaneous-preterm-birth
  45. https://www.acog.org/womens-health/health-tools/sample-birth-plan
  46. https://pubmed.ncbi.nlm.nih.gov/38462255/
  47. https://www.ncbi.nlm.nih.gov/books/NBK544290/
  48. https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/signs-of-labor/art-20046184
  49. https://pubmed.ncbi.nlm.nih.gov/32898773/
  50. https://www.acog.org/news/news-releases/2017/09/acog-expands-recommendations-to-treat-postpartum-hemorrhage
  51. https://pmc.ncbi.nlm.nih.gov/articles/PMC3991404/
  52. https://pmc.ncbi.nlm.nih.gov/articles/PMC7279832/
  53. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/03/prelabor-rupture-of-membranes
  54. https://www.ncbi.nlm.nih.gov/books/NBK470368/
  55. https://www.aafp.org/pubs/afp/issues/2022/0200/p177.html
  56. https://www.uptodate.com/contents/induction-of-labor-techniques-for-preinduction-cervical-ripening
  57. https://www.aafp.org/pubs/afp/issues/2021/0115/p90.html
  58. https://www.acog.org/womens-health/faqs/labor-induction
  59. https://www.acog.org/womens-health/faqs/assisted-vaginal-delivery
  60. https://www.ncbi.nlm.nih.gov/books/NBK459234/
  61. https://www.cdc.gov/nchs/fastats/delivery.htm
  62. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/11/immersion-in-water-during-labor-and-delivery
  63. https://pubmed.ncbi.nlm.nih.gov/38462266/
  64. https://www.ncbi.nlm.nih.gov/books/NBK542219/
  65. https://www.acog.org/womens-health/faqs/medications-for-pain-relief-during-labor-and-delivery
  66. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/12/delayed-umbilical-cord-clamping-after-birth
  67. https://www.ncbi.nlm.nih.gov/books/NBK555904/
  68. https://my.clevelandclinic.org/health/body/22485-lochia
  69. https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/exercise-after-pregnancy/art-20044596
  70. https://www.aafp.org/pubs/afp/issues/2014/0215/p273.html
  71. https://www.hopkinsmedicine.org/health/conditions-and-diseases/postpartum-thyroiditis
  72. https://www.canada.ca/en/public-health/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-5.html
  73. https://pubmed.ncbi.nlm.nih.gov/9678098/
  74. https://pmc.ncbi.nlm.nih.gov/articles/PMC8886522/
  75. https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-for-maternal-health-services/telehealth-and-postpartum-care
  76. https://www.pcori.org/research-results/2023/comparing-effectiveness-telehealth-follow-care-approach-usual-care-after-giving-birth
  77. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2021/06/antepartum-fetal-surveillance
  78. https://www.ncbi.nlm.nih.gov/books/NBK537123/
  79. https://journals.lww.com/greenjournal/fulltext/2021/06000/antepartum_fetal_surveillance__acog_practice.37.aspx
  80. https://www.aafp.org/pubs/afp/issues/2000/0901/p1184.html
  81. https://www.acog.org/womens-health/faqs/special-tests-for-monitoring-fetal-well-being
  82. https://my.clevelandclinic.org/health/diagnostics/22849-contraction-stress-test
  83. https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2025/10/intrapartum-fetal-heart-rate-monitoring-interpretation-and-management
  84. https://www.ajog.org/article/S0002-9378%2806%2900695-8/abstract
  85. https://journals.lww.com/greenjournal/fulltext/2025/10000/acog_clinical_practice_guideline_no_.22.aspx
  86. https://www.acog.org/womens-health/faqs/routine-tests-during-pregnancy
  87. https://www.cdc.gov/pregnancy-hiv-std-tb-hepatitis/php/screening/index.html
  88. https://pmc.ncbi.nlm.nih.gov/articles/PMC6295587/
  89. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.23692
  90. https://www.aafp.org/pubs/afp/issues/1998/0801/p453.html
  91. https://www.ncbi.nlm.nih.gov/books/NBK562268/
  92. https://www.acog.org/womens-health/faqs/amniocentesis
  93. https://www.acog.org/womens-health/faqs/prenatal-genetic-diagnostic-tests
  94. https://www.sciencedirect.com/science/article/pii/S2405844024001865
