A

abdomen cavity between diaphragm and pelvis, lined by peritoneum; contains stomach, intestines, liver, gallbladder, spleen, pancreas, kidneys, suprarenal glands, ureters. Bladder, and uterus become abdominal organs when distended in pregnancy. Pendulous a. anterior abdominal wall hangs down over pubis. Scaphoid a. sunken abdomen in low-birthweight babies, due to shrinkage of liver and spleen in utero.

abdominal concerning abdomen. A. enlargement during pregnancy, abdomen becomes progressively larger as uterine size increases; visible externally from 16 weeks’ gestation. Excess enlargement may be due to multiple pregnancy, polyhydramnios, uterine fibroids, abnormal ovum development. A. examination systematic examination of mother’s abdomen: visual inspection, for shape, scars, striae gravidarum, skin tension, contour, symphysis–fundal height measurement (see diagram); palpation; uterus palpable above symphysis pubis by 12 weeks’ gestation, reaches diaphragm 36 weeks’ gestation, drops slightly with engagement. presentation palpated, possibly confirmed by ultrasound. Fetal heart auscultated with electric monitor and/or Pinard’s stethoscope for rate, rhythm, regularity, differentiated from uterine souffle. Postnatally, abdomen palpated to monitor uterine involution, check uterus regaining non-pregnant size and position, identify deviations from normal, e.g. constipation.

A. pain minor antenatal abdominal discomfort is common due to growth, stretching, alteration in position; severe pain may be due to threatened abortion, ectopic pregnancy, fibroids, torsion or placental abruption.

A. wall structure covering abdominal organs: skin, fat, fascia, muscles, peritoneum. Neonatal defects, developing in utero, include exomphalos, gastroschisis.

abduct to draw away from axis or median plane.

abduction drawing away from centre, e.g. abduction of mother’s legs for vaginal delivery.

aberrant wandering or deviating from normal site or course.

ABO blood groups classification of blood groups according to whether they contain agglutinogens A, B, A and B (AB) or none (O). Serum may contain antibodies, anti-A agglutinins, anti-B agglutinins or both; blood given in transfusion must not contain same antibodies as recipient’s blood group (e.g. group A person must not receive group B blood, which contains anti-A agglutinins) as fatal reaction occurs. Group AB individuals have no agglutinin or antibody in serum so can receive blood from anyone, i.e. universal recipients; group O individuals have no agglutinogens, i.e. they are universal donors. See also rhesus factor. ABO incompatibility occurs in approximately 1 in 200 pregnancies when maternal blood group is O, serum contains anti-A and anti-B antibodies. If fetus is group A, B or AB, antibody differing immunologically from normal anti-A and anti-B may cross placenta, causing neonatal haemolysis. Jaundice develops within 24 hours of birth, usually mild. Serum bilirubin level rises rapidly, anaemia is less obvious. coombs’ test is usually negative, unlike in Rhesus incompatibility. Jaundice is treated with phototherapy or exchange transfusion. See also ABO blood groups, isoimmunisation and rhesus factor.

abort to bring to premature end, especially pregnancy.

abortifacient chemical or surgical means of causing abortion, miscarriage.

abortion expulsion from uterus of products of conception before 24 weeks’ gestation. 1990 amendment to Human Fertilisation and Embryology Act changed legal limit for termination from 28 to 24 weeks gestation. Complete a. spontaneous miscarriage – complete products of conception expelled with no retained products. Incomplete a. miscarriage with some products of conception retained in uterus; may cause serious haemorrhage, requires curettage. Inevitable a. irreversible vaginal bleeding, unavoidable miscarriage. Therapeutic a. induced abortion in accordance with Abortion Act. Methods: vacuum extraction, dilatation and curettage (first trimester); drugs, e.g. prostaglandins (second trimester). Spontaneous a. may be due to blighted ovum, e.g. hydatidiform, vesicular or carneous mole. Treatment aims to prevent complications, e.g. haemorrhage and sepsis. See also miscarriage, ectopic pregnancy.

abrachia congenital absence of arms.

abrasion skin cut or scratch. Neonatal a. skin damage, caused by delivery trauma from forceps blades, vacuum extraction cups, electrodes.

abreaction reliving experience so previously repressed associated emotions are released.

abruption tearing assunder. Placental a. partial or complete separation of placenta from its site, after 24 weeks of pregnancy, causing pain, haemorrhage. See placenta.

