OBSTETRICS
1.01 OVERVIEW OF THE COURSE
DR. TRICIAN JAN TAGUBA-VILLAROSA | APRIL 1, 2022
OUTLINE
I. General Objectives III. Maternal Morbidity
II. Introduction to Indicators
Obstetrics IV. Definition of Terms
LEGENDS
Lecturer Book
I. GENERAL OBJECTIVES
 Understand the definitions in obstetrics
 Discuss the anatomy and physiology, adaptations of
the female body to pregnancy and post-partum.
 Review and recall the proper assessment and
evaluation of a pregnant woman
 Examination of female patients is the same with
males except for the pelvis and genitals.
 Consider that not all women are comfortable with
a male gynecologist. Respect practices and
beliefs of patients.
 Discuss how to diagnose and management cases in
obstetrics
II. INTRODUCTION TO OBSTETRICS
 Obstetrician
 Medical doctors who specialize in pregnancy and
childbirth, especially in the management of high-
risk pregnancies and pregnancy complications.
 Gynecologist: Provide general care for the
female reproductive system.
 Midwife
 Typically are experienced, registered nurses that
are specially trained to provide care and support
throughout a woman’s pregnancy experience.
 Hospital-delivery room
 Written consent
 A written agreement shall always be done
between the physician and the patient witnessed
by the staff (operating or delivery room staff) and
should also be signed by the patient and patient’s
significant other (husband or partner)
 Let them understand and be aware that every
procedure will pose a risk or complication to the
patient.
 Vital statistics
 Maternal Vital Statistics
 Blood pressure, heart rate, respiratory rate, and
temperature
 Never skip taking the vital statistics of the
mother. VS, especially during the first part of the
physical examination, will already give a hint of
the diagnosis and further management.
TRANS APONGOL, CUMLAT, MUNDOC, LAPPAY, VILLION, RENIEDO
-E.g. BP: 70/50 (hypotensive); HR: 112 and
above (tachycardic); RRS: 27; temp: 35.8
(hypothermic), consider blood loss
 Neonatal Vital Statistics
 Heart rate, RR, temperature
 APGAR SCORE (most important assessment)
Presentation III. DEFINITION OF TERMS
(Definition of terms are all adapted from Williams
Obstetrics, 26th Ed.)
 Perinatal Period
 The interval between the birth of a neonate born
after 20 weeks’ gestation and the 28 completed
days after that birth.
 When perinatal rates are based on birthweight,
rather than gestational age, it is defined as
commencing at the birth of a 500 g neonate.
 Birth
 Complete expulsion or extraction rom the mother
of a fetus after 20 weeks’ gestation.
 In absence of accurate dating criteria, fetus
weighing <500 g are usually not considered births
but rather are termed abortuses for purposes of
vital statistics.
 Birthweight
 Neonatal weight determined immediately after
delivery or as soon thereafter as feasible. Should
be expressed to the nearest gram.
 Live birth
 Term to record a birth whenever the newborn at
or sometime after birth breathes spontaneously or
shows any other sign of life such as a heartbeat
or a definite spontaneous movement of voluntary
muscles.
 Heartbeats are distinguished from transient
cardiac contractions, and respirations are
differentiated from fleeting respiratory efforts or
gasps.
 Stillbirth or fetal death
 The absence of signs of life at birth.
 Early neonatal death
 Death of a liveborn neonate during the first 7 days
after birth.
 Late neonatal death
 Death after 7 days but before 29 days.
 Infant death
 All deaths of liveborn infants from birth through 12
months of age.
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1.01 Overview of the Course
Birth weights______________________________  Late maternal death
 Death of a woman from direct or indirect
Table 1. Birth weights obstetrical causes more than 42 days but less
Weight than 1 year after the pregnancy’s end.
Low birth weight < 2500 g
 Nonmaternal death
Very low birth weight < 1500 g
Extremely low birth weight < 1000 g  Death of a mother that results from accidental or
Abortus < 500 g incidental causes not related to pregnancy. E.g.
Death from an automobile accident or concurrent
Neonates_________________________________ malignancy.
 Pregnancy-associated death
Table 2. Classification of Neonates  Death of a woman, from any cause, while
Time period born pregnant or within 1 calendar year of termination
Preterm Neonate Before 37 weeks (259th day) of pregnancy, regardless of the duration and the
- Early preterm - Before 34 weeks site of pregnancy.
- Late preterm - 34 to 36 weeks  Pregnancy-related death
Term Neonate 37 to 42 weeks (260-294 days)  A pregnancy-associated death that results from:
- Early term - 37 to 386/7 weeks  Complications of pregnancy itself
- Full term - 39 to 406/7 weeks
 The chain of events initiated by pregnancy that
- Late term - 41 to 416/7 weeks
Postterm Neonate After 42nd week (Day 295)
led to death; or
 Aggravation of an unrelated condition by the
physiological or pharmacological effects of
 Abortus
pregnancy and that subsequently caused death
 Fetus or embryo removed or expelled from the
uterus in the first half of gestation—20 weeks of Statistical Terms / Ratio and Rates____________
less.
 Birth rate
 In absence of accurate dating criteria, born
 The number of live births per 1000 population.
weighing < 500g
 Fertility Rate
 Induced termination of pregnancy
 The number of live births per 1000 females aged
 The purposeful interruption of an intrauterine
15 through 44 years
pregnancy that has the intention other than to
 Stillbirth rate or fetal death rate
produce a liveborn neonate and that does not
result in a live birth.  Number of stillborn neonates per 1000 neonates
born, including livebirths and stillbirths.
 This definition excludes retention of products of
conception following fetal death  Neonatal mortality rate
 Number of neonatal deaths per 1000 live births’
Maternal Death____________________________  Perinatal Mortality Rate
 Direct maternal death  Number of stillbirths plus neonatal deaths per
 Death of a mother that results from obstetrical 1000 total births
complications of pregnancy, labor, or the  Infant mortality rate
puerperium and from interventions, omissions,  Number of infant deaths per 1000 live births
incorrect treatment, or a chain of events resulting  Maternal mortality ratio
from any of these factors.  The number of maternal deaths that result from
 E.g. maternal death from exsanguination after the reproductive process per 100,000 live births.
uterine rupture  Maternal mortality rate / maternal death rate: more
 Indirect maternal death commonly used but less accurate
 Maternal death no directly due to an obstetrical  Ratio is more accurate because it includes in the
cause. Death results from previously existing numerator the number of deaths regardless of
disease or a disease developing during pregnancy outcome whereas the denominator
pregnancy, labor or the puerperium that was includes the number of livebirths.
aggravated by maternal physiological adaptation
to pregnancy. Modes of Delivery___________________________
 E.g. maternal death from complications of mitral  Normal
valve stenosis  Spontaneous
 Poses the lowest risk of most maternal
comorbidity

