H

Haberman feeders special feeding device used to give expressed breast milk to babies with cleft lip and palate, prior to surgery.

habitual abortion three or more miscarri ages, treated with hormone therapy, cervical cerclage or antibiotics, depending on cause. See also abortion.

HbA1c (glycosylated haemogolobin) most widely used measure of diabetic glycaemic control; elevated blood glucose binds with haemoglobin, producing glycosylated haemoglobin; in well-controlled diabetes level should be below 7%. Test is performed monthly in cases of maternal diabetes.

haem insoluble, non-protein, iron protoporphyrin constituent of haemoglobin, other respiratory pigments and many cells; responsible for oxygen-carrying properties of haemoglobin molecule.

haema-, haemo-, haemato- prefixes denoting or relating to blood.

haemagglutination agglutination of erythrocytes.

haemagglutinin antibody that causes agglutination of erythrocytes.

haemangioma tumour comprising blood vessels clustered together; sometimes present at birth in various parts of body, appearing as network of small, blood-filled capillaries near surface of skin, forming flat red or purple birthmark (‘strawberry’ or ‘raspberry’ mark); most disappear in childhood although ‘port-wine’ stain type may persist.

haematemesis vomiting of blood; in newborn babies may indicate haemorrhagic disease or be due to swallowed maternal blood; fetal and maternal blood are differentiated by singer’s test.

haematinic 1. improving quality of blood. 2. agent that improves quality of blood, increasing haemoglobin level and number of erythrocytes, e.g. iron preparations, B complex vitamins.

haematocele collection of blood in cavity. Pelvic h. collection of blood in pouch of Douglas, usually due to tubal abortion or rupture.

haematocolpos accumulation of blood in vagina.

haematocrit See packed cell volume.

haematology science dealing with nature, functions and diseases of blood.

haematoma localised collection of extravasated blood in organ, space or tissue; may occur in vagina, vulva or perineum from trauma during labour. Intrapartum fetal trauma may cause cephalhaematoma.

haematometra accumulation of blood in uterus.

haematopoiesis formation and development of blood cells, in bone marrow, spleen, liver and lymph nodes (extramedullary haematopoiesis).

haematoporphyrin iron-free derivative of haem, product of decomposition of haemoglobin.

haematosalpinx accumulation of blood in fallopian tube.

haematuria blood in urine, due to injury, infection or disease of urinary organs.

haemoconcentration loss of fluid from blood into tissues, as in shock or dehydration.

haemodialysis procedure to remove toxic waste from blood in cases of acute or chronic renal failure. See peritoneal dialysis.

haemodilution increase of plasma in blood in proportion to cells; occurs normally in pregnancy as blood volume increases (see hydraemia), or in haemorrhage, when fluid is drawn from tissues into blood to maintain volume of circulating blood.

haemoglobin pigment in red blood cells facilitates transport of oxygen; compound of ferrous iron-containing pigment haem combined with protein globin. Each haemoglobin molecule contains four atoms of ferrous iron, one in each haem group, can unite with four molecules of oxygen. Oxygenated haemoglobin is bright red; deoxygentated haemoglobin is darker. In utero fetal haemoglobin (HbF), formed in liver and spleen, has increased affinity for oxygen; when erythropoiesis shifts to bone marrow in first year of life, adult haemoglobins HbA and HbA₂ start to be produced.

haemoglobinopathies inherited haemoglobin disorders in which baby has abnormal quantity (thalassaemia syndromes) or quality (e.g. sickle cell disease) of globin chains of haemoglobin.

haemolysin antibody with complement that releases haemoglobin from red blood cells.

haemolysis liberation of haemoglobin from red blood cells; in excess causes anaemia and jaundice; some microbes, e.g. beta-haemolytic streptococcus, form haemolysins specifically to destroy red blood corpuscles. In transfusion reaction or haemolytic disease of the newborn, incompatibility causes red blood cells to clump together; agglutinated cells eventually disintegrate, releasing haemoglobin into plasma; kidney damage may result as haemoglobin crystallises and obstructs renal tubules, producing renal shutdown and uraemia. Other haemolysins include snake venoms, certain vegetable and chemical poisons.

haemolytic pertaining to, characterised by or producing haemolysis. H. disease of newborn erythroblastosis fetalis; blood dyscrasia of newborn babies characterised by haemolysis of erythrocytes usually due to incompatibility between baby’s and mother’s blood. In Rhesus incompatibility, fetus has Rhesus-positive blood and mother has Rhesusnegative blood; mother builds up antibodies against fetal cells, which pass through placenta to fetal circulation, destroying fetal erythrocytes very rapidly, compensated for by increased bone marrow production and early release of immature red blood cells (erythroblasts).

haemophilia inherited disease of delayed blood clotting, carried by mother as sex-linked recessive gene but occurring only in males; over 80% have haemophilia A, with deficiency of clotting factor VIII; 15% have haemophilia B (Christmas disease), with deficiency of factor IX. Treatment aims to raise deficient clotting factor level and maintain it to stop local bleeding.

