DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY - DEFINITIONS
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Obstetrics
Acrocyanosis. Cyanosis of the hands and feet of the baby, common after birth, and due to peripheral
vasoconstriction.
Active management of labour. The concept of active management of labour was first implemented by O’Driscoll
and colleagues at the National Maternity Hospital, Dublin in 1968. It is designed to ensure labour progression and
intervene to decrease labour dystocia, particularly in the first stage. Its main components are: patient education,
strict labour diagnosis, early amniotomy, regular assessment of progress, prompt administration of oxytocin, one-toone reassurance and support, pain relief and hydration.
Afterpains (after-birth pains). Uterine contractions due to release of oxytocin from the posterior lobe of the
pituitary gland, especially during suckling; more intense in multiparas. They promote involution of the uterus.
Amniocentesis. Aspiration of a sample of amniotic fluid through the mother's abdomen for diagnosis of fetal
maturity and/or disease by assay of the constituents of the fluid; when performed in the second trimester for genetic
counselling (usually at 16-18 weeks) the fetal loss rate is 0.5%.
Amnion. A smooth membrane enclosing the fetus and amniotic fluid; it is loosely fused with the outer chorionic
membrane
Amnioscope. A lighted tubular instrument which is introduced through the internal os in late pregnancy and in
labour; it enables an inspection of the colour and amount of amniotic fluid through the intact membranes, and also
facilitates fetal blood sampling if the membranes are ruptured
Amniotic fluid. Fluid surrounding and protecting the fetus within the amniotic sac. After 20weeks gestation, the
main source of amniotic fluid is the fetal kidneys (urine) and cleared by fetal swallowing. Any disruptions to these
mechanisms will result in major changes of liquor volume. It is measured by cord-free Deepest Vertical Pool
(DVP) or Amniotic Fluid Index (AFI).
Oligohydramnias. Term used when there is virtually no liquor. Some of the causes of oligohydramnios are
idiopathic, ruptured membranes, renal agenesis, polycystic kidneys, FGR and post-term fetus.
Polyhydramnias. Term used to describe excessive liquor volume. Causes of polyhydramnios include
maternal diabetis mellitus, idiopathic, multiple pregnancy, fetal GIT atresias and macrosomia.
Amniotic fluid embolism. Entry of amniotic fluid into the maternal venous circulation. Fetal squamous cells, hair,
and vernix become impacted in the pulmonary arterioles, and thromboplastic substances cause intravascular
coagulation
Amniotomy. Surgical rupture of the membranes to induce or augment labour.
Anaemia. A maternal haemoglobin value below 11.5 g/dl in the first trimester or below 10.5 g/dl in later
pregnancy. The World Health Organization recommends that the haemoglobin concentration should not fall below
11.0 g/dl at any time in pregnancy.
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY - DEFINITIONS
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Anencephalus. Absence of the brain and vault of the skull, the cerebellum and basal ganglia are sometimes present.
Antepartum haemorrhage. Bleeding from or in to the genital tract, occurring from the 24th week of gestation to
the birth of the baby.
Apgar score. A numerical scoring system usually applied at 1 and 5 minutes after birth to evaluate the condition of
the baby, based on heart rate, respiration, muscle tone, reflexes and colour.
Apnoea of prematurity. Apnoea which occurs in preterm infants due to immaturity of respiratory control
mechanisms.
Areola. The pigmented zone of skin around the nipple, which contains sebaceous glands. The nipple and areola
become further pigmented during pregnancy.
Asphyxia neonatorum. Term used to describe the condition of an infant who has been subjected to hypoxia and
acidosis during delivery and who fails to breathe following birth.
Asymptomatic bacteriuria. Defined as at least 10 5 colony-forming units of urinary tract pathogens per ml of urine
without symptoms. Asymptomatic bacteriuria occurs in 2% to 10% of pregnancies and, if not treated, up to 30% of
mothers will develop acute pyelonephritis. Asymptomatic bacteriuria has been associated with low birthweight and
preterm delivery.
Asynclitism. When the sagittal suture of the fetal skull does not lie midway between the maternal sacral
promontory and pubic symphysis; there is usually disproportion, and the head is rocking fore and aft to enter the
pelvis
Attitude of the fetus. Relationship of fetal head and limbs to the fetal trunk, usually flexion
Bandl ring. The groove between upper and lower uterine segments; it is situated at the level of the pubic symphysis
at the onset of labour.
Birth plan. The plan is either a list or a statement of preferences prepared by the woman for care during labour,
birth and the postnatal period in the hospital.
Birth-weight. The first weight of the newborn obtained preferably within 1 hour of birth before significant
postnatal weight loss has occurred.
Bishop score. Assessment of suitability of the cervix for induction of labour.
Bradycardia. Fetal heart rate below 110 beats per minute.
Brandt-Andrews method of expressing the placenta from the uterus: controlled cord traction is applied with one
hand while the contracted uterus is pushed upwards away from the placenta with the other hand on the mother's
abdomen
Braxton Hicks contractions. Spontaneous uterine contractions originally as a sign of pregnancy. Occur from the
first trimester onward, and probably promote uterine blood flow and transfer of oxygen to the fetus
Breech presentation. (a) Complete: the knees and hips are flexed and buttocks, genitalia, and the feet present. (b)
Incomplete: (i) frank breech - the legs are extended and buttocks and genitalia present; (ii) footling: one or both feet
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY - DEFINITIONS
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present; there is a 10% risk of cord prolapse .
Bregma. The large diamond shaped anterior fontanelle.
Brow. That part of the fetal head between the root of the nose and the anterior fontanelle
Caesarean section. The surgical process of delivering the baby through an abdominal incision
Caput succedaneum. Oedema from obstructed venous return in the fetal scalp caused by pressure of the head
against the rim of the cervix or birth canal.
Cardiotocography (CTG). Monitoring of the fetal heart rate using Doppler ultrasound or a direct scalp electrode to
make an immediate assessment of fetoplacental well-being especially in high-risk pregnancies. There are four main
features including baseline rate, baseline variability, accelerations, decelerations, frequency and strength of
contractions.
Cephalohaematoma. A collection of blood beneath the periosteum of a skull bone, limited to that bone by
periosteal attachments
Cerebral palsy. A non-progressive disorder of the brain causing impairment of motor function (spastic rigidity).
