BOOK
Gynaecology: Prepare for the MRCOG E-book
Philip N Baker | Alec S. McEwan | Sabaratnam Arulkumaran | Shreelata T Datta | Tahir A Mahmood | Fiona Reid | Mahmood I Shafi | Catherine Aiken
(2015)
Additional Information
Book Details
Abstract
Gynaecology is a new e-book presenting a collection of key articles from Obstetrics, Gynaecology and Reproductive Medicine, mapped by module to the MRCOG Part 2 exam.
As well as mapping to the MRCOG, the Inkling version of this e-book also enables anyone with a short-term interest in a specific area to buy individual articles at a price-point which will give affordable access to all readers (from medical students to GPs and practitioners in related areas, such a genitourinary medicine). Inkling’s app-like quality of user experience on mobiles, tablets and laptops will be an added bonus for learning on the move. As well as being vital preparation for the MRCOG exam, this material is also ideal for life-long learning, CPD and, indeed, preparation for all post-graduate exams in obstetrics (not just MRCOG), including especially the new EBCOG exam in Europe and local college exams in India.[the Middle East and Africa.
The parent journal is a rolling, continuously updated review of gyanecology over a three-year cycle covering all the important topics for the MRCOG Part 2 exam. Its Editorial Board comprises some of Europe’s most influential specialists and includes, among others, the current Presidents of FIGO and EBCOG, as well as the past President of the Royal College of Obstetrics and Gynaecology. The journal’s articles are refreshed, updated, augmented or replaced as appropriate each time the subject is due for revision to provide a concise overview of knowledge and practice core to the curriculum. Each article is written by invited experts and overseen by the relevant subject specialist on the Board. There is a trainee on the Board too, ensuring relevance and accessibility to exam candidates.
- Inkling version gives a highly attractive, app-like user experience, enabling much easier, more pleasurable use of the content on smartphones, tablets and laptops for learning on the move.
- Affordable chapter-level purchase on Inkling version opens out the journal’s authority and expertise to all interested users (medical students, family clinicians, genitourinary specialists and all other related specialties).
- Derived from top-notch authoritative content from the OGRM journal.
- Overseen by a world-class Editorial Board of experts, which includes the Presidents of FIGO, EBCOG and past President of the RCOG.
- A trainee representative on the Editorial Board ensures relevance and accessibility for exam candidates.
- Relevant to all post-graduate exams, including the new EBCOG exam and college exams in India, the Middle East and Africa.
- Highly appropriate content for life-long learning, personal development portfolios and CPD.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover\r | Cover | ||
| Gynaecology: Prepare for the MRCOG | Fm-1 | ||
| Copyright Page | Fm-4 | ||
| Table of Contents | Fm-7 | ||
| Preface | Fm-6 | ||
| About The Obstetrics, Gynaecology and Reproductive Medicine Journal and eBooks | Fm-11 | ||
| Section 1: Benign gynaecology | 1 | ||
| Risk management in gynaecology | 1 | ||
| Introduction | 1 | ||
| Adopt an integrative approach | 1 | ||
| Raise awareness | 1 | ||
| Design for safety | 3 | ||
| Involve service users | 4 | ||
| Collect and analyze patient safety data | 4 | ||
| Learn from patient safety incidents | 5 | ||
| Conclusion | 7 | ||
| Further reading | 7 | ||
| Medico-legal issues in gynaecology | 8 | ||
| Introduction | 8 | ||
| Clinical negligence | 8 | ||
| NHS indemnity | 8 | ||
| CNST | 8 | ||
| Litigation: life-cycle of a claim | 9 | ||
| Burden of claims in gynaecology | 9 | ||
| Causes of claims | 9 | ||
| Reducing the number of incidents | 10 | ||
| When things go wrong | 11 | ||
