Obstetrics  &  gynecology

 

GYNECOLOGY

Gynecology is branch of medicine concerning the physiology and pathology of the female reproductive system in the non pregnant state. A doctor who specializes in the practice of gynecology is called a gynecologist. Gynecologists have special education, training, and skills, both medical and surgical, to treat problems that are associated with reproductive and sexual function in women.

 

Cancers and Tumors

One important reason for periodic examinations is to detect cancer of the cervix in its earliest stages. A simple test called the smear test (Papanicolaou, or PAP test) is effective for this purpose. The doctor scrapes a few cells from the cervix or takes secretions from the vagina, and the cells are then examined under a high-powered microscope for signs of cancer. If suspicious cells are found, a larger sample of cells (a biopsy) can be taken to confirm or rule out the presence of cancer. Regular smear tests are recommended. Periodic examination of the ovaries, Fallopian tubes, and uterus is also important, because cancer of one of these organs is quite often without symptoms until the disease is advanced beyond the point of easy cure.

 

In addition, the pelvic examination enables the doctor to detect unusual masses such as cysts or fibroid tumors. Although few such masses prove to be cancerous, they must be monitored for future growth. Breast examination can also show up unusual lumps.

                                                                                                                      George Nicolas Papanicolaou

                                                                                                                                            1883 – 1962

 

Infections and Sexually Transmitted Diseases

Most vaginal infections are characterized by vaginal itching or burning, an unusual odor or excessive discharge. To diagnose such infections, doctors must examine the patient and have laboratory tests performed. Among the most common gynecological infections are vaginitis and yeast infections such as thrush (trichomoniasis), caused by trichomonas vaginalis. In vaginitis, the discharge is yellow to grey-green and can have a foul odor. Itching occurs, along with pain on urination and during intercourse. Vaginitis is treated with oral antibiotics, sulpha-based creams and suppositories, and antibacterial douches. In yeast infections, the discharge is thick and white, and severe itching sometimes occurs; they are treated with an antibiotic vaginal cream or suppositories. In trichomoniasis, the discharge is thin and greenish-white or grey, itching occurs, and redness, a foul odor, and pain are present; the most effective treatment is an oral antibiotic.

 

Genital herpes, gonorrhea, and syphilis are sexually transmitted diseases. Women who have herpes have a higher than average miscarriage rate, and if a woman gives birth while active herpes lesions are present, her baby is likely to be infected. Herpes may also play some role in the development of cervical cancer; doctors recommend that any woman who has genital herpes should thereafter have a smear test every 6 to 12 months.

 

Pelvic infection and pelvic inflammatory disease (PID) are general terms for infection anywhere in a woman's pelvic organs. It usually begins when bacteria from a cervical infection spread to these organs. Acute symptoms include severe pelvic pain, fever, shaking chills, vaginal discharge, and vaginal bleeding. Sometimes, however, the symptoms may include only mild backache or abdominal pain, or pain with intercourse. Untreated chronic PID is a leading cause of infertility. Treatment depends on the location and severity of the infection; oral antibiotics, pain medication, and rest are prescribed.

 

Endometriosis is a serious condition in which the lining of the uterus (endometrium) forms outside the organ during each menstrual cycle. Endometrium may form on all the pelvic organs and causes pain and heavy menstrual bleeding, and adhesions may form on the organs affected. Treatment is often by surgery and, in the reproductive years, by drugs such as the pill.

 

Cystitis is an infection of the bladder characterized by the urge to urinate frequently, burning during urination, cramp and pain in the lower abdomen, and urine that has an unusual color or is cloudy or bloody. More common in women than in men, it is caused by bacteria and, when it does occur, is often linked to intercourse. It is cured by antibiotics.

 

OBSTETRICS

Obstetrics is branch of medicine concerning pregnancy, labor, and the period immediately following childbirth. It also involves the psychological and social aspects of childbearing.

 

Obstetrics has not always been so broadly defined. Until recently, it involved only the mechanics of childbirth, and early practitioners did not have medical training. As early as 1303, the term midwife was used for women who assisted in home deliveries, and eventually the term midwifery evolved in reference to their practice.

 

Improvements in the practice of obstetrics can be measured by the decline in maternal and infant death rates. Historically these rates have been extremely high. In the past few decades, however, increasing attention has been paid to nutrition and hygiene. Medical care has also improved due to the discovery of antibiotics, which combat infection, the use of blood transfusions to treat hemorrhage, and the development of surgical techniques needed in childbirths threatening the life of either the mother or child. In addition, a trend developed towards hospital rather than home deliveries, along with a general upgrading in the skills and training of doctors specializing in pregnancy and childbirth in advanced industrial countries. Medical improvements have thus dramatically reduced the number of women and infants who die as a result of childbirth.

 

Obstetrics is closely related to other medical specialties, particularly gynecology. The two are often regarded as the same; gynecology, however, is concerned with the female reproductive organs in the non pregnant state, whereas obstetrics treats the pregnant state.

 

 

MIDWIFERY

Midwifery is the providing of assistance during pregnancy, especially at the time of childbirth. Midwives have assisted women in giving birth since ancient times, and even today midwives deliver more than two-thirds of the world's infants. In Western countries changes in obstetrics and gynecology caused childbearing to shift from the home to hospitals by the early 1900s, and midwives were replaced by doctors.

 

Lay midwifery is now on the wane worldwide. In the United States and Europe, however, a growing number of parents are objecting to the surgical approach and paternalistic attitudes they claim to find among hospital obstetricians. Instead they are turning to the modern, professionally trained certified nurse-midwife, with whom they feel they can better participate in the birth experience. They do not use obstetrical forceps or perform operative deliveries such as caesarean section. Midwives provide many other birth-related services, such as advice on diet and exercise instruction, and they encourage fathers (or other supportive individuals) to take part in birthing, help the family adjust to the infant, and provide follow-up care for the mother.

 

JAMES YOUNG SIMPSON 1811 – 1870

Simpson’s anesthesia: He first used chloroform in a birth

Simpson’s probe: Probe for measure of uterus

Simpson’s forceps:

 

Ignaz Philipp Semmelweis 1818 – 1865

Hungarian obstetrician, who discovered how to prevent puerperal fever from being transmitted to mothers, thus introducing antiseptic prophylaxis into medicine. Born in Buda and educated at the Universities of Pest and Vienna, Semmelweis became Assistant Professor in the maternity ward of the Vienna General Hospital. In the 1840’s puerperal, or childbed, fever, a bacterial infection of the female genital tract after childbirth, was taking the lives of up to 30% of the women giving birth in lying-in wards, whereas most women who gave birth at home remained relatively unaffected. Semmelweis noticed that women who were examined by student doctors who had not washed their hands after leaving the autopsy room had much higher mortality rates. When a colleague who had received a scalpel cut died from infection, Semmelweis concluded that the puerperal fever was septic and contagious. By ordering students to wash their hands with chlorinated lime before examining patients, he reduced the maternal mortality rate from 12.24 to 1.27% in two years.

Semmelweis nevertheless encountered strong opposition from hospital officials, and because of his political activity as well, he left Vienna in 1850 for the University of Pest, where he became Professor of Obstetrics at the university hospital. In spite of his enforcing antiseptic practices and reducing the mortality rate from puerperal fever to 0.85%, Semmelweis's findings and publications were resisted by hospital and medical authorities in Hungary and abroad. After suffering a breakdown, he went to a mental hospital in Vienna, where he died from an infection contracted during an operation he had performed earlier.