Obstetrics and Gynecology - Sanfujinka

Japanese: 産婦人科 - さんふじんか

Obstetrics is a clinical specialty that combines obstetrics and gynecology. It is the name of a clinical department that deals with diseases related to pregnancy, childbirth, and the female genitals. Obstetrics is a branch of clinical medicine that deals with pregnancy and childbirth. In medical history, obstetrics was established early on by combining midwifery and surgical medicine, which were run by experienced women, with a focus on childbirth, a physiological phenomenon unique to women, and became independent from surgery. In 1752, the first obstetrics (Tokologie) (German) classroom was opened at the University of Göttingen. Gynecology has a long history as a branch of medicine that deals with the female genitals, but the elucidation of its complex physiology and pathology was delayed, and it took slightly longer than obstetrics and other disciplines to become a systematic science. In any case, however, it is a field of study that targets women, and particularly mature women of childbearing age. As genital abnormalities are likely to occur as a result of marriage, pregnancy, childbirth, and the puerperium, there are many cases where the field is called "obstetrics and gynecology" rather than simply "gynecology." On the other hand, matters related to pregnancy and childbirth are special, and historically, they have sometimes been separated into "maternity hospitals" or "obstetrics." In addition, perinatal medicine has attracted attention due to the recent expansion of the field, and some hospitals have established maternal and child science courses or have names such as comprehensive maternal and child medical centers. There have also been remarkable advances in medical care, such as the use of fetal monitoring devices to manage pregnant women, the treatment of infertility through in vitro fertilization, and the prevention of congenital abnormalities through genetic counseling. Below, we will briefly describe gynecological examinations and special testing methods.

[Masao Arai]

Interview

At the first consultation, the doctor will ask about (1) name, age, address, marital status and when, (2) genetic relationship and whether the spouse has a contagious disease (especially a sexually transmitted disease or tuberculosis), (3) age at menarche (first menstruation) or menopause, nature of menstrual cycle (regular or irregular), amount (including the presence or absence of blood clots), degree of menstrual symptoms, date and amount of most recent menstrual flow, date and progress of most recent delivery, whether or not there has been a miscarriage, premature birth, or full-term birth and how many times, whether or not there has been an abortion and how many times, whether or not you have breastfed and how long it has lasted, (4) whether or not you have had any previous genital or other diseases, (5) type, intensity, trigger, and time of onset of your chief complaint, whether or not you have been examined by another doctor, etc. It is useful to prepare notes in advance.

[Masao Arai]

consultation

Internal examination is unique to obstetrics and gynecology. The patient stands on the examination table and assumes a certain position that is most convenient for the doctor, and is often guided by a dedicated nurse. An internal examination is performed by using fingers and instruments to check the size, hardness, mobility, and presence of abnormalities of the uterus, fallopian tubes, and ovaries, as well as the presence or absence of sores in the vagina and utero-vaginal area, and the presence and nature of secretions and bleeding. First-time patients tend to tense their abdominal walls due to psychological effects such as anxiety, embarrassment, and fear. For this reason, care should be taken to eliminate the patient's anxiety and embarrassment as much as possible by placing a curtain between the doctor and patient so that they do not meet face to face, and the doctor himself should make an effort to give the patient a sense of security and trust. A speculum examination is performed during an internal examination. In other words, a speculum is used to open the vaginal opening and check the presence or absence of sores in the vagina and utero-vaginal area, and the presence and nature of secretions and bleeding. The above is a typical gynecological examination, but various special tests may be performed to further investigate the cause of the disease, such as the following:

[Masao Arai]

Special Testing Methods

(1) Vaginal microbial testing: Vaginal contents and cervical secretions are sampled and examined under a microscope for Trichomonas protozoa, Candida, Neisseria gonorrhoeae, and other pathogenic bacteria. Culture may also be used to confirm the presence of these pathogens.

(2) Cervical mucus test: This test examines the function of the ovaries by examining the characteristics of the mucus coming from the cervix.

(3) Menstrual blood culture to check for the presence of endometrial tuberculosis, which can cause infertility.

(4) Pap smear: A vaginal cell smear test used for early diagnosis of genital cancer.

(5) Colposcopy: A magnified visual examination of the surface of the cervix using a lighted magnifying glass to check for lesions closely related to cancer.

(6) Punch biopsy: A small piece of tissue is removed from the cervix for histopathological examination. The above (4), (5), and (6) are performed as detailed examinations for uterine cancer.

(7) Endometrial examination: In order to find out about the lesions in the endometrium, the endometrium is scraped and a tissue examination is performed. This can reveal whether there is uterine cancer, endometrial tuberculosis, and whether the ovarian function is good or bad.