The risk is greatly increased in infants with birth-weight less than 1,500 g.
Cervical dystocia. Difficult labour due to failure of the cervix to dilate, in spite of adequate uterine contractions
Cervical incompetence. Premature effacement and dilatation of the cervix. The cervix dilates silently during the
second trimester resulting in bulging/rupture amniotic membrane, second trimester miscarriage or premature
delivery. However, it is a frequently imprecise term applied to women with previous mid-trimester loss or preterm
birth. Cervical cerclage may provide some structural support and maintaining the cervical length and the
endocervical mucus plug as a mechanical barrier to ascending infection.
Cervical cerclage. A transvaginal purse-string suture placed on the cervix.
History-indicated cerclage: Insertion of a cerclage offered to women with three or more previous preterm
births and/or second trimester losses. This is usually performed electively at 12-14 weeks gestation
Ultrasound-indicated cerclage: Insertion of a cerclage offered to women with a history of spontaneous
second trimester loss and/or preterm birth, with ultrasound evidence of cervical shortening (≤ 25mm).
Rescue cerclage: Insertion of a cerclage as a salvage measure in the case of premature cervical dilatation
with exposed amniotic membranes in the vagina.
Chloasma. The brown, pigmented mask of pregnancy. Usually patchy and simulates suntan it also occurs in some
women who are taking oral contraceptives.
Chorion frondosum. The part of the chorion forming the placenta
Chorion laeve. The part of the chorion forming the extraplacental membrane
Chorionic villus sampling. Under ultrasound control, 10-12 mg of chorion frondosum is obtained through a fine
cannula (via the cervix or more commonly, transabdominally); fetal karyotype is available in 2 days in 99% of
cases; the procedure has a fetal loss rate of 1-2%. Can be performed earlier (9-12 weeks) than amniocentesis.
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY - DEFINITIONS
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Chromosomes. Deeply-staining bodies in the nucleus of the cell which contain the hereditary material (genes); 23
are derived from each parent, making the normal complement of 46.
Cleft lip. Failure of the upper lip to fuse in the midline. It may be associated with cleft palate where the bones of the
roof of the mouth fail to fuse in the midline
Colostrum. Yellowish fluid expressed from the breasts during late pregnancy and before the onset of true lactation.
Congenital dislocation of the hip. The baby has a relaxed joint capsule and shallow acetabulum, which may allow
the head of the femur to become displaced. This requires early diagnosis and treatment.
Constriction ring. A localized spasm of the uterine muscle.
Controlled Cord Traction. Traction on the umbilical cord, combined with counter-pressure upwards on the uterine
body by a hand placed immediately above the symphysis pubis. CCT is used in conjunction with uterotonic drugs
that speed up the placental separation process in active management of third stage of labour.
Coombs test. Detects sensitized red blood cells (antibody attached), e.g. in erythroblastosis.
Cord presentation. The cord lies below the presenting part with the membranes intact.
Cord prolapse. As for cord presentation except that the membranes have ruptured, and pressure on the umbilical
cord vessels is more likely to occur.
Corpus luteum. An ovarian cyst formed from the Graafian follicle after ovulation which produces oestrogen and
progesterone; essential for implantation of the fertilized ovum in the endometrium.
Cotyledons. The lobes of the placenta
Couvelaire uterus (uterine apoplexy). Occurs with severe abruption of the placenta. The uterus is purple due to
haemorrhage within its musculature
Crowning of the head. Visualisation of the fetal head as birth becomes imminent. The widest diameter of the fetal
head has passed the bony pelvic outlet and emerged under the pubic arch.
Curve of Carus. The 90 degree curve of the birth canal
Decidua. The exaggerated endometrial reaction to oestrogen and progesterone during pregnancy. The glands
become tortuous and cells enlarge
Delay in the second stage of labour > 1hour in para 0 and > 30 minutes in para 1+
Dextrorotation of the uterus. The pregnant uterus is normally rotated to the right side
Diameters. The distance between certain important bony points in the fetus and the maternal pelvis. The following
10 are of value (i) anteroposterior of the brim (true conjugate) 11.5 cm; (ii) transverse diameter of pelvic brim 13.5
cm; (iii) bispinous or interspinous (transverse diameter of narrow pelvic plane) 10.5 cm; (iv) anteroposterior of
outlet 11.5 cm; (v) biparietal (between the parietal eminences) 9.5 cm; (vi) bitemporal 8.0 cm; (vii) occipitofrontal
(from occipital protuberance to above the orbital margins) 11-12 cm; (viii) suboccipitobregmatic (nape of neck to
middle of anterior fontanelle) 9.5 cm; (ix) bisacromial (between tips of acromial processes) 12.5 cm; (x)
bitrochanteric (between outer aspects of greater trochanters) 9.5 cm .
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Diastasis of the rectus abdominis muscles. The separation which occurs when the muscles can stretch no more.
The peritoneum bulges between them when the woman coughs. Postnatal exercises are required
Discharge. Physiological vaginal secretion increases in pregnancy. The vagina has a stratified squamous epithelial
lining but no glands; its moisture is provided chiefly by secretion of cervical mucus (and at coitus by vaginal
transudation). If there is itching or the discharge is yellow, speculum examination is required to exclude vaginitis.
Doppler measurement of blood flow. A non-invasive method of assessing blood flow based on the change in
frequency of reflected sound. The technique has been applied to umbilical and other fetal vessels and the
uteroplacental blood supply (uterine arteries).
Down syndrome (mongolism) congenital abnormality characterized by the presence of Trisomy 21
Ductus arteriosus. The channel between pulmonary artery and descending arch of the aorta which allows the right
ventricular output to be shunted away from the unexpanded fetal lungs.
Ductus venosus. A fetal vessel that connects the umbilical vein to the inferior vena cava.
Dystocia. Difficult or abnormal labour due to cephalopelvic disproportion or a primary disorder of uterine action.
Eclampsia. 'To flash forth'. A clinical state characterized by convulsions, not attributable to cerebral conditions
such as epilepsy or cerebral haemorrhage, and usually superimposed on preceding severe pre-eclampsia.
Ectopic pregnancy. Implantation of pregnancy (fertilized ovum) outside the uterine cavity. The commonest site is
in the Fallopian tube.
