Pregnancy Glossary

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• afterbirth - another name for the placenta (the organ that forms in the uterus during pregnancy) and supplies oxygen and nutrients for the baby and removes waste products). It is delivered from the uterus after delivery of the baby.

• alpha-fetoprotein test (AFP) - AFP is a protein produced by the liver of the baby, and a certain amount of it normally goes into the amniotic fluid around the baby, and into the maternal bloodstream. There are normal expected values for AFP in maternal blood and amniotic fluid. The blood test is drawn from the pregnant woman at 15-18 weeks, and can be drawn from amniotic fluid after 15 weeks. If levels are elevated in the maternal blood it can represent a baby with a spinal or abdominal wall defect, or other problem. If levels are too low, it can represent a baby with a chromosomal problem like down syndrome. Further testing with detailed ultrasound and amnioscentesis would be offered, and many times all is well, and it's just a false positive. AFP is usually used with three other markers drawn from the blood at 15-18 weeks for even more accuracy- this is called the midtrimester quadruple screen. If maternal serum AFP is elevated and all of the testing (ultrasound and amnio) are normal, there is still an increased risk for maternal and fetal problems in pregnancy, and the pregnancy will need to be followed more closely, especially in the last trimester.

• Amniocentesis - removal of amniotic fluid with a needle. Can be done second trimester to rule out chromosomal abnormality or spinal cord defect. Can be done in the third trimester to check if the baby's lungs are mature, and can be tested at any time if a clinical suspicion arises to see if there is an infection in the amniotic fluid. You can also tell the sex of the baby with amnioscenteisis by growing the chromosomes, which takes about 2 weeks to get results.

• Amniotic fluid - a liquid that surround the developing fetus that the baby moves around in. It is made up predominantly of fetal urine, and the fetus is always swallowing and excreting the amniotic fluid. It is the liquid we remove from the abdomen of the mother at an amnioscentesis. When the water breaks what comes out is amniotic fluid. The color should be straw colored. If it is green it is called meconium (the baby has a bowel movement in utero) and this can have implications in labor.

• Amniotic Sac - the amniotic membrane that surrounds the amniotic fluid and baby. It lies within the uterus, and is thin and transparent. When it is broken (either spontaneously or artifically with a hook) the amniotic fluid leaks out.

• Apgar scoring system - Virginia Apgar, a pediatrician, invented the Apgar scoring system to assess the status of a newborn baby at 1 and 5 minutes of birth, to see if any immediate medical intervention is needed. Maximum score is 10/10. 0, 1, or 2 points is assigned to each of 5 categories- breathing, tone, color, heartrate, and response to stimulation. If the first number is less than 7, a medical intervention is necessary.

• Braxton Hicks contractions - Practice contractions of the uterus that most often occur in the third trimester (earlier in women who have had babies in the past). They can cause discomfort, but are usually short lived, occur less than 6 times in an hour, and don't cause the cervix to dilate. Can be hard to differentiate from early labor or preterm labor, so if you're not sure and you're premature, call your doctor.

• breech birth - when the baby does not come into the birth canal in the typical position (head down)- the breech baby comes into the pelvis with the feet or buttocks presenting first. Breech position is normal in the second and early third trimester, however, by 36 or 37 weeks, most babies are head down. If not, we can try to turn the baby (a version). Years ago doctors commonly delivered breech babies vaginally, however, there are more risks to the mother and baby, and today, most breech babies that are not turned, are delivered by c-section. There are different types of breeches- a frank breech presents with the buttocks first, the complete breech sits cross legged, the footling breech presents with the feet first.