BOOK
Hacker & Moore's Essentials of Obstetrics and Gynecology E-Book
Neville F. Hacker | Joseph C. Gambone | Calvin J. Hobel
(2015)
Additional Information
Book Details
Abstract
Hacker & Moore's Essentials of Obstetrics and Gynecology, by Drs. Neville F. Hacker, Joseph C. Gambone, and Calvin J. Hobel, is the #1 choice of ob/gyn residents and medical students because of its concise focus, comprehensive coverage, and easy-to-use format. This new edition features updated clinical cases and assessments, new Clinical Key boxes, and thoroughly revised text and images that reflect today’s best knowledge on the evaluation, diagnosis, and management of a wide range of ob/gyn disorders.
- Concise, comprehensive content is well organized, highly accessible, and relevant to today’s practice.
- High-quality, full-color design for maximum readability.
- New Clinical Key boxes and judicious use of bolding make it easy to identify the high-yield material you need to know.
- Content is aligned to APGO/CREOG objectives to ensure coverage of essential, clinically relevant material.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Hacker & Moore's Essentials of Obstetrics and Gynecology | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Preface | ix | ||
| Table Of Contents | xi | ||
| 1 Introduction | 1 | ||
| 1 A Life-Course Perspective for Women’s Health Care | 2 | ||
| Clinical Keys for this Chapter | 2 | ||
| Principles of Practice | 2 | ||
| Life-Course Perspective | 3 | ||
| Impact on Public Health | 4 | ||
| Patient Safety—The First Principle of Practice | 5 | ||
| Medical Error Reporting | 5 | ||
| Disclosure of Medical Error | 6 | ||
| Ethical Practice— The Second Principle | 6 | ||
| Nonmaleficence | 6 | ||
| Beneficence | 6 | ||
| Autonomy | 6 | ||
| Justice | 7 | ||
| Other Duties of Ethical Practice | 7 | ||
| Malpractice and Maloccurrence | 8 | ||
| Value—The Third Principle of Practice | 8 | ||
| High Reliability in Health Care | 9 | ||
| Patient-Centered Prevention— The Fourth Principle of Practice | 9 | ||
| Immunizations and Preventive Health Screening | 11 | ||
| 2 Clinical Approach to the Patient | 12 | ||
| Clinical Keys for this Chapter | 12 | ||
| Obstetric and Gynecologic Evaluation | 12 | ||
| Obstetric History | 13 | ||
| Previous Pregnancies | 13 | ||
| Menstrual History | 13 | ||
| Contraceptive History | 13 | ||
| Medical History | 13 | ||
| Surgical History | 14 | ||
| Social History | 14 | ||
| Obstetric Physical Examination | 14 | ||
| General Physical Examination | 14 | ||
| Pelvic Examination | 14 | ||
| Clinical Pelvimetry | 14 | ||
| Diagnosis of Pregnancy | 14 | ||
| Symptoms of Pregnancy | 14 | ||
| Signs of Pregnancy | 14 | ||
| Presumptive Signs | 14 | ||
| Probable Signs | 14 | ||
| Positive Signs | 14 | ||
| Laboratory Tests for Pregnancy | 15 | ||
| Pregnancy Tests | 15 | ||
| Diagnostic Ultrasonography | 15 | ||
| Gynecologic History | 15 | ||
| Present Illness | 15 | ||
| Abnormal Vaginal Bleeding | 15 | ||
| Abdominal Pain | 15 | ||
| Amenorrhea | 15 | ||
| Other Symptoms | 15 | ||
| Menstrual History | 15 | ||
| Contraceptive History | 15 | ||
| Obstetric History | 16 | ||
| Sexual History | 16 | ||
| Past History | 16 | ||
| Systemic Review | 16 | ||
| Gynecologic Physical Examination | 16 | ||
| General Physical Examination | 16 | ||
| Vital Signs | 16 | ||
| General Appearance | 16 | ||
| Head and Neck | 16 | ||
| Breasts | 16 | ||
| Heart and Lungs | 16 | ||
| Abdomen | 16 | ||
| Back | 17 | ||
| Extremities | 17 | ||
| Pelvic Examination | 17 | ||
| Vulva | 17 | ||
| Speculum Examination | 17 | ||
| Bimanual Examination | 18 | ||
| Rectal Examination | 20 | ||
| Laboratory Evaluation | 20 | ||
| Assessment | 20 | ||
| Patients with Special Needs | 20 | ||
| Pediatric and Adolescent Patients | 20 | ||
| Genital Ambiguity | 20 | ||
| Trauma | 20 | ||
| Vaginal Bleeding in the Prepubertal Child | 21 | ||
| Geriatric Patients | 22 | ||
| Patients with Disabilities | 22 | ||
