Medical Specialists

Obstetrics (ŏb-STE-triks) (OB) is a medical specialty dealing with pregnancy, childbirth, and postpartum, also known as puerperium (pū-ĕr-PĒ-rē-ŭm), the period from delivery until the reproductive organs return to normal (approximately six weeks).

An obstetrician (ob-stĕ-TRISH-ăn) is a physician who specializes in obstetrics (OB) and gynecology (GYN) and are commonly referred to as “OB/GYNs.”

Midwifery (mĭd-WIF-ĕr-ē) is the practice of assisting in childbirth. A midwife (MĬD-wīf) is an individual who practices midwifery. A certified nurse-midwife (SĔR-tĭ-fīd NŬRS mĭd-wīf) (CNM) is a type of advanced practice registered nurse who has completed advanced education and training. CNMs provide health care to women, including family planning, gynecological checkups, prenatal care, delivery of babies, and postpartum care.

A pediatrician (pēd-ē-ă-TRISH-ăn) is a doctor who focuses on the health of infants, children, and adolescents. Pediatric care starts at birth. Neonatologists (nē-ō-nă-TOL-ŏ-jĭsts) are physicians who specialize in the care of newborns. Newborns can present a unique set of health challenges that require special medical expertise, especially premature newborns and those with underdeveloped organs.

Diagnostic Testing

Amniocentesis

Amniocentesis (am-nē-ō-sen-TĒ-sĭs) is a procedure that removes a small amount of amniotic fluid from the uterus under ultrasound guidance. The fluid is tested for potential fetal abnormalities. See Figure 8.10^[1] for an illustration of amniocentesis.

Chorionic Villus Sampling

Chorionic villus sampling is performed to diagnose chromosome problems or other genetic diseases in a fetus by checking chorionic villi, the tiny finger-like growths found in the placenta. Chorionic villi contain the same chromosomes as the fetus, so this test can show if an extra chromosome, missing chromosomes, or damaged chromosomes are present that can cause serious health problems.^[2]

Contraction Stress Test

A contraction stress test (kŏn-TRAK-shŏn STRĒS test) involves monitoring the baby’s heart rate while inducing contractions in the mother. This diagnostic test may be performed if there are abnormal results from a nonstress test. Fetal heart monitoring is used while oxytocin is administered to the mother, causing the uterus to contract. Every contraction means the baby gets less blood and oxygen for a short while. A contraction stress test shows how the baby’s heart rate reacts to the stress of contractions. If the baby’s heart rate slows down rather than speeds up after a contraction, the baby may have problems during labor. If the results are abnormal, delivery may be induced.^[3] Induction (in-DUK-shŏn) is when a provider administers medicine or uses other methods to artificially start labor before it begins naturally.

Noninvasive Prenatal Testing

Noninvasive prenatal testing (nŏn-ĭn-VĀ-sĭv prē-NĀ-tăl TĔS-tĭng), sometimes called noninvasive prenatal screening, is a method of determining the risk that the fetus will be born with certain genetic abnormalities. This testing analyzes small fragments of DNA that are circulating in a pregnant woman’s blood. It is considered noninvasive because it requires drawing blood only from the pregnant woman and does not pose any risk to the fetus.^[4]

Nonstress Test

A nonstress test (NŎN-strĕs tĕst) is a safe, noninvasive test that measures the heart rate of the fetus as it moves within the uterus. In most healthy babies, the fetal heart rate increases during their movement in the uterus. If nonstress test results show the fetal heart rate is not normal, it may mean that the baby is not getting enough oxygen. If this happens, additional testing may be performed, or delivery may be induced.

Pelvic Ultrasound

A pelvic ultrasound, also called pelvic sonography (PEL-vik sō-NOG-ră-fē), is the process of recording sound waves pertaining to the pelvis. It is performed during pregnancy to check the growth and wellness of the fetus and to estimate a due date. A prenatal ultrasound evaluation of fetal well-being is also referred to as a biophysical profile (BĪ-ō-FĬZ-ĭ-kăl PRO-fīl).

Procedures

Fetal Heart Monitoring

Fetal heart monitoring (FĒ-tăl HÄRT MON-ĭt-or-ing) refers to tracking the heart rate of the fetus. The most common form of monitoring is external electronic fetal monitoring. Sensors are strapped to the mother’s abdomen, and instruments record the baby’s heartbeat. If the mother is in labor, the contractions are also monitored to see how the baby is responding to the contractions.^[5]

Internal monitoring uses an electrode attached to a wire that is placed directly on the baby’s scalp to monitor the heartbeat. The electrode is threaded through the cervix and into the uterus, where it is attached to the baby’s scalp. A small tube can also be inserted to measure contractions. The two devices can provide more accurate measurements of the baby’s heartbeat and the mother’s contractions.^[6]

In Vitro Fertilization

In vitro fertilization (in VĪ-trō FĔR-tĭ-lĭ-ZĀ-shŏn) (IVF) is an assisted reproductive technology. There are many different indications for IVF. For example, a woman may produce normal eggs, but the eggs cannot reach the uterus because the uterine tubes are blocked or otherwise compromised. A man may have a low sperm count, low sperm motility, sperm with an unusually high percentage of morphological abnormalities, or sperm that are incapable of penetrating the zona pellucida of an egg. There are five basic steps of IVF^[7]:

• Stimulation (STĬM-yū-LĀ-shŏn) (also called superovulation): Medicines, called fertility drugs, are given to the woman to boost egg production.
• Egg retrieval (Ĕg rĭ-TREE-vəl): A minor surgery, called follicular aspiration, is done to remove the eggs from the woman’s ovaries. The health care provider inserts a thin needle through the vagina into the ovary and into the follicles containing mature eggs. The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle, one at a time. If a woman does not produce any eggs, donated eggs may be used.
• Insemination (in-sem-ĭ-NĀ-shŏn) and fertilization (fĕr-tĭ-lī-ZĀ-shŏn): Sperm is mixed with the best quality eggs, called insemination. The sperm most often enters (fertilizes) an egg a few hours after insemination. If the chance of fertilization is low, the sperm may be directly injected into the egg, called intracytoplasmic sperm injection.
• Embryo culture (ĔM-brē-ō Kŭl-chər): The retrieved egg is maintained and monitored under stable conditions promoting cell division until it is ready to be transferred into the uterus. The process usually takes 3-5 days.
• Embryo transfer (ĔM-brē-ō TRĂNS-fər): Embryos are placed into the woman’s uterus 3 to 5 days after egg retrieval and fertilization. The doctor inserts a thin tube containing the embryos into the vagina, through the cervix, and up into the uterus. If an embryo implants in the endometrium and grows, pregnancy results. More than one embryo may be placed into the uterus at the same time, which can lead to twins, triplets, or more. Unused embryos may be frozen and implanted or donated at a later date.