Additional Information
Book Details
Abstract
Shaw's Textbook of Gynaecology, one of the best-selling gynaecological textbooks of all time, has maintained its popularity with teachers, examiners and students. It is now in its 79th year of publication. The organization of content in this book is such that it provides the reader with a logical sequence of events that aid learning.
The main objective of this best-selling title is to meet the needs of undergraduate medical students and those preparing for postgraduate medical entrance examinations. This book will also be useful for nursing and physiotherapy students.
Salient Features
- Extensively revised and updated to incorporate the latest changes and development of newer concepts
- Systematic presentation to make reading smooth and pleasurable by deleting redundant details, adding new tests, figures and tables, and improving the earlier figures
- Provides the current methodologies and standard techniques
- Attempts to reduce the in-depth explanations by giving the subject matter in pointwise form for some important topics
Inclusion of self-assessment and suggested reading at the end of each chapter
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | Cover | ||
| Front matter | i | ||
| Copyright | iv | ||
| Dedication | v | ||
| Preface to the 16th edition | vii | ||
| Acknowledgements | viii | ||
| Preface to the 10th edition | ix | ||
| Table of contents | xi | ||
| 1 Anatomy | 1 | ||
| The vulva | 1 | ||
| Labia majora | 1 | ||
| Bartholin’s gland | 1 | ||
| Labia minora | 2 | ||
| The vagina | 3 | ||
| Relations of vagina | 5 | ||
| Anterior relation | 5 | ||
| Posterior relations | 5 | ||
| Lateral relations | 5 | ||
| Superior relations | 5 | ||
| The uterus | 6 | ||
| Perimetrium | 6 | ||
| Myometrium | 7 | ||
| Endometrium | 7 | ||
| Position of the uterus | 8 | ||
| The uterine appendages | 8 | ||
| Fallopian tubes | 10 | ||
| The ovaries | 11 | ||
| The urethra | 12 | ||
| Relations | 12 | ||
| The bladder | 12 | ||
| Nerve supply | 13 | ||
| The ureter | 13 | ||
| The rectum and anal canal | 14 | ||
| The lymphatics | 14 | ||
| Breasts | 14 | ||
| The pelvic musculature | 14 | ||
| Pelvic diaphragm | 15 | ||
| Urogenital diaphragm | 15 | ||
| Superficial muscles | 16 | ||
| The pelvic cellular tissue | 16 | ||
| The pelvic blood vessels | 18 | ||
| The vaginal arteries | 19 | ||
| The arteries of the vulva and perineum | 20 | ||
| The pelvic veins | 20 | ||
| The lymphatic system | 20 | ||
| The lymphatic glands or nodes | 20 | ||
| The inguinal glands | 20 | ||
| The glands of the parametrium | 20 | ||
| External iliac glands | 21 | ||
| Common iliac glands | 21 | ||
| The sacral group | 21 | ||
| The lumbar group of glands | 21 | ||
| The nerve supply | 21 | ||
| Applied anatomy and its clinical significance | 22 | ||
| Self-assessment | 24 | ||
| Suggested reading | 24 | ||
| 2 Normal histology | 25 | ||
| The ovary of the newborn | 25 | ||
| The primordial follicle | 25 | ||
| The graafian follicle (figure 2.2) | 26 | ||
| The fate of the graafian follicle | 27 | ||
| Ovulation | 28 | ||
| Corpus luteum (figure 2.7a and b) | 28 | ||
| Menstruation | 29 | ||
| Corpus luteum of pregnancy | 29 | ||
| The endometrium of the uterus | 29 | ||
| The proliferative phase | 30 | ||
| The secretory phase | 30 | ||
| The menstruating endometrium | 31 | ||
| Regeneration | 33 | ||
| Endometrium | 33 | ||
| The decidua of pregnancy | 33 | ||
| Ectopic decidual cells | 33 | ||
| Vaginal epithelium | 34 | ||
| Ovarian function | 34 | ||
| Pregnancy | 34 | ||
| Menopausal endometrium | 34 | ||
| Cervical mucus | 34 | ||
| Process of fertilization | 35 | ||
| Testis | 35 | ||
| Self-assessment | 35 | ||
| Suggested reading | 36 | ||
| 3 Physiology | 37 | ||
| Hypothalamus | 37 | ||
| Pituitary gland (adenohypophysis) | 39 | ||
| Follicle-stimulating hormone | 39 | ||
| Luteinizing hormone | 39 | ||
| Human chorionic gonadotropin (hcg) | 40 | ||
| Prolactin | 40 | ||
| Posterior pituitary gland (neurohypophysis) | 40 | ||
| Oxytocin | 40 | ||
| Vasopressin | 40 | ||
| Ovarian steroidogenesis | 40 | ||
| Oestrogen | 40 | ||
| Actions of oestrogens (figure 3.4) | 41 | ||
| Progesterone | 42 | ||
| Actions of progesterones | 42 | ||
| Side effects | 43 | ||
| Relaxin | 43 | ||
| Inhibin | 43 | ||
| Activin | 43 | ||
| Anti-müllerian hormone (amh) | 43 | ||
| Sex hormone-binding proteins | 43 | ||
| Testosterone | 43 | ||
| Physiology of menstruation | 44 | ||
| Feedback mechanism in the h–p–o axis | 47 | ||
| Leptin | 47 | ||
| Menstruation | 47 | ||
| Menstrual fluid in ‘stem cell’ therapy | 48 | ||
| Self-assessment | 49 | ||
| Suggested reading | 49 | ||
| 4 Puberty, paediatric and adolescent gynaecology | 51 | ||
| Introduction | 51 | ||
| Reproductive endocrinology of the growing girl child | 51 | ||
| The newborn female infant | 52 | ||
| The growing girl child | 53 | ||
| Common paediatric gynaecologic problems | 53 | ||
| Puberty and adolescence | 55 | ||
| Biological sequential events observed during puberty | 55 | ||
| Factors affecting time of onset of puberty | 56 | ||
| Physical growth and body weight | 56 | ||
| Secondary sex characters (ssc)—tanner classification of the sequence of development | 56 | ||
| Thelarche | 56 | ||
| Adrenarche | 58 | ||
| Pubic hair development | 58 | ||
| Axillary hair development | 58 | ||
| Genital organs: | 58 | ||
| Menarche | 58 | ||
| Skeletal age | 58 | ||
| Management | 58 | ||
| Puberty—anomalies of gonadal function | 58 | ||
| Adolescent contraception | 60 | ||
| Miscellaneous problems | 61 | ||
| Development and growth in a male | 61 | ||
| Structure of the sperm (figure 4.7) | 61 | ||
| Endocrine control (figure 4.9) | 62 | ||
| Self-assessment | 63 | ||
| Suggested reading | 63 | ||
| 5 Perimenopause, menopause, premature menopause and postmenopausal bleeding | 65 | ||
| Introduction | 65 | ||
| Perimenopause | 65 | ||
| Prediction of approaching menopause | 65 | ||
| Menopause | 66 | ||
| Demography | 66 | ||
| Age | 66 | ||
| Pathophysiology | 66 | ||
| Hormone levels | 66 | ||
| Anatomical changes | 67 | ||
| Menopausal symptoms (table 5.2) | 67 | ||
| Menstrual | 67 | ||
| Hot flushes | 67 | ||
| Other symptoms | 68 | ||
| 6 Gynaecological diagnosis | 79 | ||
| History | 79 | ||
| Present illness | 80 | ||
| Past and personal history | 80 | ||
| Family history | 81 | ||
| Marital and sexual history | 81 | ||
| Menstrual history | 81 | ||