| Conclusion | 12 | ||
| Further reading | 12 | ||
| The ethics of medical performance | 14 | ||
| Introduction | 14 | ||
| The ethical framework of clinical practice | 14 | ||
| Revalidation | 14 | ||
| The process of revalidation | 14 | ||
| The Role of Royal Medical Colleges in maintaining performance standards | 15 | ||
| Summary and conclusion | 15 | ||
| Further reading | 16 | ||
| Possible reference for other reports of unacceptable performance are: | 16 | ||
| Maternal confidentiality: an ethical, professional and legal duty | 17 | ||
| Introduction | 17 | ||
| The law | 17 | ||
| Professional guidance | 17 | ||
| Ethical arguments | 17 | ||
| Breaching confidentiality | 18 | ||
| Challenges to maintaining patient privacy; traditional and modern problems | 18 | ||
| Conclusion | 18 | ||
| Further reading | 18 | ||
| Ultrasound in obstetrics and gynaecology | 20 | ||
| Introduction | 20 | ||
| How does ultrasound work? | 20 | ||
| Preparation | 20 | ||
| Gynaecological ultrasound | 20 | ||
| Diagnosing malignancy on ultrasound | 22 | ||
| Early pregnancy ultrasound | 22 | ||
| Obstetric ultrasound | 23 | ||
| Conclusion | 24 | ||
| Further reading | 24 | ||
| Perioperative care in gynaecology | 26 | ||
| Introduction | 26 | ||
| Preoperative care | 26 | ||
| Day-case surgery | 28 | ||
| Intraoperative care | 28 | ||
| Postoperative period | 29 | ||
| Discharge | 30 | ||
| Risk management and patient safety | 31 | ||
| Further reading | 31 | ||
| Principles of surgical technique | 32 | ||
| Introduction | 32 | ||
| Fundamental elements of surgical treatment | 32 | ||
| Preoperative evaluation and investigations | 32 | ||
| Anatomy | 34 | ||
| Complications | 36 | ||
| Postoperative care | 38 | ||
| Further reading | 39 | ||
| An overview of hysteroscopy and hysteroscopic surgery | 40 | ||
| Introduction | 40 | ||
| Indications | 40 | ||
| Applications of operative hysteroscopy | 40 | ||
| Theatre set-up | 40 | ||
| Equipment | 40 | ||
| Hysteroscope | 40 | ||
| Principles of electrosurgery needed for operative hysteroscopy using energy | 41 | ||
| Distension media | 41 | ||
| Operative techniques | 42 | ||
| Comparison of endometrial destruction techniques – Cochrane review 2009 | 43 | ||
| Comparison of first generation ablation techniques: TCRE, rollerball, laser | 43 | ||
| Pre-operative endometrial preparation and thinning | 44 | ||
| Reproductive hysteroscopic surgery for fibroids | 44 | ||
| Complications | 45 | ||
| Early complications: damage to the uterus or cervix | 45 | ||
| Absorption of distension media | 46 | ||
| Late complications | 46 | ||
| Team work and training | 46 | ||
| Conclusion | 46 | ||
| Further reading | 46 | ||
| Hysterectomy for benign gynaecological disease | 48 | ||
| Introduction | 48 | ||
| Various routes of hysterectomy: outcomes and cost-effectiveness | 48 | ||
| Supracervical hysterectomy/subtotal hysterectomy | 49 | ||
| Robotically assisted hysterectomies | 49 | ||
| Alternatives to hysterectomy and current stand in the United Kingdom | 49 | ||
| Ovarian conservation at hysterectomy | 50 | ||
| Complications of hysterectomy | 50 | ||
| Quality of life and psychological sequelae of hysterectomy | 51 | ||
| The varying hysterectomy rates | 51 | ||
| Health economics of hysterectomy | 51 | ||
| Innovative approaches to hysterectomy | 52 | ||
| Further reading | 53 | ||
| Complications of laparoscopic surgery | 54 | ||
| Introduction | 54 | ||
| Scenario 1: delayed presentation of a bowel injury | 54 | ||
| Case 2: neurological complication from laparoscopic surgery | 55 | ||
| Case 3: management of an intraoperative bladder injury | 56 | ||
| Conclusion | 56 | ||
| Further reading | 56 | ||
| Laparoscopy and laparoscopic surgery | 58 | ||
| Current practice | 58 | ||
| Ectopic pregnancy (Figure 2) | 59 | ||
| Laparoscopic surgery for pelvic organ prolapse | 59 | ||
| Laparoscopic surgery for endometriosis | 60 | ||
