William Goodell (gynecologist)
William Goodell was an eminent American gynecologist from Philadelphia, best remembered for first describing what is now referred to as Goodell's sign. William Goodell was born in Malta, the son of missionary William Goodell, studied at William's College and Jefferson Medical College, graduating in 1854, he worked in Constantinople until 1861. He worked in general practice in West Chester until he was appointed Lecturer on Obstetric Diseases of Women at the University of Pennsylvania in 1870, Clinical Professor in Diseases of Women and Children in 1874. A Sketch of the Life and Writings of Louyse Bourgeois, Midwife to Marie de' Medici, the Queen of Henry IV of France, The Annual Address of the Retiring President before the Philadelphia County Medical Society. Lessons in Gynecology, a textbook A Years Work in Oöphorectomy, University Medical Magazine, University of Pennsylvania Laceration of the Perineum and of the Cervix, a clinical lecture delivered at the Hospital of the University of Pennsylvania, University Medical Magazine, University of Pennsylvania Chronic Peritonitis with Pseudo-Membranous Exudation and Matting Together of the Intestines, Simulation a Tumor.
Laparotomy. A clinical lectured delivered at the Hospital of the University of Pennsylvania, University Medical Magazine, University of Pennsylvania The Abuse of Uterine Treatment Through Mistaken Diagnosis, Transactions of the College of Physicians of Philadelphia, The Effect of Castration on Woman, Other Problems in Gynecology The Medical News. Year 1882; the American Journal of Insanity, Volume 38
Obstetrics is the field of study concentrated on pregnancy and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology, a surgical field. Prenatal care is important in screening for various complications of pregnancy; this includes routine office visits with physical exams and routine lab tests: Complete blood count Blood type General antibody screen for HDN Rh D negative antenatal patients should receive RhoGam at 28 weeks to prevent Rh disease. Rapid plasma reagin to screen for syphilis Rubella antibody screen Hepatitis B surface antigen Gonorrhea and Chlamydia culture PPD for tuberculosis Pap smear Urinalysis and culture HIV screenGenetic screening for Down syndrome and trisomy 18, the national standard in the United States, is evolving away from the AFP-Quad screen for Down syndrome, done in the second trimester at 16–18 weeks; the newer integrated screen can be done at 10 plus weeks to 13 plus weeks with an ultrasound of the fetal neck and two chemicals PAPP-A and βHCG.
It gives an accurate risk profile early. A second blood screen at 15 to 20 weeks refines the risk more accurately; 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. This is an evolving standard of care in the United States. MSAFP/quad. Screen – elevations, low numbers or odd patterns correlate with neural tube defect risk and increased risks of trisomy 18 or trisomy 21 Ultrasound either abdominal or transvaginal to assess cervix, placenta and baby Amniocentesis is the national standard for women over 35 or who reach 35 by mid pregnancy or who are at increased risk by family history or prior birth history. Hematocrit Group B Streptococcus screen. If positive, the woman receives IV penicillin or ampicillin while in labor—or, if she is allergic to penicillin, an alternative therapy, such as IV clindamycin or IV vancomycin. Glucose loading test – screens for gestational diabetes.
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. The standard modified criteria have been lowered to 135 since the late 1980s. Obstetric ultrasonography is 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 influenced by other factors. Ultrasound is used for detecting congenital anomalies and determining the biophysical profiles, which are easier to detect in the second trimester when the foetal structures are larger and more developed. Specialised ultrasound equipment can evaluate the blood flow velocity in the umbilical cord, looking to detect a decrease/absence/reversal or diastolic blood flow in the umbilical artery. X-rays and computerized tomography are not used in the first trimester, due to the ionizing radiation, which has teratogenic effects on the foetus.
No effects of magnetic resonance imaging on the foetus have been demonstrated, but this technique is too expensive for routine observation. Instead, obstetric ultrasonography is the imaging method of choice in the first trimester and throughout the pregnancy, because it emits no radiation, is portable, allows for realtime imaging; the safety of frequent ultrasound scanning has not be confirmed. Despite this, increasing numbers of women are choosing to have additional scans for no medical purpose, such as gender scans, 3D and 4D scans. A normal gestation would reveal a gestational sac, yolk sac, fetal pole; the gestational age can be assessed by evaluating the mean gestational sac diameter before week 6, the crown-rump length after week 6. Multiple gestation is evaluated by the number of placentae and amniotic sacs present. Other tools used for assessment include: Fetal screening is used to help assess the viability of the fetus, as well as congenital abnormalities. Fetal karyotype can be used for the screening of genetic diseases.