| Lesbian, Gay, Bisexual, and Transgender Patients | 22 | ||
| 3 Female Reproductive Anatomy and Embryology | 23 | ||
| Clinical Keys for This Chapter | 23 | ||
| Development of the External Genitalia | 23 | ||
| Anatomy of the External Genitalia | 24 | ||
| Vulva | 25 | ||
| Internal Genital Development | 26 | ||
| Vagina | 27 | ||
| Uterus | 28 | ||
| Fallopian Tubes | 30 | ||
| Normal Embryologic Development of the Ovary | 30 | ||
| Anatomy of the Ovaries | 32 | ||
| Anatomy of the Ureters | 33 | ||
| Lymphatic Drainage | 34 | ||
| Anatomy of the Bony Pelvis | 34 | ||
| Anatomy of the Lower Abdominal Wall | 34 | ||
| Abdominal Wall Incisions | 36 | ||
| 4 Female Reproductive Physiology | 37 | ||
| Clinical Keys for this Chapter | 37 | ||
| Reproductive Cycle | 37 | ||
| Hypothalamic-Pituitary Axis | 38 | ||
| Pituitary Gland | 38 | ||
| Gonadotropin Secretory Patterns | 39 | ||
| Hypothalamus | 40 | ||
| Ovarian Cycle | 42 | ||
| Estrogens | 42 | ||
| Progestins | 42 | ||
| Androgens | 42 | ||
| Serum-Binding Proteins | 43 | ||
| Prolactin | 43 | ||
| Follicular Development | 43 | ||
| Ovulation | 44 | ||
| Luteinization and Corpus Luteum Function | 44 | ||
| Histophysiology of the Endometrium | 44 | ||
| Menstrual Phase | 45 | ||
| Proliferative Phase | 45 | ||
| Secretory Phase | 45 | ||
| Spermatogenesis, Sperm Capacitation, and Fertilization | 46 | ||
| Cleavage, Morula, Blastocyst | 47 | ||
| Implantation | 47 | ||
| Placenta | 48 | ||
| Amniotic Fluid | 49 | ||
| 2 Obstetrics | 51 | ||
| 5 Endocrinology of Pregnancy and Parturition | 52 | ||
| Clincal Keys for This Chapter | 52 | ||
| Fetoplacental Unit | 52 | ||
| Fetus | 54 | ||
| Placenta | 54 | ||
| Mother | 54 | ||
| Hormones | 54 | ||
| Peptide Hormones | 54 | ||
| Human Chorionic Gonadotropin | 54 | ||
| Human Placental Lactogen | 54 | ||
| Corticotropin-Releasing Hormone | 55 | ||
| Prolactin | 55 | ||
| Steroid Hormones | 55 | ||
| Progesterone | 55 | ||
| Estrogens | 55 | ||
| Androgens | 55 | ||
| Glucocorticoids | 56 | ||
| Other Hormones and Transmitters | 57 | ||
| Oxytocin | 57 | ||
| Relaxin | 57 | ||
| Prostaglandins and Leukotrienes | 57 | ||
| Changes in Maternal Metabolism | 58 | ||
| Angiotensin-Aldosterone | 58 | ||
| Calcium Metabolism | 58 | ||
| Parturition | 58 | ||
| Biochemical Basis of Contraction | 58 | ||
| Hormonal Control of Gestational Length and Initiation of Labor | 59 | ||
| Animal Models | 59 | ||
| The Human | 59 | ||
| Phase 0: Quiescence. | 59 | ||
| Phase 1: Activation. | 60 | ||
| Phase 2: Stimulation. | 60 | ||
| Phase 3: Involution. | 60 | ||
| 6 Maternal Physiologic and Immunologic Adaptation to Pregnancy | 61 | ||
| Clinical Keys for this Chapter | 61 | ||
| Normal Values in Pregnancy | 62 | ||
| Cardiovascular System | 62 | ||
| Cardiac Output | 62 | ||
| Intravascular Pressures | 63 | ||
| Mechanical Circulatory Effects of the Gravid Uterus | 63 | ||
| Regional Blood Flow | 64 | ||
| Control of Cardiovascular Changes | 64 | ||
| Oxygen-Carrying Capacity of Blood | 64 | ||
| Respiratory System | 64 | ||
| Respiratory Mechanics in Pregnancy | 64 | ||
| Oxygen Consumption and Ventilation | 65 | ||
| Alveolar-Arterial Gradient and Arterial Blood Gas Measurements | 65 | ||
| Dyspnea of Pregnancy | 66 | ||
| Renal Physiology | 66 | ||
| Anatomic Changes in the Urinary Tract | 66 | ||
| Renal Blood Flow and Glomerular Filtration Rate | 66 | ||
| Renal Tubular Function | 66 | ||
| Fluid Volumes | 66 | ||
| Renin-Angiotensin System in Pregnancy | 66 | ||
| Homeostasis of Maternal Energy Substrates | 67 | ||
| Insulin Effects and Glucose Metabolism | 67 | ||
| Lipid Metabolism | 67 | ||
| Placental Transfer of Nutrients | 67 | ||
| Other Endocrine Changes | 67 | ||
| Thyroid | 67 | ||
| Adrenal | 68 | ||
| Weight Gain in Pregnancy | 68 | ||
| Placental Transfer of Oxygen and Carbon Dioxide | 68 | ||
| Fetal Oxygenation | 68 | ||
| Fetal and Maternal Hemoglobin Dissociation Curves | 70 | ||