| Laparoscopic surgery and infertility management | 61 | ||
| Laparoscopic surgery in gynaecological oncology | 61 | ||
| Litigation and laparoscopic surgery | 62 | ||
| Difficulties with obtaining and maintaining a pneumoperitoneum | 63 | ||
| Injury to bowel when creating pneumoperitoneum or during insertion of trocar | 63 | ||
| Vascular injuries | 63 | ||
| Training | 64 | ||
| Laparoscopic training: virtual reality as an option for the future? | 64 | ||
| Conclusion | 65 | ||
| Further reading | 65 | ||
| Training information | 65 | ||
| Avoiding and managing complications in gynaecological surgery | 66 | ||
| Introduction | 66 | ||
| Predisposing factors | 66 | ||
| Preventing complications | 66 | ||
| Surgical techniques and equipment | 67 | ||
| Recognizing and managing complications | 68 | ||
| Conclusions | 71 | ||
| Further reading | 72 | ||
| Medical and surgical management of chronic pelvic pain | 73 | ||
| Introduction | 73 | ||
| Diagnosis | 73 | ||
| History | 73 | ||
| Examination | 74 | ||
| Investigations | 74 | ||
| Management strategies | 74 | ||
| Conclusions | 78 | ||
| Further reading | 78 | ||
| Heavy menstrual bleeding | 80 | ||
| Introduction | 80 | ||
| Prevalence | 80 | ||
| Causes of heavy menstrual bleeding | 80 | ||
| Obesity and HMB | 80 | ||
| Bleeding of endometrial origin | 81 | ||
| History, examination and investigations for HMB | 81 | ||
| Examination | 81 | ||
| Investigations (Table 2) | 81 | ||
| Treatment for HMB | 83 | ||
| Risks related to various routes for hysterectomy | 86 | ||
| Severe acute heavy menstrual bleeding | 87 | ||
| Further reading | 87 | ||
| Endometriosis | 88 | ||
| Introduction | 88 | ||
| Risk factors and genetics | 88 | ||
| Aetiology | 88 | ||
| Presentation | 89 | ||
| Diagnosis | 89 | ||
| Imaging | 90 | ||
| Surgical management | 92 | ||
| Deep infiltrating endometriosis (DIE) | 92 | ||
| Uterosacral ligaments | 92 | ||
| Rectovaginal septum | 93 | ||
| Bowel | 93 | ||
| Endometriomas | 93 | ||
| Bladder | 94 | ||
| Ureters | 95 | ||
| Presacral neurectomy (PSN) | 95 | ||
| Hysterectomy | 95 | ||
| Conclusion | 96 | ||
| Further Reading | 96 | ||
| Menorrhagia | 97 | ||
| Introduction | 97 | ||
| Definition | 97 | ||
| Aetiology | 97 | ||
| History and examination | 97 | ||
| Investigations | 97 | ||
| Management | 97 | ||
| Further reading | 99 | ||
| Intermenstrual and postcoital bleeding | 100 | ||
| Who should be referred? | 100 | ||
| Further reading | 106 | ||
| Dysmenorrhoea | 107 | ||
| Background | 107 | ||
| Pathophysiology | 107 | ||
| Primary dysmenorrhoea | 107 | ||
| Secondary dysmenorrhoea | 108 | ||
| Clinical features | 108 | ||
| Investigations | 109 | ||
| Management | 109 | ||
| Medical treatments | 110 | ||
| Surgical treatments | 111 | ||
| Conservative treatments | 111 | ||
| Other non-hormonal therapies | 112 | ||
| Prognosis | 112 | ||
| Conclusions | 113 | ||
| Further reading | 113 | ||
| Modern management of fibroids | 114 | ||
| Diagnosis of fibroids | 114 | ||
| Fibroids and fertility | 114 | ||
| Uterine artery embolization | 114 | ||
| Levonorgestrel secreting intrauterine system | 117 | ||
| Progesterone receptor modulators | 117 | ||
| High intensity focused ultrasound | 117 | ||
| Uterine artery occlusion | 118 | ||
| Conclusion | 118 | ||
| Further reading | 118 | ||
| Management of a pelvic mass | 120 | ||
| Introduction | 120 | ||
| Case 1 | 120 | ||
| Further case history | 120 | ||
| Case 2 | 123 | ||
| Case 3 | 125 | ||
| Further reading | 126 | ||
| Non-hormonal contraception | 127 | ||
| Intra-uterine contraception | 127 | ||
| Barrier methods | 128 | ||
| Male condoms | 128 | ||
| Female condoms | 128 | ||
| Diaphragms and caps | 129 | ||
| Spermicides | 129 | ||
| Natural family planning [NFP]/fertility awareness | 129 | ||
| Further reading | 129 | ||
| Non-oral contraception | 131 | ||
| Combined hormonal contraceptives | 131 | ||
| Progestogen only methods – implants and injectables | 133 | ||