Haemophilus influenzae serotype B (Hib) bacterial infection carried in nasopharynx of approximately 75% of children, spread by coughing and sneezing, especially in day nurseries; causes bacteraemia, bacterial meningitis, otitis media, sinusitis, epiglottitis, pneumonia, cellulitis, joint and muscle pains, osteomyelitis. Treatment is by administration of cephalosporins or sulphur drugs; erythromycin is ineffective. Children are offered routine immunisation at 2, 3, 4 and 12 months of age.

haemopoiesis See haematopoiesis.

haemoptysis coughing up blood from lungs, distinguishable from vomited blood by bright colour and frothy character.

haemorrhage escape of blood from vessels either externally or within body. Antepartum h. any bleeding in pregnancy after 24 weeks’ gestation. Causes: accidental h. or abruption of normally situated placenta; placenta praevia, bleeding from abnormally situated placenta; incidental causes. Cerebral h. bleeding from rupture of cerebral blood vessel, associated with eclampsia, essential hypertension. Concealed h. bleeding in which clinical signs, e.g. shock, are not in keeping with measured blood loss. Intracranial h. neonatal bleeding due to difficult delivery causing tear at junction of tentorium cerebelli and falx cerebri and blood vessels they contain. Intraventricular h. bleeding occurring between ventricles in brain in small and preterm babies. Petechial h. subcutaneous haemorrhage occurring in minute spots, sometimes seen in neonates when cord has been tightly around neck or following difficult delivery. See also postpartum haemorrhage.

haemorrhagic characterised by haemorrhage. H. disease of newborn haemorrhage occurring in first week of life showing as haematemesis, melaena, haematuria, or from umbilicus, or puncture sites associated with very low blood prothrombin, treated by administering vitamin K and blood transfusion; must be clearly differentiated from haemolytic disease of newborn.

haemorrhoids piles; varicose veins of lower rectum and anal canal (internal), or around anal orifice (external). In pregnancy they often enlarge and become painful due to relaxation of smooth muscle by progesterone; constipation, increased vascularity and congestion increase dilatation of veins, causing discomfort, which may be relieved by applying local analgesic ointment or suppositories. Vaginal delivery, particularly with forceps, aggravates condition by direct pressure from fetal head increasing venous congestion and stasis. They usually resolve spontaneously postnatally as hormone levels fall; medical or surgical treatment is occasionally necessary; may recur in subsequent pregnancy.

haemostasis arrest of bleeding.

haemostatic astringent drug (styptics) or other agent capable of arresting bleeding.

Haig-Ferguson’s forceps mid-cavity forceps to deliver fetus when head is engaged but above ischial spines.

hair analysis test used in preconception care to assess nutritional status and detect metal concentrations, e.g. lead, high levels of which may be associated with congenital abnormalities; deficiencies, e.g. of zinc, can be treated with dietary advice and/or supplements.

hallucination false perception or psychosis, triggering false beliefs of seeing, smelling, hearing, tasting or feeling objects or people; may be organic, as a result of bacterial toxins, drugs or thyrotoxicosis, psychogenic or functional, with no apparent changes in the central nervous system; stress, e.g. childbirth, can precipitate condition if there is inherited susceptibility. See also puerperal psychosis.

hamamelis witch hazel, astringent useful for haemorrhoids or vulval oedema.

hand presentation in labour with uncorrected oblique lie, shoulder presentation and arm prolapse, or in compound presentation, fetal hand may present; on vaginal examination hand can be distinguished from foot by ability of thumb to abduct, absence of prominent heel and digits being longer than toes.

haploid half number of chromosomes characteristically found in somatic (diploid) cells of organism.

hard chancre contagious syphilitic ulcer of first stage; may be seen on labium.

hare lip See cleft lip.

harlequin fetus rare genetic skin condition, most severe form of congenital ichthyosis, characterised by excess keratin layer resulting in large diamond-shaped reddish skin scales which limits movement and easily becomes fatally infected; eyes, ears, penis, and appendages may be abnormally contracted; can be diagnosed in utero by fetal skin biopsy, amniocentesis and 3D ultrasound.

Hartmann’s solution solution of sodium chloride, sodium lactate, and calcium and potassium phosphate used intravenously as systemic alkaliser and as fluid and electrolyte replenisher.