| Fetal Circulation | 70 | ||
| Changes in the Anatomy of the Cardiovascular System after Birth | 72 | ||
| Immunology of Pregnancy | 72 | ||
| Innate and Adaptive Immunity | 73 | ||
| Development of Fetal Immunity | 73 | ||
| Immunobiology of the Maternal-Fetal Interaction | 74 | ||
| Immunologic Response during Normal Pregnancy | 74 | ||
| 7 Antepartum Care | 76 | ||
| Clinical Keys for this Chapter | 76 | ||
| Preconception Care | 77 | ||
| Prenatal Care | 77 | ||
| The First Prenatal Visit | 77 | ||
| Confirming Pregnancy and Determining Viability | 79 | ||
| Incidence of Early Pregnancy Loss | 79 | ||
| Types of Spontaneous Abortion | 80 | ||
| Threatened Abortion | 80 | ||
| Inevitable Abortion | 80 | ||
| Incomplete Abortion | 80 | ||
| Complete Abortion | 80 | ||
| Missed Abortion | 80 | ||
| Recurrent Abortion | 80 | ||
| Etiology of Recurrent Abortion | 80 | ||
| General Maternal Factors | 80 | ||
| Infection. | 80 | ||
| Smoking and Alcohol. | 80 | ||
| Psychosocial Stress. | 80 | ||
| Medical Disorders. | 80 | ||
| Maternal Age. | 81 | ||
| Local Maternal Factors | 81 | ||
| Fetal Factors | 81 | ||
| Placental Factors | 81 | ||
| Chromosomal Factors | 82 | ||
| Immunologic Factors | 82 | ||
| Management | 82 | ||
| Threatened Abortion | 82 | ||
| Incomplete Abortion | 82 | ||
| Missed Abortion | 82 | ||
| General Management Considerations | 82 | ||
| Recurrent Abortion | 82 | ||
| Estimating Gestational Age and Date of Confinement | 83 | ||
| Patients Who Require Genetic Counseling | 83 | ||
| Congenital and Hereditary Disorders | 83 | ||
| Chromosomal Disorders | 83 | ||
| Single Gene Disorders | 84 | ||
| Autosomal Dominant Disorders | 84 | ||
| Autosomal Recessive Disorders | 85 | ||
| Genetic Screening for Autosomal Recessive Disorders | 85 | ||
| Sex-Linked Disorders | 85 | ||
| Multifactorial Disorders | 85 | ||
| Maternal Ultrasonic and Serum Marker Screening | 86 | ||
| First-Trimester Screening | 86 | ||
| Second-Trimester Screening | 86 | ||
| Combined First- and Second-Trimester Screening | 87 | ||
| Integrated Screening. | 87 | ||
| Sequential Screening. | 87 | ||
| Diagnostic Procedures | 87 | ||
| Teratology | 87 | ||
| Exposure | 88 | ||
| Principles of Teratology | 88 | ||
| Fetal Susceptibility | 88 | ||
| Dose | 88 | ||
| Timing | 88 | ||
| Nature of Teratogenic Agents | 88 | ||
| Teratogenic Agents | 88 | ||
| Alcohol | 88 | ||
| Antianxiety Agents | 88 | ||
| Antineoplastic Agents | 88 | ||
| Anticoagulants | 89 | ||
| Coumarin Derivatives. | 89 | ||
| Heparin. | 89 | ||
| Anticonvulsants | 89 | ||
| Diphenylhydantoin (Dilantin). | 89 | ||
| Oxazolidinedione Anticonvulsants. | 89 | ||
| Valproic Acid. | 89 | ||
| Carbamazepine. | 90 | ||
| Phenobarbital. | 90 | ||
| Hormones | 90 | ||
| Estrogen/Progestin Combinations. | 90 | ||
| Miscellaneous Agents | 90 | ||
| Retinoids. | 90 | ||
| Tobacco Smoking. | 90 | ||
| Illicit Drugs. | 90 | ||
| Infectious Agents. | 90 | ||
| Radiation. | 90 | ||
| Advice during Pregnancy | 90 | ||
| Alleviating Unpleasant Symptoms | 90 | ||
| Nutritional Counseling | 91 | ||
| Lifestyle Advice | 91 | ||
| Breastfeeding | 92 | ||
| Follow-Up Visits | 92 | ||
| Assessment of Fetal Well-Being | 93 | ||
| Maternal Self-Assessment of Fetal Well-Being | 93 | ||
| Nonstress Test Assessment | 93 | ||
| Ultrasonic Assessment | 93 | ||
| Umbilical Artery Doppler Assessment | 93 | ||
| Preventive Health Care | 93 | ||
| 8 Normal Labor, Delivery, and Postpartum Care | 96 | ||
| Clinical Keys for This Chapter | 96 | ||
| Anatomic Characteristics of the Fetal Head and Maternal Pelvis | 96 | ||
| Fetal Head | 97 | ||
| Sutures | 97 | ||
| Fontanelles | 97 | ||
| Landmarks | 97 | ||
| Diameters | 97 | ||
| Pelvic Anatomy | 98 | ||
| Bony Pelvis | 98 | ||
| Pelvic Planes | 98 | ||
| Pelvic Diameters | 99 | ||
| Pelvic Inlet | 99 | ||
| Plane of Greatest Diameter | 100 | ||
| Plane of Least Diameter (Midplane) | 100 | ||