| Intrauterine contraception copper intrauterine device (CU-IUD) | 134 | ||
| Barrier methods | 135 | ||
| Further reading | 136 | ||
| Contraception in patients with medical conditions | 137 | ||
| Hypertension | 137 | ||
| Migrainous headaches | 140 | ||
| Venous thromboembolism and hypercoagulable states | 140 | ||
| Further reading | 142 | ||
| Contraception for healthy women | 143 | ||
| Introduction | 143 | ||
| Initial assessment | 143 | ||
| Case 1: contraception for adolescents | 143 | ||
| Case 2: post-partum contraception | 145 | ||
| Case 3: contraception for the perimenopausal period | 145 | ||
| Conclusion | 147 | ||
| Further reading | 147 | ||
| Contraception and its ethical considerations | 148 | ||
| Introduction | 148 | ||
| Clinical assessment | 148 | ||
| Case 1: The adolescent attender | 148 | ||
| Case 2: Comorbidities and the older woman | 152 | ||
| Case 3: A request for permanent contraception | 153 | ||
| Conclusion | 154 | ||
| Further reading | 154 | ||
| Male and female sterilization | 156 | ||
| Introduction | 156 | ||
| Case 1: long term relationship with three children | 156 | ||
| Case 2: young female, new relationship, 4 children | 158 | ||
| Case 3: high BMI with multiple medical problems requesting sterilization | 158 | ||
| Case 4: childless female, tried LARC requesting sterilization | 159 | ||
| Discussion | 160 | ||
| Further reading | 160 | ||
| Intimate partner violence and women's reproductive health | 161 | ||
| Background | 161 | ||
| What are some of the risk factors for intimate partner violence? | 161 | ||
| Dynamics of intimate partner violence and reproductive health | 161 | ||
| Violence and adverse pregnancy outcomes | 162 | ||
| Violence during pregnancy | 163 | ||
| Health outcomes for the women | 163 | ||
| Women's responses to violent relationships | 163 | ||
| What healthcare providers can do about intimate partner violence? | 164 | ||
| Responding to intimate partner violence | 165 | ||
| Policy implications and systems response | 167 | ||
| Appendix 1. Domestic violence screening tool | 167 | ||
| Appendix 2. Example of cue card for healthcare providers responding to intimate partner violence in the UK | 168 | ||
| Further reading | 169 | ||
| Psychosexual problems | 170 | ||
| Introduction | 170 | ||
| Female sexual function | 170 | ||
| Case 1 | 170 | ||
| Case 2 | 171 | ||
| Female sexual dysfunction classification | 171 | ||
| Case 3 | 173 | ||
| Case 4 | 173 | ||
| How to ask about sex | 174 | ||
| The examination | 174 | ||
| Case 5 | 174 | ||
| Conclusion | 175 | ||
| Further reading | 175 | ||
| Dyspareunia: a difficult symptom in gynaecological practice | 176 | ||
| Introduction | 176 | ||
| Epidemiology | 176 | ||
| Aetiology | 176 | ||
| Common causes | 177 | ||
| History taking | 179 | ||
| Examination | 179 | ||
| Further investigations | 180 | ||
| Conclusions | 180 | ||
| Further reading | 181 | ||
| Sexual assault and rape | 182 | ||
| Introduction | 182 | ||
| Acute assault | 182 | ||
| Recent assault | 183 | ||
| Domestic violence and sexual assault | 185 | ||
| Historic abuse and sexual assault | 186 | ||
| Conclusion | 187 | ||
| Further reading | 187 | ||
| Non-HIV sexually transmitted infections | 188 | ||
| Why are sexually transmitted infections important? | 188 | ||
| Who gets STIs and why? | 188 | ||
| Microscopy, culture, antigen/antibody tests and NAATS | 189 | ||
| General principles of management of STIs | 190 | ||
| Gonorrhoea | 190 | ||
| Syphilis | 190 | ||
| Vaginal discharge | 191 | ||
| Bacterial vaginosis | 191 | ||
| Genital ulcers | 191 | ||
| Other viral infections excluding HIV infection | 192 | ||
| Human papilloma virus | 192 | ||
| Section 2: Subfertility/endocrine\r | 261 | ||
| Investigation and management of recurrent miscarriage | 261 | ||
| Introduction | 261 | ||
| Risks factors | 261 | ||
| Clinical approach | 263 | ||
| Management | 264 | ||
