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Essential Obstetrics and Gynaecology E-Book

Essential Obstetrics and Gynaecology E-Book

Ian M. Symonds | Sabaratnam Arulkumaran

(2013)

Additional Information

Book Details

Abstract

This is the fifth edition of a popular, highly readable primer in obstetrics and gynaecology. It has been thoroughly updated and reconfigured to key into the new undergraduate curriculum n O&G devised by the Royal College of Obstetrics and Gynaecology.

  • Highly illustrated throughout.
  • Essential information points at the end of chapters.
  • Case histories throughout.
  • Practical procedures boxes throughout.
  • Alert (warnings or advice) and tick (guidance or definitions) boxes throughout.
  • New editor: Professor Sabaratnam Arulkumaran.
  • Now a multi-authored text written by eminent experts from across the specialty.
  • Book entirely restructured to reflect the national undergraduate curriculum in obstetrics and gynaecology.
  • Two new appendices: Principles of Perioperative Care and Governance, Audit and Research.
  • Over 100 self-assessment MCQs at the end of the book.

Table of Contents

Section Title Page Action Price
Front cover cover
Half title page i
Dedication ii
Essential Obstetrics and Gynaecology iii
Copyright page iv
Preface to fifth edition v
Preface to fourth edition vi
Contributors vii
Table of Contents ix
1 Essential reproductive science 1
1 Anatomy of the female pelvis 3
The bony pelvis 3
The external genitalia 3
The internal genital organs 5
The vagina 5
The uterus 5
Supports and ligaments of the uterus 6
The Fallopian tubes 6
The ovaries 7
The blood supply to the pelvic organs 7
Internal iliac arteries 7
Anterior division 8
Posterior division 8
The ovarian vessels 8
The pelvic lymphatic system 8
Nerves of the pelvis 9
Somatic innervation 9
Autonomic innervation 9
The pelvic floor 9
The perineum 10
2 Conception and nidation 13
Oogenesis 13
Meiosis 13
Follicular development in the ovary 14
Hormonal events associated with ovulation 15
The action of gonadotrophins 16
The endometrial cycle 17
Production of sperm 18
Spermatogenesis 18
Structure of the spermatozoon 18
Seminal plasma 19
Fertilization 19
Sperm transport 19
Capacitation 19
Fertilization and implantation 19
The physiology of coitus 20
3 Physiological changes in pregnancy 23
Immunology of pregnancy 23
The uterus 24
The cervix 24
The isthmus 25
The corpus uteri 25
Uterine contractility 27
The development of myometrial activity 27
The vagina 28
The cardiovascular system 28
Cardiac position and size 28
Cardiac output 29
Total peripheral resistance 29
Arterial blood pressure 29
The blood 30
Erythrocytes 30
The white cells 30
Platelets 31
Clotting factors 31
Respiratory function 32
Renal function 33
Anatomy 33
Physiology 33
The alimentary system 34
Nutrients in blood 34
Maternal carbohydrate metabolism 34
Changes in plasma proteins 35
Amino acids 35
Lipids 35
Calcium 35
Maternal weight gain 35
Postpartum weight 36
The breasts 37
Breast development during pregnancy 37
The initiation of lactation 37
The skin 37
Endocrine changes 37
Placental hormones 38
The pituitary gland 38
Anatomy 38
Anterior pituitary 38
Posterior pituitary 38
Hypothalamus 38
The thyroid 38
The parathyroids 39
The renin–angiotensin system (RAS) 39
The adrenal gland 39
Conclusion 39
4 Placental and fetal growth and development 41
Early placental development 41
Further placental development 41
The villus 42
Structure of the umbilical cord 43
Uteroplacental blood flow 43
Factors that regulate fetoplacental and uterine blood flow 43
Placental transfer 44
Simple diffusion 44
Facilitated diffusion 44
Active transport 45
Pinocytosis 45
Transport of intact cells 45
Water and electrolyte transfer 45
Sodium 45
Potassium 45
Calcium 45
Placental function 45
Gaseous exchange 45
Oxygen transfer 45
Carbon dioxide transfer 45
Acid–base balance 46
Fetal nutrition and removal of waste products 46
Carbohydrate metabolism 46
Fat metabolism 46
Protein metabolism 46
Urea and ammonia 47
Placental hormone production 47
Protein hormones 47
Chorionic gonadotrophin 47
Human placental lactogen 47
Steroid hormones 47
Progesterone 47
Oestrogens 47
Corticosteroids 48
Corticotrophin-releasing hormone 48