| Pelvic Outlet | 100 | ||
| Pelvic Shapes | 100 | ||
| Gynecoid | 100 | ||
| Android | 100 | ||
| Anthropoid | 101 | ||
| Platypelloid | 101 | ||
| Engagement | 101 | ||
| Clinical Pelvimetry | 102 | ||
| Radiologic Assessment of the Pelvis | 103 | ||
| Indications | 103 | ||
| Preparation for Labor | 103 | ||
| Lightening | 103 | ||
| False Labor | 103 | ||
| Cervical Effacement | 104 | ||
| Induction and Augmentation of Labor | 104 | ||
| Technique for Induction and Augmentation of Labor | 105 | ||
| Oxytocin Infusion | 105 | ||
| Complications. | 106 | ||
| Stages of Labor | 106 | ||
| First Stage of Labor as Defined by the Friedman Labor Curve | 106 | ||
| Phases. | 106 | ||
| Length. | 106 | ||
| Measurement of Progress. | 106 | ||
| Clinical Management of the First Stage. | 107 | ||
| Maternal Position. | 107 | ||
| Administration of Fluids. | 107 | ||
| Investigations. | 107 | ||
| Maternal Monitoring. | 107 | ||
| Analgesia. | 108 | ||
| Fetal Monitoring. | 108 | ||
| Uterine Activity. | 108 | ||
| Vaginal Examination. | 108 | ||
| Amniotomy. | 108 | ||
| Second Stage of Labor | 108 | ||
| Mechanisim of Labor. | 108 | ||
| Descent. | 108 | ||
| Flexion. | 108 | ||
| Internal Rotation. | 108 | ||
| Extension. | 109 | ||
| External Rotation. | 109 | ||
| Expulsion. | 110 | ||
| Clinical Management of the Second Stage. | 110 | ||
| Maternal Position. | 110 | ||
| Bearing Down. | 110 | ||
| Fetal Monitoring. | 110 | ||
| Vaginal Examination. | 110 | ||
| Delivery of the Fetus. | 110 | ||
| Third Stage of Labor | 110 | ||
| Delivery of the Placenta. | 111 | ||
| Fourth Stage of Labor | 112 | ||
| Puerperium | 113 | ||
| Anatomic and Physiologic Changes | 113 | ||
| Involution of the Uterus | 113 | ||
| Vagina | 113 | ||
| Cardiovascular System | 113 | ||
| Psychosocial Changes | 114 | ||
| Return of Menstruation and Ovulation | 115 | ||
| Breastfeeding | 115 | ||
| Lactation | 115 | ||
| Lactation Suppression | 116 | ||
| Complications of Breastfeeding | 116 | ||
| Cracked Nipples | 116 | ||
| Mastitis | 116 | ||
| Drug Passage to the Newborn | 116 | ||
| Interconception Care | 116 | ||
| Obstetric Analgesia and Anesthesia | 116 | ||
| Uterine Blood Flow | 117 | ||
| Pain Pathways | 117 | ||
| Adverse Effects of Labor Pain | 117 | ||
| Options for Labor Pain Relief | 118 | ||
| Anesthesia for Cesarean Delivery | 118 | ||
| Patients Who Benefit From Early Anesthetic Consultation | 120 | ||
| Unintended Consequences of Regional Anesthesia And/or Analgesia | 120 | ||
| Resuscitation of the Newborn | 120 | ||
| Preparation for Extrauterine Life | 120 | ||
| Etiology of Neonatal Cardiorespiratory Depression | 121 | ||
| Facilitating Neonatal Adaptation | 121 | ||
| 1. Clear the Airway | 121 | ||
| 2. Dry the Newborn | 121 | ||
| 3. Clamp the Cord | 121 | ||
| 4. Ensure Onset of Respiration | 121 | ||
| 5. Correct Surfactant Deficiency | 122 | ||
| Apgar Score | 123 | ||
| Resuscitation of the Asphyxiated Infant | 123 | ||
| Sequence of Procedures | 123 | ||
| 1. Establish an Airway | 123 | ||
| 2. Initiate Breathing | 123 | ||
| 3. Ensure Cardiac Performance | 123 | ||
| 4. Correct Biochemical Abnormalities | 123 | ||
| Acidosis. | 123 | ||
| Anemia. | 124 | ||
| Narcotic Depression. | 124 | ||
| Hypoglycemia. | 124 | ||
| Other Factors. | 124 | ||
| Neonatal Respiratory Failure | 124 | ||
| Long-Term Outcome | 124 | ||
| 9 Fetal Surveillance during Labor | 125 | ||
| Clinical Keys for this Chapter | 125 | ||
| Methods of Monitoring Fetal Heart Rate | 125 | ||
| Auscultation of the Fetal Heart Rate | 125 | ||
| Continuous Electronic Fetal Heart Rate Monitoring | 126 | ||
| Pathophysiology of Abnormal Fetal Heart Rate Patterns | 126 | ||
| Etiology of Hypoxia, Acidosis, and Fetal Heart Rate Changes | 127 | ||
| Fetal Heart Rate Patterns | 127 | ||
| Baseline Assessment | 127 | ||
| Periodic Fetal Heart Rate Changes | 128 | ||
| Types of Patterns | 128 | ||
| Early Deceleration (Head Compression). | 128 | ||