| Further reading | 266 | ||
| Induction of ovulation | 267 | ||
| Introduction | 267 | ||
| Case 1 | 267 | ||
| Discussion | 267 | ||
| How to monitor response to treatment | 268 | ||
| Case 2 | 268 | ||
| Discussion | 268 | ||
| Complications of gonadotropin treatment | 269 | ||
| Case 3 | 269 | ||
| Discussion | 269 | ||
| Conclusions | 270 | ||
| Further reading | 270 | ||
| Preimplantation genetic diagnosis | 272 | ||
| Introduction | 272 | ||
| Technique | 272 | ||
| Clinical applications | 272 | ||
| Outcomes | 274 | ||
| Risks | 276 | ||
| Ethics and controversies | 276 | ||
| Future | 278 | ||
| Further reading | 278 | ||
| Adolescent gynaecology | 279 | ||
| Introduction | 279 | ||
| Menstrual dysfunction | 279 | ||
| Menorrhagia | 279 | ||
| Treatment | 279 | ||
| Acute menorrhagia | 280 | ||
| Dysmenorrhoea | 280 | ||
| Sexually transmitted diseases and pregnancy related problems | 280 | ||
| Disorders of puberty | 280 | ||
| Precocious puberty | 281 | ||
| Premature adrenarche | 281 | ||
| Delayed puberty | 281 | ||
| Amenorrhoea | 281 | ||
| Assessment and investigation | 281 | ||
| Uterine and vaginal causes | 282 | ||
| Ovarian causes | 283 | ||
| Pituitary/hypothalamic causes | 284 | ||
| Conclusion | 284 | ||
| Further reading | 284 | ||
| Management of premenstrual syndrome: evidence-based guidelines | 285 | ||
| Definition | 285 | ||
| Aetiology | 285 | ||
| Prevalence | 285 | ||
| Diagnosis | 285 | ||
| Treatment | 286 | ||
| Medical treatment of PMS | 288 | ||
| Conclusions | 291 | ||
| Key to superscripts | 291 | ||
| Further reading | 291 | ||
| Further information | 291 | ||
| Surgical management of tubal disease and infertility | 293 | ||
| Introduction | 293 | ||
| Causes of tubal disease | 293 | ||
| Assessment of the fallopian tubes | 293 | ||
| Tubal disease and surgery | 294 | ||
| General consideration and patient selection | 297 | ||
| Microsurgical principles | 298 | ||
| Conclusion | 298 | ||
| Further reading | 298 | ||
| Male fertility and infertility | 299 | ||
| Introduction | 299 | ||
| Causes of male infertility | 299 | ||
| Evaluation of male infertility | 299 | ||
| Treatment options for male infertility | 301 | ||
| Further reading | 305 | ||
| Ovarian hyperstimulation syndrome | 306 | ||
| Introduction | 306 | ||
| Pathogenesis | 306 | ||
| Diagnosis | 306 | ||
| Classification | 307 | ||
| Prevention | 307 | ||
| Management | 308 | ||
| Further reading | 311 | ||
| Hirsutism | 312 | ||
| Definition | 312 | ||
| The hair growth cycle | 312 | ||
| Androgen metabolism in the female | 312 | ||
| Aetiology of hirsutism | 312 | ||
| Diagnosis | 313 | ||
| Treatment | 314 | ||
| Further reading | 315 | ||
| Polycystic ovary syndrome: diagnosis and management of related infertility | 316 | ||
| Introduction | 316 | ||
| Historical perspective | 316 | ||
| Pathophysiology | 316 | ||
| Diagnosis | 317 | ||
| Racial difference in expression | 317 | ||
| Signs and symptoms | 317 | ||
| Endocrinological features | 318 | ||
| Ultrasound features of PCOS | 318 | ||
| Management of infertility in PCOS | 318 | ||
| Pharmacological management of infertility in PCOS | 319 | ||
| Surgical management of infertility in PCOS | 320 | ||
| Assisted reproduction techniques: IVF | 321 | ||
| Conclusion | 321 | ||
| Further reading | 321 | ||
| The subfertile couple | 323 | ||
| Case 1 | 324 | ||
| What initial advice would you give to this couple? | 325 | ||
| What conditions in Mr PT could produce the unusual clinical and endocrine profiles shown above? | 325 | ||
| What are the effects of anabolic steroids and androgens on fertility? | 326 | ||
| What is the prognosis? | 326 | ||
| Case 3 | 326 | ||
| What differential diagnoses should be considered in this woman? | 326 | ||
| Case 4 | 327 | ||
| What impact does endometriosis have on reproductive performance? | 327 | ||
| What is the optimal management of ovarian endometriomas? | 328 | ||