  95. https://pmc.ncbi.nlm.nih.gov/articles/PMC12055489/
  96. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2021/08/anemia-in-pregnancy
  97. https://diabetesjournals.org/care/article/46/Supplement_1/S19/148056/2-Classification-and-Diagnosis-of-Diabetes
  98. https://diabetesjournals.org/care/article/48/Supplement_1/S306/157565/15-Management-of-Diabetes-in-Pregnancy-Standards
  99. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/06/gestational-hypertension-and-preeclampsia
  100. https://journals.lww.com/greenjournal/fulltext/2020/06000/gestational_hypertension_and_preeclampsia__acog.46.aspx
  101. https://journals.lww.com/greenjournal/fulltext/2021/08000/anemia_in_pregnancy__acog_practice_bulletin%2C.34.aspx
  102. https://journals.lww.com/greenjournal/fulltext/2018/01000/acog_practice_bulletin_no__189__nausea_and.39.aspx
  103. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/07/thromboembolism-in-pregnancy
  104. https://journals.lww.com/greenjournal/fulltext/2018/07000/acog_practice_bulletin_no__196__thromboembolism_in.54.aspx
  105. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/10/postpartum-hemorrhage
  106. https://www.acog.org/womens-health/experts-and-stories/the-latest/so-you-have-a-high-risk-pregnancy-heres-what-to-expect
  107. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/01/prepregnancy-counseling
  108. https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2022/08/pregnancy-at-age-35-years-or-older
  109. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2021/06/obesity-in-pregnancy
  110. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2021/06/multifetal-gestations-twin-triplet-and-higher-order-multifetal-pregnancies
  111. https://www.acog.org/womens-health/faqs/multiple-pregnancy
  112. https://www.ncbi.nlm.nih.gov/books/NBK563133/
  113. https://pmc.ncbi.nlm.nih.gov/articles/PMC4492531/
  114. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2014/02/cerclage-for-the-management-of-cervical-insufficiency
  115. https://pmc.ncbi.nlm.nih.gov/articles/PMC3437772/
  116. https://publications.aap.org/neoreviews/article/22/11/e734/181272/Multifetal-Gestations-and-Associated-Perinatal
  117. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/02/vaginal-birth-after-cesarean-delivery
  118. https://www.ajog.org/article/S0002-9378%2824%2900760-9/fulltext
  119. https://www.afro.who.int/news/african-regions-maternal-and-newborn-mortality-declining-progress-still-slow
  120. https://www.who.int/data/nutrition/nlis/info/births-attended-by-skilled-health-personnel
  121. https://www.sciencedirect.com/science/article/abs/pii/S0020729205001244
  122. https://data.unicef.org/topic/maternal-health/delivery-care/
  123. https://pmc.ncbi.nlm.nih.gov/articles/PMC9300345/
  124. https://www.aafp.org/pubs/afp/issues/2021/0601/p672.html
  125. https://www.ghspjournal.org/content/12/5/e2400057
  126. https://pmc.ncbi.nlm.nih.gov/articles/PMC9994459/
  127. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/06/refusal-of-medically-recommended-treatment-during-pregnancy
  128. https://www.qualityhealth.org/smoothtransitions/wp-content/uploads/sites/7/2022/10/Informed-consent-and-refusal-in-obstetrics-A-practical-ethical-guide.pdf
  129. https://ir.lawnet.fordham.edu/cgi/viewcontent.cgi?article=2171&context=ulj
  130. https://www.ajog.org/article/S0002-9378%2819%2930500-9/fulltext
  131. https://www.acog.org/clinical/clinical-guidance/committee-statement/articles/2023/07/ethical-considerations-for-the-delivery-of-obstetric-and-gynecologic-care-during-a-pandemic
  132. https://pmc.ncbi.nlm.nih.gov/articles/PMC7356077/
  133. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2023/maternal-mortality-rates-2023.htm
  134. https://www.kff.org/racial-equity-and-health-policy/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/