| Obstetric history | 81 | ||
| Physical examination | 82 | ||
| General examination | 83 | ||
| Systemic examination | 83 | ||
| Abdominal examination | 83 | ||
| Inspection | 83 | ||
| Palpation | 83 | ||
| Percussion | 83 | ||
| Auscultation | 83 | ||
| Gynaecological examination | 83 | ||
| External examination | 83 | ||
| Bimanual examination | 84 | ||
| Rectal examination | 86 | ||
| Investigations | 86 | ||
| Special tests | 86 | ||
| Hanging drop preparation | 86 | ||
| Schiller test.  | 87 | ||
| Papanicolaou test | 87 | ||
| Cytohormonal evaluation | 89 | ||
| Uterine aspiration cytology | 89 | ||
| Colposcopy | 89 | ||
| Endometrial biopsy (figure 6.14a and b) | 90 | ||
| Hormonal assays | 90 | ||
| Ultrasonography | 90 | ||
| Other imaging modalities | 90 | ||
| Gynaecological endoscopy | 90 | ||
| Aspiration of pouch of douglas | 90 | ||
| Pregnancy test | 91 | ||
| Self-assessment | 91 | ||
| Suggested reading | 91 | ||
| 7 Endoscopy in gynaecology | 93 | ||
| Laparoscopy | 93 | ||
| Indications for laparoscopy | 94 | ||
| Diagnostic laparoscopy | 94 | ||
| Infertility and tubal disease. | 94 | ||
| Endometriosis. | 97 | ||
| Chronic pelvic pain. | 97 | ||
| Ovarian disorders. | 98 | ||
| Suspected adnexal masses. | 98 | ||
| Suspected ectopic pregnancy. | 98 | ||
| Pelvic inflammatory disease. | 98 | ||
| Ovarian malignancy. | 98 | ||
| Ascites. | 98 | ||
| Tuberculosis. | 98 | ||
| Uterine abnormalities. | 98 | ||
| Inspection of the pouch of douglas. | 98 | ||
| Operative laparoscopy | 98 | ||
| General indications. | 98 | ||
| Other indications | 99 | ||
| Technique of laparoscopy | 100 | ||
| Procedure | 100 | ||
| Complications | 100 | ||
| Other complications | 100 | ||
| Contraindications to laparoscopy | 101 | ||
| Advantages of laparoscopy over laparotomy | 101 | ||
| Hysteroscopy (figure 7.8) | 101 | ||
| Technique | 101 | ||
| Normal appearance of endometrium | 102 | ||
| Diagnostic indications | 102 | ||
| Therapeutic indications | 103 | ||
| Indications | 103 | ||
| Contraindications | 103 | ||
| Distension media in hysteroscopy | 104 | ||
| Contact hysteroscopy | 104 | ||
| Complications of hysteroscopy | 104 | ||
| Late complications | 105 | ||
| Salpingoscopy and falloscopy | 105 | ||
| Colposcopy | 105 | ||
| Indications | 105 | ||
| Therapeutic indications | 105 | ||
| Technique | 106 | ||
| Colposcopic findings (figures 7.13–7.15) (table 7.3) | 106 | ||
| Abnormal findings (figures 7.16–7.20) | 107 | ||
| Colpomicroscopy | 109 | ||
| Extragenital endoscopy | 109 | ||
| Self-assessment | 110 | ||
| Suggested reading | 110 | ||
| 8 Imaging modalities in gynaecology | 111 | ||
| Plain radiography | 111 | ||
| Hysterosalpingography | 111 | ||
| Technique | 111 | ||
| Contraindications | 111 | ||
| Complications | 112 | ||
| Advantages | 112 | ||
| Sonosalpingography | 112 | ||
| Intravenous urography | 112 | ||
| Indications | 112 | ||
| Precautions and contraindications | 113 | ||
| Cystography and urethrography | 114 | ||
| Gastrointestinal studies | 114 | ||
| Barium meal and follow through | 114 | ||
| Barium enema | 114 | ||
| Arteriography and arterial embolization | 115 | ||
| Ultrasonography (figures 8.6–8.15) | 115 | ||
| Normal ultrasonic findings | 117 | ||
| Diagnostic indications | 117 | ||
| Computed tomography scan | 119 | ||
| Technique | 119 | ||
| Indications | 119 | ||
| Magnetic resonance imaging | 119 | ||
| Indications | 120 | ||
| Contraindications | 120 | ||
| Radionuclide imaging | 120 | ||
| Dual photon densitometry | 120 | ||
| Self-assessment | 121 | ||
| Suggested reading | 121 | ||
| 9 Malformations of the female generative organs | 123 | ||
| Development of the female generative organs | 123 | ||
| The urogenital sinus and the external genital organs (figures 9.6 and 9.7) | 125 | ||
| Development of the ovary | 125 | ||
| Gonad | 127 | ||
| Müllerian ducts | 128 | ||
| Detailed consideration of müllerian defects | 128 | ||
| Introduction | 129 | ||
| Defining features | 129 | ||
| Differential diagnosis | 129 | ||
| Investigations | 131 | ||
| Müllerian inhibiting substance—mis (müllerian inhibiting factor—mif) | 131 | ||
| Management | 131 | ||
| Detailed consideration of relevant anomalies of the müllerian ducts | 131 | ||
| Classification. | 131 | ||
| Prevalence | 133 | ||
| Background | 134 | ||
| Adverse obstetric outcomes. | 135 | ||
| Surgical resection of the intrauterine septum (metroplasty): ​today hysteroscopic resection is considered best as it avo ... | 135 | ||
| Hermaphroditism and pseudohermaphroditism | 135 | ||
| Developmental defects of the urogenital sinus | 135 | ||
| Malformations of the rectum and anal canal | 135 | ||
| Imperforate anus | 135 | ||
| Atresia recti | 136 | ||
| Congenital rectovaginal fistula | 136 | ||
| Wolffian duct anomalies | 136 | ||
| Renal tract abnormalities | 136 | ||
| Self-assessment | 137 | ||
| Suggested reading | 137 | ||
| 10 Sexual development and development disorders | 139 | ||
| Principles of sexual development (figure 10.1) | 139 | ||
| Summary of sex organs development | 141 | ||
| Gonads | 141 | ||
| Internal genitalia | 141 | ||
| External genitalia | 141 | ||
| Facets of sexual differentiation | 141 | ||
| Classification of intersex | 141 | ||
| Gender identity disorders associated with normal sex chromosome constitutions | 141 | ||
| Gender identity disorders associated with abnormal sex chromosome constitutions | 142 | ||
| Components contributing to determination of sex | 142 | ||
| Genetic sex | 142 | ||
| External anatomical sex | 143 | ||
| Internal anatomical sex | 143 | ||
| Gonadal sex | 143 | ||
| Hormonal influences | 144 | ||
| Psychological sex | 144 | ||
| Environment and upbringing | 144 | ||
| Clinical diagnosis of sex | 144 | ||
| 11 Sexually transmitted diseases | 155 | ||
| Vulvar infections | 155 | ||
| Parasites (pediculosis pubis) | 155 | ||
| 12 Inflammation of the cervix and uterus | 171 | ||
| Acute cervicitis | 171 | ||
| Chronic cervicitis | 171 | ||
| Erosion of the cervix | 171 | ||
| Erosion associated with chronic cervicitis | 171 | ||
| Hormonal or papillary erosion | 172 | ||
| Clinical features | 172 | ||
| Differential diagnosis | 172 | ||
| Treatment of chronic cervicitis and erosion | 172 | ||
| Ectropion | 173 | ||
| Cervical polypi (figure 12.6) | 174 | ||
| Treatment | 174 | ||
| Cervical stenosis | 175 | ||
| Aetiology | 175 | ||
| Clinical features | 175 | ||
