Obstetrical /Neonatal Medicine

Acid-Base Metabolism - The acts that maintain the balance of acids and bases in the body. When this balance is upset, either too much acid is present (acidosis) or the opposite (alkalosis). Acidosis may be caused by diarrhea, vomiting, kidney disease (uremia), uncontrolled diabetes mellitus, and some drugs. Alkalosis may be caused by too much of an alkaline drug (antacids), vomiting, and some drugs that increase urine production (diuretics).

Acidemia - A decreased pH (increased hydrogen ion concentration or increased acid) of the blood.

Acidosis - An abnormal increase in hydrogen in the body from too much acid or the loss of base.

Acidosis (Metabolic) - A decreased pH and bicarbonate concentration in the body fluids caused either by the accumulation of acids or by abnormal losses of fixed base from the body, as in diarrhea or renal disease.

ACOG - American College of Obstetricians and Gynecologists

Acute Renal Failure - Kidney failure of relatively short duration arising suddenly and manifesting intense severity.

Acyclovir - An antiviral drug used to treat herpes, including genital herpes. It is an ointment for treating herpes of the eye and other types of herpes. Acyclovir does not work on other viral infections.

Afebrile - Without fever.

Amniotic Fluid - A liquid made by the amnion and the fetus. It usually totals about 1,500 mg (a little more than 1 quart) at 9 months. It surrounds the fetus during pregnancy, providing it with protection. It is swallowed, processed, and excreted as fetal urine at a rate of 50 mg (more than 2 ounces) every hour. Amniotic fluid is clear, though cells and fat give it a cloudy look.

Amniotomy - Artificial rupture of the fetal membranes as a means of inducing or expediting labour.

Anoxemia - Reduction of oxygen content of the blood below physiologic levels.

Anoxemic - Characterized by or due to lack of the normal proportion of oxygen in the blood.

Anoxi - Complete absence of oxygen within a body tissue (eg. the brain or a muscle).

Anoxia - absence or almost complete absence of oxygen from inspired gases, arterial blood or tissue

Anoxic - Pertaining to or characterized by anoxia; degenerative disease of the brain caused by hypoxia, ischemia or hypoglycemia or secondarily to disease of other organs, such as the kidney, lung or liver.

Antenatal - See Prenatal.

Apgar Score - A system devised to assess the condition of a newborn whereby five features are scored at one minute and at five minutes post delivery. Features scored are respiratory effort, heart rate, colour, muscle tone, and reaction to nasal stimulation. Most important are the infant's attempts to breathe and the infant's heart rate.

Apnea - An absence of automatic breathing.

Arterial Line - The insertion of a line into the arteries for the purpose of administering resuscitative medication.

Artificial Rupture of Membranes (ARM) - Rupture of the membrane around the baby in order to release some of the amniotic fluid in an effort to induce labour.

Asphyxia - suffocation; a condition in which there is anoxia and increased carbon dioxide tension in the blood and tissues; the impaired exchange of oxygen and carbon dioxide. Related terms include:

(a) anoxia - the absence of oxygen in inspired gases, arterial blood, or tissues (to be differentiated from hypoxia); oxygen deficiency;

(b) hypoxia - low oxygen content or tension; deficiency of oxygen in the inspired air; a decrease below normal levels of oxygen in air, blood, or tissue short of anoxia;

(c) hypoxic ischemic encephalopathy - brain damage due to the lack of oxygen and blood flowing to the brain;

(d) ischemia - an inadequate flow of blood to a part of the body caused by a constriction or blockage of the blood vessels supplying it; oxygenated blood fails to reach tissue due to a constriction or an obstruction;

(e) encephalopathy - any disease or disorder of the brain;

Ataxia - A blocked ability to coordinate movements. A staggering walk and poor balance may be caused by damage to the spinal cord or brain. This can be the result of birth trauma, inborn disorder, infection, tumour, poison, or head injury.

Auscultation - The act of .listening for sounds within the body to evaluate the condition of the heart, lungs, intestines, or other organs or to hear the fetal heart beat. The frequency, intensity, duration and quality of the sounds are noted.

Baroreceptor - One of the pressure-sensitive nerve endings in the walls of the upper chambers (atria) of the heart and in the large blood vessels (the vena cave, the aortic arch, and the carotid sinus). Baroreceptors stimulate reflex mechanisms that allow the body to adapt to changes in blood pressure by dilating or constricting the blood vessels.

Base Excess (BE) - Measure of alkalinity; this blood result determines metabolic illness.

Baseline - An observation or value that represents the normal background level, or an initial level, of a measurable quantity; used for comparison with values representing response to experimental intervention or an environmental stimulus, usually implying that the baseline and response values refer to the same individual or system.

Bilateral Strabismus - Deviation of the eye which the patient cannot overcome - pertaining to both eyes.

Biophysical Profile -- a set of fetal behaviours and the physical visual observations that interpret those behaviours - the fetus is observed for certain specific issues:

(i) body movement;

(ii) fetal breathing - a respiratory-like movement (because a fetus is not actually breathing for the sake of oxygen exchange);

(iii) tone - an issue of flexion and resumption of position of extremities, extension and flexion of extremities;

(iv) the presence or absence (but not the precise measurement of volume) of amniotic fluid.

Each of these four observations or assessments is assessed a score of between 0 and 2 and the aggregate is summed up to produce the net result or score of the biophysical profile.

Birth Apnea - Initial birth apnea is a condition in which an infant fails to establish sustained respiration within two minutes of delivery.

Birth Asphyxia - Suffocation at birth.

Blood Gas - Gas dissolved in the liquid part of the blood. Blood gasses include oxygen, carbon dioxide and nitrogen.

Blood Pressure (BP) - The pressure of blood on the walls of the arteries dependent on the energy of the heart action, the elasticity of the walls of the arteries and the volume and viscosity of the blood; the maximum pressure occurs near the end of the stroke output of the left ventricle of the heart and is termed maximum or systolic pressure; the minimum pressure occurs late in ventricular diastole and is termed minimum or diastolic pressure; mean blood pressure is the average of the blood pressure levels; basic blood pressure is the pressure during quiet rest or basal conditions.

