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Obstetrics and Gynaecology
Lawrence Impey, Tim Child
Verlag Wiley-Blackwell, 2016
ISBN 9781119010807 , 384 Seiten
5. Auflage
Format PDF, OL
Kopierschutz DRM
Geräte
Obstetrics & Gynaecology
5
Contents
7
Preface to the fifth edition
9
Preface to the first edition
9
Acknowledgements
11
List of abbreviations
12
About the companion website
15
Gynaecology
17
Chapter 1 The history and examination in gynaecology
19
The gynaecological history
19
Personal details
19
Presenting complaint(s)
19
Specific gynaecological questions
19
Other history
20
Other questions
20
Summarizing the history
21
The gynaecological examination
21
General examination
21
Breast and axillary examination
21
Abdominal examination
21
Vaginal examination
22
Rectal examination
23
Chapter 2 The menstrual cycle and its disorders
25
Physiology
25
Puberty
25
The menstrual cycle
25
Abnormal uterine bleeding (AUB)
26
Definition
26
Causes of AUB
26
Heavy menstrual bleeding (HMB)
28
Definition
28
Epidemiology
28
Aetiology
29
Clinical features
29
Investigations
29
Management
30
Irregular menstruation and intermenstrual bleeding
32
Epidemiology
32
Causes
32
Clinical features
32
Investigations
32
Management
32
Absent and infrequent menstrual bleeding (amenorrhoea and oligomenorrhoea)
33
Definitions
33
Classification of causes
33
Management
34
Postcoital bleeding
34
Definition
34
Aetiology
35
Management
35
Dysmenorrhoea
35
Causes and their management
35
Precocious puberty
35
Causes and their management
35
Ambiguous development and intersex
35
Increased androgen function in a genetic female
36
Reduced androgen function in a genetic male
36
Premenstrual syndrome
36
Epidemiology
36
Aetiology
36
Clinical features
36
Management
36
Further reading
37
Chapter 3 The uterus and its abnormalities
38
Anatomy and physiology of the uterus
38
Anatomy and function
38
Blood and lymph
38
The endometrium
39
Fibroids
39
Definition and epidemiology
39
Pathology and sites of fibroids
39
Pathology and sites of fibroids
39
Aetiology
39
Clinical features
39
Natural history/complications of fibroids
40
Fibroids and pregnancy
40
Hormone replacement therapy and fibroids
40
Investigations
40
Treatment
40
Adenomyosis
43
Definition and epidemiology
43
Pathology and aetiology
43
Clinical features
43
Investigations
43
Treatment
43
Other benign conditions of the uterus
43
Endometritis
43
Intrauterine polyps
43
Haematometra
44
Congenital uterine malformations
44
Endometrial carcinoma
44
Epidemiology
44
Pathology
45
Aetiology
45
Spread and staging
45
Investigations
46
Treatment
46
Prognosis
47
Uterine sarcomas
47
Further reading
47
Chapter 4 The cervix and its disorders
49
Anatomy and function of the cervix
49
Anatomy
49
Histology and the transformation zone
49
Blood supply and lymph drainage
49
Benign conditions of the cervix
49
Premalignant conditions of the cervix: cervical intraepithelial neoplasia
50
Definitions
50
Epidemiology
51
Aetiology
51
Pathology
51
Diagnosis: screening for cervical cancer
51
Treatment: prevention of invasive cervical cancer
53
Results and problems with screening for cervical cancer
53
Psychological aspects of cervical screening
53
Malignant disease of the cervix
53
Epidemiology
53
Pathology
53
Aetiology
54
Clinical features
54
Spread and staging
54
Investigations
54
Treatment of cervical malignancies
54
Prognosis
56
Further reading
56
Chapter 5 The ovary and its disorders
58
Anatomy and function of the ovaries
58
Ovarian symptoms
58
Ovarian cyst ‘accidents’
58
Disorders of ovarian function
58
Classification of ovarian tumours
59
Primary neoplasms
59
Secondary malignancies
60
Tumour-like conditions
60
Ovarian cancer
60
Epidemiology
60
Pathology (see classification of ovarian tumours)
61
Aetiology
61
Screening for ovarian cancer
61
Clinical features
61
Spread and staging
62
Investigations
62
Management of ovarian cancer
63
Follow-up and prognosis
64
Palliative care
65
Definition and aims
65
