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Clinical Obstetrics and Gynaecology E-Book

Clinical Obstetrics and Gynaecology E-Book

Brian A. Magowan | Philip Owen | Andrew Thomson

(2018)

Additional Information

Book Details

Abstract

The fourth edition of this highly regarded textbook has been thoroughly overhauled. There is ■ a new chapter bridging the gap between learning and doing (On-Call); ■ new coverage of FGM and the Zika virus; ■ sepsis has been updated; ■ there is access to a further five chapters; ■ there are ten videos to guide learners through the more difficult, complex issues they might face in O&G; ■ and new self-assessment has been written to help with testing understanding.

  • Key points boxes throughout
  • Full-colour illustrations throughout
  • Over 350 illustrations
  • Comprehensive coverage
  • New chapter covering On-Call O&G with practical guidance and steps for acute and important issues likely to be encountered (hypertension, sepsis, bleeding, labour-ward emergencies etc.).
  • New sections on FGM.
  • Expanded areas in medical disorders in pregnancy and mental illness.
  • Access to nine videos with experts guiding viewers through a range of essential issues, from on-call scenarios to fetal medicine.
  • Access to a further five chapters.

Self-assessment. Over 40 SBAs and case-based questions


Table of Contents

Section Title Page Action Price
Front Cover cover
Inside Front Cover ifc1
Half title page i
Dedication ii
Clinical Obstetrics and Gynaecology iii
Copyright Page iv
Preface v
List of Contributors vi
Video List of Contributors ix
Video Table of Contents ix
Table Of Contents x
1 Fundamentals 1
1 Clinical pelvic anatomy 1
Introduction 1
Obstetric anatomy 1
The bony pelvis 1
The pelvic organs during pregnancy 1
The uterus 1
The cervix 2
Additional changes 2
The urinary tract in pregnancy 3
The perineum 3
Anatomical points for obstetric analgesia 3
Pudendal nerve block 3
Spinal block 3
Epidural block 3
Gynaecological anatomy 5
The uterus 5
Endometrium 5
Myometrium 5
Peritoneum 5
The cervix 6
Clinical aspects 6
The uterine attachments and supports 7
The pelvic diaphragm 8
Congenital abnormalities of the uterus 9
The vulva 9
Blood supply 10
Nerve supply 11
Lymph drainage 11
The fallopian tubes 11
Tubal function 11
The vagina 11
Vaginal structure 12
The ovary 13
Anatomy of the lower urinary tract 13
The bladder 13
The urethra 13
Nerve supply 13
2 History and examination 15
Introduction 15
Gynaecological history 15
Menstrual history 15
The pattern of bleeding 15
Bleeding too little 15
Bleeding too much 15
Bleeding at the wrong time 15
Fertility history 16
Last menstrual period (LMP) 16
Contraception 16
Cervical smears 16
Pelvic pain history 16
Painful periods 16
Pelvic pain 16
Pain on intercourse 16
Vaginal discharge 16
Urogynaecological history 16
Urinary symptoms 16
Prolapse 17
Gynaecological examination 17
Passing a speculum 17
Preparation 17
Inspection 17
Speculum examination 17
Taking a cervical smear 18
Pelvic examination 19
Obstetrical history 20
Establishment of the estimated day of delivery (EDD) 21
Obstetrical summary 21
What is happening now? 21
History of this pregnancy 21
Past obstetric history 21
Medical history 21
Gynaecological history 22
Drug history 22
Family history 22
Social history 22
Systemic enquiry 22
Low-risk versus high-risk pregnancy 22
Obstetrical examination 22
Blood pressure assessment 22
Abdominal palpation 23
Obstetrical vaginal and speculum examination 25
2 Gynaecology 27
3 Paediatric gynaecology and disorders of sex development 27
Normal puberty 27
Introduction 27
Pathophysiology of normal puberty 27
Pubertal development 27
Age of menarche 27
Variations of normal puberty 27
Precocious puberty 29
Causes of precocious puberty 29
Gonadotrophic-dependent precocious puberty (GDPP) 29
Gonadotrophic-independent precocious puberty (GIPP) 29
Investigation and management of precocious puberty 30
Treatment 30
Delayed puberty 30
Causes of delayed puberty 30
Constitutional delay 30
Hypogonadotrophic hypogonadism 30
Premature ovarian insufficiency (POI) 31
Other causes 31
Investigation of delayed or arrested puberty 31
Management of delayed puberty 31
Constitutional delay 31
Hypogonadotrophic hypogonadism 31
Premature ovarian insufficiency 31
Induction of puberty 31
Pre-pubertal conditions 31
Vaginal discharge 31
Vaginal bleeding 31