Fetal development 48
Growth 48
The cardiovascular system 49
The respiratory system 50
The gastrointestinal tract 50
The kidney 50
The special senses 51
Amniotic fluid 51
Formation 51
Volume 51
Clinical significance of amniotic fluid volume 52
Oligohydramnios 52
Polyhydramnios 52
Clinical value of tests on amniotic fluid 52
Amniocentesis 52
Indications for amniocentesis 53
Chromosomal abnormalities and sex-linked diseases 53
Metabolic disorders 53
Estimation of fetal lung maturity 53
5 Perinatal and maternal mortality 55
Perinatal mortality 55
Introduction 55
Definitions 55
Mortality rates 56
Incidence 56
Sociodemographic factors and perinatal mortality 57
Maternal age 57
Deprivation 57
Ethnicity 57
Other maternal characteristics 57
Causes of stillbirths 58
Intrapartum stillbirth 58
Causes of neonatal deaths 58
Maternal mortality 59
Definition 59
Maternal mortality rates 59
Major causes of maternal death in the UK 60
2 Essential obstetrics 63
6 History taking and examination in obstetrics 65
Taking a relevant and comprehensive history 65
Obstetric history 65
History of present pregnancy 66
Symptoms of pregnancy 66
Pseudocyesis 67
Previous obstetric history 67
Previous medical history 67
Family history 67
Examination 68
General and systemic examination 68
Heart and lungs 68
Head and neck 68
Breasts 69
Abdomen 69
Limbs and skeletal changes 69
Pelvic examination 70
Assessment of the bony pelvis 70
The planes of the Pelvis 71
Plane of the pelvic inlet 71
Plane of greatest pelvic dimensions 71
Plane of least pelvic dimensions 72
Outlet of the pelvis 72
Obstetrical examination at subsequent routine visits 72
Abdominal palpation 73
Palpation of the uterine fundus 73
Measurement of symphysial–fundal height 73
Measurement of abdominal girth 73
Palpation of fetal parts 73
Lie 73
Presentation 74
Position 75
Station and engagement 75
Auscultation 75
7 Normal pregnancy and antenatal care 79
Aims and patterns of routine antenatal care 79
Preconceptual care and vitamin supplementation 80
The risk of substance abuse in pregnancy 80
Smoking 80
Alcohol intake 81
Illicit drug use 81
Changing demographics of pregnancy 82
The booking visit 82
Consideration of past obstetric history, including mode of delivery 82
Recommended routine screening tests 82
Haematological investigations 82
Blood group and antibodies 83
The use of anti-D immunoglobulin 83
Infection screening 83
Rubella 83
Syphilis 83
Non-specific tests 83
Specific tests 84
Hepatitis (see Chapter 9) 84
Human immunodeficiency virus 84
Group B Streptococcus 84
Urinary tract infection 84
Gestational diabetes 84
Screening for fetal anomaly 85
Nuchal translucency and biochemical screening 85
Schedules of routine antenatal care 85
Subsequent visits 85
Antenatal education 85
Dietary advice 85
Energy intake 86
Protein 86
Fats 86
Carbohydrates 86
Minerals and vitamins 87
Exercise in pregnancy 87
Coitus in pregnancy 87
Breast care 87
Social and cultural awareness 88
Safe prescribing in pregnancy 88
8 Obstetric disorders 89
Hypertensive disorders of pregnancy 89
Definitions 89
Classification 90
Pathogenesis and pathology of pre-eclampsia and eclampsia 90
The renal lesion 92
Placental pathology 92
Disseminated intravascular coagulation (DIC) 92
Other associations with pregnancy hypertension 93
The HELLP syndrome 93
Management of gestational hypertension and pre-eclampsia 93
Blood pressure measurement 93
Antihypertensive drug therapy 94
Maternal investigations 94
Laboratory investigations 94
Fetoplacental investigations 94
Prevention of pre-eclampsia 95
Symptoms of pre-eclampsia and eclampsia 95
Induction of labour 96
Complications 96
Eclampsia 96
Management of eclampsia 97
Control of fits 97
Control of blood pressure 97
Delivery of the infant 98
Management after delivery 98
Antepartum haemorrhage 98
Placenta praevia 99
Incidence 99
Aetiology 99
Classification 99
Symptoms and signs 100
Diagnosis 100
Clinical findings 100
Abdominal examination 100
Diagnostic procedures 100
Management 100
Abruptio placentae 101
Aetiology 101
Clinical types and presentation 102
Haemorrhage 102
Clinical assessment/differential diagnosis 103
Management 103
Complications 104
Afibrinogenaemia 104
Renal tubular or cortical necrosis 104