This can be obtained via amniocentesis or chorionic villus sampling Foetal haematocrit for the assessment of foetal anemia, Rh isoimmunization, or hydrops can be determined by percutaneous umbilical blood sampling, done by placing a needle through the abdomen into the uterus and taking a portion of the umbilical cord. Fetal lung maturity is associated with. Reduced production of surfactant indicates decreased lung maturity and is a high risk factor for infant respiratory distress syndrome. A lecithin:sphingomyelin ratio greater than 1.5 is associated with increased lung maturity. Nonstress test for fetal heart rate Oxytocin challenge test A pregnant woman may have intercurrent diseases, that is, other diseases or conditions that may become worse or be a potential risk to the pregnancy. Diabetes mellitus and pregnancy deals with the interactions of diabetes mellitus and pregnanc
Human reproduction is any form of sexual reproduction resulting in human fertilization involving sexual intercourse between a man and a woman. During sexual intercourse, the interaction between the male and female reproductive systems results in fertilization of the woman's ovum by the man's sperm; these are specialized reproductive cells called gametes, created in a process called meiosis. While normal cells contains 46 chromosomes, 23 pairs, gamete cells only contain 23 chromosomes, it is when these two cells merge into one zygote cell that genetic recombination occurs and the new zygote contains 23 chromosomes from each parent, giving them 23 pairs. A typical 9-month gestation period is followed by childbirth; the fertilization of the ovum may be achieved by artificial insemination methods, which do not involve sexual intercourse. The male reproductive system contains two main divisions: the testes where sperm are produced, the penis. In humans, both of these organs are outside the abdominal cavity.
Having the testes outside the abdomen facilitates temperature regulation of the sperm, which require specific temperatures to survive about 2-3 °C less than the normal body temperature i.e. 37 °C. In particular, the extraperitoneal location of the testes may result in a 2-fold reduction in the heat-induced contribution to the spontaneous mutation rate in male germinal tissues compared to tissues at 37 °C. If the testicles remain too close to the body, it is that the increase in temperature will harm the spermatozoa formation, making conception more difficult; this is. The female reproductive system contains two main divisions: the vagina and the Ovum; the ovum meets with sperm cell, a sperm may penetrate and merge with the egg, fertilizing it with the help of certain hydrolytic enzymes present in the acrosome. The fertilization occurs in the oviducts, but can happen in the uterus itself; the zygote becomes implanted in the lining of the uterus, where it begins the processes of embryogenesis and morphogenesis.
When the fetus is developed enough to survive outside of the uterus, the cervix dilates and contractions of the uterus propel it through the birth canal, the vagina. The ova, which are the female sex cells, are much larger than the spermatozoon and are formed within the ovaries of the female fetus before its birth, they are fixed in location within the ovary until their transit to the uterus, contain nutrients for the zygote and embryo. Over a regular interval known as the menstrual cycle, in response to hormonal signals, a process of oogenesis matures one ovum, released and sent down the Fallopian tube. If not fertilized, this egg is flushed out of the system through menstruation. Human reproduction begins with copulation, followed by nine months of pregnancy before childbirth, though it may be achieved through artificial insemination. Many years of parental care are required before a human child becomes independent between twelve and eighteen or more. Pregnancy can be avoided with the use of contraceptives such as Intrauterine devices.
Human reproduction takes place as internal fertilization by sexual intercourse. During this process, the male inserts his penis, which needs to be erect, into the female's vagina, either partner initiates rhythmic pelvic thrusts until the male ejaculates semen, which contains sperm, into the vaginal canal; this process is known as "coitus", "mating", "having sex", or, euphemistically, "making love". The sperm and the ovum are known as gametes; the sperm travels through the cervix into the uterus or Fallopian tubes. Only 1 in 14 million of the ejaculated sperm will reach the Fallopian tube; the egg moves through the Fallopian tube away from the ovary. One of the sperm encounters and fertilizes the ovum, creating a zygote. Upon fertilization and implantation, gestation of the fetus occurs within the female's uterus. Pregnancy rates for sexual intercourse are highest during the menstrual cycle time from some 5 days before until 1 to 2 days after ovulation. For optimal pregnancy chance, there are recommendations of sexual intercourse every 1 or 2 days, or every 2 or 3 days.
Studies have shown no significant difference between different sex positions and pregnancy rate, as long as it results in ejaculation into the vagina. As an alternative to natural sexual intercourse, there are many methods of assisted reproductive technology, such as artificial insemination where sperm is introduced into the female reproductive system without sexual intercourse. Another method of assisted reproductive technology is in vitro fertilization, where one or more egg cells are retrieved from a woman's ovaries and co-incubated with sperm outside the body; the resulting embryo can be reinserted into the woman's womb. Pregnancy is the period of time during which the fetus develops, dividing via mitosis inside the female. During this time, the fetus receives all of its nutrition and oxygenated blood from the female, filtered through the placenta, attached to the fetus' abdomen via an umbilical cord; this drain of nutrients can be quite taxing on the female, required to ingest higher levels of calories.
