🤰 Obstetrics is the medical specialty dedicated to the care of women during pregnancy, childbirth, and the postpartum period.
It is both an art and a science—requiring detailed knowledge of maternal–fetal physiology, keen clinical judgement, and skilled hands in emergencies.
🌱 History of Obstetrics
- Traditional midwifery predates modern medicine and laid the foundations for safe childbirth.
- Obstetrics emerged as a medical specialty in the 19th century with the advent of anaesthesia, antisepsis, and Caesarean section techniques.
- Today, obstetrics is integrated with maternal medicine, fetal medicine, and neonatal care.
🔑 Key Concepts in Obstetrics
- Antenatal Care: Monitoring mother and fetus throughout pregnancy—screening for risk factors (e.g., pre-eclampsia, gestational diabetes), providing education, and preparing for labour.
- Labour and Delivery: The process of childbirth, divided into three stages. Skilled management reduces risks of maternal and neonatal morbidity and mortality.
- Postpartum Care: Support in the puerperium (first 6 weeks after birth), addressing complications such as haemorrhage, infection, and postnatal depression.
- Maternal–Fetal Medicine: High-risk pregnancies (e.g., multiple gestations, placenta praevia, congenital anomalies).
- Operative Obstetrics: Assisted vaginal delivery (forceps, vacuum) and Caesarean section.
⚖️ Physiological Changes in Pregnancy
- 🫀 Cardiovascular: ↑ Blood volume by ~40%, ↑ cardiac output, ↓ systemic vascular resistance.
- 🫁 Respiratory: ↑ Tidal volume, mild respiratory alkalosis.
- 🩸 Haematological: Physiological anaemia, hypercoagulable state (↑ risk of DVT/PE).
- 🧠 Endocrine: Placental hormones (hCG, progesterone, oestrogen) support pregnancy.
- 🩺 Renal: ↑ GFR, ↑ renal plasma flow.
🍼 The Stages of Labour
- ⏱️ First Stage: Onset of painful, regular contractions → full cervical dilatation (10 cm).
- 👩🍼 Second Stage: From full dilatation to birth of the baby (active pushing + descent).
- 🟣 Third Stage: From birth of baby to expulsion of placenta and membranes.
👶 Fetal Assessment
- Antenatal: Ultrasound scans (dating, anomaly, growth), Doppler studies, non-stress tests.
- Intrapartum: Cardiotocography (CTG) for fetal heart monitoring, scalp blood sampling if indicated.
🚨 Common Obstetric Emergencies
- 💉 Postpartum Haemorrhage (PPH): Leading cause of maternal mortality; requires rapid resuscitation, uterotonics, and sometimes surgery.
- ⚡ Pre-eclampsia/Eclampsia: Hypertension, proteinuria, seizures; treated with magnesium sulphate and BP control.
- 🫁 Amniotic Fluid Embolism: Rare but catastrophic.
- 🫄 Shoulder Dystocia: “Head-to-body” delivery problem requiring specific manoeuvres.
- 🩺 Uterine Rupture: Emergency laparotomy and delivery required.
📚 Key Terms (Labour & Delivery)
- 🧑⚕️ Presentation: Fetal part over the cervix (cephalic, breech, shoulder).
- 🍼 Presenting Part: Occiput, face, brow, sacrum, foot.
- 📐 Position: Orientation of the presenting part in relation to maternal pelvis (OA, OP).
- ⬇️ Engagement: Fetal head passes pelvic brim.
- 🌀 Moulding: Overlap of fetal skull bones during passage.
- 🎈 Caput Succedaneum: Scalp swelling from pressure, resolving post-birth.
🤝 Multidisciplinary Approach
- 👩🍼 Midwives: Lead on normal pregnancies and labours.
- 👨⚕️ Obstetricians: Manage complications, operative interventions.
- 🧑⚕️ Anaesthetists: Provide epidurals, general anaesthesia for C-sections, and resuscitation support.
- 👶 Neonatologists: Care for newborns, especially preterm or unwell babies.
📖 Obstetrics underpins safe motherhood.
"Every pregnancy is unique—what is routine for one woman may be life-threatening for another."