Other causes of antepartum haemorrhage 104
Vasa praevia 104
Unexplained antepartum haemorrhage 104
Vaginal infections 105
Cervical lesions 105
Multiple pregnancy 105
Prevalence 105
Types of twinning and determination of chorionicity 105
Monozygotic multiple pregnancy 105
Dizygotic twins 106
Complications of twin pregnancy 107
Complications unrelated to zygosity 107
Nausea and vomiting 107
Anaemia 107
Miscarriage 107
Antepartum haemorrhage 108
Pre-eclampsia 108
Intra-uterine growth restriction (IUGR) 108
Preterm labour 108
Complications related to zygosity 108
Twin-to-twin transfusion syndrome (TTTS) 108
Monoamniotic and conjoined twinning 108
Prenatal diagnosis 108
Management of twin pregnancy 109
Management of labour and delivery 109
Presentation at delivery 109
Method of delivery 109
Caesarean section 109
Vaginal delivery 109
Complications of labour 110
Locked twins 111
Conjoined twins 111
Perinatal mortality 111
Prolonged pregnancy 111
Aetiology 112
Management 112
Labour management 112
Breech presentation 112
Types of breech presentation 112
Causation and hazards of breech presentation 113
Management 113
Antenatal management 113
External cephalic version (ECV) 113
Indication 113
Contraindications 113
Technique 113
Complications 113
Method of delivery 114
Vaginal breech delivery 114
Technique 114
Caesarean section 115
Unstable lie, transverse lie and shoulder presentation 116
Complications 116
Management 116
9 Maternal medicine 119
Introduction 119
Minor complaints of pregnancy 119
Abdominal pain 120
Heartburn 120
Constipation 120
Backache 120
Syncope 121
Varicosities 121
Carpal tunnel syndrome 121
Pelvic girdle dysfunction (symphyseal pelvic dysfunction, SPD) 121
Medical problems arising in pregnancy 121
Anaemia 121
Aetiology 121
Risk factors 121
Clinical features and diagnosis 122
Implications on pregnancy 122
Management 122
Prophylaxis 122
Gestational diabetes 123
Aetiology 123
Risk factors 123
Clinical features and diagnosis 123
Implications on pregnancy 123
Management 124
Infections acquired in pregnancy 125
Risk factors 125
Implications on pregnancy and management 125
Chicken pox 125
Parvovirus B19 125
Influenza H1N1 125
Human Immunodeficiency Virus (HIV) Infection 125
Implications of pregnancy on the disease 126
Implications of the disease on pregnancy 126
Screening 126
Management 126
Acute viral hepatitis 126
Tuberculosis 127
Malaria 127
Acute pyelonephritis and urinary tract infections 127
Thromboembolic disease 128
Aetiology 128
Risk factors 128
Clinical features and diagnosis 128
Implications on pregnancy 128
Management 128
Liver disease 129
Obstetric cholestasis 129
3 Essential gynaecology 221
15 Basic clinical skills in gynaecology 223
History 223
The presenting complaint 224
Menstrual history 224
Previous gynaecological history 225
Previous medical history 225
Family and social history 225
Examination 225
Breast examination 225
Examination of the abdomen 225
Pelvic examination 226
Bimanual examination 228
Special circumstances 228
Rectal examination 229
Presenting your findings 229
16 Gynaecological disorders 233
Introduction 233
Benign conditions of the upper genital tract 233
The uterus 233
Symptoms and signs 233
Diagnosis and management 234
Surgical treatment 234
Endometrial polyps 235
Symptoms 235
Signs 235
Pathology 236
Treatment 236
Benign tumours of the myometrium 236
Histopathology 236
Pathological changes 236
Symptoms and signs 236
Management 237
Medical treatment 237
Uterine artery embolization (UAE) 237
Surgical treatment 237
Treatments in development 238
Adenomyosis 238
Symptoms and signs 238
Pathology 238
Treatment 238
Lesions of the ovary 238
Symptoms 238
Signs 239
Endometriosis 239
Pathophysiology 239
Diagnosis 241
Management 241
Abnormal uterine bleeding 241
Intermenstrual bleeding 241
Postcoital bleeding 242
Postmenopausal bleeding 242
Heavy menstrual bleeding 242
Causes 242
Structural 242
Non structural 243
History and examination 243
Investigations 243
Management 244
Medical treatment 244
Non-hormonal treatments 244
Hormonal treatments 244
Surgical treatment 244
Endometrial resection or ablation 244
Hysterectomy 245
Secondary amenorrhoea and oligomenorrhoea 245
Aetiology 245
Physiological 245
Pathological 246