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1.01 Overview of the Course
 Cesarean  Vitamins
 Birth of a fetus by laparotomy and then  Vaccination
hysterectomy.  Birth plan
 This definition is not applied to removal of fetus
from abdominal cavity in the case of uterine IV. MATERNAL MORBIDITY INDICATORS
rupture or of abdominal pregnancy
 Postmortem / Perimortem cesarean delivery: Table 3. Severe maternal morbidity indicators
Hysterectomy done in a woman who has just died - Acute myocardial - Hysterectomy
or whom death is expected soon infarction - Injuries of thorax,
- Acute renal failure abdomen and pelvis
 In cases of emergency CS because of fetal - Adult respiratory distress - Intracranial injuries
distress, the case should always be prioritized in syndrome - Puerperal
the operating room even if there is already a - Amniotic fluid embolism cerebrovascular
patient on the table for surgery (e.g. removal of - Cardiac arrest/ventricular disorders
gall bladder) fibrillation - Pulmonary edema
- Cardiac monitoring - Severe anesthesia
 Assisted vaginal / Operative vaginal Delivery - Cardiac surgery complications
(OVD) - Conversion of cardiac - Sepsis
 Birth accomplished with assistance from forceps rhythm - Shock
- Disseminated - Sickle-cell crisis
or a vacuum-cup device. Once these are applied
intravascular coagulation - Thrombotic embolism
to the fetal head, outward traction generates - Eclampsia - Tracheostomy
forces that augment maternal pushing to deliver - Heart failure during - Ventilation
the fetus. procedure

Hysterectomy_____________________________  Covid-19 Pandemic

 Abdominal Hysterectomy  Severe acute respiratory syndrome (SARS)
 Abdominal pregnancy: Can be ectopic pregnancy.  Effects of COVID-19 on pregnancy are yet to be
Placenta is implanted at the posterior serosa of completely understood and the effect of
the uterus where the amnion and amniotic sac pregnancy on disease course is controversial
located at the outside of the uterus
 May be indicated after delivery in some cases  Other disorders affecting pregnancy outcome
 Cesarean hysterectomy: performed at time of  Placental disorders
cesarean delivery  Threatened abortion
 Postpartum hysterectomy: done shortly after  Bleeding through a closed cervical os in the
vaginal delivery first 20 weeks of pregnancy and with a live
 Total hysterectomy embryo or fetus.
 In most cases. Performed and removes the  Threatened preterm labor
uterine body and cervix. Adnexia not usually
excised REFERENCES
 Supracervical hysterectomy  Williams Obstetrics 26th Edition
 Selected less often and removes only the uterine  Dr. Villarosa ppt and side notes (2022)
body. Adnexia not usually excised
 Simple hysterectomy
 Also a Type I hysterectomy
 Radical hysterectomy
 For women with invasive cervical cancer.
Removes uterus, parametrium and proximal
vagina to achieve tumor excision with negative
margins.

Prenatal Consultation_______________________
 Not only checking the vital signs of the pregnant
woman but also educating them about pregnancy,
postpartum, proper diet, vitamins, vaccination and
birth plan for them to be prepared
 Diet

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