Organization of palliative care
65
Symptom control
65
Further reading
66
Chapter 6 Disorders of the vulva and vagina
67
Anatomy
67
Vulval symptoms
67
Miscellaneous benign disorders of the vulva and vagina
67
Lichen simplex (or chronic vulvaldermatitis)
67
Lichen planus
68
Lichen sclerosus
68
Vulvar dysaesthesia (vulvodynia) or the vulval pain syndromes
68
Infections of the vulva and vestibule
68
Bartholin’s gland cyst and abscess
69
Introital damage
69
Vaginal cysts
69
Vaginal adenosis
69
Premalignant disease of the vulva: vulval intraepithelial neoplasia
69
Carcinoma of the vulva
70
Epidemiology
70
Pathology
70
Aetiology
70
Clinical features
70
Spread and staging
70
Investigations
70
Treatment
70
Prognosis
71
Malignancies of the vagina
71
Further reading
71
Chapter 7 Prolapse of the uterus and vagina
73
Anatomy and physiology of the pelvic supports
73
Prolapse
73
Types of prolapse
73
Grading of prolapse
73
Epidemiology
74
Aetiology of prolapse
74
Clinical features
74
Investigations
76
Prevention
76
Management
76
Pessaries
76
Surgical treatment
76
Further reading
77
Chapter 8 Disorders of the urinary tract
78
Anatomy and function of the female lower urinary tract system
78
Neural control of the bladder and urethra
78
Continence
78
Micturition
78
Incontinence
78
Investigation of the urinary tract
79
Urinary stress incontinence
80
Definition
80
Epidemiology
80
Aetiology
80
Mechanism of incontinence
80
Clinical features
80
Investigations
81
Management
81
Overactive bladder
83
Definition
83
Epidemiology
83
Aetiology
83
Mechanism of incontinence
83
Clinical features
83
Investigations
83
Management
83
Other urinary disorders
84
‘Mixed’ USI and overactive bladder
84
Acute urinary retention
84
Chronic retention and urinary overflow
84
Painful bladder syndrome and interstitial cystitis
85
Fistulae
85
Further reading
85
Chapter 9 Endometriosis and chronic pelvic pain
86
Endometriosis
86
Definition and epidemiology
86
Pathology
86
Aetiology
86
Clinical features
86
Investigations
87
Management
88
Endometriosis and fertility
90
Chronic pelvic pain
90
Definition
90
Assessment and investigation
90
Possible causes of pain
90
Management
90
Further reading
90
Chapter 10 Genital tract infections
92
Infections of the vulva and vagina
92
Non-sexually transmitted infections
92
Sexually transmitted infections (STIs)
93
Infections of the uterus and pelvis
96
Endometritis
96
Acute pelvic infection and pelvic inflammatory disease
97
Chronic pelvic inflammatory disease
98
Vaginal discharge: causes and treatment
99
Further reading
99
Chapter 11 Fertility and subfertility
101
Definitions
101
Conditions for pregnancy
101
Counselling and support for the subfertile couple
101
Disorders of ovulation
101
Physiology of ovulation
101
Detection of ovulation
103
Causes of anovulation: polycystic ovary syndrome
103
Other causes of anovulation
105
Induction of ovulation
107
Male subfertility
108
Physiology of sperm production
108
Detection of adequate sperm production: semen analysis
108
Common causes of abnormal/absent sperm release
109
Investigations
109
Management of male factor subfertility
110
Disorders of fertilization
110
Physiology of fertilization
110
Causes of failure to fertilize: tubal damage
110
Other causes of failure to fertilize
111
Detection of tubal damage
111
Assisted conception
111
Intrauterine insemination (IUI)
112
Intracytoplasmic sperm injection (ICSI)
112
Oocyte donation
114
Preimplantation genetic diagnosis (PGD)
114
Surrogacy
114
Complications of assisted conception
115
Fertility preservation
115
Further reading
115
Chapter 12 Contraception
118
The ideal contraceptive
118
Efficacy of contraception
118
Safety of contraception
118
Compliance with contraception
118
Special patient groups
118
Hormonal contraception
119
Combined oral contraceptives
119
Other combined hormonal contraception
122
Progestogen-only pill (POP)
122
Long-acting reversible contraceptives (LARCs)
123
Progestogen-impregnated intrauterine system
123
