Obstetrics is the surgical specialty dealing with the care of women and their unborn children during pregnancy, childbirth and care for the woman during the period shortly after birth (the puerperium) Midwifery is the equivalent non-surgical specialty. Most obstetricians are also gynaecologists. Antenatal (before birth) care is marked by regular check-ups with the obstetrician during which the growth and health of the fetus is monitored.
Some of the important risk factors looked for, especially in advancing pregnancy, are pre-eclampsia, abnormal placentation (growth of the placenta in places other than the inner lining of hte uterus), abnormal fetal position and Intrauterine Growth Restriction. To identify pre-eclampsia, blood-pressure and albuminuria (urine protein) are checked at regular intervals. Placenta praevia (low lying placenta that, at least partially, obstructs the birth canal and therefore warrants elective caesarean delivery) must be excluded and this is achieved with the use of an ultrasound scan.
In late pregnancy fetal position must be determined. Cephalic presentation (head first) is the norm but the fetus may present feet-first or buttocks-first (breech), side-on (transverse), or at an angle (oblique presentation). Intrauterine Growth Restriction means the the fetus is smaller than expected when compared to its gestational age (below the 10th percentile when plotted on a fetal growth chart). Causes can be intrinsic (to the fetus) or extrinsic (maternal or placental problems).
In the First Trimester (first three months) elevated β-hCG (human chorionic gonadotrophin) of up to 100,000 mIU/mL by 10 weeks of gestation is thought to contribute to morning sickness, fatigue, mood swings and food cravings. The symptoms can last up to16 weeks of gestation. In the Second Trimester (middle three months) the abdomen shows obvious swelling arising from the pelvis, starting the “obvious phase” of pregnancy. Hyperpigmentation, including linea nigra (literally dark line), which is a line straight down the middle of the belly, may appear. In the Third Trimester (last three months) the mother may experience backaches due to increased strain. Typically, the curvature of the spine is tilted backwards as pregnancy evolves in order to counteract the weight in the anterior aspect of the abdomen. The mother may also suffer mild urinary incontinence due to pressure on the bladder by the pregnant uterus, as well as heartburn due to compression of the stomach.
Various aspects of the mother’s overall health are carefully evaluated by the obstetrician in the following categories:
- Hematology (blood health)
- Renal (kidney function)
- Pulmonary (lungs)
- Endocrine (hormone balance)
- Lower back pain (due to a shift in gravity)