abscess localised accumulation of pus in space or cavity. Bartholin’s a. in Bartholin’s gland, near vaginal orifice; pelvic a. in pouch of Douglas.

abuse deliberate inflicting of physical, emotional or sexual injury, trauma, pain on individual.

acardiac twin twin developing without viable cardiac structure; life is maintained in utero via placental circulation of other viable twin.

acceleration speeding up. Fetal heart a. heard via Pinard’s stethoscope or Sonicaid, or detected from cardiotocograph printout, may indicate fetal distress. A. of labour. See augmentation of labour.

accessory extra or supplementary. A. auricles extra tissue commonly anterior to ear. A. nipple extra nipple, commonly axillary.

accountable liable to be held responsible for course of action.

accreditation process of evaluation for official recognition of standards set against agreed criteria, e.g. education. A. of prior learning (APL) credit awarded towards current programme of study for courses or modules previously completed. A. of prior experiential learning (APEL) credit awarded towards current programme of study for previous professional experience not formally assessed; may entail completing professional development portfolio.

accreta morbid attachment. Placenta a. placenta attached to uterine muscle due to deficiency of decidua basalis.

ACE inhibitors See angiotensin.

acetabulum cup-shaped socket in pelvic innominate bone into which head of femur fits.

acetoacetic acid product of abnormal fat metabolism, occurring in diabetic and dehydrated mothers.

acetone by-product of acetoacetic acid, produced in abnormal amounts in uncontrolled diabetes mellitus, metabolic acidosis, resulting in characteristic odour on mother’s breath or urine.

acetylcholine chemical transmitter released by nerve endings at synapse between one neuron and the next, or between cholinergic nerve ending and effector organ it supplies; rapidly destroyed by cholinesterase; antagonised by cortisol.

achlorhydria absence of hydrochloric acid in gastric juice; associated with pernicious anaemia, stomach cancer.

achondroplasia failure to form cartilage. Autosomal dominant genetic condition causing dwarfism, due to shortening of long bones, development of very short limbs, large head, normal trunk; normal mentality.

aciclovir, acyclovir antiviral agent to treat herpes simplex, orally or intravenously.

acid substance which forms salt when combined with alkali; turns blue litmus paper red; assists in body’s chemical processes;. Hydrochloric a. colourless compound of hydrogen and chlorine, present in gastric juice; causes mendelson’s syndrome if inhaled. See also acid–base balance.

acid–base balance state of equilibrium between acidity and alkalinity of body fluids; hydrogen ion (H+) balance. Positively charged H+ is active constituent of all acids. Most metabolic processes produce acids as end products, but alkaline body fluid is required as medium for vital cellular activities; chemical exchanges of H+ must occur continuously to maintain equilibrium and optimal pH (H+ concentration) between 7.35 and 7.45.

acidaemia acid accumulation in blood which alters pH (acidity), normally slightly alkaline. Occurs with dehydration, e.g. hyperemesis gravidarum, prolonged labour, diabetes mellitus. Fetal or neonatal a. may result from hypoxia, leading to coma, death if untreated.

acidosis pathological accumulation of acid or depletion of alkaline reserve (bicarbonate content) in blood and body tissues; increased hydrogen ion concentration (decreased pH below 7.30). Adj acidotic. Metabolic a. results from serum accumulation of ketoacids (derived from fat metabolism) at expense of bicarbonate, which diminishes body’s ability to neutralise acids. Occurs in diabetic ketoacidosis, lactic acidosis, failure of renal tubules to reabsorb bicarbonate. Respiratory a. results from ventilatory impairment and accumulation of carbon dioxide in blood, which unites with water as carbonic acid. Occurs with severe birth asphyxia, other neonatal respiratory conditions. Maternal acidosis occurs with either acute airways obstruction or chronic respiratory conditions.

acini alveoli, minute hollow structures, lined by secreting cells, with duct. Acini in breast secrete milk. Sing acinus.

acquired immune deficiency syndrome (AIDS) severe progressive disease caused by human immunodeficiency virus; manifests as fever, weight loss, diarrhoea, lymphadenopathy. Opportunistic infections, e.g. cytomegalovirus, herpes simplex, Mycobacterium tuberculosis, Pneumocystis carinii, or tumours, e.g. lymphoma or Kaposi’s sarcoma eventually lead to death. See human immunodeficiency virus.

acridine orange stain used in fluorescence microscopy; causes bacteria to fluoresce green to red.

acromegaly chronic disease involving enlargement of bones and tissues of hands, feet, face, due to overfunctioning pituitary gland excess growth hormone; often due to pituitary tumour.