Emergency contraception
123
The ‘morning-after pill’
123
Intrauterine device
124
Barrier contraception
124
Male condom
124
Female condom
124
Diaphragms and caps
124
Spermicides
124
Intrauterine contraceptive devices (‘the coil’)
124
Types of IUDs
124
Contraceptive efficacy
125
Indications
125
Complications
125
Advantages
126
Female sterilization
126
Contraceptive efficacy
126
Indications
126
Complications
127
Male sterilization
127
Male hormonal contraception
127
Natural contraception
127
Further reading
127
Chapter 13 The menopause andpostre productive health
130
Definitions
130
Postmenopausal bleeding
130
Definition
130
Causes
130
Management
130
Symptoms and consequences of the menopause
131
Cardiovascular disease
131
Vasomotor symptoms
132
Urogenital problems
132
Sexual problems
132
Osteoporosis
132
Investigations of the menopause
133
Follicle-stimulating hormone (FSH)
133
Anti-mullerian hormone
133
Other blood tests
133
Bone density estimation
133
Biochemical markers of bone metabolism
134
Treatment: hormone replacement therapy
134
Oestrogens
134
Progestogens
134
Tibolone
135
Androgens
135
Regimens of HRT
135
Benefits, risks and uncertainties of oestrogen-based HRT
135
Duration of therapy
136
Other treatments for the menopause
137
Non-oestrogen-based therapies
137
Alternative and complementary therapies
137
Further reading
137
Chapter 14 Disorders of early pregnancy
139
Physiology of early pregnancy
139
Spontaneous miscarriage
139
Definition and epidemiology
139
Types of miscarriage
139
Aetiology of sporadic miscarriage
140
Clinical features
140
Investigations
140
Management
141
Complications
142
Counselling after miscarriage
142
Recurrent miscarriage
142
Definition and epidemiology
142
Causes and their management
142
Unwanted pregnancy and therapeutic abortion
143
Definition
143
Methods of abortion
143
Complications of therapeutic abortion
144
Ectopic pregnancy
144
Definition and epidemiology
144
Pathology and sites of ectopic pregnancy
144
Aetiology
144
Clinical features
145
Investigations
145
Management
146
Complications
147
Hyperemesis gravidarum
147
Definition and epidemiology
147
Management
147
Gestational trophoblastic disease
147
Definitions, pathology and epidemiology
147
Clinical features
148
Investigations
148
Management and follow-up
148
Complications
148
Further reading
148
Chapter 15 Gynaecological operations
151
Endoscopy and endoscopic surgery
151
Diagnostic hysteroscopy
151
Hysteroscopic surgery
151
Diagnostic laparoscopy
151
Laparoscopic surgery
151
Hysterectomy
152
Types of hysterectomy
153
Other common gynaecological problems
153
Dilatation and curettage (D&C)
153
Evacuation of retained products of conception (ERPC)
153
Operations for cervical intraepithelial neoplasia
154
Operations for prolapse
154
Operations for urinary stress incontinence
154
Operations for fibroids
154
Precautions in major gynaecological surgery
155
Thromboembolism
155
Infection
155
Urinary tract
155
Further reading
155
Obstetrics
157
Chapter 16 The history and examination in obstetrics
159
The obstetric history
159
Personal details
159
Presenting complaint/present circumstances
159
History of present pregnancy
159
Past obstetric history
160
Other history
160
Other questions
161
The obstetric examination
161
General examination
161
Abdominal examination
162
Inspection
162
Palpation
162
Auscultation
164
Other features of relevance
164
The postnatal history andexamination
164
History
164
Examination
165
Basic neonatal assessment
166
Further reading
166
Chapter 17 Antenatal care
168
The aims of antenatal care
168
Preconceptual care and counselling
168
The booking visit
168
History
168
Examination
169
Booking visit investigations
169
Health promotion and advice
170
Routine later pregnancy tests
171
Ultrasound for structural abnormalities
171
Ultrasound screening for risk assessment
171
Other routine later pregnancy tests
171
Continuing antenatal care
171
Frequency of antenatal visits
171
Conduct of antenatal visits