Effacement of cervix. Effacement occurs when the entire length of the cervical canal has been taken up into the
lower segment of the uterus; usually occurs during the early (latent) phase of labour
Embryo. The name given to the conceptus up to the 10th week of gestation (8th week post conception), after this,
the word fetus is used
Endometrium. The mucous membrane lining the uterus, which responds to ovarian hormones during the menstrual
cycle.
Engagement. The fetal head is engaged when its maximum diameters (suboccipitobregmatic and biparietal when
the head is well flexed) have passed the pelvic inlet.
Engorgement of breasts. Full, red, hard, sore breasts due to increased blood flow before milk secretion
commences.
Epidural analgesia. Injection of analgesic agent outside the dura, which covers the spinal canal. A sacral (caudal)
epidural gives complete analgesia of all pelvic structures
Episiotomy. A surgical procedure in which the perineum is cut with a scissors, with the intention of widening the
soft tissue diameter of the introitus in order to prevent a severe perineal tear or accelerate delivery.
Ergometrine The active oxytocic drug derived from ergot used to promote uterine contraction (uterotonic agent).
Erythema toxicum. A common maculoerythematous rash with vesicles containing eosinophils, which appears on
the newborn in the first days after birth. It resolves spontaneously within 2-3 weeks and requires no treatment.
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY - DEFINITIONS
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Erythroblastosis Haemolytic disease of the newborn, usually due to Rhesus antibodies. Hypoxia due to fetal
anaemia stimulates production of primitive red cells (erythroblasts) which are present in excessive numbers in the
blood.
Exchange transfusion. The blood of the baby is gradually replaced with donor blood; most commonly used in
babies with erythroblastosis, to remove harmful bilirubin pigment, maternal rhesus antibodies and the infant's
Rhesus positive cells, as well as to treat anaemia
Face. The area of fetal head below the root of the nose and the orbital ridges.
Ferning. During the proliferative phase of the menstrual cycle cervical mucus forms a palm-leaf pattern when it
dries on a slide.
Fertilization. The union of sperm and the mature ovum; usually occurs in the outer half of the Fallopian tube
Fetal Acidosis. The fetus is acidotic when the fetal blood pH is 7.20 or less in labour or at birth, or 7.25 or less if
tested at induction of labour or after elective Caesarean section.
Fetal monitoring. The use of methods such as ultrasound and cardiotocography to assess the fetal well-being
especially of the high-risk fetus.
Fontanelle. Space at the junction of 3 or more skull bones, covered only by a membrane and skin.
Foramen ovale. An opening in the interatrial septum which allows oxygenated blood from the umbilical vein to
flow from the right to the left side of the heart in the fetus.
Fourchette. The fold of skin formed by merging of the labia minora and labia majora posteriorly.
Funic souffle. The sound of blood passing through the umbilical cord, synchronous with the fetal heart beat.
Funnel (android) pelvis. A pelvis in which midpelvic and outlet diameters are narrower than those at the pelvic
brim.
Gene. The functional unit of heredity; large numbers are situated in each of the 46 chromosomes in the cell nucleus.
Generalized oedema. Excessive accumulation of fluid in the tissues demonstrated by swelling of the legs, hands,
and face, is often associated with pre-eclampsia.
Genotype. The hereditary constitution of genes of an individual.
Gestational age. Time from the first day of the last normal menstrual period to birth.
Grand multipara. Para 4 or more, these woman are likely to have powerful and coordinated uterine contractions,
hence the risk of uterine rupture if there is cephalopelvic disproportion.
Gravida. The number of times the mother has been pregnant, irrespective of duration or gestation.
Haemorrhoids. Enlarged haemorrhoidal veins of the lower bowel. These are common during pregnancy,
particularly in labour when the head distends the perineum
Heartburn. A common symptom in late pregnancy due to regurgitation of acid from the compressed stomach, more
usual when the woman lies down.
Hegar sign of pregnancy Bimanual palpation of a soft uterine isthmus between the cervix below and the uterine
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body above. Used before modern biochemical pregnancy confirmation became available.
Hyaline membrane. A homogeneous eosinophilic membrane lining the alveoli, and respiratory bronchioles;
commonly seen in the lungs of infants who die from respiratory distress syndrome
Hydatidiform mole. A condition in which there is partial or complete conversion of the chorionic villi into grapelike vesicles. The villi are avascular and there is trophoblastic proliferation. The condition may result in malignant
trophoblastic disease (invasive mole or choriocarcinoma).
Hydrocephalus. Accumulation of excessive amounts of cerebrospinal fluid within the ventricles of the brain
Hydrops fetalis. Gross oedema of fetal subcutaneous tissues together with ascites, pericardial and pleural effusion;
usually due to erythroblastosis
Hyperbilirubinaemia. An excessive amount of bilirubin in the blood, most commonly due to haemolysis. .
Hyperemesis gravidarum.
Severe intractable vomiting in pregnancy with inadequate hydration and
nutritional/electrolyte imbalance.
Hypertension in pregnancy. A systolic blood pressure ≥of 140mmHG and/or a diastolic blood pressure of ≥
90mmHg. These measurements should be based on two measurements taken using the same arm, several hours
apart.
Chronic/pre-existing hypertension predates the pregnancy or hypertension diagnosed for the first time
before 20 weeks gestation.
Gestational Hypertension is diagnosed after 20 weeks gestation.Severe hypertension is defined as a systolic BP of >160 mmHg or a diastolic BP of >110mmHg.
Pre-eclampsia. Multi-systemic disease characterised by hypertension in pregnancy with the addition of
significant proteinuria (greater than 300 mg/24 hours in the absence of a urinary tract infection, chronic
renal disease or contamination of the urine) after 20 weeks gestation.
Hypofibrinogenaemia. The commonest cause of blood coagulation failure in obstetrics. The blood fibrinogen level
falls below the normal of 4-6 g/L. Usually secondary to severe placental abruption, severe pre-eclampsia, prolonged
retention of a dead fetus, or amniotic fluid embolism.
Hypospadias. A malformation of the male penis where the urethra opens on it’s under surface or on the perineum
Hysterotomy. Incision of the uterus via the abdominal route. This term is generally used for delivery of the fetus
via abdominal route prior to viability - after this time the operation is termed a Caesarean section.
Implantation. Penetration of the endometrium by the early fertilized ovum (blastocyst) which becomes completely
surrounded by decidua occurs 6-8 days after ovulation.