In addition, certain vitamins and other nutrients are required in greater quantities than normal creating abnormal eating habits. Gestation period is about 266 days in humans. While in the uterus, the baby f
The Apgar score is a method to summarize the health of newborn children against infant mortality. Virginia Apgar, an anesthesiologist at NewYork–Presbyterian Hospital, developed the score in 1952 to quantify the effects of obstetric anesthesia on babies; the Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two summing up the five values thus obtained. The resulting Apgar score ranges from zero to 10; the five criteria are summarized using words chosen to form a backronym. The test is done at 1 and 5 minutes after birth and may be repeated if the score is and remains low. Scores 7 and above are normal. A low score on the one-minute test may show that the neonate requires medical attention but does not indicate a long-term problem if the score improves at the five-minute test. An Apgar score that remains below 3 at times, such as 10, 15, or 30 minutes, may indicate longer-term neurological damage, including a small but significant increase in the risk of cerebral palsy.
However, the Apgar test's purpose is to determine whether or not a newborn needs immediate medical care. It is not designed to predict long-term health issues. A score of 10 is uncommon, due to the prevalence of transient cyanosis, does not differ from a score of 9. Transient cyanosis is common in babies born at high altitude. A study that compared babies born in Peru near sea level with babies born at high altitude found a significant average difference in the first Apgar score but not the second. Oxygen saturation was lower at high altitude; some ten years after initial publication, a backronym for APGAR was coined in the United States as a mnemonic learning aid: Appearance, Grimace and Respiration. Spanish: Apariencia, Gesticulación, Respiración. Another eponymous backronym from Virginia Apgar's name is American Pediatric Gross Assessment Record. Another mnemonic for the test is “How Ready Is This Child?”, which summarizes the test criteria as Heart rate, Respiratory effort, Irritability and Color.
Ballard Maturational Assessment Bishop score Glasgow Coma Scale Paediatric Glasgow Coma Scale Apgar, Virginia. "The Newborn Scoring System: Reflections and Advice". Pediatric Clinics of North America. 13: 645–650. Online calculator of the Apgar score
In obstetrics, Leopold's Maneuvers are a common and systematic way to determine the position of a fetus inside the woman's uterus. They are used to estimate term fetal weight; the maneuvers consist of each helping to determine the position of the fetus. The maneuvers are important because they help determine the position and lie of the fetus, which in conjunction with correct assessment of the shape of the maternal pelvis can indicate whether the delivery is going to be complicated, or whether a Cesarean section is necessary; the examiner's skill and practice in performing the maneuvers are the primary factor in whether the fetal lie is ascertained. Alternately, position can be determined by ultrasound performed by a physician. Leopold's Maneuvers are difficult to perform on obese women who have polyhydramnios; the palpation can sometimes be uncomfortable for the woman if care is not taken to ensure she is relaxed and adequately positioned. To aid in this, the health care provider should first ensure that the woman has emptied her bladder.
If she has not, she may need to have a straight urinary catheter inserted to empty it if she is unable to micturate herself. The woman should lie on her back with her shoulders raised on a pillow and her knees drawn up a little, her abdomen should be uncovered, most women appreciate it if the individual performing the maneuver warms their hands prior to palpation. While facing the woman, palpate the woman's upper abdomen with both hands. An obstetrician can determine the size, consistency and mobility of the form, felt; the fetal head is hard and moves independently of the trunk while the buttocks feel softer, are symmetric, the shoulders and limbs have small bony processes. After the upper abdomen has been palpated and the form, found is identified, the individual performing the maneuver attempts to determine the location of the fetal back. Still facing the woman, the health care provider palpates the abdomen with gentle but deep pressure using the palm of the hands. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman's uterus.
This is repeated using the opposite side and hands. The fetal back will feel firm and smooth while fetal extremities should feel like small irregularities and protrusions; the fetal back, once determined, should connect with the form found in the upper abdomen and a mass in the maternal inlet, lower abdomen. In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen; the individual performing the maneuver first grasps the lower portion of the abdomen just above the pubic symphysis with the thumb and fingers of the right hand. This maneuver should validate the findings of the first maneuver. If the woman enters labor, this is the part which will most come first in a vaginal birth. If it is the head and is not engaged in the birthing process, it may be pushed back and forth; the Pawlick's Grip, although still used by some obstetricians, is not recommended as it is more uncomfortable for the woman. Instead, a two-handed approach is favored by placing the fingers of both hands laterally on either side of the presenting part.
The last maneuver requires that the health care provider face the woman's feet, as he or she will attempt to locate the fetus' brow. The fingers of both hands are moved down the sides of the uterus toward the pubis; the side where there is resistance to the descent of the fingers toward the pubis is greatest is where the brow is located. If the head of the fetus is well-flexed, it should be on the opposite side from the fetal back. If the fetal head is extended though, the occiput is instead felt and is located on the same side as the back. Leopold's maneuvers are intended to be performed by health care professionals, as they have received the training and instruction in how to perform them. If performed at home as an informational exercise, the examiner should take care to not or excessively disturb the fetus, it is important to note that all findings are not diagnostic, as such ultrasound may be required to conclusively determine the fetal position. Leopold's Maneuver Demo Video