172
‘Minor’ conditions of pregnancy
172
Further reading
173
Chapter 18 Congenital abnormalities and their identification
174
Screening and diagnostic tests
174
Terms describing screening tests
174
Performance of screening tests
175
Integration of risk factors
175
Methods of prenatal testing for congenital abnormalities
175
Maternal blood testing
175
Ultrasound
175
Fetal magnetic resonance imaging
176
3-D/4-D ultrasound
177
Invasive testing
177
Preimplantation genetic diagnosis
178
Chromosomal abnormalities
178
Down’s syndrome
178
Other chromosomal abnormalities
178
Deletions, translocations and ‘microarray’ abnormalities
178
Screening for chromosomal abnormalities
179
Diagnosis of chromosomal abnormalities
179
Structural abnormalities
179
Central nervous system abnormalities
179
Cardiac defects and fetal echocardiography
180
Abdominal wall defects
181
Chest defects
182
Gastrointestinal defects
182
Urogenital defects
182
Skeletal defects
182
Facial abnormalities
183
Fetal hydrops
183
Single gene disorders
184
Further reading
184
Chapter 19 Infections in pregnancy
187
Viruses
187
Cytomegalovirus
187
Herpes simplex
187
Herpes zoster
188
Rubella
188
Parvovirus
189
Hepatitis B
189
Hepatitis C
189
Human immunodeficiency virus
189
Influenza
191
ZIKA
191
Bacteria, parasites and others
191
Group A streptococcus
191
Group B streptococcus
191
Syphilis
192
Toxoplasmosis
192
Malaria
193
Listeriosis
193
Bacterial vaginosis
193
Other obstetric infections
193
Further reading
193
Chapter 20 Hypertensive disordersin pregnancy
196
Normal blood pressure changes in pregnancy
196
Classification of hypertensive disorders in pregnancy
196
Pregnancy-induced hypertension
196
Pre-existing or chronic hypertension
196
Pre-eclampsia
196
Definitions and classification
196
Pathophysiology
197
Classification and degrees of pre-eclampsia
198
Epidemiology
198
Aetiology
198
Clinical features
198
Complications of pre-eclampsia
199
Investigations
200
Screening and prevention
201
Management
201
Postnatal care of the pre-eclamptic patient
202
Pre-existing hypertension in pregnancy
203
Definitions and epidemiology
203
Aetiology
203
Clinical features
203
Complications
203
Investigations
203
Management
203
Further reading
203
Chapter 21 Other medical disorders in pregnancy
205
Diabetes and gestational diabetes
205
Physiology
205
Definition and epidemiology
205
Fetal complications
205
Maternal complications
206
Management of pre-existing diabetes in pregnancy
206
Preconceptual care for pre-existing diabetics
206
Monitoring and treating the diabetes
207
Monitoring or treating the complications of diabetes
207
Monitoring the fetus
207
Timing and mode of delivery
208
The neonate and puerperium
208
Detection of and screening for gestational diabetes
208
Management of gestational diabetes
208
Cardiac disease
209
Epidemiology
209
Principles of management
209
Types of cardiac disease and their management
209
Respiratory disease
210
Epilepsy
210
Management of epilepsy in pregnancy
210
Thyroid disease in pregnancy
210
Hypothyroidism
211
Hyperthyroidism
211
Postpartum thyroiditis
211
Liver disease
211
Acute fatty liver
211
Intrahepatic cholestasis of pregnancy
211
Renal disease
212
Chronic kidney disease
212
Urinary infection
212
Thrombophilias and the antiphospholipid syndrome
212
Antiphospholipid syndrome (APS)
212
Other prothrombotic disorders
213
Systemic lupus erythematosus
213
Venous thromboembolic disease
213
Management of VTE in pregnancy
214
Thromboprophylaxis
214
Obesity in pregnancy
215
Risks in pregnancy
215
Management of obesity in pregnancy
215
Mental illness in pregnancy
216
Bipolar affective disorder
216
Postpartum psychosis
216
Depression
216
Anxiety disorders
216
Schizophrenia
217
‘Recreational’ drugs in pregnancy
217
Illegal drugs
217
Legal drugs
217
Anaemias
218
Iron deficiency anaemia
218
Folic acid and vitamin B12 deficiency anaemia
218
Prophylaxis against anaemia
218
Influenza
219
Haemoglobinopathies
219