| Acute endometritis | 175 | ||
| Chronic endometritis | 175 | ||
| Pyometra | 176 | ||
| Treatment | 176 | ||
| Self-assessment | 176 | ||
| Suggested reading | 176 | ||
| 13 Pelvic inflammatory disease | 177 | ||
| Pelvic inflammatory disease | 177 | ||
| Aetiology | 177 | ||
| Pathological anatomy | 179 | ||
| Acute salpingitis | 179 | ||
| Chronic pid | 179 | ||
| Hydrosalpinx (figures 13.6 | 179 | ||
| Chronic pyosalpinx (figures 13.4 | 181 | ||
| Chronic interstitial salpingitis. | 181 | ||
| Tubo-ovarian cyst. | 181 | ||
| Tuberculous form. | 181 | ||
| Staging | 181 | ||
| Symptoms and signs | 181 | ||
| Acute pelvic infection | 181 | ||
| Differential diagnosis | 182 | ||
| Acute appendicitis | 182 | ||
| Ectopic gestation | 182 | ||
| Diverticulitis | 182 | ||
| A twisted ovarian cyst | 182 | ||
| Ruptured endometriotic cyst | 182 | ||
| Septic abortion | 182 | ||
| Cholecystitis | 182 | ||
| Investigations | 182 | ||
| Chronic pid | 183 | ||
| Differential diagnosis | 183 | ||
| Ectopic gestation. | 183 | ||
| Uterine fibroids. | 183 | ||
| Pelvic endometriosis. | 183 | ||
| Ovarian tumour. | 183 | ||
| Tubercular tubo-ovarian mass. | 183 | ||
| Treatment | 183 | ||
| Acute pid | 183 | ||
| Surgical treatment. | 184 | ||
| Chronic pid | 185 | ||
| Prognosis | 185 | ||
| End results | 185 | ||
| Prophylaxis (table 13.3) | 185 | ||
| Rare variety of pid: Actinomyces | 186 | ||
| Self-assessment | 186 | ||
| Suggested reading | 186 | ||
| 14 Tuberculosis of the genital tract | 187 | ||
| Introduction | 187 | ||
| Pathogenesis | 187 | ||
| Genital tract lesions | 188 | ||
| Clinical features of genital tuberculosis | 188 | ||
| Investigations | 191 | ||
| Differential diagnosis | 193 | ||
| Treatment | 193 | ||
| Surgery | 194 | ||
| Follow-up | 194 | ||
| Prognosis | 194 | ||
| In vitro fertilization | 194 | ||
| Self-assessment | 194 | ||
| Suggested reading | 195 | ||
| 15 Injuries of the female genital tract | 197 | ||
| Obstetric injuries | 197 | ||
| Perineal tears | 197 | ||
| Prevention of perineal tears | 198 | ||
| Vaginal tears | 198 | ||
| Cervical tears | 198 | ||
| Colporrhexis | 198 | ||
| Injuries due to coitus | 198 | ||
| Direct trauma and vulval haematoma | 199 | ||
| Pelvic haematoma | 199 | ||
| Mutilation | 199 | ||
| Injuries due to foreign bodies and instruments | 199 | ||
| Vagina | 199 | ||
| Uterus | 200 | ||
| 16 Injuries to the intestinal tract | 205 | ||
| Vaginal delivery | 205 | ||
| Faecal incontinence | 205 | ||
| Aetiology | 206 | ||
| History | 206 | ||
| Investigations | 206 | ||
| Treatment | 206 | ||
| Rectovaginal fistula | 207 | ||
| Treatment | 207 | ||
| Bowel injury | 207 | ||
| Aetiology | 207 | ||
| Diagnosis | 208 | ||
| Surgical treatment | 208 | ||
| Mtp | 208 | ||
| Surgery | 208 | ||
| Prevention | 208 | ||
| Self-assessment | 208 | ||
| Suggested reading | 209 | ||
| 17 Diseases of the urinary system | 211 | ||
| Common urinary malfunctions | 211 | ||
| Acute retention of urine | 211 | ||
| Causes | 211 | ||
| Postoperative retention | 211 | ||
| Puerperal retention | 211 | ||
| Obstructive conditions | 212 | ||
| Space-occupying lesions in the pelvis | 212 | ||
| Neurological causes | 212 | ||
| Chronic retention | 212 | ||
| Urethral syndrome | 212 | ||
| Difficult micturition | 212 | ||
| Painful micturition | 213 | ||
| Increased frequency of micturition | 213 | ||
| Incontinence of urine | 213 | ||
| Cystitis | 214 | ||
| Symptoms | 214 | ||
| Diagnosis | 214 | ||
| Treatment | 214 | ||
| Chronic cystitis | 215 | ||
| Pyelonephritis (pyelitis) | 215 | ||
| 18 Genital fistulae and urinary incontinence | 219 | ||
| Genital fistulae | 219 | ||
| Aetiology | 219 | ||
| Obstetric injury | 219 | ||
| Operation injury | 219 | ||
| Radiotherapy | 220 | ||
| Laparoscopic injuries | 220 | ||
| Anatomic classification of urinary fistulae | 220 | ||
| Clinical features (table 18.1) | 220 | ||
| Vesicovaginal fistula (vvf) | 220 | ||
| Ureteric fistulae (figures 18.5–18.8) | 221 | ||
| Investigations | 221 | ||
| Urinary fistulae | 221 | ||
| Management | 222 | ||
| Vesicovaginal fistula | 222 | ||
| Ureteric fistulae (figure 18.3) | 223 | ||
| Prophylaxis. | 224 | ||
| Vesicouterine fistula | 224 | ||
| Urethrovaginal fistula | 224 | ||
| Stress urinary incontinence (figure 18.6a) | 224 | ||
| Incontinence of urine | 224 | ||
| Mechanism of female urinary incontinence | 225 | ||
| Genuine stress incontinence | 225 | ||
| Aetiology. | 225 | ||
| Urge incontinence | 226 | ||
| Primary clinical evaluation | 226 | ||
| History | 226 | ||
| Physical examination | 226 | ||
| Investigations | 228 | ||
| Stress test | 228 | ||
| Cotton swab stick test | 228 | ||
| Marshall and bonney’s test | 228 | ||
| Urethroscopy | 228 | ||
| Urodynamic evaluation | 228 | ||
| Cystometry. | 228 | ||
| Urethrocystometry. | 228 | ||
| Uroflowmetry. | 228 | ||
| Micturition cystourethrography. | 228 | ||
| Uroprofilometry. | 228 | ||
| Ultrasound. | 228 | ||
| Videocystourethrography. | 228 | ||
| MRI studies. | 228 | ||
| Treatment | 229 | ||
| Conservative treatment | 229 | ||
| Physiotherapy. | 229 | ||
| Drugs. | 229 | ||
| Intraurethral and vaginal devices. | 229 | ||
| Electric stimulation. | 229 | ||
| Artificial urinary sphincter. | 229 | ||
| Genuine stress incontinence. | 229 | ||
| Surgical repair of stress urinary incontinence | 231 | ||
| Vaginal operations. | 231 | ||
| Abdominal operations. | 231 | ||
| Combined abdominal and vaginal operations. | 231 | ||
| Burch colposuspension (figures 18.14 | 231 | ||
| Laparoscopic colposuspension. | 231 | ||
| Intravesical bladder neck plication. | 231 | ||
| Tension-free vaginal tape. | 231 | ||
| Periurethral collagen injection. | 231 | ||
| Detrusor instability | 233 | ||
| Aetiology | 233 | ||
| Pathophysiology | 233 | ||
| Symptoms | 233 | ||
| Investigations | 233 | ||
| Treatment | 233 | ||
| Self-assessment | 235 | ||
| Suggested reading | 235 | ||
| 19 Infertility and sterility | 237 | ||
| Vaginismus | 238 | ||
| Treatment | 238 | ||
| Dyspareunia | 238 | ||
| Investigations | 239 | ||
| Treatment | 239 | ||
| Infertility and sterility | 239 | ||
| Issues involved | 240 | ||
| Theoretical considerations | 240 | ||
| Male infertility | 240 | ||
| Endocrine control | 241 | ||
| Pathology of infertility | 241 | ||
| Faults in the male. | 241 | ||
| Aetiological classification | 241 | ||
| Investigations | 242 | ||
| Management of male infertility | 245 | ||