acromion process of scapula, forming point of shoulder.

acrosome cap-like membrane-bound structure covering anterior part of spermatozoon’s head; contains enzymes involved in penetration of ovum. A. reaction during fertilisation, acrosomal layer of spermatazoa becomes reactive, releases hyaluronidase which disperses corona radiata, allowing access to zona pellucida of oocyte.

active birth style of labour preparation and care in which mother is empowered to take active part in labour and decisions required to assist progress.

active management of labour intervention to prevent prolonged labour and complications. First-stage labour may be accelerated by artificial membrane rupture, intravenous oxytocin. A. m. of third-stage labour involves administration of oxytocic injection (e.g. Syntometrine 1 ml) to facilitate placental separation which occurs within 2.5 minutes; midwife delivers placenta and membranes manually by controlled cord traction.

active transport movement of ions or molecules across cell membranes and epithelial layers, usually against concentration gradient, resulting directly from expenditure of metabolic energy; process of maintaining normal differences in electrolytic composition between intracellular fluids.

acupressure Chinese medicine technique involving application of pressure to specific points on body to stimulate or sedate internal energies, sometimes used to treat gestational sickness or relieve pain in labour. See also acupuncture, shiatsu.

acupuncture Chinese medicine technique; based on energy lines (meridians) running through body, linking one part to another. In optimum health this energy (chi) flows along meridians unimpeded; ill health, physical, psychological or spiritual stress, including pregnancy, may unbalance flow, causing blockages or excesses of energy at certain points. Application of fine needles to specific acupuncture points aims to rebalance energy flow and assist in regaining full health. Acupuncture may be used to treat pregnancy discomforts, labour pain and, in China, for surgical anaesthesia.

acute developing rapidly, running short course; reverse of chronic. A. fatty liver of pregnancy (AFLP) acute yellow atrophy; rare complication of pregnancy, unknown aetiology; rapid progressive liver atrophy with massive fatty necrosis; over 80% mortality. Typically, obese woman presents with third-trimester vomiting, headache, malaise, drowsiness, tender, but not enlarged, liver and jaundice; fulminating pre-eclampsia symptoms can mask diagnosis; liver enzymes are slightly raised, hypoglycaemia and renal failure follow quickly; liver biopsy is contraindicated because of coagulopathy risk. Management involves correction of coagulopathy, immediate delivery, preferably vaginally, although Caesarean section may be safer. A. inversion of the uterus See inversion of uterus. A. renal failure sudden, severe, reversible, interruption of kidney function, usually complication of another disorder, e.g. haemorrhage, shock. oliguria; fluid and electrolyte imbalance, anaemia, hypertension, uraemia. Dialysis required to monitor fluid and electrolyte imbalance until kidney function improves. A. tubular necrosis damage to tubule cells of kidney, caused by ischaemia due to septic shock, severe blood loss, blood transfusion reaction or severe hypotension; renal dialysis may be required.

acyclovir See aciclovir.

adactylia, adactyly congenital absence of fingers or toes.

addiction physiological or psychological dependence, e.g. alcohol or drugs.

adduct to draw towards centre or median line.

adherent placenta placenta firmly attached to uterine wall; fails to separate during third-stage labour. See placenta, placenta accreta, placenta percreta.

adhesion union between two surfaces normally separated, usually due to inflammation when fibrous tissue forms. Possible cause of infertility, by occlusion of lumen in fallopian tubes following salpingitis.

adipose tissue See tissue.

adnexa appendages. Uterine a. ovaries and fallopian tubes.

adnexal mass enlarged area between uterus and ovaries; suggests ectopic pregnancy if viewed on first-trimester ultrasound, especially if fluid in pouch of Douglas, no visible intrauterine pregnancy; may be due to physiological follicular or corpus luteal cysts, tumours.

adolescence developmental stage from puberty to cessation of physical growth.

adoption legal procedure, responsibility for child transferred from natural parents to adopting parents, regulated by Adoption Act 2002; local authorities offer advice, social work support, may act as adoption agency; private and charitable adoption organisations registered with local authority also available.

adrenal pertaining to adrenal (suprarenal) glands, two complex endocrine glands, situated one at upper pole of each kidney. Congenital a. hyperplasia autosomal recessive condition; adrenal glands overproduce androgens due to deficiency of 21-hydroxylase enzyme, necessary for production of steroids from cholesterol; causes rapid salt loss; ambiguous genitalia.