Sickle cell disease
219
Thalassaemias
219
Female genital mutilation (FGM)
220
Further reading
220
Chapter 22 Red blood cell isoimmunization
225
Definition
225
Pathophysiology
225
Blood groups
225
Sensitization
225
Haemolysis
225
Prevention: using anti-D
225
Epidemiology
226
Manifestations of Rhesus disease
226
Management of isoimmunization
227
Identification
227
Assessing severity of fetal anaemia
227
Treatment of fetal anaemia: in utero transfusion
227
Further reading
228
Chapter 23 Delivery before term
229
Definitions and epidemiology
229
Complications
229
Aetiology of spontaneous preterm labour
229
Prediction of preterm labour
230
Prevention of preterm labour
231
Clinical features
233
Investigations
233
Management
233
Preterm prelabour rupture of the membranes
234
Definition
234
Complications
234
Clinical features
234
Investigations
234
Management
235
Further reading
235
Chapter 24 Antepartum haemorrhage
237
Placenta praevia
237
Definitions and epidemiology
237
Classification
237
Aetiology
237
Complications
237
Clinical features
237
Investigations
238
Management
238
Placental abruption
239
Definition
239
Pathology
239
Complications
240
Aetiology
240
Clinical features
240
Investigations
240
Management
241
Other causes of antepartum haemorrhage
241
Bleeding of undetermined origin
241
Ruptured vasa praevia
241
Uterine rupture
242
Bleeding of gynaecological origin
242
Further reading
242
Chapter 25 Fetal growth, health and surveillance
244
Fetal health and growth: terminology
244
Small for gestational age (SGA)
244
Intrauterine/fetal growth restriction (IUGR or FGR)
244
Fetal distress
244
Fetal compromise
245
Fetal surveillance
245
Aims of fetal surveillance
245
Problems with fetal surveillance
245
Identification of pregnancy risk
245
Methods of fetal surveillance
247
Routine pregnancy care
247
Ultrasound assessment of fetal growth
247
Doppler waveforms of the umbilical artery
248
Doppler waveforms of the fetal cerebral circulation
249
Doppler waveforms of the fetal venous circulation
249
Cardiotocography or non-stress test
249
Kick chart
249
The small for gestational age fetus and the IUGR fetus
250
Epidemiology
250
Aetiology
250
Complications
251
Diagnosis
251
Management of IUGR
251
Stillbirth
252
Definition and epidemiology
252
Aetiology
252
Diagnosis
253
Prevention of stillbirth
253
Potentially beneficial routine interventions
253
Management of stillbirth
253
The prolonged pregnancy
253
Epidemiology and aetiology
253
Risks
254
Management
254
Further reading
254
Chapter 26 Abnormal lie and breech presentation
256
Abnormal (transverse and oblique) lie
256
Definitions and epidemiology
256
Aetiology
256
Complications
256
Management
256
Breech presentation
256
Definitions and epidemiology
256
Aetiology
257
Diagnosis
258
Complications
258
Management
258
Further reading
259
Chapter 27 Multiple pregnancy
261
Epidemiology
261
Types of multiple pregnancy
261
Aetiology
261
Diagnosis
261
Maternal complications
261
Fetal antenatal complications
261
Antepartum management
265
Intrapartum management
266
Further reading
267
Chapter 28 Labour 1: Mechanism – anatomy and physiology
269
Mechanical factors of labour
269
The powers
269
The passage
269
The passenger
270
Cervical dilatation: the ‘stages’ of labour
272
Initiation and diagnosis of labour
272
The first stage
273
The second stage
274
Delivery
274
The third stage
274
Perineal trauma
274
Further reading
274
Chapter 29 Labour 2: Management
276
General care of the woman in labour
276
Physical health in labour
276
Mental health in labour
277
Progress in labour: problems and their treatment
277
Monitoring progress: the partogram
277
The powers
277
The passenger
279
The passage
281
The cervix
282
Care of the fetus
282
Fetal distress and hypoxia
282
Other causes of fetal damage and their treatment
286
Care of the mother
286
Pain relief in labour
287
Anaesthesia for obstetric procedures
288
Conduct of labour
288
Initiation and diagnosis of labour
288
First stage of labour