| Management of azoospermia. | 245 | ||
| Psychological considerations. | 245 | ||
| Female infertility | 249 | ||
| Aetiology | 249 | ||
| Investigations | 250 | ||
| Tests for tubal patency. | 250 | ||
| Newer modalities. | 250 | ||
| Management of tubal infertility | 254 | ||
| Tests of ovulation | 255 | ||
| Basal body temperature | 255 | ||
| Endometrial biopsy | 255 | ||
| Fern test | 256 | ||
| Ultrasound | 256 | ||
| Hormonal study | 257 | ||
| Management of anovulation | 257 | ||
| Peritoneal disorders | 259 | ||
| Endometriosis | 259 | ||
| Luteinized unruptured follicular syndrome | 259 | ||
| Unexplained infertility | 259 | ||
| Assisted reproductive technology: An overview | 260 | ||
| Definition | 260 | ||
| Indications | 260 | ||
| Investigations prior to art | 260 | ||
| Types of art procedures in practice | 260 | ||
| Brief points in ivf | 260 | ||
| Self-assessment | 262 | ||
| Suggested reading | 262 | ||
| 20 Birth control and medical termination of pregnancy | 263 | ||
| Birth control | 263 | ||
| Definition of contraception | 263 | ||
| Methods of contraception | 264 | ||
| Natural methods of family planning | 264 | ||
| Abstinence during the fertile phase. | 264 | ||
| The calendar method or the rhythm method. | 264 | ||
| Calendar method. | 264 | ||
| Mucus method (billings or ovulation method). | 264 | ||
| Temperature method. | 264 | ||
| Symptothermal method. | 264 | ||
| Withdrawal method (coitus interruptus). | 264 | ||
| 21 Ectopic gestation | 293 | ||
| Types of ectopic gestation | 293 | ||
| Epidemiology | 294 | ||
| Incidence | 294 | ||
| Aetiology (table 21.1) | 294 | ||
| Pathogenesis | 294 | ||
| Pathological anatomy | 295 | ||
| Tubal pregnancy | 295 | ||
| Location | 295 | ||
| Ovarian pregnancy | 295 | ||
| Primary abdominal pregnancy | 297 | ||
| Secondary abdominal pregnancy | 297 | ||
| Interstitial pregnancy | 297 | ||
| Pregnancy in an accessory horn (figure 21.10) | 298 | ||
| Multiple pregnancy and ectopic gestation (heterotopic) | 298 | ||
| Fate of the ovum | 299 | ||
| Symptoms and diagnosis | 299 | ||
| Amenorrhoea | 299 | ||
| Pain | 299 | ||
| Vaginal bleeding | 299 | ||
| Retention of urine | 300 | ||
| Fever | 300 | ||
| Physical signs | 300 | ||
| Acute ectopic pregnancy | 300 | ||
| Differential diagnosis | 300 | ||
| Localized intraperitoneal haemorrhage (subacute and chronic) | 301 | ||
| Differential diagnosis | 301 | ||
| Pyosalpinx | 301 | ||
| Septic abortion | 301 | ||
| Pelvic abscess | 301 | ||
| Retroverted gravid uterus | 301 | ||
| Twisted ovarian cyst | 302 | ||
| Rupture of a chocolate cyst | 302 | ||
| Uterine fibroid | 302 | ||
| Corpus luteal haematoma | 302 | ||
| Acute appendicitis | 302 | ||
| Diagnostic investigations (table 21.3) | 302 | ||
| Hormonal tests | 302 | ||
| β-hcg | 302 | ||
| Culdocentesis or aspiration of pouch of douglas | 302 | ||
| Ultrasound | 302 | ||
| Other hormonal studies | 303 | ||
| Laparoscopy | 304 | ||
| Treatment | 304 | ||
| Medical management | 304 | ||
| Methotrexate therapy | 304 | ||
| Indications. | 304 | ||
| Side effects of methotrexate. | 304 | ||
| Contraindications. | 304 | ||
| Other surgically administered medical (sam) drugs | 304 | ||
| Postmedication management. | 305 | ||
| Surgical treatment | 305 | ||
| Types of surgery | 305 | ||
| Interstitial pregnancy | 306 | ||
| Treatment | 306 | ||
| Prognosis | 306 | ||
| Unruptured ectopic gestation | 307 | ||
| Prognosis | 307 | ||
| Expectant treatment (figure 21.20) | 308 | ||
| Ovarian pregnancy | 308 | ||
| Cervical pregnancy | 308 | ||
| 22 Gestational trophoblastic diseases | 311 | ||
| Hydatidiform mole | 311 | ||
| Incidence and aetiology | 311 | ||
| Morbid anatomy | 311 | ||
| Invasive mole (persistent or residual) | 313 | ||
| Placental site trophoblastic tumour | 313 | ||
| Aetiology | 313 | ||
| Classification (figure 22.4) | 314 | ||
| Symptoms and signs | 314 | ||
| Differential diagnosis | 315 | ||
| Mistaken date | 315 | ||
| Multiple pregnancy | 315 | ||
| Acute hydramnios | 315 | ||
| Fibroid in pregnancy | 315 | ||
| Threatened abortion | 315 | ||
| Complications | 315 | ||
| Investigations | 315 | ||
| Doppler | 315 | ||
| Ultrasound | 315 | ||
| Serum β-hcg | 315 | ||
| Treatment | 316 | ||
| Follow-up (figure 22.6) | 316 | ||
| Persistent trophoblastic disease | 318 | ||
| Perforating mole | 318 | ||
| Recurrent molar pregnancy | 318 | ||
| Coexisting molar pregnancy | 319 | ||
| Self-assessment | 319 | ||
| Suggested reading | 319 | ||
| 23 Disorders of menstruationamenorrhoea | 321 | ||
| Menstrual cycle irregularities | 321 | ||
| Definitions of menstrual cycle irregularities | 321 | ||
| Amenorrhoea | 321 | ||
| Primary amenorrhoea | 322 | ||
| Classification | 322 | ||
| Hypergonadotropic primary amenorrhoea. | 322 | ||
| Eugonadotropic primary amenorrhoea. | 322 | ||
| Hypogonadotropic primary amenorrhoea. | 323 | ||
| Aetiology | 323 | ||
| Anorexia nervosa. | 323 | ||
| Management. | 323 | ||
| Kallmann disease. | 323 | ||
| Management. | 324 | ||
| Clinical approach | 324 | ||
| Management | 324 | ||
| Hypergonadotropic primary amenorrhoea. | 324 | ||
| Eugonadotropic primary amenorrhoea. | 324 | ||
| Hypogonadotropic primary amenorrhoea. | 324 | ||
| Other hormonal dysfunctions. | 324 | ||
| Nutrition. | 324 | ||
| Secondary amenorrhoea | 325 | ||
| Aetiology (figure 23.2) | 326 | ||
| Resistant ovarian syndrome. | 326 | ||
| Simmond’s disease. | 326 | ||
| Investigations (figure 23.9) | 326 | ||
| Pregnancy. | 326 | ||
| Elevated levels of serum prolactin. | 326 | ||
| Causes. | 328 | ||
| Treatment. | 329 | ||
| Evidence of oestrogen deficiency. | 329 | ||
| Positive progesterone challenge test. | 329 | ||
| Fsh and lh concentrations. | 329 | ||
| Oligomenorrhoea and hypomenorrhoea | 331 | ||
| Oligomenorrhoea | 331 | ||
| Hypomenorrhoea | 332 | ||
| Polymenorrhoea or epimenorrhoea | 332 | ||
| Metrorrhagia | 332 | ||
| Self-assessment | 333 | ||
| Suggested reading | 334 | ||
| 24 Menorrhagia | 335 | ||
| Normal control of menstrual bleeding | 335 | ||
| Causes (table 24.1) | 335 | ||
| Investigations | 338 | ||
| Management | 338 | ||
| Abnormal uterine bleeding (aub) | 339 | ||
| Incidence | 339 | ||
| Pathogenesis | 339 | ||
| Classification | 339 | ||
| Puberty menorrhagia | 339 | ||
| Aetiology | 339 | ||
| Clinical features | 339 | ||
| Investigations | 339 | ||
| Management | 340 | ||
| Abnormal uterine bleeding (aub) in the reproductive age | 340 | ||