Incarceration of the gravid uterus. The uterus is retroverted and with enlargement becomes imprisoned in the
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pelvis, impacting beneath the sacral promontory leading to urethral obstruction and acute urinary retention.
Uncoordinated uterine action. Fundal dominance is lost, intrauterine tension between contractions is increased,
the uterus is tender on palpation, and the woman complains of backache.
Infant mortality. Death in the first year of life of infants born alive (includes neonatal deaths). The rate is 5-10 per
1,000 births in developed countries.
Introitus. Entrance to the vagina
Inversion of the uterus. Uterus turned inside-out, usually due to pulling on the cord when the uterus is relaxed.
Kernicterus. Yellow staining of the baby's brain due to high blood levels of billirubin causing severe neurological
damage (billirubin encephalopathy) or death.
Labour. The onset of regular uterine activity associated with progressive effacement and dilatation of the cervix
and descent of the presenting part through the cervix.
Lactiferous sinus. A dilatation of the mammary duct just before it enters the nipple.Leucorrhoea. Colourless
(white) non-itchy, non-offensive vaginal discharge.
Lie of the fetus. Relationship of the long axis of fetus to the long axis of the uterus. Usually longitudinal but can be
transverse or oblique
Lightening. Usually occurs after 36 weeks and is commoner in nulliparos; the presenting part enters the pelvis and
thus reduces the pressure on the diaphragm; the mother notices that it is easier to breathe. Lightening is not
synonymous with engagement; often 3-4 cm of head remain palpable abdominally.
Linea nigra. Brown or black line of pigmentation in the midline of the abdominal wall during pregnancy.
Lochia. The discharge from the uterus during the puerperium; it is initially red (lochia rubra), then yellow (serosa),
and finally white (alba).
Lovset manoeuvre. Rotation and traction of the fetal trunk during breech birth to facilitate delivery of the arms and
shoulders.
Lower uterine segment. The thin expanded lower portion of the uterus which forms from the isthmus in the last
trimester of pregnancy; it provides the usual method of approach to the baby in the operation of Caesarean section
Manual removal of the placenta. Removal of the placenta by means of a hand inside the uterus; it is performed
when other methods fail.
Manual rotation of the occiput. Performed prior to forceps application, as an alternative to forceps rotation when
the mechanism of anterior rotation of the head has failed.
Maternal death. Death occurring during pregnancy, childbirth, or within 42 days of the puerperium, irrespective of
the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management.
The maternal mortality rate in the UK, calculated from all maternal mortality Directly or Indirectly due to
pregnancy for 2006–08 was 11.39 per 100 000 maternities.
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Direct Maternal Death. Direct maternal deaths are those resulting from conditions or complications or their
management that are unique to pregnancy, occurring during the antenatal, intrapartum or postpartum
periods.
Indirect Maternal Death. Indirect maternal deaths are those resulting from previously existing disease, or
disease that develops during pregnancy not as the result of direct obstetric causes, but which were
aggravated by the physiological effects of pregnancy.
Coincidental/Fortuitous Maternal Death. Deaths from unrelated causes which happen to occur in
pregnancy or the puerperium.
Late Maternal Death. Deaths occurring between 42 days and 1 year after abortion, miscarriage or delivery
that are the result of Direct or Indirect maternal causes.
Maternities. Pregnancy resulting in a live birth at any gestation or stillbirth occurring at 24 weeks’ gestation
onwards, with multiple births being counted only once.
Meconium. The first greenish-black stool of the newborn, composed of cellular debris, bile, lanugo, and vernix
caseosa.
Menarche. Onset of menstruation.
Meningomyelocele. Protrusion of the meninges and spinal cord through a defect (spina bifida) in the vertebral
arches of the spine
Milia. Tiny white papules on the nose due to retention of secretions in sebaceous glands, which disappear in the
first weeks after birth
Miscarriage. Spontaneous loss of pregnancy from the time of conception until 24 weeks gestation.
Complete miscarriage: all the products of conception have been passed without the need for medical or
surgical intervention
Incomplete miscarriage: some, but not all, of the products of conception have been passed; retained
products may be part of the fetus, placenta or membranes
Inevitable miscarriage: the cervical os is open, but the products of conception have not been expelled
Missed miscarriage: ultrasound evidence of fetal demise but no uterine activity to expel the products.
Threatened miscarriage: vaginal bleeding before 24 weeks gestation, viable pregnancy on ultrasound
Septic miscarriage: a spontaneous miscarriage that is complicated by intrauterine infection
Recurrent miscarriage: three or more consecutive pregnancy losses before 24 weeks gestation. This affects
1% of couples trying to conceive.
Montgomery follicles. Hypertrophied sebaceous glands, which appear as lumps scattered throughout the areola
surrounding the nipple
Morula. The mulberry-like mass of cells formed by repeated divisions of the fertilized ovum
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Moulding. Alteration in shape and diameters of the fetal head during labour. The fontanelles and sutures permit the
force of contractions to compress the head against the bony pelvis and adapt its shape and size to that of the birth
canal.
Mullerian duct. An embryonic tubular structure, which forms the female genital tract (Fallopian tubes, uterus,
vagina).
Naegle’s rule. Method of calculating estimated date of delivery: add 9 months and 7 days to the first day of the last
menstrual period. A correction is required if the woman does not have 28-day cycles.
Narrow pelvic plane or plane of least pelvic dimensions. From the lower border of the symphysis pubis, to the
ischial spines laterally and to the lower border of the fourth sacral vertebra posteriorly. This is below the mid pelvic
plane which runs from the middle of the symphysis, above the ischial spines, to the junction of the second and third
sacral vertebrae
Neonate. Infant from birth to 28 completed days of age.
Neonatal death. Death of a liveborn baby from 24 weeks gestation or with birthweight ≥500g occuring within 28
completed days of birth.
Early neonatal death is the death of a liveborn baby from 24 weeks gestation or with birthweight ≥500g
occurring within 7 completed days of birth.
Late neonatal death is the death of a live born baby from 24 weeks gestation or with birthweight ≥500g
occurring after 7th day and within 28 completed days of birth.
Newborn screening. All newborn babies are screened for a range of health conditions shortly after their birth.
