Lecture Notes 1

I. Basic Obstetric Terminologies

A. Perinatal period The period after birth of an infant weighing 500 g or more and ending at 28 completed days after birth.
When perinatal rates are based on gestational age, rather than birthweight, it is recommended that the perinatal period be
defined as commencing at 20 weeks.

B. Birth The complete expulsion or extraction from the mother of a fetus, irrespective of whether the umbilical cord has
been cut or the placenta is attached.

Conceptus: Fetus, Umbilical cord, Placenta, Placental Membrane: 1. Chorion (outer layer) 2. Amnion (inner layer);
Amniotic Fluid

1. Fetuses weighing less than 500 g are usually not considered as births, but rather are termed abortuses for
purposes of vital statistics.
2. >2 weeks up to < 8 weeks (7 weeks + 6 days)  Embryo – germ layers (ectoderm, mesoderm,
endoderm/entoderm)
3. > 8 weeks + 1 day up to 40 weeks or 42 weeks  Fetus

C. Birthweight The weight of a neonate determined immediately after delivery or as soon thereafter as feasible. It should
be expressed to the nearest gram. (2,500 g – 3,500 g) or (5.5 lb – 7.7 lbs)

2.5 Kg x 2.2 lb = 5.5 lb.

1 Kg

3.5 Kg x 2.2 lb = 7.7 lb

1 kg

D. Birth rate  The number of live births per 1000 population.

E. Fertility rate  The number of live births per 1000 females aged 15 through 44 years.

F. Live birth  The term used to record a birth whenever the newborn at or sometime after birth breathes spontaneously
or shows any other sign of life such as a heartbeat or definite spontaneous movement of voluntary muscles.
1. Heartbeats are to be distinguished from transient cardiac contractions,
2. Respirations are to be distinguished from fleeting respiratory efforts or gasps

A  Appearance P  Pulse  the most important

P  Pulse Rate R  Respiration
G  Grimace A  Activity
A  Activity G  Grimace
R  Respiration A  Appearance  the least important

Labor
1st  efface and dilation
2nd  expulsion of the fetus
3rd  expulsion of the placenta
4th  1st 4 hours post-partum

G. Stillbirth or fetal death  The absence of signs of life at or after birth.

H. Neonatal death:
 1. Early neonatal death refers to death of a liveborn neonate during the first 7 days after birth.
2. Late neonatal death refers to death after 7 days but before 29 days.

I. Stillbirth rate or fetal death rate  The number of stillborn neonates per 1000 neonates born, including live births and
stillbirths.

J. Neonatal mortality rate  The number of neonatal deaths per 1000 live births.
K. Perinatal mortality rate  The number of stillbirths plus neonatal deaths per 1000 total births.
L. Infant death  All deaths of liveborn infants from birth through 12 months of age.
M. Infant mortality rate  The number of infant deaths per 1000 live births.

N. Low-birthweight  A newborn whose weight is less than 2500 g.

O. Very-low-birthweight  A newborn whose weight is less than 1500 g.
P. Extremely-low-birthweight  A newborn whose weight is less than 1000 g.

NEONATOLOGY
A. Term neonate A neonate born anytime after 37 completed weeks of gestation and up until 42 completed weeks of
gestation (260 days - 280 days - 294 days).

< 37 weeks  36 weeks and 6 days

B. Preterm neonate  A neonate born before 37 completed weeks (the 259th day).

C. Post term neonate  A neonate born anytime after completion of the 42nd week, beginning with day 295.

D. Abortus  A fetus or embryo removed or expelled from the uterus during the first half of gestation—20 weeks or less—
and weighing less than 500 g.

E. Induced termination of pregnancy The purposeful interruption of an intrauterine pregnancy with the intention other
than to produce a live-born neonate, and which does not result in a live birth. This definition excludes retention of
products of conception (POC) following fetal death.

Abortion

Philippines’s Abortion Provisions

1. Constitution of the Republic of the Philippines (1987), Article II, Section 12

Section 12: The State recognizes the sanctity of family life and shall protect and strengthen the family as a basic
autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from
conception. The natural and primary right and duty of parents in the rearing of the youth for civic efficiency and the
development of moral character shall receive the support of the Government.

Family – is the basic unit of society

State:

Physical State

1. Population

2. Territory

Political State

1. Sovereignty  ability of the state to enforce the law

2. Government  executive, judiciary, legislative

Nuclear Family – mama, papa ,anak

Extended family – mama, papa, anak, lolo, lola, auntee

Cohabitated family –

Single parent family –

Homosexual Family –

Blended Family: AB – sons and daughters

A B

CD – sons and daughters

C D

A- With sons and daughters & C – with sons and daughters

The Revised Penal Code of the Philippines, Act. No. 3815 of December 8, 1930, Articles 256 – 259

Section Two. - Infanticide and abortion.

