Historical Primer on Obstetrics and Gynecology Health Inequities in America: A Narrative Review of Four Events.

Four historical events provide context for racial injustices and inequities in medicine in the United States today: the invention of race as a social construct, enslavement in the Americas, the legal doctrine of Partus sequitur ventrem, and the American eugenics movement. This narrative review demonstrates how these race-based systems resulted in stereotypes, myths, and biases against Black individuals that contribute to health inequities today. Education on the effect of slavery in current health care outcomes may prevent false explanations for inequities based on stereotypes and biases. These historical events validate the need for medicine to move away from practicing race-based medicine and instead aim to understand the intersectionality of sex, race, and other social constructs in affecting the health of patients today.

Saberes intactos, saberes en contacto. Una revisión feminista del significado del contacto en los debates contemporáneos sobre las relaciones clínicas / From “intact knowledge” to “knowledge in contact”. A feminist review of the meaning of “contact” in contemporary debates about clinical relationships

En la última década, profesionales de la biomedicina han propuesto varios modelos que parecen plantear un papel renovado y esperanzador para las y los pacientes en las relaciones clínicas. Se trata del modelo de paciente inteligente (“smart patient”) y de otras propuestas procedentes de corrientes humanizadoras de la medicina. En este artículo analizo críticamente el modelo del “smart patient” como un ensamblaje histórico contemporáneo que refleja una tendencia aparentemente positiva en la biomedicina: la revalorización del “contacto” entre profesionales y pacientes, y el fomento de la participación y educación de estas últimas para estar mejor informadas y digitalizadas. Sin embargo, ¿implica esta puesta en valor del contacto una transformación de los saberes expertos? Tomando como guía esta pregunta, en este artículo analizo los límites de los modelos emergentes, y aporto una relectura basada en la perspectiva del contacto. Para ello contrasto dichos modelos, que mantienen los saberes profesionales epistémicamente intactos, con el enfoque de dos trabajos clásicos de la antropología feminista, publicados hace dos décadas, y que abordan críticamente la llamada “Evidence-Based Obstetrics” (Obstetricia Basada en la Evidencia), poniéndolos en diálogo con lecturas fenomenológicas que trascienden una visión del cuerpo basada en el binomio generizado cuerpo / mente. El objetivo es abordar la clínica como una zona de contacto que hay que entender en contextos (g)locales específicos. Este análisis presenta un valor crítico para el presente pues permite argumentar a favor de encuentros ‒entre profesionales, pacientes y organizaciones‒ asentados sobre reequilibrios epistémicos; yendo más allá de modelos de relación que excluyen los conocimientos y experiencias de quienes padecen y con la finalidad de preservar intacto el papel único de los saberes biomédicos.(AU)

In the last decade, medical professionals have proposed an apparently renewed and hopeful role for patients in their relationship with professionals, namely the “smart patient” model and other proposals coming from humanizing medical trends. In this article, I critically analyze the “smart patient” model as a contemporary historical assemblage that reflects an apparent trend in biomedicine: the revaluation of “contact”, between professionals and patients, and the promotion of patient participation and education to be better informed. However, does this enhancement of contact implies, within the relationship, a transformation of the consideration of biomedical expert knowledge? To answer this question, I analyze the limits of emerging models, and I provide a rereading of the contact perspective. I contrast this perspective with the approach of two classic works of feminist anthropology, published two decades ago, and which critically address the so-called “Evidence-Based Obstetrics”. I will put these works into dialogue with phenomenological readings that transcend a vision of the body based on the gendered binary body / mind. These dialogues will allow me to delve into the proposal to analyze the clinic as a space for the creation of “contact zones” in specific (g)local contexts. This analysis has a critical value for the present. It will also allow me to argue in favor of encounters ‒between transdisciplinary professional teams, patients and organizations- that look for an epistemic rebalancing that embraces the experiential knowledge of those who suffer. These encounters I am proposing do not leave medical knowledge intact.(AU)

History of ultrasound in obstetrics and gynaecology from 1971 to 2021 on occasion of the 50 years anniversary of EFSUMB.

Diagnostic ultrasound in obstetrics and gynaecology has experienced a fantastic evolution during the past seven decades. Initial steps with A-mode technology were followed by B-mode and B-mode real-time imaging, then by Doppler and colour Doppler ultrasound, and finally by 3D/4D ultrasound. Other evolutionary steps were the development of high-resolution transabdominal and transvaginal transducers providing high quality images in the first, second and third trimesters of pregancy, as well as in gynaecology and breast imaging.The progression from two-dimensional (2D) to three-dimensional ultrasound (3D) and 3D real-time imaging (4D) has brought new options in displaying anatomical structures. In comparison with CT or MRI, it is not a static but functional technique, cheap and safe, and applicable at any time.

The Italian gynecology at the beginnings of the twentieth century: analysis of medical records from the Institute directed by Luigi Mangiagalli.

The history of the modern Italian gynecology is closely related to the figure of an enlightened clinician and passionate master, Luigi Mangiagalli (1850-1928), who, with good reason, can be considered one of the fathers of this discipline. In 1906, Mangiagalli founded the Obstetric-Gynecological Institute in Milan, directing this structure until 1925. The aim of this paper is to describe some aspects of Italian gynecology at the beginnings of the twentieth century through the analysis of 250 original medical records, dating back to the years 1906-1912, fragments of real life of women, midwives and doctors in a pioneering era of obstetrics and gynecology.