| Late Deceleration (Uteroplacental Insufficiency). | 128 | ||
| Variable Deceleration (Cord Compression). | 131 | ||
| Nonpattern Signs of Fetal Distress | 131 | ||
| Fetal Tachycardia | 131 | ||
| Meconium | 131 | ||
| Strategies for Intervention | 132 | ||
| Category I FHR (Normal) | 132 | ||
| Category II FHR (Intermediate/Possible Early Dysregulation) | 132 | ||
| Strategies for Resuscitation | 132 | ||
| Amnioinfusion | 133 | ||
| Category III FHR (Abnormal) | 133 | ||
| Strategies for Intervention | 133 | ||
| Fetal Assessment at Birth to Document the Status of the Fetus at Risk for Birth Asphyxia | 134 | ||
| Apgar Score | 134 | ||
| Umbilical Cord Blood Sampling | 135 | ||
| Controversies about Fetal Monitoring for the Diagnosis and Treatment of Fetal Distress | 135 | ||
| 10 Obstetric Hemorrhage | 136 | ||
| Clinical Keys for This Chapter | 136 | ||
| Antepartum Hemorrhage | 136 | ||
| Initial Evaluation | 137 | ||
| Abnormal Placentation: Placenta Previa and Placenta Accreta | 137 | ||
| Placenta Previa | 137 | ||
| Predisposing Factors | 137 | ||
| Classification | 137 | ||
| Diagnosis | 138 | ||
| Management | 138 | ||
| Low-Lying Placenta | 138 | ||
| Maternal-Fetal Risks | 138 | ||
| Placenta Accreta | 139 | ||
| Abruptio Placentae | 139 | ||
| Predisposing Factors and Pathophysiology | 139 | ||
| Diagnosis and Management | 139 | ||
| Maternal-Fetal Risks | 139 | ||
| Uterine Rupture | 140 | ||
| Diagnosis and Management | 140 | ||
| Maternal-Fetal Risk | 140 | ||
| Fetal Bleeding | 140 | ||
| Postpartum Hemorrhage | 140 | ||
| Uterine Atony | 140 | ||
| Management of Patients at Risk for Postpartum Hemorrhage | 141 | ||
| Differential Diagnosis: Other Less Common Causes of Postpartum Hemorrhage | 141 | ||
| Genital Tract Trauma | 142 | ||
| Retained Placental Tissue | 142 | ||
| Low Placental Implantation | 142 | ||
| Coagulation Disorders | 143 | ||
| Uterine Inversion | 143 | ||
| Obstetric Shock and External Bleeding | 143 | ||
| Management of Established Postpartum Hemorrhage and Obstetric Shock | 143 | ||
| Uterine Atony | 143 | ||
| Genital Tract Trauma | 144 | ||
| Retained Products of Conception | 144 | ||
| Uterine Inversion | 144 | ||
| Amniotic Fluid Embolus | 145 | ||
| Management of Coagulopathy | 145 | ||
| 11 Uterine Contractility and Dystocia | 147 | ||
| Clinical Keys for This Chapter | 147 | ||
| Physiologic Changes of Labor | 147 | ||
| Normal Labor | 148 | ||
| Abnormalities of the Latent Phase of Labor | 149 | ||
| Management | 149 | ||
| Abnormalities of the Active Phase of Labor | 149 | ||
| Management | 150 | ||
| Active Management of Labor | 151 | ||
| Dystocia Caused by Abnormal Presentation and Position | 151 | ||
| Persistent Occipitotransverse Position | 151 | ||
| Persistent Occipitoposterior Position | 152 | ||
| Dystocia Caused by Abnormalities of Fetal Structure | 152 | ||
| Macrosomia and Shoulder Dystocia | 152 | ||
| Developmental Abnormalities | 153 | ||
| Dystocia Caused by Maternal Pelvic Abnormalities | 153 | ||
| Dystocia Caused by Conduction Anesthesia | 154 | ||
| 12 Obstetric Complications | 155 | ||
| Clinical Keys for This Chapter | 155 | ||
| Preterm Labor | 156 | ||
| Definition and Incidence | 156 | ||
| Etiology and Risk Factors | 156 | ||
| Socioeconomic Factors | 156 | ||
| Obstetric, Medical, and Environmental Factors | 156 | ||
| Pathways Thought to Cause Preterm Birth: | 157 | ||
| Infection-Cervical Pathway | 157 | ||
| Placental-Vascular Pathway | 157 | ||
| Stress-Strain Pathway | 157 | ||
| Uterine Stretch Pathway | 158 | ||
| Prevention of Preterm Birth | 158 | ||
| Diagnosis and Management of Preterm Labor | 158 | ||
| Uterine Tocolytic Therapy | 159 | ||
| Magnesium Sulfate | 159 | ||
| Nifedipine | 159 | ||
| Prostaglandin Synthetase Inhibitors | 160 | ||
| Oxytocin Receptor Antagonists | 160 | ||
| Efficacy of Tocolytic Therapy | 160 | ||
| Antibiotic Therapy | 160 | ||
| Contraindications to Tocolytic Therapy | 160 | ||