Blood-Gas - An analysis of the acid-base balance (pH) of the blood. This includes

Bolus - A large round mass of a drug for swallowing that is usually soft and not prepackaged. A dose of a drug or a drug injected all at once into the vein.

bpm - beats per minute

Bradycardia - An abnormal condition in which the heart contracts steadily but at a rate of less than 60 beats per minute (under 120 bpm in a fetus). The heart normally slows during sleep, and, in some physically fit people, the pulse may be quite slow. Bradycardia may be a symptom of a brain tumour, digitalis overdose, or an abnormal response of the vagus nerve (vagotonia). The blood circulating is reduced, causing faintness, dizziness, chest pain, and eventually fainting and collapse of the circulation. Treatment may include giving atropine, implanting a pacemaker, or reducing the digitalis dose.

Braxton Hicks - Short relatively painless contractions of the uterus during pregnancy.

Breech Delivery - A birth in which the baby's bottom emerges before the head.

Caesarean Section - An operation to deliver the baby from the uterus through a vertical or horizontal incision in the abdomen.

Caput - head

Cardiac Arrest - A halt in the pump action of the heart due to the cessation of its rhythmic, muscular activity.

Cardiotocography - An electronic fetal heart rate monitor used to make a continuous paper or sound recording of the heart beat together with a recording of uterine contractions.

CAT Scan - Computerized axial tomography.

Catecholamine - Any one of a group of chemicals made by the body that work as important nerve transmitters. Catecholamines are also made by chemists as drugs. The main catecholamines made by the body are dopamine, epinephrine (also called adrenaline), and norepinephrine. Norepinephrine and epinephrine are made by the adrenal medulla glands. Epinephrine opens up blood vessels that serve muscles. Norepinephrine slightly closes down these blood vessels. Both compounds excite the heart. Dopamine is found mainly in certain types of nerve tissue in the brain (basal ganglia). The main job of catecholamines is to prepare the body to activate the "flight or fight" syndrome which includes increased blood pressure, faster heart beat, faster breathing. At the same time other processes shut down, as digestion. Synthetic catecholamines are used to raise blood pressure and excite the heart in emergencies.

Central Cyanosis - Produced as a result of arterial unsaturation, the aortic blood carrying reduced hemoglobin.

Cerebral - Pertaining to the cerebrum, which is the main portion of the brain, occupying the upper part of the cranial cavity; its two hemispheres united by the corpus callosum form the largest part of the central nervous system in man; it is derived from the telencephalon of the embryo.

Cerebral Edema - A pooling of fluid in the brain tissues. It may be caused by an infection, tumour, injury, or poison. Early symptoms are involuntary contraction of muscles, widening of pupils of the eye, and gradual loss of consciousness. It is a possibly fatal condition that requires emergency medical care.

Cerebral Palsy - A persisting qualitative motor disorder appearing before the age of three years old, due to a non-progressive damage to the brain.

Cervix - A small, cylindrical organ, several centimeters in length and less than 2.5 cm in diameter, comprising the lower part and neck of the uterus.

CNS - central nervous system

Cortical Atrophy - Wasting of an area of cerebral cortex; excision of an area of cerebral cortex may occur in the treatment of focal epilepsy.

CPAP - Continuous positive airway pressure: this is when the ventilator flows in a small amount of pressure to keep the lung open (ie., inflated).

Crackle - A fine, bubbling sound heard when listening to breath sounds through a stethoscope. It is heard when watery secretions are present in the lungs.

Cranium - The upper part of the head; the skeleton of the head variously construed as including all of the bones of the head, all of them except the mandible, or the 8 bones which form the vault that lodges the brain.

CVS - Cardiovascular system.

Cyanosis - Bluish discoloration of the skin and mucous membranes from lack of oxygen. The cause can be hemoglobin without oxygen in the blood or a defect in the hemoglobin molecule, as in methemoglobin. - cyanotic, adj.

Cyanotic - Pertaining to or characterized by cyanosis.

Deceleration - Early deceleration - in fetal heart rate monitoring, a transient decrease in heart rate that coincides with the onset of a uterine contraction. Late deceleration - in fetal heart rate monitoring, a transient decrease in heart rate occurring at or after the peak of a uterine contraction, which may result from fetal hypoxia. Variable decelerations - in fetal heart rate monitoring, a transient series of decelerations in heart rate that vary in duration, intensity, and relation to uterine contractions; they are abrupt in onset and cessation and result from vagus nerve firing in response to stimuli such as umbilical cord compression in the first stage of labour.

Determination - measuring the amount and pressure of oxygen, carbon dioxide, and hydrogen in the blood. Blood-gas determination is important for evaluating heart failure, bleeding, kidney failure, drug overdose, shock, uncontrolled diabetes mellitus, or any other condition of severe stress.

Dextrose - A liquid sugar solution (glucose) given in the vein.

Dextrostix - Trademark for a reagent strip designed for determination of blood-glucose levels with the use of fingertip venous blood.

•·Dusky - Term used to describe a baby that is grey in colour secondary to hypoxia.

Dyskinetic Syndrome - A type of cerebral palsy involving a brain disorder. Patients have unusual movements of the arms, legs, and sometimes the trunk of the body. The movements tend to increase with emotional tension and decrease during sleep.

Dysmorphology - Refers to abnormal formation.

ECG - Electrocardiogram.

Echogenicity - In ultrasonography, the extent to which a structure gives rise to reflections of ultrasound waves.

Echolalia - Also called echophrasia, echo speech. The automatic and meaningless repeating of another's words or phrases, especially as seen in schizophrenia. A baby's imitation of words produced by others. It occurs normally in early childhood development.

EDC - estimated date of confinement

Edema - Presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body; usually applied to demonstrate accumulation of excessive fluid in the subcutaneous tissues; edema may be localized due to venous or lymphatic obstruction or to increased vascular permeability or it may be systemic due to heart failure or renal disease.