adrenaline (epinephrine) hormone secreted by adrenal medulla, help regulate sympathetic nervous system; powerful vasopressor, increases blood pressure, heart rate, cardiac output, glucose release from liver; can be produced synthetically. Increased adrenaline secretion due to tumour (phaeochromocytoma) causes acute hypertension; can occur in pregnancy; diagnosis made by measuring excretory product of catecholamines, vanillylmandelic acid (vma) in 24-hour urine collection.

adrenocortical pertaining to cortex of adrenal glands. A. insufficiency in newborn, caused by congenital hypoplasia, adrenal haemorrhage, enzyme defects or secondary to pituitary gland problems; presents with hypoglycaemia, poor feeding and weight gain, vomiting, prolonged jaundice; hyponatraemia, hypoglycaemia, hyperkalaemia, acidosis. Treatment: intravenous glucose and electrolyte replacement of corticosteroid and mineralocorticoid hormones. A. hyperfunction congenital adrenal hyperplasia; group of inherited disorders due to enzyme deficiency, leading to excess androgenic hormones, deficiency of glucocorticoid and mineralocorticoid hormones; characterised by genitalia malformations, vomiting, diarrhoea, vascular collapse, hypoglycaemia, hyponatraemia, hyperkalaemia.

adrenocorticotrophic hormone (ACTH) anterior pituitary gland hormone that stimulates adrenal cortex.

adult respiratory distress syndrome (ARDS) See respiratory distress syndrome.

Advanced Life Support in Obstetrics (ALSO) specialist training courses for midwives, doctors, other staff; cover advanced methods of dealing with emergency situations. See appendices 1,2,3.

aerobe organism requiring air or free oxygen to sustain life. Adj aerobic.

aetiology science of causes, e.g. of disease.

afebrile without fever.

affective pertaining to emotional tone or feeling. A. disorder mental disorder characterised by mood disturbance with either manic or depressive symptoms, or both, e.g. bipolar disorder, depression, cyclothymic disorder, dysthymic disorder (depressive neurosis).

afferent towards centre. A. nerve sensory nerve fibre carrying impulses from periphery to central nervous system.

affiliation order court order by which absent father required to make regular payments towards his child’s maintenance.

afibrinogenaemia absence of fibrinogen in blood; hypofibrinogenaemia.

afterbirth lay term for placenta and membranes expelled from uterus after birth of baby.

aftercoming head fetal head (coming after trunk) in breech delivery. See breech.

afterpains painful uterine contractions occurring in early puerperium, common in multiparous women, frequently felt during breastfeeding. Severe, persistent afterpains may indicate blood clot, membrane or fragment of placenta is retained in uterus.

agenesis absence of organ.

agglutination aggregation of separate particles into clumps or masses. 1. clumping of red blood corpuscles in serum; may occur if incompatible cells are transfused. Agglutination of sensitised red blood cells by urine reveals presence of chorionic gonadotrophin (hCG) in pregnancy test. 2. clumping of platelets due to action of platelet agglutinins. 3. clumping of bacteria when brought into contact with specific immune serum.

agglutinin substance that reacts with agglutinogen, causes agglutination to occur.

agglutinogen substance that stimulates specific agglutinin to cause agglutination.

agnathia failure of jaw development.

AIDS See acquired immune deficiency syndrome.

air atmosphere surrounding earth, mainly composed of two gases: oxygen (21%) and nitrogen (79%). A. hunger deep, sighing respiration occurring when body’s oxygen supply depleted, as in severe haemorrhage, shock.

airway 1. passage by which air enters lungs. 2. mechanical device used for securing unobstructed respiration during general anaesthesia or other occasions when patient is not ventilating or exchanging gases efficiently.

ala wing, e.g. sacral ala. Pl alae.

alanine aminotransferase liver function test assessed in mothers with pre-eclampsia or hellp syndrome.

alba, albicans white. Linea a. white line in midline of abdomen in Caucasians.

albumin any protein, soluble in water and moderately concentrated salt solutions, coagulable by heat. Serum a. plasma protein formed principally in liver; responsible for colloidal osmotic pressure of blood and regulating exchange of water between plasma and interstitial compartments (spaces between cells). Reduced plasma albumin leads to increased flow of water from capillaries into interstitial compartment, causing increased tissue fluid and oedema. Albumin also transports fatty acids, bilirubin, drugs, some hormones.

albuminuria presence in urine of albumin, usually serum albumin; occurs in renal or severe cardiac disease, some pregnancy complications.

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