OBSTETRICS AND GYNECOLOGY

medical/surgical specialty concerned with the care of women from pregnancy until after delivery and with the diagnosis and treatment of disorders of the female reproductive tract. The medical care of pregnant women (obstetrics) and of female genital diseases (gynecology) developed along different historical paths. Obstetrics had for a long time been the province of female midwives (see midwifery), but in the 17th century, European physicians began to attend on normal deliveries of royal and aristocratic families; from this beginning, the practice grew and spread to the middle classes. The invention of the forceps used in delivery, the introduction of anesthesia, and Ignaz Semmelweis' discovery of the cause of puerperal (childbed) fever and his introduction of antiseptic methods in the delivery room were all major advances in obstetrical practice. Asepsis in turn made cesarean section, in which the infant is delivered through an incision in the mother's uterus and abdominal wall, a feasible surgical alternative to natural childbirth. By the early 19th century, obstetrics had become established as a recognized medical discipline in Europe and the United States. In the 20th century, obstetrics developed chiefly in the areas of fertility control and the promotion of healthy births. The prenatal care and instruction of pregnant mothers to reduce birth defects and problem deliveries was introduced about 1900 and was thereafter rapidly adopted throughout the world. Beginning with the development of hormonal contraceptive pills in the 1950s, obstetrician-gynecologists have also become increasingly responsible for regulating women's fertility and fecundity. With the development of amniocentesis, ultrasound, and other methods for the prenatal diagnosis of birth defects, obstetrician-gynecologists have been able to abort defective fetuses and unwanted pregnancies. At the same time, new methods for artificially implanting fertilized embryos within the uterus have enabled obstetrician-gynecologists to help previously infertile couples to have children. The obstetrician's main tasks are to diagnose and bring a woman through pregnancy, deliver her child, and give the new mother adequate postnatal care. The most important surgical operation performed by obstetricians is cesarean section. Episiotomy, a surgical procedure in which an incision is used to enlarge the vaginal opening to facilitate childbirth, is also common. Gynecology as a branch of medicine dates back to Greco-Roman civilization, if not earlier. The renewal of interest in diseases of women is shown in the huge encyclopaedia of gynecology issued in 1566 by Caspar Wolf of Zrich. In the early and mid-19th century, physicians became able to successfully perform a limited variety of surgical operations on the ovaries and uterus. The American surgeon James Marion Sims and other pioneers of operative gynecology also had to combat the violent prejudice of the public against any exposure or examination of the female sexual organs. The two great advances that finally overcame such opposition and made gynecologic surgery generally available were the use of anesthesia and antiseptic methods. The separate specialty of gynecology had become fairly well established by 1880; its union with the specialty of obstetrics, arising from an overlap of natural concerns, began late in the century and has continued to the present day. Gynecologists make routine examinations of cervical and vaginal secretions to detect cancer of the uterus and cervix. They perform two main types of surgical operations: repairing any significant injuries caused to the vagina, uterus, and bladder in the course of childbirth; and removing cysts and benign or malignant tumours from the uterus, cervix, and ovaries. The modern practice of gynecology requires skill in pelvic surgery; a knowledge of female urologic conditions, because the symptoms of diseases of the urinary tract and the genital tract are often similar; and skill in dealing with the minor psychiatric problems that often arise among gynecologic patients. The diagnosis and treatment of infertility are a combined obstetric-gynecologic effort.