Newborn Bloodspot screening. In Ireland, all babies are offered the ‘Heel Prick Test’ screening for
Phenylketonuria (PKU), Homocystinuria, Maple Syrup Urine Disease, Classical Galactosaemia, Cystic
Fibrosis, Congenital Hypothyroidism. This is done on blood collected on blotting paper from a heel prick on
the 4-5th day of life. The screening ensures that any babies with these rare conditions are identified and
treated as early as possible.
Newborn Hearing Screening. 1-2: 1,000 babies born in Ireland are born with a hearing loss in one or both
ears. Most babies born with a hearing loss are born into families with no history of hearing loss so it is
important to screen all babies as early as possible. The hearing screen will usually be carried out while the
baby is settled or sleeping at the mother's bedside. Any baby who does not have a clear response from the
screen will be seen for a full audiological (hearing) assessment at our Audiology Clinics (hearing clinics).
Newborn Screening for Critical Congenital Heart Disease. Babies with a critical congenital heart defect
(CCHD) are at significant risk of disability or death if their condition is not diagnosed soon after birth.
Newborn screening using pulse oximetry (oxygen saturation) can identify some infants with a CCHD before
they show signs of the condition. Pulse oximetry screening is most likely to detect seven of the critical
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CHDs. These seven main screening targets are hypoplastic left heart syndrome, pulmonary atresia, tetralogy
of Fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia, and
truncus arteriosus.
Normal labour. A labour in which the fetus presents by the vertex, the occiput rotates anteriorly, and the result is
the birth of a living, mature fetus with no complications, the duration of labour ranging from 4-24 hours.
Obstructed labour. There is no descent of the presenting part in the presence of good contractions. Usually there is
extensive caput and moulding, a malposition or malpresentation, and a retraction ring, the fetus is often large and
the pelvis small or abnormal in shape.
Occiput. The back of the fetal head behind the posterior fontanelle
Onset of labour. Regular uterine contractions, leading to dilatation and effacement of the cervix.
Operculum. The plug of mucus that occludes the cervical canal during pregnancy
Ovulation. Extrusion of the ripened ovum from the Graafian follicle in the ovary to the peritoneal cavity (and then
into the tube)
Oxytocic. Hastens birth of fetus and/or placenta by stimulating contractions of the uterine muscle; by definition
may accelerate first, second or third stages of labour.
Parity: The number of completed pregnancies, whether live birth or stillbirth, of at least 24 weeks gestation or with
birthweight ≥500g.
A primigravida is a women who is in her first pregnancy.
A multigravida is a woman who has had more than one completed pregnancy (whether live birth or
stillbirth, of at least 24 weeks gestation or with birthweight ≥500g).
Partograph (cervicograph) is a graphic representation of cervical dilatation and descent of the presenting part;
used to indicate departure from normal and the need for active management of labour, especially in nulliparas
Pawlik’s grip. Suprapubic palpation with the outstretched hand to identify the presenting part of the fetus, its
position, flexion and its station within the mother's pelvis
Pelvic brim or inlet. The plane (flat surface) of division, between the true and false pelvis. The plane passes from
the upper border of the symphysis pubis, along the pubic crest to the iliopectineal eminence then to the sacroiliac
joint, along the wings of the sacrum to the centre of the sacral promontory. The shape is transversely oval with the
promontory causing a projection posteriorly.
Pelvic outlet. A diamond-shaped opening, which runs from beneath the symphysis pubis along the ischiopubic
ramus to the ischial tuberosity (on which we sit) along the sacrotuberous ligament to the fifth piece of the sacrum
(the coccyx being mobile folds back in labour).
Pelvimetry. Measurement of the size of the pelvis, either clinically or by radiography.
Pendulous abdomen. Characteristic of the obese with poor muscle tone and diastasis of the rectus muscles and in
multiple pregnancy. The uterus bulges forward and malpresentations are common.
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Perinatal mortality. Stillbirths plus early neonatal deaths (first seven days of life).
Perinatal mortality rate (PMR) is the number of stillbirths and early neonatal deaths per 1000 livebirths
and stillbirths
Corrected/Adjusted perinatal mortality rate is perinatal mortality rate excluding perinatal deaths
associated or due to a congenital malformation. The PMR for 2012 in Ireland was 6.2 per 1,000 births.
When corrected for congenital malformations, the Adjusted PMR was 4.1 per 1000 births.
Perineal body. A triangular-shaped wedge of tissue based on the perineum separating the lower one third of the
posterior vaginal wall from the anal canal
Perineal massage. Technique of gradually widening the vaginal opening during the third trimester in preparation
for delivery of the baby; the birth is usually easier and episiotomy may not be necessary.
Perineal Tear.
First Degree Perineal Tear. Disruption of the vaginal and perineal mucosa.
Second Degree Perineal Tear. Disruption of the vaginal mucosa and perineal muscles but does not involve
anal sphincter muscles.
Third degree tear. Partial or complete disruption of the anal sphincter muscles, which may involve either or
both the external (EAS) and internal anal sphincter (IAS) muscles.
Fourth Degree Perineal Tear. Disruption of the anal sphincter muscles with a breach of the rectal mucosa.
Period of gestation. The number of completed weeks, from the first day of the last menstrual period to the date in
question.
Persistent occipitoposterior or face to pubes. Birth of the fetus with the occiput directed posteriorly; anterior
rotation of the occiput fails to occur
Phenylketonuria. A hereditary enzyme deficiency which can cause mental retardation; a blood test is routinely
taken a few days after birth to exclude this condition; incidence I in 10,000 births.
Phototherapy. Use of light energy, (around wavelength 450 nm) to convert the bilirubin molecule in the jaundiced
infant's skin to a form which can be excreted without conjugation in the liver.
Pica. Eating of a substance usually considered inedible.
Placenta. The organ which permit gas and nutrient transport between the fetus and the mother. Forms from the
chorion frondosum with a maternal decidual contribution.
Placenta abruption. Placental separation from the uterine decidua prior to birth of the baby.
Placenta accreta. Deficiency of decidua basalis and/or deeper than normal implantation of the placenta, with
chorionic villi attached to uterine muscle. In placenta increta the villi are in the muscle wall; in placenta percreta
the villi are through the muscle wall (a variety of uterine rupture)
Placenta circumvallata. Placenta with a double fold of amnion forming a ring on the fetal surface some distance in
from the edge of the placenta
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Placenta membranacea. A thinner, larger placenta where there is failure of atrophy of the usual proportion of the
chorionic villi
Placenta praevia. Placenta praevia exists when the placenta is inserted wholly or in part into the lower segment of
the uterus. It is classified by ultrasound imaging according to what is relevant clinically:
Major praevia: the placenta lies over the internal cervical os
Minor/partial praevia: the leading edge of the placenta is in the lower uterine segment but not covering
the cervical os, minor or partial praevia exists.