| Further reading | 328 | ||
| In vitro fertilization | 329 | ||
| Indications | 329 | ||
| Preparation before treatment | 329 | ||
| Assisted reproduction treatment cycle | 330 | ||
| Ovarian stimulation | 331 | ||
| Ovarian monitoring/final oocyte maturation | 332 | ||
| Oocyte retrieval | 333 | ||
| Laboratory aspects of IVF/ICSI | 333 | ||
| Embryo transfer | 333 | ||
| The technique of embryo transfer | 333 | ||
| Factors affecting the success rate of IVF cycles outcomes | 333 | ||
| Complications of assisted reproduction treatment | 334 | ||
| Multiple pregnancies | 335 | ||
| Other complications | 335 | ||
| Long term safety of IVF | 336 | ||
| Further reading | 336 | ||
| Menstrual dysfunction | 338 | ||
| Introduction | 338 | ||
| The normal menstrual cycle | 338 | ||
| Case 1: abnormal uterine bleeding around the menarche | 338 | ||
| Case 2: ovulatory abnormal uterine bleeding | 338 | ||
| Case 3: anovulatory abnormal uterine bleeding | 340 | ||
| Case 4: abnormal uterine bleeding secondary to uterine fibroids | 341 | ||
| Case 5: abnormal uterine bleeding in the perimenopause | 342 | ||
| Conclusion | 342 | ||
| Further reading | 342 | ||
| Implications of obesity on surgical management of infertility and heavy menstrual bleeding | 343 | ||
| Introduction | 343 | ||
| Fertility | 343 | ||
| Heavy menstrual bleeding | 345 | ||
| Further reading | 346 | ||
| Re-definition and re-classification of menstrual disorders | 348 | ||
| Introduction | 348 | ||
| Normal uterine bleeding | 349 | ||
| Abnormal uterine bleeding | 349 | ||
| Conclusions | 352 | ||
| Further reading | 353 | ||
| Investigation and treatment of primary amenorrhoea | 354 | ||
| Introduction | 354 | ||
| Approach to a patient presenting with primary amenorrhoea | 354 | ||
| Diagnostic workup | 355 | ||
| Evaluation of amenorrhoea | 355 | ||
| Management | 355 | ||
| Turner's syndrome | 357 | ||
| Pure gonadal dysgenesis | 357 | ||
| Swyer syndrome | 357 | ||
| Amenorrhoea of hypothalamic origin | 358 | ||
| Amenorrhoea of pituitary origin | 358 | ||
| Further reading | 359 | ||
| Section 3: Gynaecological oncology\r | 360 | ||
| Colposcopy and cervical intraepithelial neoplasia | 360 | ||
| Introduction | 360 | ||
| Classification of cervical intraepithelial neoplasia | 360 | ||
| Risk factors | 360 | ||
| Natural history of HPV infection | 362 | ||
| Screening | 363 | ||
| Colposcopy | 363 | ||
| Management and treatment | 364 | ||
| Glandular disease | 368 | ||
| Follow-up after treatment | 368 | ||
| HPV vaccines | 370 | ||
| The future | 370 | ||
| Further reading | 370 | ||
| Human papillomavirus update (including vaccination) | 371 | ||
| Background | 371 | ||
| HPV virology | 371 | ||
| Prophylactic HPV vaccination | 373 | ||
| Management of HPV related anogenital neoplasia (AGIN) | 374 | ||
| Future developments | 375 | ||
| Further reading | 377 | ||
| Screening for gynaecological conditions | 378 | ||
| Introduction | 378 | ||
| Gynaecological cancers | 378 | ||
| Screening for non-cancerous conditions | 382 | ||
| Conclusions | 382 | ||
| Further reading | 383 | ||
| Invasive vulval cancer | 384 | ||
| Introduction | 384 | ||
| Predisposing factors | 384 | ||
| Vulval intraepithelial neoplasia (VIN) | 384 | ||
| Human papilloma virus | 385 | ||
| Lichen sclerosis (LS) | 385 | ||
| Lichen planus (LP) | 385 | ||
| Paget's disease | 386 | ||
| Cigarette smoking | 386 | ||
| Squamous cell carcinoma | 386 | ||
| Malignant melanoma | 386 | ||
| Bartholin's gland tumour | 386 | ||
| Basal cell carcinoma | 387 | ||
| Verrucous carcinoma | 387 | ||
| Vulval sarcomas | 387 | ||
| Clinical presentation of vulval cancer | 387 | ||
| Diagnosis and investigations | 387 | ||
| Assessing nodal spread | 387 | ||
| Staging | 388 | ||
| Frailty assessment | 388 | ||
| Management | 388 | ||
| Surgical treatment for early vulval cancer | 389 | ||
| Surgical treatment in advanced disease | 390 | ||
