obstetrics(redirected from Antenatal care)
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See J. Bonnar, ed. Recent Advances in Obstetrics and Gynecology (1992).
the science dealing with pregnancy, labor, and the puerperium, their physiology and pathology, and rational assistance to the pregnant woman, the woman in childbirth, and the woman after childbirth. Obstetrics is one of the most ancient branches of medicine. The ancient Egyptian papyrus of Ebers (2000–1000 B.C.) contains instructions for several methods of rendering assistance during difficult and complicated labor. In the holy books of the Hindus, Yajurveda (eighth century B.C.), dietetics of pregnancy is examined and a number of active methods for inducing labor are introduced. Hippocrates taught how to perform cephalic version if the fetus was in an incorrect position and how to perform operations to destroy the fetus if it was impossible to give birth to a live infant. Soranus of Ephesus and Galen (second century A.D.) developed and implemented the operation of podalic version, which is used with minor modifications in modern obstetrics. Cesarean section has been known since remote antiquity. Mentions of it appear in ancient Greek mythology, ancient Egyptian sources, the Talmud, and the most ancient northern sagas. In Rome (715–673 B.C.), cesarean section was prescribed for extracting the fetus from a dead mother.
During the Middle Ages, the development of obstetrics was suspended, and operations for destroying the fetus became widely used. A major event in obstetric development was the opening in the 13th century of wards for women in labor in the Paris hospital Hotel Dieu; the first obstetric clinic was created there in the 17th century.
In the 16th century, the first anatomical information about the structure of female sexual organs was obtained, laying the foundation for the development of scientific obstetrics; operative obstetrics began to develop as well. The French surgeon A. Paré revived the forgotten operation of podalic version and organized the first school of obstetrics. L. Bourgeois and other graduates from this school made significant contributions to obstetric development. The invention by the English obstetrician P. Chamberlen (1560–1631) of the obstetrical forceps—an instrument permitting the careful extraction of a living fetus under proper conditions—had great significance in the development of operational obstetrics. Unfortunately, the construction of the forceps was kept a secret; they were introduced into practice only in 1723 by the Dutch surgeon J. Palfyn and were perfected by the French doctor A. Levret (1751) and the English doctor W. Smellie (1754). In the 17th century, the French obstetrician F. Mauriceau wrote one of the best books on obstetrics of the time and also introduced methods for obstetric operations and instrumentation. In Germany, an obstetric version was described by the midwife Siegemundin, who proposed a method using two hands to turn and extract the fetus. In the 18th century, obstetric departments at universities and obstetric clinics were opened, and systematic teaching of obstetrics was introduced.
The founder of obstetrics in Russia, N. M. Ambodik-Maksimovich, introduced the visual method of teaching obstetrics by using a specialized model of a woman (phantom) constructed by him. He provided the first unique Russian manual on obstetrics, The Art and Science of Midwifery (1784–86).
I. Semmelweiss, a 19th-century Hungarian obstetrician, made a great contribution with his discovery of the contagion of postpartum septic diseases. After J. Simpson’s introduction of anesthesia in obstetric practice and the introduction of antiseptics and aseptics as well, it became possible to undertake more complex obstetric operations. The percentage of septic diseases and deaths after childbirth dropped sharply.
At the turn of the 20th century, the processes connected with menstrual functions and pregnancy became the subject of obstetric study. The Russian obstetrician V. V. Stroganov worked out a cure for eclampsia which led to a sharp decrease in mortality and received worldwide recognition.
Before the introduction of antiseptics in obstetrics, cesarean section in most instances ended with death and thus was very rarely performed. At the turn of the 20th century, favorable results were observed when the operation was performed at the onset of labor. Modern obstetrics considers cesarean section, under suitable conditions and evidences, to be the safest method of delivery compared to other obstetric operations.
The study of internal secretions had great significance in obstetric development. The English scientist H. Dale (1906) discovered the ability of the hormone of the posterior lobe of the hypophysis to produce uterine contractions; this hormone, oxytocin, and its synthetic analogues are widely used during weak labor activity. For the early diagnosis of pregnancy, the German doctors S. Aschheim and B. Zondek proposed a hormone test in 1928. Vacuum extractors invented by the Swedish doctor T. Malmstrom (1954) and the Yugoslavian doctor V. Finderle (1956) replaced obstetric forceps in the 1950’s.
Modern obstetrics is concerned with regulating labor, studying the placenta’s structure and physiology, and determining how nutrients penetrate the placental membrane. Drug therapy and obstetric endocrinology are also studied.