| Use of Glucocorticoids for Fetal Pulmonary Maturation | 160 | ||
| Labor and Delivery of the Preterm Infant | 160 | ||
| Premature Rupture of the Membranes | 161 | ||
| Definition and Incidence | 161 | ||
| Etiology and Risk Factors | 161 | ||
| Diagnosis | 161 | ||
| Management | 161 | ||
| General Considerations | 161 | ||
| Laboratory Tests | 162 | ||
| Conservative Expectant Management | 162 | ||
| Management of Chorioamnionitis | 162 | ||
| Tocolytic Therapy | 162 | ||
| Use of Corticosteroids | 162 | ||
| Outpatient Management | 163 | ||
| Labor and Delivery | 163 | ||
| Tests of Pulmonary Maturity | 163 | ||
| Lung Profile | 163 | ||
| Rapid Tests for Fetal Lung Maturity | 163 | ||
| Surfactant Therapy | 163 | ||
| Intrauterine Growth Restriction | 164 | ||
| Etiology | 164 | ||
| Maternal | 164 | ||
| Placental | 165 | ||
| Fetal | 165 | ||
| Clinical Manifestations | 165 | ||
| Diagnosis | 165 | ||
| Clinical Example of Fetal Growth Restriction | 166 | ||
| Management | 166 | ||
| Prepregnancy | 166 | ||
| Antepartum | 166 | ||
| Labor and Delivery | 167 | ||
| Prognosis | 167 | ||
| Postterm Pregnancy | 167 | ||
| Etiology | 167 | ||
| 3 GYNECOLOGY | 235 | ||
| 18 Benign Conditions and Congenital Anomalies of the Vulva and Vagina | 236 | ||
| Clinical Keys for This Chapter | 236 | ||
| Vulva | 236 | ||
| Benign Conditions of the Vulva | 236 | ||
| Epithelial Changes | 236 | ||
| White Lesions. | 237 | ||
| Red Lesions. | 239 | ||
| Pigmented Lesions. | 240 | ||
| Ulcerations and Fissures | 240 | ||
| Solid or Cystic Masses of the Vulva | 241 | ||
| Other Vulvar Masses | 241 | ||
| Congenital Anomalies of the Vulva | 241 | ||
| Iatrogenic Anatomical Changes | 243 | ||
| Vagina | 243 | ||
| Benign Conditions of the Vagina | 243 | ||
| Epithelial Changes | 243 | ||
| Ulceration and Fistulas | 243 | ||
| Cystic Masses | 244 | ||
| Trauma | 245 | ||
| Other Benign Abnormalities of the Vagina | 245 | ||
| Congenital Abnormalities of the Vagina | 246 | ||
| 19 Benign Conditions and Congenital Anomalies of the Uterine Corpus and Cervix | 248 | ||
| Clinical Keys for This Chapter | 248 | ||
| Benign Neoplastic Conditions | 248 | ||
| Uterine Fibroids (Leiomyomas) | 248 | ||
| Pathogenesis of Fibroids | 249 | ||
| Characteristics of Fibroids | 249 | ||
| Symptoms of Fibroids | 250 | ||
| Signs of Fibroids | 250 | ||
| Differential Diagnosis for Fibroids | 250 | ||
| Management of Fibroids | 251 | ||
| Medical Management | 251 | ||
| Surgical Management Options | 251 | ||
| Endometrial Polyps | 253 | ||
| Normal Cervix | 253 | ||
| Cervical Polyps | 254 | ||
| Trauma of the Uterine Corpus and Cervix | 254 | ||
| Epithelial Conditions of the Uterus | 254 | ||
| Endometrial Hyperplasia | 254 | ||
| Diagnosis | 254 | ||
| Treatment | 254 | ||
| Asherman Syndrome | 255 | ||
| Functional Conditions of the Uterine Corpus and Cervix | 255 | ||
| Congenital Anomalies of the Uterine Corpus and Cervix | 255 | ||
| Diagnosis and Treatment of Congenital Anomalies | 257 | ||
| 20 Benign Conditions and Congenital Anomalies of the Ovaries and Fallopian Tubes | 258 | ||
| Clinical Keys for This Chapter | 258 | ||
| Benign Conditions of the Ovaries | 258 | ||
| Functional Ovarian Cysts and Tumors | 258 | ||
| Clinical Features | 259 | ||
| Diagnosis | 260 | ||
| Management | 260 | ||
| Benign Neoplastic Ovarian Tumors | 261 | ||
| Epithelial Ovarian Neoplasms | 261 | ||
| Sex Cord–Stromal Ovarian Neoplasms | 261 | ||
| Germ-Cell Tumors | 262 | ||
| Mixed Ovarian Neoplasms | 263 | ||
| Diagnosis of Benign Ovarian Tumors | 263 | ||
| Management of Ovarian Neoplasms | 263 | ||
| Ovarian Remnant Syndrome | 264 | ||
| Congenital Anomalies of the Ovaries | 264 | ||
| Benign Conditions of the Fallopian Tubes | 264 | ||
| Congenital Anomalies of the Fallopian Tubes | 265 | ||
| 21 Pelvic Pain | 266 | ||
| Clinical Keys for This Chapter | 266 | ||
| Acute Pelvic Pain | 267 | ||