Electronic Fetal Heart Rate Monitoring - an electronic system devised for monitoring and measuring the fetal heart rate during labour (and before) to assist in preserving fetal well-being by early detection and relief of fetal distress. The monitor produces a continuous and contemporaneous tracing. Monitoring can be done internally by attaching the "clip" to the fetus or externally through the abdominal wall (ultrasound). During labour the normal average baseline fetal heart rate is generally accepted to be between 110 or 120 and 160 beats per minute ("bpm"). The terms "acceleration" and "decelerations" are used generally to describe increases and decreases (respectively) from the baseline fetal heart rate. The following are some of the terms used to describe the occurrences evidenced on a tracing:

(a) bradycardia - slowness of the heart beat, usually defined as a rate under 110 bpm;

(b) deep decelerations - a situation where the fetal heart rate goes below 110 bpm for a period longer than 45 seconds (this can, and often does, represent cord compression and a stress on the fetus);

(c) beat-to-beat variability - this is the interval between fetal heart beats reflecting beat-to-beat changes in rate. The absence, rather than the presence, of beat-to-beat variability is often considered a sign of fetal compromise, although various drugs commonly used at the time of delivery may be responsible for a lack of beat-to-beat variations;

(d) short term variability - a description of the instantaneous changes in fetal heart rate from one beat to the next;

(e) long term variability - changes in the fetal heart rate that occur over a period of time (one minute);

(f) early decelerations - a deceleration or drop in fetal heart rate occurring concurrently with uterine contractions (during labour);

(g) late decelerations - decreases in fetal heart rate beginning at or after the peak contractions and returning to baseline after the contractions end;

(h) variable decelerations - this pattern evidences a slowing of the fetal heart rate that does not correspond to any phase of the contraction; generally (often) caused by a compression of the umbilical cord;

Electroencephalogram - A recording of the potentials on the skull generated by currents emanating spontaneously from nerve cells in the brain; the dominant frequency of these potentials is about 8 to 10 cycles per second and the amplitude about 10 to 100 microvolts; variations in wave characteristics correlate well with neurological conditions and so have been useful as diagnostic criteria .

Encephalitis - Inflammation of the brain, usually caused by viral infection.

Encephalomalacia - Softening of the brain, especially that caused by infarct.

Encephalopathy - oxygenation. This results in recognized sequelae in infants of altered level of consciousness, seizures, abnormal EEG and neuro imaging as well as later neurologic impairment.

Encephalopathy - Any defect of the structure or function of brain tissues. It often refers to long-term defects in which there is a breakdown or death of tissue, as Wernicke's encephalopathy or Schilder's disease.

Enterovirus - A virus that flourishes mainly in the intestinal tract. Kinds of enteroviruses are coxsackievirus, echovirus, poliovirus. enteroviral, adj.

Enterovirus Infection - A genus of viruses (family Picornaviridae) that includes poliovirus types 1 to 3, Coxsackievirus A and B, echoviruses identified since 1969 and assigned type numbers. They are transient inhabitants of the alimentary canal and are stable at pH 3.0 to 5.0 for 1 to 3 hours.

Epidural - A method of pain relief in which a local anesthetic is injected into the epidural space (the space around the membranes surrounding the spinal cord) in the middle and lower back to numb the nerves that supply the chest and the lower half of the body.

Epileptic Seizures - Paroxysmal transient disturbances of brain function that may be manifested by episodic impairment or loss of consciousness, abnormal/normal phenomena, psychic or sensory disturbances or perturbation of the autonomic nervous system; symptoms are due to paroxysmal disturbance of the electrical activity of the brain.

Episiotomy - a surgical incision into the perineum, a commonly used obstetric procedure to relieve the pressure placed on the perineum by the movement and dissent of the fetus;

Fetal Distress - Physical stress experienced by a fetus during labour as a result of not receiving enough oxygen.

FHR - fetal heart rate

Fi02 - Fraction of inspired oxygen (if baby is breathing room air, the result would be 0.21, and if on 100% oxygen, the result would be 1.00).

Flaccid - Weak, lax and soft, lacking normal firmness, limp.

Folliculitis - Swelling of hair follicles, as in sycosis barbae.

Fontanelle - A space between the bones of an infant's skull covered by tough membranes. The front fontanelle, roughly diamond-shaped, remains soft until about 2 years of age. The back fontanelle, triangular in shape, closes about 2 months after birth. Increased brain pressure may cause a fontanelle to become tense or bulge. A fontanelle may be soft and sunken if the infant is dehydrated. Also spelled fontanel.

Fragile X Syndrome - A reproductive disorder characterized by an almost broken X chromosome, which has a tip hanging by a weak thread. It is the most common cause of inherited mental retardation. Tests for the broken chromosome are accurate only about 75% of the time. Some healthy people may have fragile X chromosomes without knowing it, and may pass the condition to children or grandchildren.

FSC - fetal scalp clip

Fundus - The base or the deepest part of an organ; the part farthest from the mouth of an organ, as the fundus of the uterus.

Gag Reflex - Contact of a foreign body with the mucous membrane of the fauces causing retching or gagging.

Gavage - The process of feeding a patient through a tube.

Grasp Reflex - An involuntary flexion of the fingers to tactile or tendon stimulation on the palm of the hand, producing an uncontrollable grasp; usually associated with frontal lobe lesions.

H103 - Measure of bicarbonate in the blood gases.

Haemorrhage - loss of a large amount of blood in a short period of time, either outside or inside the body. Haemorrhage may be from arteries, veins, or capillaries. DIAGNOSIS: Symptoms are related to shock: rapid pulse, thirst, cold and clammy skin, sighing breaths, dizziness; fainting, paleness, apprehension, restlessness, and low blood pressure. If bleeding is within a cavity or joint, pain will develop as the cavity is stretched by the rapidly expanding amount of blood. TREATMENT: all effort is made to stop the bleeding. If haemorrhage is external, pressure is applied directly to the wound or to the proper points. The part of the body that is wounded may be raised. Ice, applied directly to the wound, may slow bleeding by shrinking the blood vessels. Body temperature may be maintained by keeping the person covered and flat. If an arm or leg is wounded, and if the bleeding is severe, a tourniquet may be applied near the wound. PATIENT CARE: a tourniquet is not applied if there is any other way to stop the flow, because the risk is great that the limb will not survive the loss of oxygen caused by blocking the supply of blood. The tourniquet is not removed until surgical repair of the wound is possible. Internal bleeding requires prompt medical attention. The patient is kept warm and quiet.

Heart Rate - The pulse, figured by counting the number of contractions of the heart per unit of time. Tachycardia is a heart rate of more than100 beats per minute; bradycardia is a heart rate of fewer than 60 beats per minute.

Hydrocephalus - And excessive amount of cerebral spinal fluid, usually under increased pressure, within the skull.

Hypertension - Persisting high arterial blood pressure.

Hypertonic - Spastic or having a greater degree of tension.