(8) Pregnancy tests are used to check for the presence or absence of pregnancy, the prognosis of miscarriage, and to diagnose hydatidiform mole and choriocarcinoma by examining a hormone called chorionic gonadotropin secreted from the placenta. Usually, gonadotropin in urine is examined. Pregnancy tests can be performed either in an immunological method that can be done in a test tube or in a biological method in which a test rabbit is injected to check for the presence or absence of ovulation. In recent years, immunological methods that use radioisotopes to measure minute amounts of hormones have also been used.

(9) Fallopian tube patency methods These are methods to check whether the fallopian tubes are open or not. There are three methods: fallopian tube aeration, which is done by passing air through the fallopian tubes; fallopian tube water passage, which is done by passing water through the fallopian tubes; and hysterosalpingography, which involves taking X-rays by injecting an oil-based or water-based contrast agent. Hysterosalpingography is also used to diagnose tumors in the uterus and ovaries and to check for abnormalities in the cervical canal.

(10) Measurement of hormones in the blood and urine This is done to examine the amounts of various hormones and primarily to examine the function of the diencephalon-pituitary-ovarian axis.

(11) Ultrasound Examination There are various methods available, including the Doppler method, which can measure fetal blood flow during the third month of pregnancy, i.e., whether the fetus is viable, and the method to measure the size of the fetal head and diagnose the attachment site of the placenta, hydatidiform mole, and tumors.

(12) Laparoscopy: A long, thin endoscope with a light and lens at the tip is inserted into the abdominal cavity through the abdominal wall to observe lesions in the internal genital organs. One application of this method is tubal sterilization.

(13) Pelvic angiography: X-rays are taken by injecting a contrast agent into the arteries leading to the pelvic cavity to examine abnormalities in the organs of the pelvic cavity. This is an essential method for diagnosing uterine destructive hydatidiform mole and choriocarcinoma.

[Masao Arai]

"Principles of Obstetrics and Gynecology, revised edition (1997, Medical View Co., Ltd.)" ▽ "Progress of Obstetrics and Gynecology in the 20th Century, edited by Sato Kazuo (1999, Medical View Co., Ltd.)" ▽ "Clinical Compass of Obstetrics and Gynecology, revised edition (2000, Medical Review Co., Ltd.)" ▽ "Testing and Diagnosis Methods in Obstetrics and Gynecology, edited by Takeya Yuji (2001, Nakayama Shoten)"

Source: Shogakukan Encyclopedia Nipponica About Encyclopedia Nipponica Information | Legend

Japanese:

産科と婦人科が結合した臨床医学の専門分科の一つ。妊娠・分娩(ぶんべん)および女性性器に関係のある病気を取り扱う臨床科名である。産科学obstetricsは女性の妊娠と出産を対象とする臨床医学の一部門で、医学史上は、女性特有の生理的現象である出産を中心に、女性の経験者による助産部門と外科医学の一部が合体して早くから確立され、外科から独立した。1752年ゲッティンゲン大学で初めて産科学Tokologie（ドイツ語）の教室が開設されている。また婦人科学gynecologyは女性性器を対象とする医学の一部門として長い歴史をもつが、その複雑な生理と病理の解明が遅れ、体系づけられた科学としての成立は産科学などよりやや遅れた。しかし、いずれにしても女性を対象とする学問であり、とくに出産年齢に達した成熟女性を対象の中心に置いており、結婚・妊娠・分娩・産褥(さんじょく)などによって性器に異常をおこしやすいところから、単に「婦人科」とせずに「産婦人科」とする例が多くなった。一方、妊娠・分娩に関する事項は特殊であり、歴史的にも「産院」あるいは「産科」として別に独立させることがある。また、近年の学問的広がりから周産期医学が注目され、母子科学講座を設けたり、母子総合医療センターなどを表示するところも現れた。なお、分娩監視装置による妊婦管理をはじめ、体外受精による不妊症の治療、遺伝相談による先天性異常の予防など、診療面の進歩も著しい。以下、婦人科的診察および特殊検査法について簡単に述べる。

［新井正夫］

問診

初診の際に医師が尋ねる事項は、(1)姓名・年齢・住所、結婚の有無と時期、(2)遺伝的関係や配偶者の伝染性疾患（とくに性病や結核など）の有無、(3)初経（初潮）または閉経の年齢、月経周期の性状（順・不順）、量（凝血の有無を含む）、月経違和症状の程度、最近月経の時日と量など、また最近分娩の時日や分娩経過、流産・早産、満期産の有無とその回数、中絶手術の有無とその回数、授乳の有無とその持続、(4)これまでの性器または他の疾患の有無、(5)主訴の種類・強度・誘因・発現時期、他の医師による診察の有無、などについてである。あらかじめメモを用意しておくと便利である。