289
Second stage of labour
290
Third stage of labour
290
Perineal repair
291
Different approaches to delivery
292
Natural approaches to labour
292
Further reading
293
Chapter 30 Labour 3: Special circumstances
295
Induction of labour
295
Methods of induction
295
Induction with prostaglandins
295
Induction with amniotomy ± oxytocin
295
Natural induction
295
Indications for induction
295
Contraindications
296
Management of induced labour
296
Complications
296
Labour/vaginal birth after a previous caesarean section
297
Contraindications
297
Factors influencing vaginal delivery after one caesarean section
297
Safety of vaginal delivery after caesarean section
297
Management of labour after a caesarean section
298
Prelabour, term rupture of theme mbranes
298
Diagnosis of prelabour term rupture of the membranes
298
Risks of prelabour term rupture of the membranes
298
Management
298
Further reading
298
Chapter 31 Instrumental and operative delivery
300
Forceps or ventouse delivery
300
Ventouse
300
Obstetric forceps
300
Safety of ventouse and forceps
300
Indications for instrumental vaginal delivery
301
Prevention of instrumental vaginal delivery
301
Types of instrumental vaginal delivery
301
Low-cavity delivery
302
Mid-cavity delivery
302
Prerequisites for instrumental vaginal delivery
302
Failure of instrumental vaginal delivery
303
Caesarean section
303
Indications
303
Safety and complications of caesarean section
304
Further reading
305
Chapter 32 Obstetric emergencies
307
Shoulder dystocia
307
Definition and consequences
307
Risk factors and prevention
307
Management
307
Cord prolapse
307
Definition and consequences
307
Risk factors and prevention
307
Management
308
Amniotic fluid embolism
308
Definition and consequences
308
Risk factors
308
Management
308
Uterine rupture
308
Definition and consequences
308
Risk factors and prevention
309
Management
309
Other obstetric emergencies
309
Uterine inversion
309
Epileptiform seizures
309
Local anaesthetic toxicity
310
Massive antepartum haemorrhage
310
Massive postpartum haemorrhage
310
Pulmonary embolus
310
Further reading
310
Chapter 33 The puerperium
311
Physiological changes in thepuerperium
311
The genital tract
311
The cardiovascular system
311
The urinary tract
311
The blood
311
General postnatal care
311
Lactation
312
Physiology
312
Management
312
Primary postpartum haemorrhage
312
Definition and epidemiology
312
Aetiology
313
Prevention
313
Clinical features
313
Management
313
Other problems of the puerperium
314
Secondary PPH
314
Postpartum pyrexia
314
Thromboembolic disease
314
Psychiatric problems of the puerperium
315
Hypertensive complications
315
The urinary tract
315
Perineal trauma
316
Bowel problems
316
Further reading
316
Chapter 34 Birth statistics and audit
318
Audit
318
Perinatal mortality
318
Definitions and terms in the UK
318
Perinatal mortality rate
318
Risk factors for perinatal mortality
318
Causes of perinatal mortality
318
Maternal mortality
319
Definitions
319
Maternal death rate
319
Factors affecting maternal death rates
320
Causes of maternal mortality
321
Intervention in pregnancy and labour
321
Reasons why the caesarean rate is high
322
Further reading
322
Chapter 35 Legal (UK) and ethical issues in obstetrics and gynaecology
324
Consent
324
Consent to procedures
324
Refusal of medical treatment
324
Consent by children
324
Clinical negligence
325
Negligence claims in the UK
325
Avoiding litigation
325
Clinical governance
326
Risk management
327
Complaints procedure
327
Confidentiality
327
Regulation of fertility treatment
327
Reducing multiple births
327
Embryo testing
327
Embryo research
327
Regulation of abortion
327
Some ethical issues in obstetrics and gynaecology
328
Is there a right to have children?
328
Choosing embryos
328
Abortion
328
Further reading
329
Gynaecology management
331
Obstetric management
345
Appendix 1
361
Appendix 2
365
Index
367
EULA
379
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