| Cyclic Pelvic Pain: Dysmenorrhea | 267 | ||
| Primary Dysmenorrhea | 268 | ||
| Pathophysiology | 268 | ||
| Clinical Features | 268 | ||
| 4 Reproductive Endocrinology and Infertility | 369 | ||
| 32 Puberty and Disorders of Pubertal Development | 370 | ||
| Clinical Keys for This Chapter | 370 | ||
| Endocrinologic Changes of Puberty | 371 | ||
| Fetal and Newborn Period | 371 | ||
| Childhood | 371 | ||
| Late Prepubertal Period | 372 | ||
| Pubertal Onset | 372 | ||
| Somatic Changes of Puberty | 373 | ||
| Stages of Pubertal Development | 373 | ||
| Adolescent Growth Spurt | 375 | ||
| Body Composition and Bone Age | 376 | ||
| Precocious Puberty | 376 | ||
| Heterosexual Precocity | 376 | ||
| Isosexual Precocious Puberty | 376 | ||
| True Isosexual Precocity | 377 | ||
| Pseudoisosexual Precocity | 377 | ||
| Treatment of True Isosexual Precocious Puberty | 378 | ||
| Delayed Puberty | 378 | ||
| Polycystic Ovarian Syndrome and Puberty | 379 | ||
| 33 Amenorrhea, Oligomenorrhea, and Hyperandrogenic Disorders | 380 | ||
| Clinical Keys for this Chapter | 380 | ||
| Primary Amenorrhea | 380 | ||
| Primary Amenorrhea with Sexual Infantilism | 382 | ||
| Hypogonadotropic Primary Amenorrhea and Sexual Infantilism | 382 | ||
| Hypergonadotropic Primary Amenorrhea and Sexual Infantilism | 382 | ||
| Primary Amenorrhea with Breast Development and Müllerian Anomalies | 383 | ||
| Androgen Insensitivity Syndrome | 383 | ||
| Müllerian Dysgenesis or Agenesis | 383 | ||
| Amenorrhea or Oligomenorrhea with Breast Development and Normal Müllerian Structures | 384 | ||
| Uterine Defects | 384 | ||
| Amenorrhea or Oligomenorrhea Associated with Hypoestrogenism | 384 | ||
| Hypothalamic-Pituitary Dysfunction | 385 | ||
| Premature Ovarian Failure | 385 | ||
| Amenorrhea or Oligomenorrhea with Hyperprolactinemia And/or Galactorrhea | 385 | ||
| Prolactinomas | 386 | ||
| Other Central Nervous System Lesions Affecting Prolactin | 386 | ||
| Pharmacologic Agents Affecting the Secretion of Prolactin | 386 | ||
| Miscellaneous Causes of Hyperprolactinemia | 386 | ||
| Treatment of Galactorrhea and Hyperprolactinemia | 386 | ||
| Observation. | 386 | ||
| Medical Therapy. | 387 | ||
| Surgery. | 387 | ||
| Amenorrhea or Oligomenorrhea with Normal Estrogen Levels | 387 | ||
| Amenorrhea or Oligomenorrhea with Hyperandrogenism | 388 | ||
| Normal Androgen Metabolism | 388 | ||
| Hyperandrogenic Disorders | 389 | ||
| Adrenal Disorders | 389 | ||
| Congenital Adrenal Hyperplasia | 389 | ||
| Cushing Syndrome | 389 | ||
| Adrenal Neoplasms | 390 | ||
| Ovarian Disorders | 390 | ||
| Polycystic Ovarian Syndrome | 390 | ||
| Hyperandrogenic Insulin Resistance and Acanthosis Nigricans Syndrome | 391 | ||
| Ovarian Neoplasms | 391 | ||
| Idiopathic Hirsutism | 391 | ||
| Evaluation of Patients with Signs of Hyperandrogenism | 391 | ||
| History | 391 | ||
| Physical Examination | 392 | ||
| Laboratory Evaluation | 392 | ||
| Treatment of Hyperandrogenism | 392 | ||
| Insulin Resistance and Polycystic Ovarian Syndrome | 394 | ||
| 34 Infertility and Assisted Reproductive Technologies | 395 | ||
| Clinical Keys for This Chapter | 395 | ||
| Infertility and the Physiology of Conception | 395 | ||
| Evaluation of the Infertile Couple | 396 | ||
| Etiologic Factors | 397 | ||
| Male Coital Factors | 397 | ||
| History | 397 | ||
| Physical Examination | 398 | ||
| Investigations | 398 | ||
| Treatment | 398 | ||
| Ovulatory Factors | 399 | ||
| History | 399 | ||
| Investigations | 399 | ||
| Treatment | 400 | ||
| Cervical Factors | 400 | ||
| 5 Gynecologic Oncology | 419 | ||
| 37 Principles of Cancer Therapy | 420 | ||
| Clinical Keys for This Chapter | 420 | ||
| Cellular Biology | 420 | ||
| Chemotherapy | 421 | ||
| Classification of Chemotherapeutic Agents | 421 | ||
| Principles of Chemotherapy | 421 | ||
| Chemotherapeutic Agents | 422 | ||
| Alkylating Agents | 422 | ||
| Antimetabolites | 422 | ||
| Antibiotics | 422 | ||