| Management of groin lymph nodes | 390 | ||
| Suspicious/enlarged groin nodes | 390 | ||
| Role of sentinel node dissection | 390 | ||
| Positive groin nodes | 391 | ||
| Radiotherapy | 391 | ||
| Primary radiotherapy | 391 | ||
| Adjuvant radiotherapy | 391 | ||
| Recurrent disease | 391 | ||
| Palliative treatment | 391 | ||
| Quality of life and psychosexual issues | 392 | ||
| Summary | 392 | ||
| Further reading | 392 | ||
| Skin diseases affecting the vulva | 393 | ||
| Infections | 393 | ||
| Disorders associated with malignancy | 394 | ||
| Other inflammatory dermatoses | 396 | ||
| Blisters & ulcers | 397 | ||
| Other conditions affecting the vulva | 398 | ||
| Further reading | 398 | ||
| Principles of chemotherapy and radiotherapy | 400 | ||
| Radiotherapy | 400 | ||
| Chemotherapy | 402 | ||
| Further reading | 406 | ||
| The impact of cancer treatment on reproductive health in young women | 407 | ||
| Introduction | 407 | ||
| Case 1: premature menopause | 407 | ||
| Case 2: primary infertility | 408 | ||
| Measurement of ovarian reserve | 408 | ||
| Case 3: preservation of female fertility | 409 | ||
| Case 4: pregnancy outcome | 410 | ||
| Further reading | 410 | ||
| Current management of gestational trophoblastic disease | 412 | ||
| Introduction | 412 | ||
| Hydatidiform mole | 412 | ||
| GTN | 414 | ||
| Tumours of intermediate trophoblast | 420 | ||
| Further reading | 421 | ||
| Ovarian cancer: current management and future directions | 422 | ||
| Introduction | 422 | ||
| Incidence-mortality | 422 | ||
| Prevention | 422 | ||
| Screening | 422 | ||
| Types of ovarian cancer (Table 3) | 423 | ||
| Epithelial tumours | 423 | ||
| Sex cord-stromal tumours | 424 | ||
| Malignant germ cell tumours | 424 | ||
| Diagnosis | 424 | ||
| Investigations – staging | 424 | ||
| Treatment | 425 | ||
| Surgery | 425 | ||
| Chemotherapy | 426 | ||
| Palliative care | 426 | ||
| Further reading | 427 | ||
| Palliative care in gynaecological oncology | 428 | ||
| Introduction | 428 | ||
| Symptom management | 428 | ||
| Recurrent ascites | 431 | ||
| Genital fistulae | 431 | ||
| Conclusion | 432 | ||
| Further reading | 432 | ||
| Endometrial cancer | 434 | ||
| Introduction | 434 | ||
| Pathology | 434 | ||
| Risk factors | 434 | ||
| Screening | 436 | ||
| Diagnosis | 436 | ||
| Investigations | 436 | ||
| Staging | 436 | ||
| Management | 436 | ||
| Surgical considerations | 437 | ||
| Radiotherapy | 437 | ||
| Chemotherapy | 437 | ||
| Controversies in the management of endometrial cancer | 437 | ||
| Predicting nodal disease | 438 | ||
| Advanced and recurrent disease | 438 | ||
| Endometrial carcinomas in young women | 439 | ||
| Prognosis and follow-up | 439 | ||
| Future directions | 439 | ||
| Further reading | 440 | ||
| Endometrial hyperplasia | 441 | ||
| Introduction | 441 | ||
| Classification | 441 | ||
| Epidemiology | 443 | ||
| Clinical presentation | 443 | ||
| Risk factors | 443 | ||
| Risk of cancer | 444 | ||
| Genetics | 444 | ||
| Investigation | 444 | ||
| Treatment | 445 | ||
| Conclusion | 446 | ||
| Further reading | 446 | ||
| Invasive cancer of the cervix | 447 | ||
| Introduction | 447 | ||
| Epidemiology | 447 | ||
| Pathological subtypes | 447 | ||
| Patterns of spread | 447 | ||
| Clinical management | 448 | ||
| Follow-up | 453 | ||
| Management of recurrent disease | 453 | ||
| Palliation | 453 | ||
| Cervical cancer in pregnancy | 453 | ||
| Prognostic factors | 454 | ||
| Survival | 454 | ||
| Psychological impact | 454 | ||
| The future | 454 | ||
| Further reading | 455 | ||
| Section 4: Urogynaecology & pelvic floor problems \r | 456 | ||
| Assessment of pelvic organ prolapse: a practical guide to the pelvic organ prolapse quantification | 456 | ||
| Introduction | 456 | ||
| Anatomy | 456 | ||
| Definition of prolapse | 457 | ||
| Understanding POP-Q | 458 | ||
| Assessment of symptoms of prolapse | 461 | ||