Hashimoto’s disease postpartum transient autoimmune thyroiditis, occurring in 10% of mothers within 12 months of delivery, characterised by mild hyperthyroidism followed by hypothyroidism, both causing fatigue, painless goitre; may mimic postnatal depression. Recovery is usually spontaneous but may recur in subsequent pregnancies, may progress to permanent hypothyroidism.

hashish extract of hemp plant, Cannabis sativa, smoked or chewed for euphoric effect; marijuana. Not recommended in pregnancy as longterm use adversely affects mother or fetus.

head, fetal See fetal skull.

headache pain in head; in early pregnancy dilatation of cerebral blood vessels due to progesterone causes physiological headaches; those occurring after 20 weeks’ gestation may be symptom of fulminating preeclampsia; if there are other prodromal signs of eclampsia, e.g. raised diastolic blood pressure, nausea, visual disturbances, epigastric pain, immediate action should be taken to prevent or control imminent fits. Spinal h. occasional complication of epidural anaesthesia when dura mater is inadvertently punctured causing loss of cerebrospinal fluid; may persist for several days.

headbox Perspex box placed over baby’s head into which additional oxygen can be administered.

head circumference measurement of head circumference, usually suboccipitobregmatic diameter (33 cm) or occipitofrontal diameter (35 cm).

head fitting attempt to fit nonengaged fetal head into maternal pelvic brim at term or in labour, to exclude cephalopelvic disproportion; ultrasound provides more accurate, detailed information to assess if vaginal delivery is possible.

Heaf test form of tuberculin testing.

healing restoration of structure and function of injured or diseased tissues, including blood clotting, inflammation and repair.

health state of complete physical, mental and social well-being, not merely absence of disease or infirmity.

Health Act 2006 legislation providing for several administrative changes within NHS; introduced provisions for creation of ban on smoking in public places; in relation to midwifery, clarifies regulations for governance and monitoring of controlled drugs.

health centre strategically placed community building providing full range of primary healthcare, commonly focused around general practitioner services and facilities for minor surgery.

Health and Safety at Work Act 2010 comprehensive legislation dealing with welfare, health and safety of all employers and employees, except domestic workers in a private house; defines structure and authority for regulation and enforcement of workplace health, safety and welfare within United Kingdom.

health promotion information and education of individuals, families and communities to prevent disease and improve general health and well-being.

health visitor (HV) registered nurse who has completed 1-year full-time course in social and preventive medicine; responsible for health promotion and disease prevention in mothers and children under 5; some specialise in care of elderly, disabled or other special groups; midwife liaises with health visitor when care of mother and baby is transferred after tenth postnatal day.

hearing test neonatal screening test within National Newborn Hearing Screening Programme, for early diagnosis and treatment of hearing loss, including otoacoustic emissions (oae) test and automated auditory brainstem response (aabr) test.

heart organ that pumps blood into arteries for transfer to every part of body; cardiac output is increased in pregnancy because of increased blood volume, body weight, metabolism and size of uterus. H. disease in pregnancy more common in recent years due to delayed motherhood, morbid obesity, immigrant populations, survival to adulthood of girls with congenital heart conditions; commonest indirect cause of maternal death. Pre-existing heart disease usually worsens by at least one degree in pregnancy due to extra pressure exerted on heart and circulation; antenatal care should be shared between obstetrician and cardiologist. H. defects disorders, some of which may be congenital, e.g. fallot’s tetralogy, patent ductus arteriosus. H. failure inability of heart to pump sufficient blood to assure normal flow through circulation. H. murmur any sound in heart region other than normal heart sounds.

heartburn burning sensation in chest, caused by regurgitation of stomach contents into lower oesophagus. In pregnancy it results from relaxation of cardiac sphincter of stomach; may be particular problem at night but can be relieved by sleeping propped up on pillows; antacid medications give transient relief; osteopathy, acupuncture or homeopathy may be effective treatments.

heat shield Perspex shield placed over low-birthweight and/or sick baby in incubator to prevent radiant and convective heat loss.

Hegar’s dilators series of graduated dilators used to dilate cervix uteri.

Hegar’s sign pregnancy sign. Bimanual examination at 6–8 weeks since last menstrual period aims to identify firm cervix and softened isthmus. Also called Goodell’s sign.

Hellin’s law formula used to calculate incidence of multiple pregnancies in UK: twins, 1:89 pregnancies; triplets, 1:89² pregnancies; quadruplets, 1:89³ pregnancies; assisted reproduction techniques increase chances of multiple pregnancy; therefore formula is less indicative of true incidence.

HELLP syndrome Haemolysis, Elevated Liver proteins and Low P

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