Hypertrophy - Enlargement of an organ or tissue due to an increase in the size, rather than the number, of constituent cells.

Hypoglycemia - An abnormally low level of glucose in the blood.

Hypoglycemic - Pertaining to, characterized by, or producing hypoglycemia to an agent that acts to lower the level of glucose in the blood.

Hyponatremia - Deficiency of sodium in the blood; salt depletion.

Hypoplasia - Incomplete development or underdevelopment of an organ or tissue; it is less severe in degree than aplasia.

Hypotension - Abnormally low blood pressure; seen in shock but not necessarily indicative of it.

Hypothermia - A low body temperature such as that due to exposure in cold weather or a state of low temperature of the body induced as a means of decreasing metabolism of tissues and thereby the need for oxygen, as used in various surgical procedures, especially on the heart or in an excised organ being preserved for transplantation.

Hypotonia - A condition of diminished tone of the skeletal muscles; diminished resistance of muscles to passive stretching.

Hypovolemia - Abnormally decreased volume of circulating fluid (plasma) in the body.

Hypovolemic Shock - Shock pertaining to or characterized by hypovolemia.

Hypoxemia - An abnormal lack of oxygen in the blood in the arteries. Symptoms of acute hypoxemia are the patient turning blue, restlessness, stupor, coma, increased blood pressure, too-rapid heart beat, and an initial increase in heart output that later falls, resulting in low blood pressure and irregular heart beat or heart stoppage. Chronic hypoxemia stimulates red blood cell production by the bone marrow, leading to an excess of red cells. Hypoxemia caused by decreased oxygen pressure in the blood or too little oxygen intake improves with oxygen therapy. Hypoxemia resulting from shunting of blood from the right side of the heart to the left side of the heart without exchange of gases in the lungs is treated with bronchial hygiene and breathing therapy.

Hypoxia - Too-little oxygen in the cells characterized by the patient turning blue, a too-rapid heart rate, high blood pressure, contractions of blood vessels, dizziness, and mental confusion. Mild hypoxia increases heart and respiratory rates. However, the central mechanisms that regulate breathing fail in severe hypoxia, leading to irregular breathing, failure to breathe, and heart failure. Increased sensitivity to the effect of certain drugs in reducing breathing is common in chronic hypoxia, resulting in severe depression or failure of breathing when relatively small doses of opiates are taken. The tissues most sensitive to hypoxia are the brain, heart, vessels of the lungs, and liver. Treatment may include heart and . lung stimulant drugs, oxygen therapy, mechanic ventilation, and frequent analysis of blood gases.

Hypoxic - Pertaining to or characterized by hypoxia.

Hypoxic Ischemic - Dysfunction of the brain due to lack of blood flow and

Intercostal Breathing - Intercostal indrawing situating between the ribs.

Internal Lead - An electrode attached to the fetus' head and attached to a fetal monitor.

Intrapartum - Occurring during childbirth, or during delivery.

Intrauterine Growth Retardation (Restriction) - Growth retardation within the uterus or in utero growth retardation.

Intubation - The process of passing an endotracheal tube (breathing tube) into the trachea.

Ischemia - Poor blood supply to an organ or part, often marked by pain and organ dysfunction, as in ischemic heart disease. Some causes of ischemia are arterial embolism, atherosclerosis, thrombosis, and vasoconstriction.

Isolette - Synonymous with incubator, an apparatus for maintaining a premature infant in an environment of proper temperature and humidity.

IUGR - intrauterine growth retardation

Labour - delivery; child birth; The various stages of labour are defined as follows:

(a) first stage - the period from the onset of regular contractions to the clinically confirmed complete effacement of the cervix (full dilatation of the cervix); this stage lasts on average about 12 hours in the primigravida (a mother's first pregnancy);

(b) second stage - the period from the time of completion of cervical dilatation to the delivery of the baby;

(c) third stage - the period following the delivery of the baby and continuing until the placenta is delivered (the placenta normally delivers within five minutes after the baby);

Late Apnea - Cessation of respiration in an infant for more than 60 seconds after spontaneous breathing has been established and sustained.

Lesions (Genital) - A wound, injury or pathologic change in the tissues.

Locomotor - Relating to movement from one place to another.

Lumbar Puncture - Introducing a hollow needle into the lumbar portion of the spinal canal. It is performed in various therapeutic and diagnostic procedures that include obtaining cerebrospinal fluid for laboratory analysis; evaluating the canal for the presence of a tumour; and injecting a dye for x-ray visualization of the structures of the nervous system, including the spinal canal and brain. Therapeutic reasons for lumbar puncture include removing blood or pus from the canal space; injecting drugs; withdrawing cerebrospinal fluid to reduce pressure in the skull; introducing an anesthetic to induce spinal anesthesia; and placing a small amount of the patient's blood in the space to form a clot to patch a cut or hole in the spinal membrane. Lumbar puncture is not performed if a brain tumour is suspected, if there are signs of infection at the site of puncture, or if other cerebrospinal procedures are planned in the near future. Infection, leakage of cerebrospinal fluid, headache, nausea, vomiting, urination difficulty, or signs of meningitis occur in approximately 25% of patients.

Mal Presentation - Not lying in the normal head down position in the uterus.

Meconium - The thick, sticky, greenish-black feces passed by infants during the first day or two after birth.

Metabolic Acidosis - Acidosis in which excess acid is added to the body fluids or bicarbonate is lost from them. In starvation and in uncontrolled diabetes mellitus, sugar (glucose) is not present or is not available to burn for body fuel. The blood plasma bicarbonate of the body is used up in neutralizing substances (ketones) that result from the breakdown of body fat used for energy in the lack of glucose. Metabolic acidosis also occurs when carbohydrates are burned without enough oxygen, as in heart failure or shock. Excess blood potassium is often seen with the condition.

Microcephaly - A birth defect with an abnormally small head in relation to the rest of the body. It also leads to slowed growth of the brain. The result is some degree of mental retardation. The face is generally normal. The condition may be caused by heredity, an accident while an embryo or fetus, as exposure to irradiation, chemical agents, or mother's infection, or an injury, especially during the last 3 months of pregnancy. There is no treatment. Also called microcephalia, microcephalism.

Moro Reflex - A normal reflex in a young infant caused by a sudden loud noise. It results in drawing up the legs, an embracing position of the arms, and usually a short cry. Also called Startle Reflex.