| Further reading | 462 | ||
| Management of urinary incontinence in frail elderly women | 463 | ||
| Introduction | 463 | ||
| Prevalence | 463 | ||
| Associated factors | 463 | ||
| Conditions caused by urinary incontinence | 463 | ||
| How is continence maintained? | 464 | ||
| Age related changes affecting the urinary tract | 465 | ||
| What are the symptoms and subtypes of UI? | 465 | ||
| Assessment of frail older patients with UI | 466 | ||
| Urinary incontinence and cognitive impairment | 469 | ||
| Conclusion | 469 | ||
| Further reading | 469 | ||
| Painful bladder syndrome | 471 | ||
| Introduction | 471 | ||
| Prevalence | 471 | ||
| Aetiology and pathogesesis | 471 | ||
| Clinical presentation | 472 | ||
| Management | 472 | ||
| Further reading | 476 | ||
| Conservative management of pelvic organ prolapse | 477 | ||
| Introduction | 477 | ||
| Lifestyle advice | 477 | ||
| Pelvic floor muscle training | 478 | ||
| Pessaries | 480 | ||
| Further reading | 481 | ||
| Basic understanding of urodynamics | 482 | ||
| Introduction | 482 | ||
| Background | 482 | ||
| Urodynamic investigations | 482 | ||
| Filling and voiding cystometry – practical points | 483 | ||
| Interpretation | 484 | ||
| After the test | 484 | ||
| Terminology | 484 | ||
| Quality control | 484 | ||
| Troubleshooting | 485 | ||
| Additional urodynamic investigations | 486 | ||
| Setting up equipment | 486 | ||
| Conclusion | 487 | ||
| Further reading | 487 | ||
| Surgical management of stress urinary incontinence | 488 | ||
| Introduction | 488 | ||
| Initial assessment | 488 | ||
| Management of stress urinary incontinence | 488 | ||
| Surgery for stress urinary incontinence | 488 | ||
| Recurrent stress urinary incontinence | 492 | ||
| Conclusion | 492 | ||
| Further reading | 493 | ||
| Modern management of overactive bladder syndrome | 494 | ||
| Introduction | 494 | ||
| Conservative management of OAB | 494 | ||
| Second line management of OAB | 494 | ||
| Further reading | 497 | ||
| Changing trends in pelvic organ prolapse surgery | 498 | ||
| The extent of the problem | 498 | ||
| The changes in POP surgery | 498 | ||
| The evidence for sacral colpopexy | 498 | ||
| Route of sacral colpopexy | 499 | ||
| Sacral colpopexy and uterine prolapse | 499 | ||
| Sacral colpopexy and retropubic surgery | 500 | ||
| Ventral rectopexy | 500 | ||
| Conclusion | 501 | ||
| Further reading | 501 | ||
| Complications of polypropylene mesh in prolapse surgery: an update | 503 | ||
| Introduction | 503 | ||
| Mesh use in the United Kingdom | 503 | ||
| Recent concerns with mesh | 503 | ||
| Efficacy of mesh and mesh kits | 503 | ||
| Complications | 504 | ||
| Specific complications | 504 | ||
| Mesh exposure | 504 | ||
| Mesh infection | 506 | ||
| Mesh contraction | 506 | ||
| Pain and dyspareunia | 507 | ||
| Denovo urinary and faecal incontinence | 507 | ||
| Visceral injury | 507 | ||
| Perioperative haemorrhage | 507 | ||
| Reoperation rates | 507 | ||
| Prolapse of other compartments | 507 | ||
| How to minimize complications | 507 | ||
| Selecting the right mesh | 507 | ||
| Selecting the right surgeon: who should perform mesh surgery? | 508 | ||
| Patient selection | 508 | ||
| Informed consent | 508 | ||
| Selecting the right technique | 508 | ||
| Post procedural follow-up | 508 | ||
| Conclusions | 509 | ||
| Further reading | 509 | ||
| Urological complications following gynaecological surgery | 510 | ||
| Introduction | 510 | ||
| Incidence | 510 | ||
| Risk factors | 511 | ||
| Pathogenesis | 511 | ||
| Prevention of urinary tract injuries | 512 | ||
| Detection of urinary tract injuries | 513 | ||
| Immediate presentation | 513 | ||
| Delayed presentation | 513 | ||
| Management | 514 | ||
| Ureteric injuries | 514 | ||
| Bladder injury | 514 | ||
| Urethral injury | 514 | ||
| Medicolegal implications of urinary tract injuries | 514 | ||
| Conclusion | 515 | ||
| Further reading | 515 |