Placenta succenturiata. Accessory lobe of the placenta may be multiple.
Placental separation mechanisms: (a) Schultze retroplacental haematoma turns the placenta inside-out and the
shiny fetal surface, with umbilical cord attached, presents. (b) Matthews-Duncan. The placenta separates edge first
and slides out with the maternal surface (cotyledons) exposed.
Polyhydramnios. The clinical diagnosis of an excessive amount of liquor amnii (more than 1,500 ml at term)
Position of the fetus. The relationship of a defined area on the presenting part (called the denominator) to the
mother's pelvis
Positive signs of pregnancy. Signs that are infallible; fetal heart sounds, palpable fetal parts or movements,
ultrasonography and tests for the presence of chorionic gonadotrophic hormone in the urine or blood.
Posterior fontanelle. Small triangular space in the fetal or infant skull situated at the posterior end of the sagittal
suture
Posterior position of the occiput. The fetal occipital bone is directed to the posterior aspect of the maternal pelvis,
either to the left (LOP) or to the right (ROP). It occurs in about 15-20% of labours and is commonly associated with
prolonged and difficult labour It causes more trouble in labour than any other obstetric complication
Postpartum haemorrhage. (a) Primary. Blood loss in excess of 500 mL from the birth canal, during the third stage
and for 24 hours afterwards, (b) Secondary. Excessive bleeding, occurring in the interval from 24 hours after
delivery until the end of the puerperium (volume not specified).
Post-term infant. Baby born after more than 40 completed weeks of gestation.
Precipitate labour. Labour of less than 4 hours duration.
Preterm prelabour rupture of the membranes. Premature spontaneous rupture of the membranes before 37
weeks gestation without the onset of contractions Preterm infant. Baby born before 37 weeks gestation. The
incidence of prematurity is approximately 6% and it accounts for 60% of all neonatal deaths
Presenting part. That part of the fetus felt on abdominal or vaginal examination.
Proliferative phase of menstrual cycle. The interval after menstruation, and up to ovulation during which growth
of the endometrium is stimulated by oestrogen from the developing Graafian follicle.
Prolonged labour. Labour of more than 24 hours' duration.
Prolonged pregnancy. Pregnancy prolonged 14 days or more past the due date of confinement (full term); the
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incidence is approximately 4% (table 17.1) and has fallen since induction of labour is often performed at full term +
7 - 10 days.
Prostaglandins. Naturally occurring substances, in the decidua, semen and many tissues. The PGEI, PGE2 and
PGF2 compounds stimulate uterine muscle activity and also cause oxytocin release from the posterior lobe of the
pituitary.
Pseudocyesis. A phantom pregnancy, the woman thinks she is pregnant but she is not. A royal illness (Queen
Mary). Seen typically in the premenopausal nullipara anxious for a child.
Pudendal nerve block. Bilateral injection of local analgesic in the region of the ischial spines, which renders the
vagina and perineum insensitive to pain.
Puerperal sepsis. Sepsis developing after birth until 6 weeks postpartum. Sepsis may be defined as infection plus
systemic manifestations of infection.Most common site of puerperal sepsis is the genital tract. It could also cause by
mastitis, UTI, pneumonia, skin and soft-tissue infection, gastroenteritis, pharyngitis and bacterial meningitis.
Puerperium. The period during which the reproductive organs return to their prepregnant condition, usually
regarded as an interval of 6 weeks after delivery
Quickening. When the woman in first becomes aware of fetal movements, add 5 calendar months (22 weeks) to
calculate the due date.
Red degeneration. A common complication, of large fibromyomas in pregnancy associated with pain due to
ischaemic necrosis.
Respiratory distress. Term used to describe any infant who develops a respiratory rate greater than 60 per minute,
has difficulties in breathing as shown by retraction of the sternum and lower costal margin, and an expiratory grunt.
Respiratory distress syndrome (RDS). A condition which is due to lung immaturity and surfactant deficiency in
preterm infants, previously it was known as hyaline membrane disease. May be treated with exogenous surfactant.
Restitution. When the fetal head is born it is free to undo any twisting caused by internal rotation
Retained placenta. Placenta still in utero 1 hour after birth of the baby
Retraction. The quality of uterine muscle, whereby permanent shortening occurs after contractions in labour. The
uterine fundus thickens and pulls up the dilating cervix like a hood over the presenting part
Retraction ring. Occurs in obstructed labour when Bandl's ring rises to about the level of the umbilicus and
becomes visible and palpable
Retroversion of the uterus. The uterine fundus lies in the rectovaginal pouch of Douglas instead of anteriorly on
the bladder. Occurs in 20% of women.
Rhesus factor. An antigen attached to red blood cells capable of causing production of antibodies when introduced
into the circulation of a person lacking this factor (a Rh negative person).
Rotation of the head. (a) Internal. The occiput rotates to the anterior position and rarely (1-2%) to the posterior
position. (b) External. The head rotates after it is born because the shoulders (bisacromial diameter) are turning into
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the anteroposterior diameter of the pelvic outlet
Round ligament strain. Causes pain in mid-pregnancy that may be confused with renal infection or red
degeneration of a fibroid. The hypertrophied muscular ligament is in spasm and often is readily palpated lateral to
the uterus in the lower abdomen. Appendicitis must be considered when the pain is unilateral and right-sided.
Sclero-oedema. Cold oedema of the newborn.
Secondary powers in labour. Voluntary muscles of the abdominal wall, and diaphragm, which by their contraction
increase intra-abdominal pressure in the second stage of labour. Intrauterine pressure rises to 110 mm of mercury
with the combined effect of primary uterine action (35-60 mm) and secondary powers (50 mm).
Secretory phase of menstrual cycle. The interval between ovulation and the succeeding menstrual period during
which oestrogen and progesterone from the corpus luteum stimulate growth of the endometrium and glycogen
secretion of the glands.