Muscle Tone - The natural tension in the fibres of the muscle.

Myelin - The substance of the cell membrane of Schwann's cells that coils to form the myelin sheath; it has a high proportion of lipid to protein and serves as an electrical insulator.

Myelination (Myelinization) - The act of furnishing with or taking on myelin.

NAACOG - Organization for Obstetric Gynecologic and NeoNatal Nurses

Narcan - A trademark for a drug reversing the effects of narcotics (naloxone hydrochloride).

Neonatal - Pertaining to the first four weeks after birth.

Neonate - Newly born; a newborn infant.

Neonatologist - A physician whose specialty is the care of newborns in the first 30 days of life.

Non-stress test (NST) - a fetal heart tracing taken prior to the onset of labour. It is done by putting two belts on the mother's abdomen; one is an acoustic instrument that listens to the echos of the fetal heart and translates those sounds into a printout strip (a graph) that can be read and studied; the second belt on the mother's abdomen is a strain gauge tokodynamometer, which indicates or signals the presence of uterine contractions. The two belts are connected to electronic instruments that analyze the signals they are receiving and produce a paper printout (tracing) of two lines. The terms "reassuring" and "non-reassuring" are used to describe the results of an NST as providing the physician with some confidence in a particular pattern (reassuring) or concern or lack of confidence in a particular pattern (non-reassuring);

Nuchal Cord - A condition in which the umbilical cord is wrapped around the neck of the fetus in the uterus or as it is being born. Usually the loop or loops of cord are gently slipped over the infant's head. The shoulders may come through a single loose loop. The condition occurs in more than 25% of births, more often with long cords than with short ones.

Occipital Lobe - Pertaining to the occiput, located near to the occipital bone as in the occipital lobe.

Oligohydramnios - An unusually small amount or lack of amniotic fluid.

Organomegaly (Visceromegaly) - Abnormal enlargement of the viscera (internal organs), such as may be seen in acromegaly and other disorders.

Ovarian Cyst - An abnormal, fluid-filled swelling in an ovary. Benign in about 95 percent of all cases.

PA02 - Pressure of arterial oxygen (amount of oxygenation in the arterial blood).

PAC02 - Pressure of arterial carbon dioxide.

Papules - A small, solid, slightly raised area of the skin.

Para 0, Gravida 1 - Obstetrical term for no live births, first pregnancy.

Parietal - Of, or pertaining to the walls of a cavity; pertaining to or located near the parietal bone as the parietal lobe.

Parturitional Blood Loss - Blood loss during the act or process of giving birth to a child.

Pathognomic - Specifically distinctive or characteristic of a disease or pathologic condition; a sign or symptom on which a diagnosis can be made.

Pediatrician - A physician who specializes in pediatrics.

Pediatrics - That branch of medicine which treats the child and its development and care and of the diseases of children in their treatment.

Pelvic Exam - Examination of a woman's external and internal genitalia. During labour, pelvic examinations are performed to help assess the 'position and descent, and the well-being, of the baby.

Perinatal - Referring to the time and process of giving birth or being born.

Perinatal Asphyxia - Asphyxia occurring in the period shortly before and after birth.

Perineum - The area bounded internally by the pelvic floor (the muscles that form the supportive base of the pelvis) and the surrounding bony structures.

Peripheral Cyanosis - Cyanosis produced as a result of an excessive amount of reduced hemoglobin in the venous blood, caused by extensive oxygen extraction at the capillary level.

Peritoneum - The two layered membrane that lines the wall of the abdominal cavity and covers the abdominal organs. The peritoneum contains blood vessels, lymph vessels and nerves.

Periventricular Leukamalacia - Periventricular means around or adjacent to a ventricle; leuko refers to white; malacia refers to sickness (i.e. sickness of the white matter around the ventricles).

Pfannenstiel Incision - An incision made transversely, and through the external sheath of the recti muscles, about an inch above the pubes, the muscles being split or separated in the direction of their fibers.

pH - Measure of the amount of acid in the blood (normal value 7.3 to 7.4); above a normal value, alkalinity increases and below it acidity increases.

Phenobarbital - A barbiturate, antiseizure, and tranquilizing drug given to treat many seizure disorders and as a long-acting sleeping pill.

Placenta - A membranous vascular organ that develops during pregnancy, lining the uterine wall and partially enveloping the fetus, to which it is attached by the umbilical cord. Following birth, the placenta is expelled.

Placenta Previa - Implantation of the placenta in the lower part of the uterus, near or over the cervix.

Postpartum - After childbirth, or after delivery.

Prenatal - Occurring before birth. The term may refer to the care of the woman and the growth and development of the fetus. Also called Antenatal.

Presentation (Hand) - That part of the fetus presenting at the superior strait of the maternal pelvis.

Primipara (Primip) - First pregnancy.

PRN - "pro re nata"; when necessary

Prolapsed Cord - Presentation of part of the umbilical cord ahead of the fetus which may cause fetal death due to compression of the cord between the presenting part of the fetus and the maternal pelvis

Q or q - every

Rale - An abnormal breath sound. It is a bubbling noise heard in the chest while breathing in. Fine rales have a crackling sound caused by air entering the lower air sacs (alveoli) of the lungs that have a buildup of fluids. It is heard in congestive heart failure, pneumonia, or early tuberculosis. Coarse rales start in the larger bronchial tubes or windpipe (trachea) and have a lower pitch.

Reflex Irritability - Irritability in response to stimuli measured on apgar scale.

Renal Failure - Kidney failure; the reduction in the ability of the kidney to filter waste products from the blood and excrete them in the urine, to control the body's salt balance and to regulate the blood pressure.

Renal Tubular - Variety of metabolic acidosis resulting from impairment of renal function.

Respiratory Acidosis - An abnormal condition with high blood levels of carbon dioxide. A lowered breathing rate slows the release of carbon dioxide, which then joins with water and makes large amounts of an acid (carbonic acid). This causes more acid in the blood. Many disorders can cause it, as a block in an airway, a muscle disease, chest injuries, pneumonia, and fluid in the lungs. It may also be caused by narcotics, sleeping pills, tranquilizers, or anesthetics, which hold down breathing reflexes. Some common signs and symptoms are headache, breathing difficulty, fine tremors, rapid heart beat, high blood pressure, and widened blood vessels. Failed treatment can lead to coma and death. Any block in an airway must be taken out at once. Treatment may be giving oxygen and lung drugs (bronchodilators) and baking soda (sodium bicarbonate).