| Plant Alkaloids | 422 | ||
| Other Drugs | 422 | ||
| Radiation Therapy | 422 | ||
| Types of Radiation | 422 | ||
| Electromagnetic Radiation | 422 | ||
| Particulate Radiation | 422 | ||
| Unit of Radiation Measurement | 422 | ||
| Inverse Square Law | 424 | ||
| Biologic Considerations | 424 | ||
| Ionization of Molecules | 424 | ||
| Oxygen Effect | 424 | ||
| Pharmacologic Modification of the Effects of Radiation | 424 | ||
| Time-Dose Fractionation of Radiation | 424 | ||
| Modalities of Radiation Therapy | 424 | ||
| Teletherapy | 425 | ||
| External Beam Therapy. | 425 | ||
| Intensity Modulated Radiation Therapy. | 425 | ||
| Brachytherapy | 425 | ||
| Intracavitary Radiation. | 425 | ||
| Interstitial Radiation. | 426 | ||
| Complications Associated with Radiation | 426 | ||
| Acute Complications | 426 | ||
| Chronic Complications | 426 | ||
| Radiation Enteropathy | 426 | ||
| Vaginal Vault Necrosis | 427 | ||
| Urologic Injuries | 427 | ||
| Hormonal Therapy | 427 | ||
| Mechanism of Action of Hormonal Receptors | 427 | ||
| Clinical Applications | 427 | ||
| Targeted Therapies | 427 | ||
| Pain Management | 428 | ||
| End-of-Life Issues | 428 | ||
| 38 Cervical Dysplasia and Cancer | 429 | ||
| Clinical Keys for This Chapter | 429 | ||
| Etiology and Epidemiology | 429 | ||
| Primary Prevention | 430 | ||
| Screening of Asymptomatic Women | 430 | ||
| Cervical Topography | 430 | ||
| Classification of an Abnormal Papanicolaou Smear | 431 | ||
| Cervical Intraepithelial Neoplasia | 431 | ||
| Colposcopy | 431 | ||
| Evaluation of a Patient with an Abnormal Papanicolaou Smear | 432 | ||
| Biopsy and Endocervical Curettage | 433 | ||
| Treatment of Intraepithelial Neoplasia | 434 | ||
| Large Loop Excision of the Transformation Zone | 434 | ||
| LASER | 434 | ||
| Cryosurgery | 434 | ||
| Cervical Conization | 434 | ||
| Hysterectomy | 434 | ||
| Invasive Cancer | 434 | ||
| Symptoms | 434 | ||
| Physical Findings | 434 | ||
| Pathologic Features | 435 | ||
| Patterns of Spread | 435 | ||
| Preoperative Investigations | 435 | ||
| Treatment of Invasive Cancer | 435 | ||
| Stage IA (Microinvasive Carcinoma) | 435 | ||
| Stages IB1 and IB2 | 435 | ||
| Radical Hysterectomy. | 436 | ||
| Radical Trachelectomy. | 436 | ||
| Radiation Therapy. | 436 | ||
| Stage IIA1 or IIA2 | 437 | ||
| Stage IIB | 437 | ||
| Stages IIIA and IIIB | 437 | ||
| Stage IVA | 437 | ||
| Stage IVB | 437 | ||
| Recurrent or Metastatic Disease | 437 | ||
| Chemotherapy. | 437 | ||
| Pelvic Exenteration. | 437 | ||
| Cervical Carcinoma in Pregnancy | 437 | ||
| Symptoms | 437 | ||
| Diagnosis | 438 | ||
| Management | 438 | ||
| Prognosis for Cervical Cancer | 439 | ||
| 39 Ovarian, Fallopian Tube, and Peritoneal Cancer | 440 | ||
| Clinical Keys for This Chapter | 440 | ||
| Epithelial Ovarian Cancer | 440 | ||
| Etiology and Epidemiology | 440 | ||
| Screening for Ovarian Cancer | 441 | ||
| Clinical Features of Epithelial Ovarian, Fallopian Tube, and Peritoneal Cancer | 441 | ||
| Symptoms | 441 | ||
| Signs | 441 | ||
| Preoperative Evaluation | 442 | ||
| Differential Diagnosis | 442 | ||
| Mode of Spread | 442 | ||
| Staging | 442 | ||
| Classification of Ovarian Neoplasms | 444 | ||
| Pathologic Features | 444 | ||
| Management of Epithelial Ovarian, Fallopian Tube, and Peritoneal Cancer | 445 | ||
| Early-Stage Disease | 445 | ||
| Advanced-Stage Disease | 446 | ||
| Prognosis | 446 | ||
| Germ Cell Tumors | 446 | ||
| Dysgerminomas | 446 | ||
| Treatment | 446 | ||
| Index | 473 | ||
| A | 473 | ||
| B | 475 | ||
| C | 476 | ||
| D | 478 | ||
| E | 479 | ||
| F | 480 | ||
| G | 481 | ||
| H | 483 | ||
| I | 484 | ||
| J | 485 | ||
| K | 485 | ||
| L | 485 | ||
| M | 486 | ||
| N | 488 | ||
| O | 488 | ||
| P | 489 | ||
| Q | 492 | ||
| R | 492 | ||
| S | 493 | ||
| T | 494 | ||
| U | 495 | ||
| V | 496 | ||
| W | 497 | ||
| X | 497 | ||
| Y | 497 | ||
| Z | 497 | ||
| Inside Back Cover | ibc1 |