Shoulder dystocia (impacted shoulders). Obstruction to the passage of the shoulders through the bony pelvis; the
head having been delivered, the neck fails to appear and the baby's chin burrows into the mother's perineum when
the occiput is anterior
Show. A discharge of mucus and blood at the onset of labour when the cervix dilates and the operculum (cervical
mucus plug) falls out
Sinciput. That part of the fetal head in front of the anterior fontanelle, it is subdivided into the brow and the face
Small for gestational age. Infant born with a birth weight less than the 10th centile. The term is synonymous with
'small for dates'. The use of centiles customised for maternal characteristics (maternal height, weight, parity and
ethnic group) as well as gestational age at delivery and infant sex, identifies small babies at higher risk of morbidity
and mortality than those identified by population centiles. Small for gestational age infants will include both
constitutionally small infants and infants which show evidence of growth retrictions.
Severe SGA fetus has an estimated fetal weight or abdominal circumference of less than the 3rd centile
Fetal -Growth Restriction. A pathological restriction of the genetic growth potential. Growth restricted
fetuses may manifest evidence of fetal compromise (abnormal Doppler studies, reduced liquor volume).
Low birth-weight. An infant with birth weight less than 2500g at or beyond 37 weeks gestation.
Very low birth-weight infants are those weighing less than 1500g; they comprise 1 % of all births and
provide 50% of perinatal deaths.
Extremely low birth-weight infants weigh less than 1000 g at birth and comprise 0.5% of all births.
Spalding sign. Overlapping of the cranial bones seen radiographically; is a sign of fetal death if moulding due to
labour can be excluded. Fetal death is now confirmed with ultrasonography and/or cardiotocography.
Spurious or false labour. Painful uterine contractions, without cervical effacement or dilatation.
Stages of labour. (a) The first stage is that of dilatation of the cervix and is finished when the uterine cavity and
vagina are no longer separated by a rim of cervix (full dilatation) (b) The second stage is from full dilatation of the
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cervix to delivery of the fetus (c) The third stage is completed with the delivery of the placenta and membranes
(secundines)
Station. The level of the presenting part, within the mother's pelvis. The ischial spines are the reference points on
vaginal examination
Stillbirth. Baby delivered without signs of life from 24 weeks gestation or a birthweight ≥500g.
Striae (stretch marks). Are red or purple in colour during the pregnancy in which they first appear, later become
white
Stripping of the membranes, A method of inducing labour. Less effective than amniotomy. but also carries the
risk of infection.
Supine hypotensive syndrome. In late pregnancy 10% of women experience faintness when lying supine due to
inferior vena caval obstruction causing reduced venous return and a fall in cardiac output,
Surfactant. In the respiratory distress syndrome, pulmonary surfactant is deficient; exogenous surfactant (both
bovine and synthetic are available) may be used in treatment.
Suture. Term applied to the membranous junction between the bones of the fetal (and infant) skull; the chief
sutures are between the frontal bones (frontal), parietal bones (sagittal), parietal and frontal (coronal). parietal and
occipital (lambdoid)
Symphysiotomy. Division of the pubic symphysis, to enlarge the diameters of the bony pelvis.
Tachycardia. A fetal heart rate above 160 beats per minute and a maternal heart rate above 100 beats per minute; in
each case is indicative of distress.
Talipes. A deformed or twisted foot (clubfoot)
Term. From 37 to 42 completed weeks'gestation (259-293 days), neither preterm <37 weeks nor postterm
(prolonged pregnancy >42 weeks. The due date of confinement or full term (often mistakenly referred to as 'term')
is calculated to be 40 weeks (280 days).
Termination of pregnancy. Medical process of ending a pregnancy as to not result in the birth of a baby.
Thalassaemia minor. A hereditary disorder of haemoglobin synthesis present in about 6% of women who were
born in Greece and 4% of those born in Italy. It is also common in South East Asia. May cause severe pregnancy
anaemia.
Thrush. Infection with Candida albicans; usual sites are the mother's vagina and the baby's mouth
Trial of labour after caesarean section (TOLAC). Women with one previous caesarean delivery should be
reviewed formally by a senior obstetrician early in pregnancy to discuss the management of the pregnancy and the
mode of delivery. The views of the woman should be sought, including her plans for future pregnancies. This
discussion may include information on a reduction of postnatal morbidity associated with successful vaginal birth
after caesarean (VBAC) and on the risks of uterine rupture. In the setting of a large Irish maternity hospital with
strict guidelines for a TOLAC, the uterine rupture rate was 2 per 1000 overall, and 1 per 1000 for women in
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spontaneous labour who did not receive oxytocin augmentation.
Trimester. A period of approximately 3 months
Trophoblast or chorion. The cells, which line the blastodermic vesicle and surround the embryonic cell mass.
Chorionic processes or villi develop with outer syncytial and inner cytotrophoblastic layers
Turner syndrome. A genetic abnormality, where the individual has 45 chromosomes (XO karyotype) instead of 46
and is sex chromatin negative, despite being female in appearance.
Ultrasonography Use of high frequency, short wavelength, sound wave reflections to diagnose pregnancy, assess
gestational age fetal and neonatal anatomy diagnose multiple pregnancy malpresentations and hydatidiform mole
identify non-viable pregnancies, locate the placental site investigate fetal and neonatal haemodynamics, detect fetal
malformations and direct intrauterine manipulation
Umbilical cord. The connecting lifeline between the fetus and placenta; it contains 2 umbilical arteries and 1
umbilical vein encased in Wharton jelly
Uterine inertia. (a) Primary;Inefficient uterine activity. (b) Secondary; (uterine exhaustion). Occurs usually in the
late first, or second stage when uterine action becomes poor or ceases. In the second stage the commonest cause is
obstruction due to a tight perineum in a nullipara.
Uterine souffle. Noise made by maternal blood passing through the uterine vessels.
Uterine tetany. Generalized tonic contraction, of the uterus usually due to misuse of oxytocic drugs.