RS - Respiratory System.

Seizures - The sudden attack or recurrence of a disease; an attack of epilepsy.

Shock - A sudden disturbance of mental equilibrium; a condition of acute peripheral circulatory failure due to derangement of circulatory control or loss of circulating fluid; it is marked by hypotension, coldness of the skin, usually tachycardia, and often anxiety.

SOGC - Society of Obstetricians and Gynecologists of Canada

Spastic - Of or relating to spasms or other uncontrolled tightenings of the skeletal muscles.

Station (of the baby) - a term used to describe the location of the lowest edge of the presenting part of the fetus (baby), categorized according to its location vis-à-vis the ischial spines (the sharp projections on the ischial bone that are located about midway between the pelvic outlet and the pelvic inlet). When the presenting part is on the level of the ischial spines, it is said to be at "0" station. Stations above the ischial spines are recorded negative values; stations below the spines are given positive values (e.g. if the leading edge of the head is 1 cm above the ischial spines it will be said to be at the -1 station; if the edge of the head is 2 cm below the ischial spines, it is at station +2, etc.). The following terms are used in describing the station of the baby:

(a) Perineum - the area between the thighs extending from the coccyx to the pubis and lying below the pelvic diaphragm; the external surface of the central tendon of the perineum, lying between the vulva and the anus in the female;

(b) Crowning - the bulging of the presenting part through the perineum.

Stridor - An abnormal, high-pitched, musical breathing sound, caused by a blockage in the throat or larynx. It is usually heard when breathing in.

Symphysa - Joint in which union between two bones is effected by means of fibrocartilage. A pathologic adhesion or growing together.

• Syntocinon (Oxytocin) - a hormone or drug used for the induction or stimulation of labour (the causing of contractions);

Tachycardia - An abnormal condition in which the heart (myocardium) contracts regularly but at a rate greater than X100 beats per minute." The heart rate normally speeds up in response to fever, exercise, or nervous excitement. Pathological tachycardia goes along with lack of oxygen (anoxia), as caused by anemia, congestive heart failure, bleeding, or shock. A slow heart beat (bradycardia) develops because the heart muscle gets too-little oxygen and cannot maintain the sped-up pace. Tachycardia acts to increase the amount of oxygen given to the cells of the body by increasing the amount of bleed circulated through the vessels.

Thrombocytopenia - Decrease in the number of blood platelets.

TORCH - An abbreviation for toxoplasmosis, other, rubella virus, cytomegalovirus, and herpes simplex viruses. This is a group of agents that can infect the fetus or the newborn infant causing a set of morbid effects called the TORCH syndrome.'

V/E - vaginal examination

Varicella - Chickenpox.

Ventricular - Small cavity, such as one of the several cavities of the brain or one of the lower chambers of the heart.

Ventricular Hypertrophy - The hypertrophy of the myocardium of a ventricle.

Vernix - A waxy white protective substance covering the skin of a fetus.

Vertex - The topmost point of the vault of the skull, a landmark in craniometry. In obstetrics, the portion of the fetal head bounded by the planes of the trachelobregmatic and biparietal diameters, with the posterior fontanelle at the apex.

Vescicles - A small skin blister, usually filled with clear fluid, that usually forms at the site of skin damage. Used to refer to any small sac like structure in the body.

Vitamin K - A group of fat-soluble vitamins (K1, K2 and K3) which promote clotting of the blood by increasing the synthesis of prothrombin by the liver; they occur naturally in alfalfa, spinach, cabbage, putrefied fish meal, hog liver fat, egg yolk, hemp seed; vitamin K and its synthetic analogues have an anti-hemorrhagic activity with a specific effect prothrombin deficiency; they are used in obstructive jaundice, in hemorrhagic states associated with intestinal diseases and with disease of the liver in the hypoprothrombinemia of the newborn, administered parenterally to the infant or the mother during labour.

White Matter - Whitish nerve tissue, especially of the brain and spinal cord, consisting chiefly of myelinated nerve fibers.

Emergency/Cardiac Arrest

Affect - an impression of personality, presentation, mood, communication (non-verbal and verbal)

Anoxic encephalopathy - A complication resulting from oxygen starvation to the brain

Asystole - Heart and pulse stoppage

BER - Benign early repolarization - an innocuous heart condition which occurs between 3 to 34% of the population, most frequently in males, more frequently under 50 years of age. It does not cause chest pain. It is usually stable over a lifetime. It is a process of excitation and repolarization. The EKG patterns or features may be similar to those of MI patterns.

Brady - Bradycardia - slow heart beat

Cardiac enzymes - when heart muscle dies or is damaged the heart muscle may leak enzymes into the blood stream, from which it may be inferred there has been damage to or death of heart muscle.

CPR - Cardio pulmonary resuscitation

CHB - Complete heart block

EKG or ECG - Electro cardiogram machine is a diagnostic machine which records and graphs electrical activity of heart by electrodes attached to patient's chest. The EKG is a graph being a record of heart activity from 12 different areas: six being called precordial leads recorded as V1 to V6; six being called limb leads identified as Roman numerals I, II, III and a VR, a VL and a VF and an expert reading of which may disclose, inter alia, myocardial infarction or BER

EMD - Electro mechanical dissociation - state of heart


AIDS - acquired immunodeficiency syndrome, a clinical disease characterized by opportunistic infections in an HIV+ person. According to the 1993 CDC classification, any person with aCD4 (T4) count of less than 200 has AIDS, even if that person has not suffered from any opportunistic infections.

Angina pectoris - sudden and severe pain in the lower part of the chest with a feeling of suffocation; brief myocardial ischemic pain. It is most often due to a reduced supply of blood to the myocardium (the heart muscle) and is precipitated by effort and excitement. It may be relieved promptly with rest or nitroglycerin.

Antibody - an immune or protective protein, either existing naturally or evoked by an antigen; thus, the existence of an antibody will often indicate the presence of the antigen; the test for HIV is a test for the presence of the HIV antibody which is produced as a reaction to the virus entering the system; see seroconversion.

Antigen - a substance capable of inducing a specific immune reaction, e.g., toxins, foreign proteins, and bacteria. The presence of an antigen will evoke the existence of an antibody.