| Palm–coein classification | 340 | ||
| Abnormal uterine bleeding in childbearing age and premenopausal women | 341 | ||
| Metropathia haemorrhagica | 341 | ||
| Pathology | 341 | ||
| Investigations | 342 | ||
| Treatment of abnormal uterine bleeding (aub) | 343 | ||
| Conservative treatment | 343 | ||
| Hormone therapy (table 24.2) | 343 | ||
| Mirena | 344 | ||
| Minimal invasive surgery (mis) (table 24.3) | 344 | ||
| Ablative techniques. ​the idea of endometrial ablation arose from oligomenorrhoea occurring in asherman syndrome due t ... | 345 | ||
| Hysteroscopic endometrial ablation. | 345 | ||
| Radiofrequency-induced thermal ablation (ritea). | 345 | ||
| Cavaterm balloon therapy (figure 24.12). ​ | 345 | ||
| Microwave endometrial ablation. | 345 | ||
| Vesta system. | 345 | ||
| Uterine tamponade. | 345 | ||
| Bilateral uterine artery embolization. | 345 | ||
| Hysterectomy | 346 | ||
| New systems | 346 | ||
| Irregular ripening | 347 | ||
| Irregular shedding (halban’s disease) | 347 | ||
| Adenomatous endometrial polyp | 347 | ||
| Pathology | 347 | ||
| Clinical features | 347 | ||
| Endometrial hyperplasia | 347 | ||
| Self-assessment | 348 | ||
| Suggested reading | 348 | ||
| 25 Genital prolapse | 349 | ||
| Supports of the genital tract | 349 | ||
| Aetiology of prolapse (table 25.1) | 349 | ||
| Classification of prolapse (figures 25.3 and 25.4) | 349 | ||
| Cystocele | 351 | ||
| Prolapse of the uterus | 352 | ||
| Prolapse of the posterior vaginal wall | 352 | ||
| Decubitus ulcer | 354 | ||
| Elongation of the cervix | 354 | ||
| Obstruction in the urinary tract | 354 | ||
| Pop-q system (table 25.2, figure 25.3) | 354 | ||
| Symptoms of prolapse | 355 | ||
| Investigations | 355 | ||
| Differential diagnosis | 355 | ||
| Complications of prolapse | 356 | ||
| Prophylaxis of prolapse | 356 | ||
| Treatment (table 25.3) | 356 | ||
| Pessary treatment of prolapse | 356 | ||
| Operative treatment of prolapse | 357 | ||
| Preoperative treatment | 357 | ||
| Postoperative care | 357 | ||
| Surgery | 357 | ||
| Anterior colporrhaphy | 357 | ||
| Posterior colporrhaphy and colpoperineorrhaphy | 357 | ||
| Fothergill’s repair (manchester operation) | 358 | ||
| Shirodkar’s procedure | 359 | ||
| Vaginal hysterectomy with pelvic floor repair | 359 | ||
| The steps of vaginal hysterectomy (figure 25. 18). ​ | 359 | ||
| Ligasure. ​ligasure vessel sealing system is lately used to secure the pedicles in vaginal hysterectomy. | 360 | ||
| Le fort’s repair | 360 | ||
| Abdominal sling operations | 360 | ||
| Abdominal wall cervicopexy.  | 361 | ||
| Shirodkar’s abdominal sling operation for uterine prolapse. ​ | 361 | ||
| Khanna’s sling operation. ​in this operation, the mersilene tape is fixed to the isthmus posteriorly, and the two fr ... | 361 | ||
| Enterocele | 361 | ||
| Vault prolapse | 361 | ||
| Degrees of vault prolapse | 361 | ||
| Prevention | 362 | ||
| Treatment (table 25.4) | 362 | ||
| Right transverse vaginal sacrospinous colpopexy | 363 | ||
| Recurrent prolapse and prosthetics | 363 | ||
| Self-assessment | 364 | ||
| Suggested reading | 364 | ||
| 26 Displacements | 365 | ||
| Introduction | 365 | ||
| Retroversion | 365 | ||
| Aetiology | 365 | ||
| Mobile retroversion | 365 | ||
| Fixed retroversion | 366 | ||
| Symptoms | 366 | ||
| Dysmenorrhoea | 366 | ||
| Menorrhagia | 366 | ||
| Pressure | 366 | ||
| Backache | 366 | ||
| Dyspareunia | 366 | ||
| Infertility | 366 | ||
| Abortion | 366 | ||
| Diagnosis | 366 | ||
| Treatment | 366 | ||
| Pessary treatment | 366 | ||
| Surgery | 367 | ||
| Indications | 367 | ||
| Ventrosuspension | 367 | ||
| Plication of round ligaments | 367 | ||
| Baldy–webster operation | 367 | ||
| Inversion of the uterus | 367 | ||
| Acute inversion | 368 | ||
| Prevention | 368 | ||
| Treatment | 368 | ||
| Chronic inversion | 368 | ||
| Degree of inversion (figure 26.6) | 368 | ||
| Treatment | 369 | ||
| Self-assessment | 369 | ||
| Suggested reading | 370 | ||
| 27 Diseases of the vulva | 371 | ||
| Introduction | 371 | ||
| Benign conditions of the vulva | 371 | ||
| Inflammatory lesions | 371 | ||
| Skin infections | 371 | ||
| Intertrigo and folliculitis | 371 | ||
| Tinea cruris | 371 | ||
| Threadworms | 372 | ||
| Vulvovaginitis | 372 | ||
| Bartholin’s abscess | 372 | ||
| Psoriasis | 372 | ||
| Filariasis | 372 | ||
| Contact vulvitis | 372 | ||
| Pruritus vulva | 373 | ||
| Aetiology. ​there are several causes, though often it may be difficult to elucidate the cause, and the treatment becomes ... | 373 | ||
| Treatment. ​the cause of pruritus should be investigated systematically and treated. | 373 | ||
| Ulcers | 373 | ||
| Clinical features | 373 | ||
| Behcet disease | 373 | ||
| Atrophy | 374 | ||
| Vulval pain syndrome | 374 | ||
| Vestibulitis | 374 | ||
| Dysaesthetic vulvodynia | 374 | ||
| Management | 374 | ||
| Dystrophies | 374 | ||
| Hyperplastic dystrophy (squamous cell hyperplasia), previously known as leukoplakia | 374 | ||
| Lichen sclerosus (atrophic dystrophy) | 376 | ||
| Cysts and neoplasms | 377 | ||
| Vulval cysts | 377 | ||
| Sebaceous cyst | 377 | ||
| Bartholin’s cyst | 377 | ||
| Cyst of the canal of nuck | 377 | ||
| Vulval neoplasms | 377 | ||
| Fibroma and lipoma | 377 | ||
| Hidradenoma | 377 | ||
| Pigmented mole or naevi | 377 | ||
| Endometriosis | 377 | ||
| Elephantiasis vulva | 377 | ||
| Self-assessment | 378 | ||
| Suggested reading | 378 | ||
| 28 Diseases of the vagina | 379 | ||
| Biology of the vagina | 379 | ||
| Structure of vaginal epithelium | 380 | ||
| Physiological changes in the vaginal epithelium | 381 | ||
| Cytology of the vagina | 381 | ||
| Vaginal acidity | 381 | ||
| Natural defence mechanism of the vagina against infection | 381 | ||
| Flora of the female genital tract | 381 | ||
| Leucorrhoea | 382 | ||
| Excessive cervical secretion (cervical leucorrhoea) | 382 | ||
| Excessive vaginal secretion (nonpathogenic vaginal leucorrhoea) | 382 | ||
| Specific vaginal infections | 382 | ||
| Vaginitis | 383 | ||
| Vaginosis | 383 | ||
| Candidal vaginitis | 383 | ||
| Miscellaneous | 384 | ||
| Gardnerella (bacterial) vaginosis | 384 | ||
| 29 Benign diseases of the uterus | 391 | ||
| Fibromyomas of the uterus and uterine polyps | 391 | ||
| Uterine polyps | 391 | ||
| Endometrial polyp | 391 | ||
| Placental polyp | 391 | ||
| Clinical features | 391 | ||
| Management | 391 | ||
