Obstetrics and Gynecology - A.M. Hromova 2000

Introduction

Obstetrics and gynecology are two closely interrelated clinical specialties.

Obstetrics (from the French accoucher – to give birth) is a medical discipline that encompasses knowledge regarding female reproductive function and provides rational care during normal and pathological courses of Pregnancy, childbirth, and the postpartum period. An essential component of obstetrics is preventative care aimed at averting pathological processes arising during pregnancy.

Gynecology (the science of women, from the Greek gyne – woman and logos – science) is a medical discipline dedicated to studying the physiological activity of the FEMALE REPRODUCTIVE Organs and their associated pathological conditions, as well as the Prevention and Treatment of genital disorders.

Obstetrics is the most ancient branch of medicine, whereas gynecology emerged as a distinct medical discipline in the mid-19th century. Today, Ukraine features a comprehensive network of preventive and therapeutic healthcare facilities dedicated to maternal and child welfare. These include women's and children's health clinics, obstetric and gynecological inpatient units, nurseries, kindergartens, pediatric outpatient clinics, and hospitals.

The Study of obstetrics is an essential component of modern medical training, including for dental students.

One of the pioneering Russian physicians to recognize The connection between obstetrics and dentistry was N.M. Maximovich-Ambodik (1744–1812), the founder of native obstetrics and a native of the village of Vepryk in Poltava Governorate. In his treatise The Art of Midwifery, or the Science of Women's Affairs (1784–1786), N.M. Maximovich-Ambodik also addressed various dental issues, offering numerous practical recommendations on pediatric oral hygiene and describing dental and oral mucosal diseases.

Today, scientifically substantiated antenatal prevention of dental diseases is well established. It is known that specific Stages of the antenatal period correspond to the formation and mineralization of different groups of primary Teeth. Radiographic studies have demonstrated that at 18–19 weeks of gestation, mineralization begins at the cutting edge of the canine and the mesiobuccal cusps of the first molars. At 24–25 weeks of pregnancy, mineralization of the incisors continues, the cutting edge of the canine becomes almost completely calcified, mineralization of the buccal cusps of the first molar proceeds, areas of calcification appear on the linguomesial cusps, signs of initial mineralization emerge on the buccomesial cusp of the second molar, and the follicle of the first permanent molar begins to outline. At 26 weeks of gestation, mineralization of the incisors and canines continues; the buccal cusps of the first molars almost merge, initial signs of mineralization of the apex of the distobuccal cusp of the second molar are visualized, and the follicle of the sixth tooth enlarges. At 32 weeks of gestation, mineralization of the incisors and canines progresses. The buccal cusps of the first molars merge, and the apex of the mediolingual cusp of the second molar appears. At 36 weeks of gestation, all surfaces of the incisors (except the cervical region) are calcified, the buccal cusps of the first molars have fully merged, the lingual cusps of the first primary molars are more clearly delineated, and the mineralization process extends to the proximal surface of the first primary molar. Mineralization of the distolingual cusp of the second molar proceeds more intensively. The cervical region of the incisors, the vestibular, cervical, and proximal surfaces of the canines, the lingual surface of the first primary molar, the bulk of the crown of the first permanent tooth, and the fissures of all primary teeth are formed after the child's birth.

Pathology of the primary incisors is isolated from that of the molars. It occurs when a pathological factor affects the developing tooth bud prior to 17 weeks of gestation. Pathological conditions influencing primary tooth formation after 17 weeks of pregnancy induce developmental defects exclusively in the primary molars.

A pathological course of pregnancy (gestational toxicosis, maternal-fetal isoantigenic incompatibility, threatened Miscarriage) and extragenital diseases in pregnant women adversely affect The Development of the fetus's Oral Cavity and teeth. In healthy pregnant women under optimal conditions for fetal development, tooth formation proceeds more rapidly, calcification of the dental Tissues of the primary incisors is superior, whereas in women with toxicosis and extragenital disorders, the Development of the fetus's primary teeth is delayed, and tissue mineralization is significantly slowed down.

Disruptions in embryonic development concerning tooth buds manifest as Various Forms of hard tissue hypoplasia. This condition involves the degeneration or destruction of ameloblasts. Their inadequate, delayed, and sometimes distorted function impairs protein matrix formation and mineralization in primary teeth. Numerous studies have confirmed that the resistance of primary teeth to caries is influenced by Carbohydrate METABOLISM disorders observed in women with Diabetes Mellitus, or arising from thyroid dysfunction, psychological trauma, viral infections, or chronic Hypoxia. The degree of enamel mineralization and mineral saturation in primary teeth is significantly lower in preterm infants than in full-term newborns.

It is known that facial and jaw developmental anomalies, such as clefts, primarily manifest During the first three trimester months of pregnancy. During the first two months of intrauterine development, cysts and fistulas of the parotid region and neck may form. Maternal illness during these periods can lead to similar embryopathies. Defects arising later are primarily the consequence of the damaging effects of both endogenous factors (elevated serum levels of bilirubin and creatinine, presence of acetone) and

exogenous factors (medication intake, exposure to ionizing radiation and electromagnetic fields). These include Skull deformities, and underdevelopment of the nasal and ear cartilages.

Prevention of dentofacial pathology should begin during the antenatal period at the antenatal clinic through the promotion of maternal health. The objective of prevention during this phase is to eliminate occupational hazards, establish an appropriate daily routine and nutritional regimen for the woman, treat infectious diseases, and prevent and manage gestational toxicosis. Upon referral from the antenatal clinic, the dentist must place women exhibiting signs of congenital pathology (cleft lip and palate, congenital syndromes, etc.) under observation and ensure comprehensive dental clearance (sanation) for all pregnant women. It is crucial to determine whether a history of dentofacial pathology exists in the parents, as anomalies such as tooth agenesis, diastema, deep bite, and prognathic bite are hereditary. Thus, a need arises for close collaboration between the dentist and the obstetrician-gynecologist, and ideally, a clinical geneticist.