Anti-hbc test - anti-Hepatitis B core test, one of the tests to identify persons who has been infected by Hepatitis B. This was suggested as a surrogate test for persons at high risk for AIDS before the discovery of a test for the HIV antibody.

Apheresis - a procedure in which blood is withdrawn from a donor, a portion is separated and retained (e.g., plasma or platelets), and the remainder is retransfused into the donor. This is used for blood donations of specific blood products.

ARC - AIDS-related complex. This term, which is no longer in use, refers to the non-specific symptoms evinced by HIV+ persons who are not yet suffering from disease AIDS. These symptoms include night sweats; persistent unexplained low grade fever; persistent weight loss; chronic diarrhoea; swelling in the neck, armpits or groin; thrush; and skin rashes.

Asymptomatic - showing no symptoms; used to refer to a person who is HIV+ but is not showing any signs of illness.

Autologous transfusions - transfusion with blood or blood products originating from the recipient.

AZT - azidothymidine, now called zidovudine; an inhibitor of in vitro replication of HIV, used as a medication for HIV+ persons and persons with AIDS.

Blood product - in the usage of the CRCS, a product produced from blood or plasma by fractionation, such as the coagulating factors, Factor VIII and Factor IX. The CRCS distinguishes between blood products and blood components which are derived from blood donations by simpler means than fractionation.

Blood components - components into which blood donations are separated by the CRCS, e.g., red cells, plasma, and cryoprecipitate. The CRCS distinguishes between blood components which it makes itself and blood products which are produced by the more complex process of fractionation.

Bypass surgery - use of a vein to bypass an obstruction or constriction in a coronary artery; the vein is removed from another part of the body and one end is grafted into the aorta and the other end is grafted into a coronary artery below the obstruction or constriction; the grafted vein then serves as a conduit from the aorta to the coronary artery beyond the point at which it is narrowed; a person may have double, triple, quadruple, and even quintuple bypass surgery depending on the number of obstructions to be bypassed.

Candida - the fungus that causes thrush.

CD4 cell - a receptor on the surface of T4 cells. It plays an important role in the cell‑mediated immune system. HIV infection begins when a protein on the HIV viral envelope binds tightly to a CD4 receptor and then enters and merges with the T4 cell. Damage to the immune system can be monitored by counting CD4 cells receptors. A normal CD4 count in between 500 and 1500 per microlitre. When a person's count falls below 200, the person becomes susceptible to opportunistic infections. According to the 1993 CDC classification, a CD4 count of 200 is the marker of AIDS, whether or not there is opportunistic infection.

Cell-mediated immunity system - one of the three major systems constituting the body's immunological defence. As part of this defence, macrophages, a type of cell widely distributed throughout the body, present antigens to T lymphocytes. This system becomes defective in persons infected with HIV because of the loss of T lymphocytes. The majority of the opportunistic infections contracted by persons with AIDS are those that are normally combatted by the cell-mediated immune system. The way to determine damage to this system is to count the T lymphocytes.

Clinically latent phase - with regard to HIV infection, the period after primary infection when the infected person feels perfectly well. This phase may last from 6 months to 15 years.

CMI - cell-mediated immunity.

CMV - cytomegalovirus.

Crohn's disease - an inflammation of the bowel frequently leading to intestinal obstruction, fistula and abscess formation.

Cross-matching test - a test to determine that a specific unit of blood or blood component is suitable for transfusion into a specific recipient. The test determines that the blood group and the antibodies in the donated blood are compatible to those of the recipient.

Cryoprecipitate (cryo) - a component of blood used to aid coagulation; a cold precipitable protein produced by freezing plasma obtained from whole blood donors and then thawing it; cryoprecipitate from several donors are pooled, and then the pooled cryoprecipitate is administered intravenously.

Cryptococcosis - a fungal infection which frequently causes meningitis but may also damage the liver, bone, skin and other tissues.

CUE - Confidential Unit Exclusion, a procedure which allowed a donor to designate that donated blood be used for research, rather than for transfusion. The donor would "confidentially" exclude the unit of blood donated if he was in a high risk group for HIV infection without having to publicly exclude himself from donating blood.

Cytomegalovirus - one of a group of herpes viruses that attack persons who are immunosuppressed, including persons with AIDS. For a time, some researchers thought that this was the cause of AIDS.

DDI - didanosine, a drug used in the treatment of AIDS.

Dementia - an organic mental disorder characterized by general loss of intellectual abilities, including memory judgment and abstract thinking, as well as changes in personality. Persons with AIDS may be afflicted with progressive dementia.

Direct questioning - a screening process for prospective blood donors that relies on asking direct questions about belonging to groups that were at high risk of contracting and transmitting AIDS.

ELISA test - enzyme linked immunosorbent assay test, an initial screening test for detecting HIV antibody. This test is not very accurate, so blood samples that are reactive are retested. Repeatedly reactive samples must be confirmed by a more sensitive test, such as Western blot.

Epidemiology - the study of the incidence and distribution of diseases for the purpose of control and prevention.

Etiology - the science and study of the causes of diseases.

Factor VIII - a protein found in blood, which aids in coagulation. Deficiency of this factor results in Hemophilia A. Produced from plasma by fractionation.

Factor IX - a protein found in blood, involved in blood coagulation. Deficiency of this factor results in Hemophilia B. Produced from plasma by fractionation.

Female cryoprecipitate - cryoprecipitate made exclusively from blood products collected from women.

Fractionation - the biochemical process of separating out certain blood components such as factor VII and factor IX from plasma.

Hematology - the medical specialty that deals with blood and blood-forming tissues.

Hemophilus (haemophilus) influenza - a cause of pneumonia that is rare in adults. It occurs in increased incidence in persons who are HIV+, as well as in high risk individuals with chronic pulmonary and cardiac disease. Alcohol abuse significantly increases the risk of H. influenzae in adults.

Hepatitis B - an infectious liver disease spread by a virus, which can be transmitted through blood, including blood transfusions, as well as through sexual contact; affects members of certain high risk groups for HIV/AIDS.

High risk groups - groups, members of which were at high risk of being infected with HIV; there was controversy as to whether blood collection organizations should exclude donations from members of high risk groups or from persons who engaged in high risk behaviour.