| Fibromyomas | 391 | ||
| Aetiology | 391 | ||
| Anatomy | 392 | ||
| Cervical fibroid | 393 | ||
| Symptoms | 393 | ||
| Secondary changes: (table 29.1) | 393 | ||
| Atrophy. | 393 | ||
| Calcareous degeneration. | 393 | ||
| Red degeneration. | 393 | ||
| Sarcomatous change. | 393 | ||
| Other complications of myomas | 393 | ||
| Torsion. | 393 | ||
| Inversion. | 393 | ||
| Capsular haemorrhage. | 393 | ||
| Infection. | 393 | ||
| Associated endometrial carcinoma. | 393 | ||
| Symptoms (table 29.2) | 397 | ||
| Menstrual disorders | 397 | ||
| Infertility | 397 | ||
| Pain | 397 | ||
| Pressure symptoms | 397 | ||
| Abdominal lump | 397 | ||
| Vaginal discharge | 398 | ||
| Physical signs | 398 | ||
| Differential diagnosis (table 29.3) | 398 | ||
| Pregnancy | 398 | ||
| Haematometra | 398 | ||
| Adenomyosis | 398 | ||
| Bicornuate uterus | 398 | ||
| Endometriosis, chocolate cyst | 398 | ||
| Ectopic pregnancy | 398 | ||
| Chronic pid | 398 | ||
| Benign ovarian tumour | 398 | ||
| Malignant ovarian tumour | 398 | ||
| Endometrial cancer | 399 | ||
| Myomatous polyp | 399 | ||
| Chronic inversion of uterus | 399 | ||
| Pelvic kidney. | 399 | ||
| Investigations | 399 | ||
| Treatment | 399 | ||
| Medical treatment (table 29.5) | 400 | ||
| Gnrh therapy | 400 | ||
| Surgery | 401 | ||
| Myomectomy. | 401 | ||
| Preoperative requisites | 401 | ||
| Technique of myomectomy (figure 29. 17) | 402 | ||
| Results. | 402 | ||
| Complications. | 402 | ||
| Uterine artery embolization. | 402 | ||
| Contraindications | 403 | ||
| Technique. | 403 | ||
| MRI guided focused ultrasound. | 403 | ||
| Laparoscopic myolysis. | 403 | ||
| Hysterectomy (table 29.6).  | 403 | ||
| Types of hysterectomy | 406 | ||
| Abdominal hysterectomy. | 406 | ||
| Vaginal hysterectomy. | 406 | ||
| Laparoscopic-assisted vaginal hysterectomy (lavh). | 406 | ||
| Complications of hysterectomy | 406 | ||
| Family planning | 406 | ||
| Cervical fibroid | 407 | ||
| Fibroids complicating pregnancy | 407 | ||
| Mesodermal mixed tumour (including botryoid and grape-like sarcoma) | 407 | ||
| Self-assessment | 408 | ||
| Suggested reading | 408 | ||
| 30 Endometriosis and adenomyosis | 409 | ||
| Endometriosis | 409 | ||
| Aetiology | 409 | ||
| Implantation theory | 409 | ||
| Coelomic metaplasia theory | 409 | ||
| Metastatic theory | 410 | ||
| Hormonal influence | 410 | ||
| Immunological factor | 410 | ||
| Other factors | 410 | ||
| Sites of endometriosis (table 30.1) | 410 | ||
| Pathology | 411 | ||
| Pelvic endometriosis | 411 | ||
| Chocolate cysts | 411 | ||
| Classification | 411 | ||
| Clinical features | 413 | ||
| Symptoms | 413 | ||
| Dysmenorrhoea | 413 | ||
| Abdominal pain | 414 | ||
| Dyspareunia | 414 | ||
| Infertility | 414 | ||
| Menstrual symptoms | 414 | ||
| Chronic pelvic pain (cpp) | 414 | ||
| Other symptoms | 414 | ||
| Physical findings | 414 | ||
| Endocrinologic abnormalities | 414 | ||
| Differential diagnosis | 414 | ||
| Investigations (table 30.3) | 415 | ||
| Laparoscopic findings | 415 | ||
| Ultrasound and MRI | 416 | ||
| Prophylaxis | 416 | ||
| Management | 416 | ||
| Drug treatment | 417 | ||
| Minimal invasive surgery | 418 | ||
| Other modalities in an infertile woman associated with pelvic endometriosis (figure 30.8) | 419 | ||
| Surgery | 419 | ||
| Laparotomy | 419 | ||
| Combined therapy | 419 | ||
| Endometriosis of the rectovaginal septum | 420 | ||
| Clinical features | 420 | ||
| Differential diagnosis | 420 | ||
| Investigations | 420 | ||
| Management | 420 | ||
| Prognosis | 420 | ||
| Adenomyosis | 420 | ||
| Treatment (figure 30.14) | 421 | ||
| Stromal endometriosis | 422 | ||
| Self-assessment | 422 | ||
| Suggested reading | 423 | ||
| 31 Disorders of the broad ligament, fallopian tubes and parametrium | 425 | ||
| Broad ligament cysts | 425 | ||
| Anatomical considerations | 425 | ||
| Parovarian cysts | 425 | ||
| Treatment | 426 | ||
| Tumours of the fallopian tubes | 426 | ||
| Affections of the broad ligament and parametrium | 426 | ||
| Haematoma | 426 | ||
| Parametritis | 426 | ||
| Tumours of the broad ligament and parametrium | 427 | ||
| Myoma | 427 | ||
| Sarcoma | 427 | ||
| Lipoma | 427 | ||
| Retroperitoneal tumours | 427 | ||
| Self-assessment | 428 | ||
| Suggested reading | 428 | ||
| 32 Disorders of the ovary | 429 | ||
| Non-neoplastic enlargements of the ovary (table 32.1) | 429 | ||
| Follicular cysts | 429 | ||
| Follicular haematomas | 429 | ||
| Lutein cysts of the ovary | 430 | ||
| Corpus luteum (granulosa lutein) cysts | 430 | ||
| Theca lutein cysts | 430 | ||
| Multiple functional cysts | 431 | ||
| Polycystic ovarian syndrome (pcos) or disease (pcod) | 431 | ||
| Incidence | 431 | ||
| Aetiology and pathogenesis | 431 | ||
| Pathology | 432 | ||
| Clinical features (table 32.1) | 432 | ||
| Examination | 432 | ||
| Differential diagnosis | 432 | ||
| Investigations | 432 | ||
| Treatment | 433 | ||
| Surgery | 434 | ||
| Prevention | 434 | ||
| Self-assessment | 434 | ||
| Suggested reading | 434 | ||
| 33 Ovarian tumours | 435 | ||
| Pathology | 435 | ||
| Borderline ovarian tumours | 436 | ||
| Characteristics of borderline ovarian tumours | 436 | ||
| Risk factors | 436 | ||
| Pathology | 436 | ||
| Tumours of the surface epithelium | 437 | ||
| Serous cystadenoma and cystadenocarcinoma | 437 | ||
| Mucinous tumours | 437 | ||
| Endometrioid tumour | 437 | ||
| Mesonephroid tumour | 438 | ||
| Brenner tumour | 438 | ||
| Spread of epithelial tumours of the ovary | 439 | ||
| Germ cell tumours | 439 | ||
| Incidence | 439 | ||
| Teratoma | 439 | ||
| Dermoid cysts | 439 | ||
| Solid teratoma of the ovary | 440 | ||
| Struma ovarii | 440 | ||
| Carcinoid tumours | 441 | ||
| Dysgerminoma | 441 | ||
| Mixed germ cell tumour | 442 | ||
| Sex cord stromal tumours | 442 | ||
| Feminizing functioning mesenchymoma | 442 | ||
| Granulosa cell tumour | 442 | ||
| Clinical features | 442 | ||
| Macroscopic features | 442 | ||
| Association of carcinoma of the endometrium with granulosa cell tumours | 443 | ||
| Theca cell tumour | 443 | ||
| Virilizing mesenchymoma | 443 | ||
| Arrhenoblastoma | 443 | ||
| Adrenal cortical tumours of the ovary | 444 | ||
| Hilus cell tumour | 444 | ||
| Gynandroblastoma | 444 | ||
| Tumours arising from connective tissues of the ovary | 444 | ||
| Ovarian fibroma | 444 | ||
| Histogenesis of ovarian tumours | 444 | ||
| Fibromas | 444 | ||
| Papillary serous cystadenoma | 445 | ||
