Obstetrics
[11] The newer integrated screen (formerly called F.A.S.T.E.R for First And Second Trimester Early Results) can be done at 10 plus weeks to 13 plus weeks with an ultrasound of the fetal neck (thicker nuchal skin correlates with higher risk of Down syndrome being present) and two chemicals (analytes), pregnancy-associated plasma protein A and human chorionic gonadotropin (pregnancy hormone level itself[12]).
[13] The cost is higher than an "AFP-quad" screen due to the ultrasound and second blood test, but it is quoted to have a 93% pick up rate as opposed to 88% for the standard AFP/QS.
[14][15][16] Most doctors do a sugar load in a drink form of 50 grams of glucose in cola, lime or orange and draw blood an hour later (plus or minus 5 minutes).
[21] Obstetric ultrasonography is routinely used for dating the gestational age of a pregnancy from the size of the fetus, determine the number of fetuses and placentae, evaluate for an ectopic pregnancy and first trimester bleeding, the most accurate dating being in first trimester before the growth of the foetus has been significantly influenced by other factors.
[23] X-rays and computerized tomography (CT) are not used, especially in the first trimester, due to the ionizing radiation, which has teratogenic effects on the foetus.
[24] No effects of magnetic resonance imaging (MRI) on the foetus have been demonstrated,[25] but this technique is too expensive for routine observation.
[76] The expectant mother would invite close female friends and family members to her home to keep her company during childbirth.
[82]: 123 The 18th century marked the beginning of many advances in European midwifery, based on better knowledge of the physiology of pregnancy and labour.
[84] By the end of the century, medical professionals began to understand the anatomy of the uterus and the physiological changes that take place during labour.
All these medical advances in obstetrics were a lever for the introduction of men into an arena previously managed and run by women – midwifery.
[88] These early maternity hospitals were establishments where women would come to have their babies delivered, as opposed to the practice since time immemorial of the midwife attending the home of the woman in labour.
Delivery of babies by doctors became popular and readily accepted, but midwives continued to play a role in childbirth.
[93] Many European countries by the late 19th century were monitoring the training of midwives and issued certification based on competency.
The end of the 19th century did mark a significant accomplishment in the profession with the advancements in asepsis and anaesthesia, which paved the way for the mainstream introduction and later success of the Caesarean section.
His investigation discovered that washing hands with an antiseptic solution before a delivery reduced childbed fever fatalities by 90%.
It was not until the 20th century when advancements in aseptic technique and the understanding of disease would play a significant role in the decrease of maternal mortality rates among many populations.
[98] Gynaecology and Obstetrics gained attention in the American medical field at the end of the nineteenth century through the development of such procedures as the ovariotomy.
[82]: 125 J. Marion Sims was the surgeon responsible for being the first treating a vesicovaginal fistula[82]: 125 – a condition linked to many caused mainly by prolonged pressing of the foetus against the pelvis or other causes such as rape, hysterectomy, or other operations – and also having been doctor to many European royals and the 20th President of the United States James A. Garfield after he had been shot.
[106] The role of a physician was exclusively held by men who went to university, an overly male institution, who would theorize anatomy and the process of reproduction based on theological teaching and philosophy.
[83]: 16 Midwives, meaning "with woman", were those who assisted in the birth and care of both born and unborn children, a position historically held mainly by women.
[109] Gynecology developed as a new and separate field of study from obstetrics, focusing on the curing of illness and indispositions of female sexual organs,[110] encompassing conditions such as menopause, uterine and cervical problems, and tissue damage as a result of childbirth.