HIV - human immunodeficiency virus, the etiological agent responsible for the clinical disease AIDS. Initially, it usually produces no symptoms; but the interaction between HIV and the immune system leads to the destruction of the cell-mediated immune system. This removes the body's ability to fight against organisms that are ubiquitous in the environment. These organism then cause opportunistic infections; and, at that point, the HIV positive person is suffering from the clinical disease AIDS.

HIV+ - HIV antibody positive; a person who tests positive to the presence of HIV antibodies. It takes place up to one year before a person infected with HIV tests positive to the presence of the HIV antibody.

HTLV-III - Human T cell lymphotropic virus, type III, an early name for HIV

Humoral system - one of three major systems constituting the immunological defence of the human body. This system is controlled by B cells which produce antibodies. In persons who are HIV positive or are suffering from AIDS, the B cells become overactive in producing non-specific antibodies. This diminishes the system's ability to combat specific infections, such as hemophilus influenzae.

Immunocompromised - having the body's immune response attenuated.

Immunosuppressed - having the body's immune response attenuated or suppressed completely.

Incidence - the number of people in the entire population or some subset of the population who are HIV+ at any given time, expressed as a percentage.

Infarction - morbid conditions of tissue due to local ischemia resulting from obstruction of circulation to an area.

Ischemia - deficiency of blood supply to a part of the body due to constriction or obstruction of a blood vessel.

Ischemic heart disease - cardiac problem caused by deficiency of blood supply to the heart muscle.

Kaposi's sarcoma - cancer of the blood cells; a rare form of cancer which produces tumours in the skin and in the linings of internal organs; a non-specific symptom of HIV infection

Kit - a reagent used to test for the presence of a virus. For example, in the case of hepatitis B, there were three kits, one for testing for the surface antigen, the second for testing for an antibody to the surface of the virus, and a third for testing for an antibody to the core of the virus.

LAV - lymphocyte associated virus, a name originally used for HIV by researchers at the Pasteur Institute.

Lookback - the process of searching for recipients of blood donated before there was an HIV antibody test by a blood donor who on a subsequent donation was found to be HIV positive.

Lymphadenopathy - disease of the lymph nodes, characterized by fever, night sweats, weight loss and swollen lymph glands. The onset of chronic lymphadenopathy is an indicator of HIV infection.

Lymphocyte - white blood cell found in the blood, lymph and lymphoid tissues that are the body's immunologically competent cells and their precursors. They are divided into two classes, B and T lymphocytes, responsible for humoral and cellular immunity respectively.

Myocardial infarction - injury of heart muscle as a consequence of decreased blood supply; the result of acute occlusion of an artery without collateral circulation; characterized by prolonged chest pain that is unresponsive to nitroglycerin; popularly referred to as a heart attack.

Myocardial ischemia - decreased blood supply to the heart muscle.

Myocardial ischemic pain - sudden and severe pain in the lower part of the chest with a feeling of suffocation caused by lack of blood supply to heart muscle; if it is brief, intermittent, brought on by exertion or excitement, and relieved promptly by rest or nitroglycerin, it is referred to as angina pectoris.

Myocardium - the middle layer of the heart, consisting of cardiac muscle; the heart muscle.

Opportunistic infection - infection that occurs because the immune system has been suppressed or compromised. Antibiotics can be used to prevent some opportunistic infections.

PCP - pneumocystis carinii pneumonia.

Plasma - the colourless part of blood in which the corpuscles float.

Platelet - a disc-shaped structure found in blood which plays a role in damage control and healing in the event of injury to a blood vessel. Platelets accumulate in an area of injury plugging holes and releasing chemicals that encourage blood clotting. Platelets may, at times, act inappropriately, producing a blood clot where it is not required.

Pneumocystis carinii pneumonia (PCP) - the most common type of pneumonia affecting persons with AIDS; the result of a defect in the cell-mediated immunity system.

Primary infection - an infection characterized by symptoms of a vague clinical nature that shows that a person is reacting to the virus entering the body; in the case of HIV, the period of primary infection usually lasts from 3 to 20 days.

Seroconversion - development of detectable specific antibodies in the serum as a result of infection or immunization; with respect to HIV infection, the change in status of a person from HIV antibody negative to HIV antibody positive; at the time of seroconversion, people may get a primary infection; see antibody.

Seroprevalence - the proportion of total blood donors who test HIV positive at any given time, expressed as a percentage.

STD - sexually transmitted disease.

Stable angina - angina pectoris that occurs regularly as a result of a certain amount of exertion.

Surrogate test - before the availability of a test for the HIV antibody, testing for hepatitis B, a disease more prevalent in members of groups that were at high risk of being infected with HIV, as a way to screen out HIV infected donors. Hepatitis B would serve as a surrogate for HIV for which there was not yet a test.

Symptom specific questioning - questions designed to elicit a history of night sweats, unexplained fevers, unexpected weight loss, lymphadenopathy, or Kaposi's sarcoma as a way of screening out prospective blood donors who might be infected with HIV

T4 cells- T4 lymphocytes, a set of white blood cells that plays a crucial role in the body's immunological defence by activating or orchestrating other parts of the immune defence system. The loss of T4 cells seriously impairs the body's ability to fight most invaders, particularly viruses, fungi, parasites, and certain bacteria. HIV enters T4 cells, multiplies when the T4 cells are activated, and destroys the T4 cells, causing a general decline in the immune system. As HIV infection progresses, the T4 cell count (measured by CD4 cell count) decreases. A normal T4 count is about 800 per c.c. of blood. T4 lymphocytes are also called helper T cells.

T4 lymphocytes - T4 cells.

T helper cells - T4 cells.

Thrush - A fungal infection of the mucous membranes of the tongue or the oral cavity.

Traceback - where a blood recipient is found to be HIV+ and there seems to be no possible cause for the infection other than the blood received, the traceback process attempts to locate the donors of the blood to determine if any are HIV+.

TAA - transfusion-associated AIDS.

TRI - transfusion-related infection.

TRA - transfusion-related AIDS.

Unstable angina - angina pectoris that occurs when a person is at rest, i.e., a more severe form of angina than stable angina which is set off by exertion or excitement; this is usually an indication that a person's coronary artery disease is getting worse.

Viral (virus) load - the total number of virus particles in an infected human being.

Western blot - a laboratory testing method. A form of Western blot is reactive to HIV, and is used to confirm presence of HIV antibody as detected by ELISA. However, there has been considerable controversy in the medical literature about the correct interpretation of Western blot results.