History of obstetrics and perinatology

Subject and practical tasks of obstetrics

Obstetrics studies the anatomical, physiological, and pathological processes accompanying the origin and development of the human organism. The scientific aspect of the discipline investigates:

• Physiological and pathological mechanisms of conception;
• Intrauterine development of the embryo and fetus;
• Biomechanism of labor;
• The infant's transition to extrauterine life and the first 7 days of the neonatal period.

The practical side focuses on the management of normal pregnancy, timely detection of complications, development of surgical and therapeutic methods for delivery, and the formation of optimal obstetric tactics in pathologies.

Evolution of obstetric care: from the Ancient World to the Middle Ages

For centuries, obstetric care existed outside official medicine. Assistance was provided by female relatives of the laboring woman, midwives, or shamans. Views on the labor process ranged from active surgical interventions to complete fatalism ("God gave, God took away").

A notable contribution to the development of the subject was made by physicians of antiquity:

• Hippocrates (460–370 BC): believed that labor is provoked by fetal hunger, which prompts the fetus to make active movements and push off the uterine fundus with its feet. He recommended performing version by the head in breech presentation, manual removal of the placenta in case of its retention, and destructive operations in transverse lie.
• Ibn Sina (Avicenna, 980–1037): systematized methods of obstetric care, described footling extraction, fetal versions, and embryotomic operations.

Anatomical breakthrough of the 16th–18th centuries and the introduction of instruments

The 16th century marked a phase of active study of the anatomy of the female reproductive system:

1. Vesalius described the structure of the uterus, female pelvis, and hymen in greater detail.
2. Fallopius investigated the uterine tubes (oviducts), ovaries, and introduced the term "placenta".
3. Ambroise Paré reintroduced the technique of internal podalic version into surgical practice.

During the same period in France, Cesarean section began to be performed on living women. However, the lack of a technique for suturing the uterine wound led to high maternal mortality from massive hemorrhages and infections.

In the 17th and 18th centuries, Deventer described the forms of the contracted pelvis, while Baudelocque and Smellie developed pelvimetry (pelvic measurement) and described the mechanism of labor. An important breakthrough was the advent of obstetric forceps. The Chamberlen family kept the instrument secret for a long time, but in 1723 Palfyn published his model at the French Academy of Sciences. Subsequently, Russian, French, German, and English variants of forceps were created, differing in their locks and length.

Russian school of obstetrics and scientific discoveries of the 19th century

The foundation of the Russian obstetric school was laid by Nestor Maximovich Maximovich-Ambodik (the nickname "Ambodik" means "say twice"). His key achievements include:

• Compiling the first guide "The Art of Midwifery, or the Science of Midwife Affairs";
• Introducing the teaching of the discipline in the Russian language and organizing schools for midwives;
• The first practical application of obstetric forceps in Russia.

Starting from the 18th century, mass maternity hospitals for the poor with midwife schools began to open in Europe. In the 19th century, the development of natural sciences and Baer's discovery of the ovum allowed for a detailed study of the processes of fertilization, implantation, and embryogenesis, which formed the basis of modern perinatology.

Class and exam questions

What else to study on this topic

• Obstetric operations: technique of podalic and cephalic version
• Pelvimetry: methods of measuring the contracted pelvis according to Baudelocque and Smellie
• History of the improvement of Cesarean section technique and suture material
• Development of embryology in the 19th century: mechanisms of fertilization and implantation
• Evolution of obstetric forceps designs (Russian, French, German models)

Other topics in the "Obstetrics" section

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