Art. 256. Intentional abortion. - Any person who shall intentionally cause an abortion shall suffer:

1. The penalty of reclusion temporal, if he shall use any violence upon the person of the pregnant woman.

2. The penalty of prision mayor if, without using violence, he shall act without the consent of the woman.

3. The penalty of prision correccional in its medium and maximum periods, if the woman shall have consented.

Art. 257. Unintentional abortion. - The penalty of prision correccional in its minimum and medium period shall be imposed
upon any person who shall cause an abortion by violence, but unintentionally.

Art. 258. Abortion practiced by the woman herself of by her parents. - The penalty of prision correccional in its medium and
maximum periods shall be imposed upon a woman who shall practice abortion upon herself or shall consent that any other
person should do so.

Any woman who shall commit this offense to conceal her dishonor, shall suffer the penalty of prision correccional in its minimum
and medium periods.

If this crime be committed by the parents of the pregnant woman or either of them, and they act with the consent of said woman
for the purpose of concealing her dishonor, the offenders shall suffer the penalty of prision correccional in its medium and
maximum periods.

Art. 259. Abortion practiced by a physician or midwife and dispensing of abortives.- The penalties provided in Article 256
shall be imposed in its maximum period, respectively, upon any physician or midwife who, taking advantage of their scientific
knowledge or skill, shall cause an abortion or assist in causing the same.

Cytotec (Misoprostol)

Any pharmacist who, without the proper prescription from a physician, shall dispense any abortive shall suffer arresto mayor and a
fine not exceeding 1,000 pesos.
Types of Principal of the Crime
1. Principal by DIRECT PARTICIPATION = DIRECTLY PERFORMS THE ABORTION
2. Principal by INDUCTION / Inducement = FORCED BY SOMEONE TO UNDERGO ABORTION
3. Principal by INDISPENSABLE COOPERATION = THOSE WHO ASSISTED THE DIRECT PARTICIPATION

Accomplice  accessory to the crime BEFORE the FACT  Referral

Accessory to the crime  accessory AFTER the FACT  to destroy the Evidence

MATERNAL MORTALITY
A. Direct maternal death  The death of the mother resulting from obstetrical complications of pregnancy, labor, or the
puerperium, and from interventions, omissions, incorrect treatment, or a chain of events resulting from any of these
factors. An example is maternal death from exsanguination after uterine rupture.
B. Indirect maternal death A maternal death not directly due to an obstetrical cause, but resulting from previously
existing disease, or a disease that developed during pregnancy, labor, or the puerperium, but which was aggravated by
maternal physiological adaptation to pregnancy. An example is maternal death from complications of mitral valve
stenosis.
C. Non-maternal death  Death of the mother resulting from accidental or incidental causes not related to pregnancy. An
example is death from an automobile accident or concurrent malignancy.
D. Maternal mortality ratio  The number of maternal deaths that result from the reproductive process per 100,000 live
births. Used more commonly, but less accurately, are the terms maternal mortality rate or maternal death rate. The term
ratio is more accurate because it includes in the numerator the number of deaths regardless of pregnancy outcome—for
example, live births, stillbirths, ectopic pregnancies—while the denominator includes the number of live births.

E. In 1987, the CDC collaborated with the Maternal Mortality Special Interest Group of the American College of Obstetricians
and Gynecologists, the Association of Vital Records and Health Statistics, and state and local health departments to
initiate the National Pregnancy Mortality Surveillance System. Two new terms were introduced.
F. Pregnancy-associated death  The death of any woman, from any cause, while pregnant or within 1 calendar year of
termination of pregnancy, regardless of the duration and the site of pregnancy.
G. Pregnancy-related death  A pregnancy-associated death resulting from:
1. complications of the pregnancy itself,
2. the chain of events initiated by the pregnancy that led to death, or
3. aggravation of an unrelated condition by the physiological or pharmacological effects of the pregnancy that
subsequently caused death.

REFERENCE
A. Cunningham, F. Gary (2010). Williams Obstetrics. 23rd Edition. McGraw-Hill Co. Philadelphia
B. Sakala , E P (2005). USMLE Step 2CK Notes Obstetrics and Gynecology Lecture Notes. Kaplan Inc. New York