Makindo Medical Notes

🤰 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."