| Granulosa cell tumours | 445 | ||
| Teratoid tumours | 445 | ||
| Mucinous cystadenomas | 445 | ||
| Brenner tumour | 445 | ||
| Complications of ovarian tumours (table 33.3) | 445 | ||
| Axial rotation: Torsion | 445 | ||
| Clinical features of torsion of ovary | 445 | ||
| Rupture | 446 | ||
| Haemorrhage | 446 | ||
| Pseudomyxoma of the peritoneum | 446 | ||
| Infection | 447 | ||
| Extraperitoneal development | 447 | ||
| Secondary malignancy | 447 | ||
| Benign ovarian tumours | 447 | ||
| Symptoms | 447 | ||
| Menstrual cycles | 447 | ||
| Pressure symptoms | 447 | ||
| Pain | 448 | ||
| Physical signs | 448 | ||
| Differential diagnosis | 449 | ||
| Full bladder | 449 | ||
| Pregnant uterus | 449 | ||
| Myoma | 449 | ||
| Ascites | 449 | ||
| Other tumours | 450 | ||
| Investigations | 450 | ||
| Treatment | 450 | ||
| Prophylactic oophorectomy | 451 | ||
| Benign ovarian tumours | 451 | ||
| Ovarian tumours associated with pregnancy | 451 | ||
| Ovarian cyst in a menopausal woman | 451 | ||
| Ovarian remnant syndrome | 452 | ||
| Ovarian tumours in adolescents (figure 33.23) | 452 | ||
| Self-assessment | 453 | ||
| Suggested reading | 453 | ||
| 34 Breast | 455 | ||
| Congenital deformities | 455 | ||
| Benign tumours | 456 | ||
| Breast cancer | 458 | ||
| Self-assessment | 461 | ||
| Suggested reading | 461 | ||
| 35 Acute and chronic pelvic pain | 463 | ||
| Acute pelvic pain | 463 | ||
| Premenarche | 463 | ||
| Ovarian tumour | 463 | ||
| Reproductive age group | 463 | ||
| Obstetrical causes | 463 | ||
| Gynaecological causes (figure 35.1) | 464 | ||
| Non-gynaecological causes | 464 | ||
| Menopausal and postmenopausal women | 464 | ||
| History and clinical examination | 465 | ||
| Chronic pelvic pain | 465 | ||
| Incidence | 465 | ||
| Aetiology (table 35.1) | 465 | ||
| No cause of cpp found | 466 | ||
| Clinical features | 466 | ||
| Endometriosis, chocolate cyst of ovary | 466 | ||
| Ovarian adhesions and polycystic ovarian disease | 466 | ||
| Chronic pelvic inflammatory disease | 466 | ||
| Peritoneal and postoperative adhesions | 466 | ||
| Pelvic tuberculosis | 466 | ||
| Uterine fibroids and adenomyosis | 466 | ||
| Ovarian cyst or tumour | 466 | ||
| Residual ovarian syndrome | 466 | ||
| Dysmenorrhoea | 466 | ||
| Ovulation pain (mittelschmerz) | 467 | ||
| Chronic pelvic pain syndrome | 467 | ||
| Intestinal | 467 | ||
| Urinary tract | 467 | ||
| Psychological factors | 467 | ||
| Skeletomuscular pain | 467 | ||
| History | 467 | ||
| Investigations | 467 | ||
| Management | 468 | ||
| Self-assessment | 469 | ||
| Suggested reading | 469 | ||
| 36 Dysmenorrhoea, premenstrual syndrome | 471 | ||
| 471 | |||
| Definition | 471 | ||
| Aetiology | 471 | ||
| Types | 471 | ||
| Varieties | 471 | ||
| Aetiology of pain (figure 36.1) | 471 | ||
| Clinical features (table 36.1) | 471 | ||
| Investigations | 472 | ||
| Treatment | 472 | ||
| Medical measures | 472 | ||
| Surgery | 473 | ||
| Premenstrual syndrome | 473 | ||
| Aetiology | 473 | ||
| Clinical features | 473 | ||
| Diagnosis | 474 | ||
| Treatment (table 36.3) | 474 | ||
| Self-assessment | 474 | ||
| Suggested reading | 474 | ||
| 37 Vulval and vaginal cancer | 475 | ||
| Cancers of the genital tract | 475 | ||
| Cancer of the vulva | 475 | ||
| Pre-invasive lesions | 475 | ||
| Intraepithelial vulval carcinoma (vin) | 475 | ||
| Definition. | 475 | ||
| Classification. | 475 | ||
| Incidence. | 475 | ||
| Aetiology. | 475 | ||
| Histology. | 475 | ||
| Clinical features. | 475 | ||
| Investigations. | 475 | ||
| Management (table 37.3 | 477 | ||
| Follow-up. | 477 | ||
| Bowen disease | 477 | ||
| Paget’s disease | 478 | ||
| Microinvasive cancer | 478 | ||
| Invasive carcinoma of the vulva | 478 | ||
| Epidemiology | 478 | ||
| Aetiology | 478 | ||
| Clinical features | 478 | ||
| Differential diagnosis | 478 | ||
| Staging | 478 | ||
| Spread of the tumour | 479 | ||
| Investigations | 479 | ||
| Treatment. | 479 | ||
| Bartholin’s gland tumour | 480 | ||
| Vulval sarcoma | 480 | ||
| Vulval melanoma | 481 | ||
| Rodent ulcer | 481 | ||
| Persistent cancer (residual) | 481 | ||
| Secondary growth of the vulva | 481 | ||
| Prognostic factors | 481 | ||
| Vulval cancer in young women | 481 | ||
| Vaginal cancer | 481 | ||
| Clinical features | 482 | ||
| Staging | 482 | ||
| Diagnosis | 482 | ||
| Management | 482 | ||
| Pretreatment work-up | 482 | ||
| Treatment | 482 | ||
| Self-assessment | 483 | ||
| Suggested reading | 483 | ||
| 38 Cervical intraepithelial neoplasia, carcinoma of cervix | 485 | ||
| Aetiology, epidemiology and predisposing risk factors | 485 | ||
| Cervical intraepithelial neoplasia or pre-invasive cervical cancer (stage 0) | 485 | ||
| Metaplasia | 486 | ||
| Dysplasia (figures 38.2–38.7) | 486 | ||
| Diagnosis | 486 | ||
| Treatment of dysplasia and cin (table 38.6, figures 38.13–38.18) | 491 | ||
| Prophylaxis | 495 | ||
| Prophylactic hpv vaccines | 495 | ||
| Invasive cancer of the cervix | 495 | ||
| Pathology | 495 | ||
| Clinical features | 497 | ||
| Differential diagnosis | 497 | ||
| Staging of cancer of the cervix (figures 38.26–38.38, table 38.7) | 497 | ||
| Diagnosis | 497 | ||
| Investigations | 497 | ||
| Pre-invasive cancer in pregnancy | 498 | ||
| Invasive cancer of the cervix and pregnancy | 501 | ||
| Management | 501 | ||
| Treatment of invasive cancer | 501 | ||
| Endocervical cancer | 504 | ||
| Results | 505 | ||
| Prognosis | 505 | ||
| Palliative treatment in terminal stage | 505 | ||
| Future development | 505 | ||
| Self-assessment | 506 | ||
| Suggested reading | 506 | ||
| 39 Cancers of endometrium, uterus and fallopian tube | 507 | ||
| Endometrial cancer | 507 | ||
| Predisposing factors (table 39.1) | 507 | ||
| Pathology (figure 39.6) | 509 | ||
| Types | 509 | ||
| Clinical features | 510 | ||
| Investigations | 510 | ||
| Differential diagnosis | 510 | ||
| Staging (table 39.2) | 510 | ||
| Treatment | 511 | ||
| Surgery | 511 | ||
| Postoperative radiotherapy | 512 | ||
| Primary radiotherapy | 512 | ||
| Progestogens | 512 | ||
| Recurrent growths | 512 | ||
| Prophylaxis | 512 | ||
| Sarcoma of the uterus | 512 | ||
| Choriocarcinoma | 513 | ||
| Fallopian tube cancer | 518 | ||
| Self-assessment | 520 | ||
| Suggested reading | 520 | ||
| 40 Ovarian cancer | 521 | ||
| Pathology | 521 | ||
| Epithelial cancers of the ovary | 521 | ||