Hypothalamic disorders 246
Pituitary disorders 246
Ovarian disorders 247
Ovarian failure 247
Polycystic ovary syndrome 247
Pathogenesis 247
Diagnosis 248
Uterine causes 248
Cryptomenorrhoea (literally ‘hidden menstruation’) 248
Investigations in women with amenorrhoea or oligomenorrhoea 248
Management 249
Dysmenorrhoea 249
Investigations 250
Management 250
Pharmacological 250
Premenstrual syndrome 250
Symptoms and signs 250
Pathogenesis 250
Management 251
Pharmacological 251
Disorders of puberty 251
Puberty and menarche 251
Thelarche 252
Adrenarche 252
Menarche 252
Growth spurt 252
Precocious puberty 253
Evaluation 253
Investigations 253
Appendices 357
Appendix A Principles of perioperative care 357
Preoperative care 357
Patient counselling and consent (see also Appendix C) 357
Preoperative assessment 357
Clinical history and examination 357
Investigations 357
Medications 358
Preoperative preparation 358
Management of anaemia 358
Antibiotic prophylaxis 358
Management of diabetes 358
Intraoperative complications 358
Regional and general anaesthesia 358
Local anaesthesia 358
Complications secondary to patient positioning 358
Acute compartment syndrome 358
Neurological injury 359
Haemorrhage 359
Ureteric and bladder injury 359
Gastrointestinal injury 360
Postoperative care 360
Analgesia 360
Fluid and electrolyte balance 360
Cardiovascular stability 360
Bladder care 360
Oral intake 361
Postoperative complications 361
Postoperative haemorrhage 361
Pyrexia 361
Surgical site infections 361
Treatment 361
Cardiovascular and respiratory complications 362
Venous thromboembolism 362
Discharge from hospital 362
Appendix B Governance, audit and research 363
Data collection in the national health service 363
Sources of data collection and computing systems 363
GP consultations and registrations 363
Registration of births and deaths 364
Hospital episode statistics (HES) 364
Mortality rates statistics 364
Morbidity rates statistics 364
Research and data linkage 364
Data Protection Act 364
Caldicott principles 364
Evidence-based healthcare 365
Clinical audit 365
Four steps of clinical audit 365
Defining best practice 365
Preparing to monitor 365
Monitoring your achievement 365
Planning for improvement 365
National clinical audits 366
Clinical guidelines 366
Research 366
Type of research studies 366
Descriptive studies 366
Analytical studies 367
Clinical trials 367
Clinical governance 368
Risk management 368
Clinical incident reporting 368
Conclusion 368
Appendix C Medicolegal aspects of obstetrics and gynaecology 369
Principles and legal issues around informed consent 369
Litigation in obstetrics and gynaecology 370
Patient confidentiality (including data protection) 372
The rules regarding abortion 373
The use of assisted reproduction in infertility care 373
The relevant legal status of the fetus, the pregnant woman, the child and the pubertal girl 374
The role of the doctor in child protection 374
Self-assessment: Questions 377
Chapter 1 377
Chapter 2 377
Chapter 3 378
Chapter 4 379
Chapter 5 379
Chapter 6 380
Chapter 7 380
Chapter 8 381
Chapter 9 381
Chapter 10 382
Chapter 11 382
Chapter 12 383
Chapter 13 384
Chapter 14 384
Chapter 15 385
Chapter 16 385
Chapter 17 386
Chapter 18 386
Chapter 19 387
Chapter 20 388
Chapter 21 388
Appendix A 389
Appendix B 389
Appendix C 390
Self-assessment: Answers 393
Chapter 1 393
Chapter 2 393
Chapter 3 394
Chapter 4 395
Chapter 5 395
Chapter 6 396
Chapter 7 397
Chapter 8 398
Chapter 9 399
Chapter 10 399
Chapter 11 399
Chapter 12 400
Chapter 13 401
Chapter 14 402
Chapter 15 402
Chapter 16 403
Chapter 17 403
Chapter 18 404
Chapter 19 404
Chapter 20 405
Chapter 21 405
Appendix A 406
Appendix B 406
Appendix C 407
Further reading 409
Chapter 2 409
Chapter 3 409
Chapter 4 409
Chapter 5 409
Chapter 6 410
Chapter 7 410
Chapter 8 410
Chapter 9 410
Chapter 10 411
Chapter 11 411
Chapter 12 412
Chapter 13 412
Chapter 14 412
Chapter 15 412
Chapter 16 412
Chapter 17 413
Chapter 18 413
Chapter 19 414
Chapter 20 414
Chapter 21 415
Appendix A 415
Appendix B 415
Appendix C 415
Further websites 415
Index 417
A 417
B 419
C 419
D 421
E 422
F 423
G 424
H 425
I 425
J 427
K 427
L 427
M 428
N 429
O 429
P 430
Q 433
R 433
S 434
T 435
U 436
V 436
W 437
Y 437
Z 437