Causes and Treatments of OB/GYN Conditions

The primary risk in rubella infection during pregnancy is to the fetus. The rubella virus is able to cross the placenta, and acts as a teratogen by inducing apoptosis in fetal cells. This is termed congenital rubella syndrome. Birth defects can include deafness, ocular damage, cataracts, congenital heart defects, hepatomegaly, and developmental disability or delays.

Induction of labor may occur for various indications: diabetes, postmaturity, hypertensive disorders or pregnancy, fetal jeopardy, or logistical factors including distance from qualified hospital or a rate of rapid birth. Induction of labor may only occur if the mother does not have cephalopelvic disproportion (CPD), the fetus has a vertex presentation with an engaged head, and the mother has a "ripened" cervic or is prepared to be "ripened". Fetal macrosomia is a concerning condition and may require intervention, but is typically not resolved by inducing labor. With fetal macrosomia, a cesarean section may be considered instead of vaginal delivery, due to the potential risks of delivering a large infant vaginally.

Of the conditions listed, the only one that is associated with Rh incompatibility between mother and fetus is hemolytic disease of the newborn (otherwise known as hemolytic disease of the fetus and newborn). In this condition, antibodies from the mother's blood attack the blood of the fetus. This is a major cause of fetal and newborn mortality and morbidity.

Hemolytic disease of the newborn occurs when an Rh negative mother is carrying an Rh positive fetus. The mother must have previously carried an Rh positive fetus and become sensitized to Rh-D antigen during miscarriage, pregnancy (due to placental rupture), or during delivery. Then, during a second pregnancy, anti-RhD antibodies from the mother's immune system can cross the placenta and attack the blood cells of the fetus, causing hemolytic anemia.

Rh sensitization can be prevented by treatment of an Rh negative mother with Rho(D) immunoglobulin at 28 weeks, then again within 72 hours of delivery. This is a solution of IgG antibody to Rh-D, which is able to destroy any fetal red blood cells that enter the mother's bloodstream before her own immune system is able to form develop a sensitization.

In pregnancy, the ribs start to flare (expand slightly) as the pressure from the growing fetus moves the diaphragm upwards. Many women experience this during the third trimester as the baby is at it's largest. The flaring of the ribs is assisted by maternal hormones that enable more flexibility throughout the body.

Magnesium sulfate is used to prevent seizures in women with severe preeclampsia. Calcium gluconate is the antidote if magnesium toxicity is assessed. It should be readily available when a woman is receiving magnesium sulfate. Pitocin is used to stimulate the uterus, often to induce labor. Nubain is an opioid that can be given to women during labor to treat pain. Zolpidem (Ambien) is a sleep aid.

The main risk factors for uterine leiomyoma are family history, obesity, and red meat consumption. Smoking is not a risk factor.

Toxoplasmosis is a parasitic infection that is capable of crossing the placenta. It can cause birth defects such as hearing loss, learning disorders, and visual impairment. Toxoplasmosis infection is primarily a concern only in individuals who have never been exposed to the parasite before pregnancy, as most people develop immunity to infection 6-9 months after their first exposure (often through contact with cat feces in litter boxes or soil). The main routes of toxoplasmosis infection in pregnant women are exposure to cat feces, water contamination, consumption of undercooked meats, and blood transfusion.

Ectopic pregnancy is a serious condition in which an embryo implants in tissue outside the uterus. Risk factors include pelvic inflammatory disease, tubal ligation, endometriosis, tobacco smoking, history of infertility, and the use of assisted reproductive technology.