| Criteria for diagnosis of borderline tumours (see also chapter on benign ovarian tumours) | 522 | ||
| Nonepithelial malignancies of the ovary | 522 | ||
| Endodermal sinus (yolk sac) tumour | 522 | ||
| Choriocarcinoma | 523 | ||
| Embryonal cell carcinoma | 523 | ||
| Sex cord stromal tumours | 523 | ||
| Granulosa cell tumours | 524 | ||
| Androblastomas or arrhenoblastomas (sertoli–leydig cell tumours) | 524 | ||
| Uncommon ovarian cancers | 524 | ||
| Sarcoma | 524 | ||
| Metastatic carcinomas | 524 | ||
| Krukenberg tumour | 524 | ||
| Coincident carcinoma of the ovaries and the body of the uterus | 525 | ||
| Metastases in the uterus | 525 | ||
| Metastases in operation scars | 525 | ||
| Spread by way of blood stream | 525 | ||
| Lymphatic spread | 525 | ||
| Bilateral character of ovarian tumours | 525 | ||
| Clinical features | 526 | ||
| Screening | 526 | ||
| Investigations | 526 | ||
| Management | 527 | ||
| Results | 528 | ||
| Strategies to reduce the incidence of genital tract malignancies (prophylaxis) | 528 | ||
| Palliative and adjuvant therapy | 529 | ||
| Nutrition | 529 | ||
| Assessment of nutritional status | 529 | ||
| Management. | 529 | ||
| Relief of pain | 529 | ||
| Bony pain. | 529 | ||
| Bowel and bladder pain. | 529 | ||
| Nerve pain. | 529 | ||
| Relief of symptoms | 529 | ||
| Vomiting. | 529 | ||
| Psychological impact | 530 | ||
| Self-assessment | 530 | ||
| Suggested reading | 530 | ||
| 41 Radiation therapy and chemotherapy for gynaecologic cancer | 531 | ||
| Radiation therapy | 531 | ||
| Physical principles of radiation therapy | 531 | ||
| Basic physics | 531 | ||
| Radiation biology | 532 | ||
| Radiation sources: External and internal therapy | 532 | ||
| Brachytherapy | 533 | ||
| Teletherapy | 534 | ||
| Interstitial radiotherapy | 535 | ||
| Complications of radiotherapy | 535 | ||
| Contraindications to radiotherapy | 535 | ||
| Newer techniques sparing adjacent tissues | 535 | ||
| Role of preoperative and postoperative radiation | 535 | ||
| Clinical applications of radiotherapy | 535 | ||
| Cancer of the cervix | 535 | ||
| Endocervical cancer | 536 | ||
| Endometrial cancer | 536 | ||
| Ovarian cancer | 536 | ||
| Vulvar cancer | 537 | ||
| Vagina | 537 | ||
| Choriocarcinoma | 537 | ||
| Cancer chemotherapy for gynaecologic cancers | 537 | ||
| Tumour cell kinetics | 537 | ||
| Chemoradiation | 538 | ||
| Contraindications | 538 | ||
| Complications of chemotherapy | 539 | ||
| Classification of drugs | 539 | ||
| Newer anticancer drugs | 539 | ||
| Vulva | 539 | ||
| Vagina | 539 | ||
| Cervix | 539 | ||
| Endometrial cancer | 539 | ||
| Ovarian cancer | 539 | ||
| Choriocarcinoma | 540 | ||
| Sarcoma | 540 | ||
| Breast cancer | 540 | ||
| Immunotherapy | 540 | ||
| Gene therapy | 541 | ||
| Self-assessment | 541 | ||
| Suggested reading | 541 | ||
| 42 Obesity | 543 | ||
| Prevalence | 543 | ||
| Definition | 543 | ||
| Aetiology | 543 | ||
| Pathophysiology | 543 | ||
| Clinical features | 544 | ||
| Complications and sequelae (figure 42.1) | 544 | ||
| Management | 545 | ||
| Prophylaxis | 545 | ||
| Diet | 545 | ||
| Exercises | 545 | ||
| Pregnancy | 545 | ||
| Management of obesity | 545 | ||
| Drugs | 545 | ||
| Fetal obesity | 545 | ||
| Treatment | 545 | ||
| Surgery | 545 | ||
| Self-assessment | 546 | ||
| Suggested reading | 546 | ||
| 43 Hormonal therapy in gynaecology | 547 | ||
| Oestrogens | 547 | ||
| Physiology | 548 | ||
| Commonly used oestrogens | 548 | ||
| Contraindications | 549 | ||
| Indications | 549 | ||
| Side effects | 549 | ||
| Progesterone | 549 | ||
| Preparations | 549 | ||
| Classification | 549 | ||
| Therapeutic applications | 550 | ||
| Contraindications | 550 | ||
| Side effects | 550 | ||
| Androgens (figure 43.1) | 550 | ||
| Uses | 550 | ||
| Side effects | 551 | ||
| Danazol | 551 | ||
| Gestrinone | 551 | ||
| Anti-oestrogens | 551 | ||
| Clomiphene citrate | 552 | ||
| Mode of action | 552 | ||
| Indications | 552 | ||
| Contraindications | 552 | ||
| Side effects | 552 | ||
| Ovarian hyperstimulation syndrome | 552 | ||
| Aromatase inhibitors | 554 | ||
| Selective oestrogen receptor modulators acting as anti-oestrogen (table 43.4) | 554 | ||
| Tamoxifen | 554 | ||
| Dosage | 555 | ||
| Precautions | 555 | ||
| Ormeloxifene (centchroman) | 555 | ||
| Antiprogesterone | 555 | ||
| Mifepristone | 555 | ||
| Therapeutic applications | 555 | ||
| Side effects | 555 | ||
| Anti-androgens | 555 | ||
| Cyproterone acetate (dianette, androcur) | 555 | ||
| Spironolactone | 556 | ||
| 44 Pelvic adhesions and their prevention | 561 | ||
| Incidence | 561 | ||
| Sequelae | 561 | ||
| Aetiology | 561 | ||
| Nonsurgical causes | 561 | ||
| Surgical causes | 562 | ||
| Pathophysiology of formation of adhesion | 562 | ||
| Clinical features | 562 | ||
| Prophylactic measures | 562 | ||
| Nonsurgical adhesions | 562 | ||
| Surgical adhesions | 562 | ||
| Laparotomy | 562 | ||
| Intraoperative prophylaxis | 562 | ||
| Methods used | 563 | ||
| Hydroflotation | 563 | ||
| Solid material barriers and gels | 563 | ||
| Conclusion | 563 | ||
| Self-assessment | 563 | ||
| Suggested reading | 563 | ||
| 45 Preoperative and postoperative care, and surgical procedures | 565 | ||
| Preoperative investigations | 565 | ||
| Preoperative care | 565 | ||
| Purpose of preoperative care | 565 | ||
| Correct diagnosis | 565 | ||
| Clinical examination | 565 | ||
| Investigations | 566 | ||
| Fitness for surgery | 566 | ||
| Drugs | 566 | ||
| Consent | 566 | ||
| Preoperative preparation | 566 | ||
| Anaesthesia | 566 | ||
| Antibiotics | 567 | ||
| Postoperative care | 567 | ||
| Immediate care (24 h) | 567 | ||
| Surgical procedures: Dilatation of the cervix and endometrial curettage (d&c) | 567 | ||
| Procedure of d&c | 568 | ||
| Contraindications | 569 | ||
| Complications | 569 | ||
| Sequelae of d&c | 569 | ||
| Instruments used | 569 | ||
| Other types of speculum | 570 | ||
| Conization of cervix | 571 | ||
| Complications | 571 | ||
| Self-assessment | 571 | ||
| Suggested reading | 571 | ||
| Index | 573 | ||
| A | 573 | ||
| B | 573 | ||
| C | 574 | ||
| D | 575 | ||
| E | 575 | ||
| F | 576 | ||
| G | 576 | ||
| H | 577 | ||
| I | 577 | ||
| J | 578 | ||
| K | 578 | ||
| L | 578 | ||
| M | 578 | ||
| N | 579 | ||
| O | 579 | ||
| P | 580 | ||
| Q | 581 | ||
| R | 581 | ||
| S | 581 | ||
| T | 582 | ||
| U | 582 | ||
| V | 582 | ||
| W | 583 | ||
| X | 583 | ||
| Y | 583 | ||
| Z | 583 |