  135. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2820%2930045-0/fulltext
  136. https://pubmed.ncbi.nlm.nih.gov/36044627/
  137. https://pmc.ncbi.nlm.nih.gov/articles/PMC12303583/
  138. https://www.nature.com/articles/s41598-025-00450-3
  139. https://pmc.ncbi.nlm.nih.gov/articles/PMC12385597/
  140. https://umc.edu/news/News_Articles/2025/06/Maternal-Telehealth.html
  141. https://theriofoundation.org/page/Theriodefinition/What-is-Theriogenology.htm
  142. https://www.merckvetmanual.com/reproductive-system/reproductive-diseases-of-the-female-small-animal/dystocia-in-small-animals
  143. https://www.sciencedirect.com/science/article/abs/pii/S1090023307004285
  144. https://www.omnicalculator.com/biology/dog-pregnancy
  145. https://visgar.vetmed.ufl.edu/en_bovrep/episiotomy/episiotomy.html
  146. https://pmc.ncbi.nlm.nih.gov/articles/PMC7104932/
  147. https://pmc.ncbi.nlm.nih.gov/articles/PMC11943763/
  148. https://www.vetscraft.com/episiotomy/
  149. https://www.mdpi.com/journal/vetsci/special_issues/7XZ3535749
  150. https://www.sciencedirect.com/science/article/pii/S2090123210000342
  151. https://www.dwvet.com/news/pregnancy-testing-in-cows-and-horses-rectal-palpation-versus-ultrasound-for-cows-and-horses/
  152. https://veteriankey.com/obstetrical-instruments-for-large-animals/
  153. https://www.researchgate.net/publication/5379228_Bovine_Cesarean_Section_in_the_Field
  154. https://onlinelibrary.wiley.com/doi/10.1111/rda.14541
  155. https://www.dvm360.com/view/managing-dystocia-mares-proceedings
  156. https://www.thekennelclub.org.uk/health-and-dog-care/health/health-and-care/a-z-of-health-and-care-issues/birthing-difficulties-brachycephalic-dogs/
  157. https://www.petmd.com/cat/general-health/how-many-kittens-can-cats-have
  158. https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11181&catId=30095&id=3852295
  159. https://extension.psu.edu/common-sense-estrus-synchronization-in-beef-cattle
  160. https://onlinelibrary.wiley.com/doi/10.1111/vsu.13868
  161. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781119602484.ch83
  162. https://extension.psu.edu/milk-progesterone-analysis-for-determining-reproductive-status/
  163. https://www.researchgate.net/publication/228634623_Herbal_medicine_in_ancient_Egypt
  164. https://www.taylorfrancis.com/chapters/edit/10.1201/9781003088967-28-28/internal-podalic-version-breech-extraction-sanjeewa-padumadasa-malik-goonewardene
  165. https://scholarsarchive.byu.edu/cgi/viewcontent.cgi?article=1103&context=rmmra
  166. https://pmc.ncbi.nlm.nih.gov/articles/PMC9444839/
  167. https://jamanetwork.com/journals/jama/fullarticle/188144
  168. https://pmc.ncbi.nlm.nih.gov/articles/PMC3704058/
  169. https://www.campop.geog.cam.ac.uk/blog/2024/09/19/childbirth-in-the-past/
  170. https://embryo.asu.edu/pages/william-smellie-1697-1763
  171. https://pubmed.ncbi.nlm.nih.gov/2654268/
  172. https://digirepo.nlm.nih.gov/ext/dw/101741117/PDF/101741117.pdf
  173. https://pmc.ncbi.nlm.nih.gov/articles/PMC3881728/
  174. https://embryo.asu.edu/pages/ignaz-philipp-semmelweis-1818-1865
  175. https://embryo.asu.edu/pages/james-young-simpson-1811-1870
  176. https://pubmed.ncbi.nlm.nih.gov/27434694/
  177. https://pmc.ncbi.nlm.nih.gov/articles/PMC9854334/
  178. https://pmc.ncbi.nlm.nih.gov/articles/PMC11254094/
  179. https://www.nap.edu/read/4560/page/322
  180. https://pmc.ncbi.nlm.nih.gov/articles/PMC11469338/
  181. https://pubmed.ncbi.nlm.nih.gov/3511335/
  182. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm
  183. https://pmc.ncbi.nlm.nih.gov/articles/PMC2672989/
  184. https://pmc.ncbi.nlm.nih.gov/articles/PMC1114031/
  185. https://rucore.libraries.rutgers.edu/rutgers-lib/73172/PDF/1/
  186. https://scholarworks.merrimack.edu/cgi/viewcontent.cgi?article=1021&context=honors_capstones
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