Parir en palacio: Obstetricia de las reinas españolas / Giving birth in the palace: Obstetrics of Spanish queens

El parto siempre ha sido un hecho muy importante en la vida de la mujer por el riesgo y repercusión social que entraña, pero si la parturienta es una reina, la trascendencia es enorme. Las soberanas, pese al riesgo que corrían tanto ellas como el vástago, tenían que parir hijos y cuantos más mejor. En este trance siempre han contado con la ayuda de matronas y comadres, aplicando para ello los conocimientos obstétricos clásicos [Fragmento de texto] (AU)

Vindicating a traduced genius: Ignaz Philipp Semmelweis (1818-1865).

Anglophone narratives of Semmelweis's discovery of the cause and prophylaxis of childbed (puerperal) fever are based on a deficient historical record because important information about what happened to Semmelweis in Vienna, Austria, is contained in primary documents that had never been translated into English until very recently. The gaps in these narratives have been filled with invented facts and causal attributions that traduce Semmelweis by berating his character, education, and writing proficiency to hold him solely responsible for the rejection of his theory by most of his contemporaries and to explain the most puzzling aspect of his life: why he did not publish the results of his groundbreaking research in a medical journal for 11 years. This article presents the historical evidence contained in these primary documents that were missing from previous narratives and that provide very rational and understandable explanations for Semmelweis's actions. It also presents evidence that flatly contradicts the claims that have been made about Semmelweis's character, education, and writing skills and offers a more veridical portrayal of what happened to Semmelweis in Vienna that caused him to leave the city and delay publishing his results.

From Embryotomy to Cesarean: Changes in Obstetric Operatory Techniques in Nineteenth- and Twentieth-Century Urban Brazil.

This article traces the historical processes by which Brazil became a world leader in cesarean sections. It demonstrates that physicians changed their position toward and use of different obstetric surgeries, in particular embryotomies and cesarean sections, over the course of the nineteenth and twentieth centuries. The authors demonstrate that Catholic obstetricians, building upon both advancements in cesarean section techniques and new civil legislation that gave some personhood to fetuses, began arguing that fetal life was on par with its maternal counterpart in the early twentieth century, a shift that had a lasting impact on obstetric practice for decades to come. In the second half of the twentieth century, cesarean sections proliferated in clinical practice, but abortions remained illegal. Most importantly, women remained patients to be worked on rather than active participants in their reproductive lives.

In Sickness and in Health: Expert Discussions on Abortion Indications, Risks, and Patient-Doctor Relationships in Postwar Poland.

This article analyzes expert debates relating to abortion in Poland between 1956 and 1993, a period when the procedure was legal and accessible. Through the pages of the primary Polish journal for gynecology and obstetrics, Ginekologia Polska, the author traces continuities and ruptures around three major intersecting themes: the procedure's indications, its (dis)connection to health, and the patient-doctor relationship. The journal became a forum showcasing interpretative tensions over indications for abortion and the malleability of the categories "therapeutic" and "social." In addition to these tensions, abortion was represented throughout this period as a potentially risky surgery, although this was initially nuanced with parallel representations of legal abortion combating maternal mortality. During the 1970s, abortion began to be linked to infertility, often in simplistic cause-and-effect terms. Simultaneously, opposition to abortion based on the idea of defense of the nation and fetal "life," surfaced in expert discourse.

#SayHerName: Should Obstetrics and Gynecology Reckon with the Legacy of JM Sims?

Dr. James Marion Sims has been heralded as the "father of modern gynecology" for his groundbreaking surgical technique to repair post-partum vesicovaginal fistulas (VVF); however, the ethical concerns around his inhumane practices and the contributions of the enslaved women he refined his technique on are rarely recognized. Acknowledging the personal sacrifice of the enslaved women and addressing the truth behind the immoral practices of Sims, encourages reconciliation of the race-based medical atrocities of the past and sets the tone for moral, more equitable medical care moving forward.

William Hunter's aristocratic post mortems.

William Hunter's writings, lectures and his collection of circa 1,400 pathological specimens at the University of Glasgow show that, within the scientific limitations of the 18th Century, he had a sound grasp of the significance of morbid anatomical appearances. Unlike John Hunter's collection at the Royal College of Surgeons of England, few of the Hunterian specimens at Glasgow have an accompanying case history. Within the Special Collections at the Glasgow University Library are a small number of post mortem reports, including four involving William Hunter's aristocratic patients. This article explores these patient cases, and also the only instance recorded by John Hunter of William working with him on a post mortem of an aristocrat, that of the Marquis of Rockingham, Prime Minister, who died in 1782. The study aims to better understand William Hunter's medical practice and his professional connections with other practitioners. The post mortem examinations were carried out by a surgeon/anatomist and observed by the patient's physician(s). For aristocratic post mortems, those attending were senior and well-established practitioners. The notes made were not particularly detailed. The reports show clearly that William Hunter's practice, in the 1760s at least, was not confined to midwifery.