［新井正夫］

診察

産婦人科特有のものとして内診がある。患者は内診台にあがり、医師がもっとも診察しやすい一定の体位をとるが、これは専任の看護師が指導する場合が多い。内診は、手指や器具を用いて子宮・卵管・卵巣の大きさをはじめ、固さ、移動性、異常の有無を調べるほか、腟(ちつ)および子宮腟部のただれの有無、分泌物や出血の有無と性状などを検査することによって行われる。初めての患者は不安・羞恥(しゅうち)・恐怖などの心理作用から、腹壁を緊張させがちである。そのために医師と患者が直接顔をあわせないよう、カーテンをその間に設けたりして患者の不安や羞恥感をなるべく取り除くよう配慮し、医者自身も患者に安心感と信頼感を与えるように努めることが必要である。内診では腟鏡診を行う。すなわち、腟鏡を使って腟口を開き、腟・子宮腟部のただれの有無、分泌物・出血の有無、性状を検査する。以上が普通の婦人科的診察であるが、さらに病因を追究するためには次のような種々の特殊検査法が行われる。

［新井正夫］

特殊検査法

(1)腟内微生物検査　腟内容や頸管(けいかん)分泌物を採取して、トリコモナス原虫やカンジダ・淋(りん)菌そのほかの病原菌を顕微鏡で検査する。培養によって確かめることもある。

(2)頸管粘液検査　子宮頸管から出る粘液の性状を調べて卵巣の機能を検査する。

(3)月経血培養　不妊の原因となる子宮内膜結核の有無を調べる。

(4)パップ・スメア　性器癌(がん)の早期診断に応用される腟内細胞塗抹検査である。

(5)コルポスコピー　照明付きの拡大鏡により子宮腟部表面を拡大視診して癌と関連の深い病変を検査する。

(6)パンチ・バイオプシー　子宮腟部より小さな組織片を切り取り、病理組織検査をする。以上の(4)(5)(6)は子宮癌の精密検査として行われる。

(7)子宮内膜検査　子宮内膜の病変を知るために、内膜を掻爬(そうは)して組織検査をする。子宮体癌・子宮内膜結核、卵巣機能の良否がわかる。

(8)妊娠反応　胎盤から出る絨毛(じゅうもう)性ゴナドトロピンというホルモンを調べて妊娠の有無、流産の予後、胞状奇胎や絨毛上皮腫(しゅ)の診断に使う。普通、尿中のゴナドトロピンを調べる。妊娠反応は、試験管の中でできる免疫学的方法と、イエウサギに注射して排卵の有無を調べる生物学的方法とがある。近年はラジオ・アイソトープを使って微量のホルモンを測定する免疫学的方法も行われる。

(9)卵管疎通法　卵管が通っているかどうかを検査する方法で、空気を通してみる卵管通気法、水を通してみる卵管通水法、油性または水性の造影剤を入れてX線撮影する子宮卵管造影法がある。子宮卵管造影法は、子宮や卵巣の腫瘍(しゅよう)の診断や頸管の異常をみるためにも利用される。

(10)血中・尿中ホルモンの測定　各種ホルモンの量を調べ、おもに間脳‐下垂体‐卵巣系の働きを検査する。

(11)超音波検査　妊娠3か月の胎児血流、すなわち胎児の生存がわかるドップラー法と、児頭の大きさを計測したり、胎盤の付着部位や胞状奇胎、腫瘍の診断をするなど、いろいろな方法がある。

(12)腹腔(ふくくう)鏡検査　先端に照明とレンズのついた細長い内視鏡を腹壁より腹腔内に挿入し、内性器の病変を観察する方法である。応用として卵管不妊手術が可能である。

(13)骨盤脈管撮影　骨盤腔内に行く動脈に造影剤を入れてX線撮影し、骨盤腔の臓器の異常を調べる。とくに子宮の破壊性胞状奇胎や絨毛上皮腫の診断には不可欠の方法である。

［新井正夫］

『坂元正一・水野正彦・武谷雄二監修『プリンシプル産科婦人科学』改訂版（1997・メジカルビュー社）』▽『佐藤和雄編『産婦人科20世紀の歩み』（1999・メジカルビュー社）』▽『佐藤和雄監修『産婦人科臨床コンパス』改訂版（2000・メディカルレビュー社）』▽『武谷雄二総編集『産婦人科検査診断法』（2001・中山書店）』

[参照項目] | 外科 | 産院 | 子宮癌 | 出産 | 内診 | 妊娠

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