The use in obstetrics of phono- and electrocardiography, encephalography, amnioscopy, the determination of the blood’s acid-base balance, and other methods permit the study of the physiology and pathology of the fetus and the newborn in the transition period from intrauterine life to existence outside the uterus. This has great significance in the struggle for the birth of a healthy child.
The successes of hematology have established the fact that hemolytic diseases of the newborn result from the incompatibility of the blood of the mother and the fetus in terms of the Rhesus factor, as well as of group factors in the ABO system. The Rh factor was discovered in 1940 by the Austrian scientist K. Landsteiner and the German scientist A. Weiner. Methods for treating this disease have been developed and are being applied.
In the USSR the dispensary principle of medical service for pregnant women and the special attention given to mother and child protection have promoted the development of obstetrics. Because maternity leaves are granted to pregnant women, obstetrics has been faced with the urgent task of determining the period of pregnancy. Soviet scientists have studied the regulation of labor and the problems concerning the use of anesthetics in labor. A. Iu. Lur’e (1936) pioneered the wide use of anesthetics during labor. Methods using various combinations of medicines, vitamins, and other items were proposed to anesthetize women in labor (R. L. Shub, A. P. Nikolaev, and A. M. Foi). During the 1920’s, Soviet scientists (I. Z. Vel’vovskii, A. P. Nikolaev, K. I. Platonov, V. A. Ploticher, and E. A. Shug) developed the psychoprophylactic method of preparing pregnant women for childbirth that received recognition in most European countries (Czechoslovakia, the German Democratic Republic, Bulgaria, Rumania, Switzerland, France, Italy, and others), in South American countries, and several Asian countries.
Many foreign doctors use prebirth preparation in various forms under various names. The English obstetrician G. Read proposed a method for creating psychological and especially muscular relaxation.
Much attention is given to the study, in part by electrophysiological methods, of labor and the treatment of its disturbances. Due to the experiments conducted for the prevention of birth trauma in the USSR, it has been possible to virtually eliminate the origin of urogenital fistulas and to reduce sharply the number of ruptured uteri. During the 1950’s, careful methods of prevention of and therapy for asphyxiation of the fetus and the newborn were developed (A. P. Nikolaev, I. S. Legenchenko, and L. S. Per-sianinov). The major reasons for maternal mortality were ascertained—hemorrhaging, extragenital diseases, toxemia, septic diseases, and others. Because almost 100 percent of women in labor receive hospital and obstetric assistance, by 1965 it had been possible to reduce maternal mortality to one-fifteenth of that in 1913. In the USSR, of great significance is the organization of specialized maternal homes for the hospitalization of women who are pregnant or in labor and suffering from diabetes, cardiovascular diseases, or premature labor.
In various countries, special obstetric-gynecological scientific research institutes have been created for developing theoretical and practical problems in obstetrics. The leading obstetrics centers in the USSR are the Institute of Obstetrics and Gynecology of the Ministry of Public Health in Moscow and the Institute of Obstetrics and Gynecology of the Academy of Medical Sciences in Leningrad. Scientific experiments in the field of obstetrics are also carried out, with the cooperation of a wide group of practicing doctors, in obstetric-gynecological clinics of the medical institutes and in institutes of obstetrics and pediatrics.
Scientific obstetric societies first arose in the 19th century. In England the London Obstetrical Society was established in 1825. In Russia in 1887 the St. Petersburg Obstetric Society was created; almost simultaneously similar societies were founded in Moscow and Kiev as well. The All-Union Society of Obstetricians and Gynecologists has been a member of the International Federation of Gynecology and Obstetrics since 1954. The first international conference of this organization took place in Brussels in 1892 with the participation of Russian scientists. International conferences of obstetricians and gynecologists take place regularly every three years with the active participation of Soviet scientists.
The USSR publishes the journal Akusherstvo i ginekologiia (Obstetrics and Gynecology, since 1936). Other journals include American Journal of Obstetrics and Gynecology, published in the USA (St. Louis, since 1920); The Journal of Obstetrics and Gynecology of the British Commonwealth in England (London, since 1902); Gynécologie et obstétrique in France (Paris, since 1920); and Zentralblatt für Gynakologie in the German Democratic Republic (Leipzig, since 1877).
Obstetrics is taught in higher and secondary educational institutions in all countries. In the USSR, specialists are trained in medical institutes and medical departments of universities. Highly skilled specialists are prepared in advanced training institutes for physicians. Medical schools graduate midwives.
REFERENCESMnogotomnoe rukovodstvo po akusherstvy i ginekologii, vols. 1–6. Moscow, 1961–64.
Malinovskii, M. S. Operativnoe akusherstvo. Moscow, 1967.
V. A. POKROVSKII