Vacuum extraction. Instrumentation to deliver the fetal head by traction on a suction cup placed on the scalp
(usually the occipital region)
Varicose veins. Dilatation of veins, of the lower half of the body. Usually occur for the first time or become worse
in pregnancy
Vasa praevia. Fetal vessels coursing through the membranes over the internal cervical os and below
the fetal presenting part, unprotected by placental tissue or the umbilical cord. This can be secondary to a
velamentous cord insertion in a single or bilobed placenta (vasa praevia type 1), or from fetal vessels running
between lobes of a placenta with one or more accessory lobes (vasa praevia type 2)
Velamentous insertion of the cord. The umbilical cord inserts onto the membranes over which the vessels course
to reach the fetal surface of the placenta
Vernix caseosa. Produced by sebaceous glands this 'complexion cream' prevents waterlogging and maceration of
the fetal skin by the amniotic fluid
Version. A turning of the fetus in utero whereby the presentation is changed, usually from breech to vertex
Vertex. Top of the skull, the area between the anterior and posterior fontanelles and the parietal eminences
Weight gain. The average weight gain in pregnancy is about 12.5 kg. A weight gain of more than 0.5 kg per week
in late pregnancy may precede generalized oedema
Wharton jelly. The mucoid connective tissue supporting the umbilical cord vessels
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Gynaecology
Adenomyosis, ingrowth of endometrium into the myometrium, and glandular and stromal tissue are to be found
amongst uterine muscle fibres. The lesion is surrounded by muscle but, as it is thought to arise by direct growth of
the endometrium, it is likely that a connection exists to the endometrium.
Climacteric, derived from the Greek klimakter ( the rung of the ladder) and is applied to the 5-15 years before the
menopause, when the endocrine and other changes begin, and to the 5-15 years after the menopause
Detrusor Instability, defined as the presence of spontaneous or provoked detrusor contractions during the filling
phase when the patient is attempting to inhibit micturition.
Dysfunctional Uterine Bleeding (DUB), Abnormal bleeding from the uterus in the absence of organic disease of
the genital tract.
Endometriosis, It is a condition in which tissue similar to normal endometrium in structure and function is found in
sites outside the uterine cavity. It is most commonly found in the pelvis, on the ovary, the peritoneum, the fallopian
tubes and broad ligaments, or it may be seen in other remote sites.
Haematocolpos, Collection of menstural blood due to an imperforate membrane that may exist at the lower end of
the vagina, which is loosely referred to as the imperforate hymen, although the hymen can usually be distinguished
separately.
Heavy menstrual bleeding (HMB). Excessive menstrual blood loss which interferes with the woman’s physical,
emotional, social and material quality of life. This can occur alone or with other symptoms.
Menorrhagia. This is often used two describe excessive regular menstrual bleeding.
Hirsutism, excessive growth of hair in an abnormal position of the body or a degree of hair growth that worries the
patient.
Infertility. The WHO has defined infertility as failure to conceive over 12 months of exposure. This affects
approximately 1 in 7 couples. A woman of reproductive age who has not conceived after 1 year of unprotected
vaginal sexual intercourse, in the absence of any known cause of infertility, should be offered further clinical
assessment and investigation along with her partner.
Menopause, derived from the Greek men (month) and pauo (to stop) and is applied to the permanent cessation of
menstruation due to loss of ovarian activity. Post-menopause is a term used to described a woman who had
cessation of menstruatuion for at least 12 months.
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Osteoporosis, Defined as ‘a reduction in bone mass per unit volume such that the fractures may occur on minimal
of trivial trauma’. It implies an abnormal state with an increased risk of fractures
Premenstrual Syndrome (PMS). A condition which manifests with distressing physical, behavioural and
psychological symptoms, in the absence of organic or underlying psychiatric disease, which regularly recurs during
the luteal phase of each menstrual (ovarian) cycle and which disappears or significantly regresses by the end of
menstruation’.
Mild Does not interfere with personal/social and professional life
Moderate Interferes with personal/social and professional life but still able to function and interact,
although may be suboptimally
Severe Unable to interact personally/socially/professionally—withdraws from social and professional
activities (treatment resistant).
Primary amenorrhoea, refers to a patient of any age who has never menstruated.
Pelvic Organ Prolapse, derived from the Latin procidere which means to fall. Prolapse is the bulging or herniation
of one or more pelvic organs into or out of the vagina. POP is classified according to which organ has heniated into
the vagina.
Anterior compartment prolapse – This is the most common form of POP. Cystocoele refers to herniation
of the bladder in to anterior vagina wall. Cysto-urethrocoele refers to herniation of the bladder and urethra
into the vagina.
Posterior compartment prolapse – Enterocoele refers to herniation of the small intestine into the posterior
vaginal wall. Rectocoele refers to herniation of the rectum into the posterior vaginal wall.
Apical compartment prolapse – Uterine prolapse occurs when the uterus herniates into the vagina. This is
the second most common form of POP. Vaginal vault prolapse refers collapse of the cuff of vagina post
hysterectomy.
Procidentia, complete utrovaginal prolapse.
Rokitansky syndrome, Congenital absence of the uterus and vagina.
Secondary amenorrhoea, refers to cessation of the periods after menstruation has been established.
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Polycystic ovarian syndrome (PCOS). Diagnosis of PCOS can only be made when other aetiologies have been
excluded (thyroid dysfunction, congenital adrenal hyperplasia, hyperprolactinaemia, androgen-secreting tumours
and Cushing syndrome). The Rotterdam Criteria for diagnosis of PCOS; with two of the three following are present
● polycystic ovaries (either 12 or more peripheral follicles or increased ovarian volume (greater than 10
cm3)
● oligo- or anovulation
● clinical and/or biochemical signs of hyperandrogenism.
Urinary Incontinence. UI is defined by the International Continence Society as 'the complaint of any involuntary
leakage of urine'. UI may occur as a result of a number of abnormalities of function of the lower urinary tract or as a
result of other illnesses, which tend to cause leakage in different situations. Conversely continence is the ability to
hold urine within the bladder at all times except during micturition.
Stress Urinary Incontinence is involuntary urine leakage on effort or exertion or on sneezing or coughing.
Urgency Urinary Incontinence is involuntary urine leakage accompanied or immediately preceded by
urgency (a sudden compelling desire to urinate that is difficult to delay).
Mixed Urinary Incontinence is involuntary urine leakage associated with both urgency and exertion,
effort, sneezing or coughing.
Overactive bladder (OAB) is defined as urgency that occurs with or without urgency UI and usually with
frequency and nocturia. OAB that occurs with incontinence is known as 'OAB wet'. OAB that occurs
without incontinence is known as 'OAB dry'. These combinations of symptoms are suggestive of the
urodynamic finding of detrusor overactivity, but can be the result of other forms of urethrovesical
dysfunction.
Urodynamics, describes several investigations which are employed to determine bladder function.