Labial adhesions 31
Lichen sclerosus 32
Post-pubertal conditions 32
Adolescent menstrual dysfunction 32
Müllerian duct anomalies 33
Development of the genital tract 33
Imperforate hymen 33
Transverse vaginal septa 33
Longitudinal vaginal septa 34
Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) 34
Uterine anomalies 34
Disorders of sex development (DSD) 34
Normal gonadal and genital tract development 35
Turner syndrome 35
46,XX DSD 36
Congenital adrenal hyperplasia (CAH) 36
46,XY DSD 36
Complete androgen insensitivity syndrome (CAIS) 36
Disorders of testosterone biosynthesis 37
Ovotesticular DSD 37
Complete gonadal dysgenesis 37
Summary 37
Controversies 38
4 The normal menstrual cycle and amenorrhoea 39
Normal menstrual cycle 39
Overview of the cycle 39
Endocrine control of the menstrual cycle 39
The ovarian cycle 39
Follicular phase 39
Days 1–8 39
Days 9–14 39
Ovulation 40
Day 14 40
Luteal phase 40
Days 15–28 40
The uterine cycle 40
The endometrium 40
Proliferative phase 42
Secretory phase 42
Menstrual phase 42
Cervical mucus 42
Other cyclical changes 43
Basal body temperature 43
Breast changes 43
Psychological changes 43
Amenorrhoea 43
Primary amenorrhoea 43
Secondary amenorrhoea 43
Causes 43
Physiological 43
Hypothalamic 44
Pituitary 44
Ovarian 46
Premature ovarian failure 46
Polycystic ovary syndrome 46
Other endocrine causes 47
Uterine 47
Summary of clinical management 47
5 Infertility 49
Introduction 49
Definitions 49
Age and fertility 49
Causes of infertility 49
Diagnosis 49
History and examination 50
Examination of the woman 50
Examination of the man 50
Investigations and their interpretation 50
Male factors 51
Classification 51
Semen analysis 51
Tests of sperm function 51
Female factors 52
Ovulation 52
Causes of anovulation 52
Weight-related anovulation 52
Polycystic ovary syndrome 52
Luteinized unruptured follicle syndrome 52
Hyperprolactinaemia 52
Tests of ovulation 52
Other tests 52
Testing ovarian reserve 52
Further investigations 53
Tubal patency 53
Classification 53
Tests of tubal patency 53
Hysterosalpingography (HSG) 53
Hysterosalpingo-contrast sonography (HyCoSy) 54
Diagnostic laparoscopy with dye hydrotubation 54
Selective salpingography 54
Salpingoscopy 54
Falloposcopy 54
Treatment 54
Anovulation 54
Anovulation in oestrogenized patients 54
Anovulation in oestrogen-deficient women 55
Tubal disease 55
Tubal surgery 55
Selection of women 55
Techniques 55
Risks of tubal surgery 55
Endometriosis 56
Male factor problems 56
Azoospermia and a raised serum FSH 56
Donor insemination (DI) 56
Azoospermia and a normal FSH 56
Hypogonadotrophic hypogonadism 56
Idiopathic oligospermia 56
Varicocele 56
Unexplained infertility 57
Assisted conception 57
Intrauterine insemination (IUI) 57
In vitro fertilization 57
Indications 57
Technique 57
Hormonal regimen 57
Oocyte collection 57
Fertilization and incubation 58
Embryo transfer 58
Luteal support 58
Results 58
Interpreting success rates 58
Embryo freezing 59
Gamete intrafallopian tube transfer (GIFT) 59
Intracytoplasmic sperm injection 59
Technique 59
3 Reproductive Health 155
18 Pelvic infection and STIs 155
Introduction 155
Principles of STI management 155
Sexual history 156
Examination for genital infections 156
Taking samples for genital infections 157
Syndromes associated with genital infections 158
Asymptomatic 158
Vaginal discharge 158
Infections of the vagina 159
Bacterial vaginosis 159
Background information 159
Treatment and management 159
Complications 159
Candidal infections 160
4 Obstetrics 199
22 Antenatal and postnatal care 199
The aim of antenatal care 199
Models of antenatal care 199
The first trimester 199
Smoking, alcohol and drug use 201
Diet 202
Physical activity and exercise 202
The second trimester (12–20 weeks) 202
Social and environmental factors 202
The third trimester (20 weeks–term) 203
Abdominal examination 203
Presentation 203
Evaluation of fetal growth 203
Enquiry about fetal movements 203
Polyhydramnios (increased amniotic fluid volume) 203
Oligohydramnios (reduced amniotic fluid volume) 203
Identifying other antenatal complications 204
Hypertension and pre-eclampsia 204
Screening for anaemia 204
Impaired glucose tolerance and diabetes 204
Mental health problems 204
Prolonged pregnancy 204
Antenatal summary 204
Postnatal care 205
Models of postnatal care 205
Immediate post-birth care 205
Postnatal follow-up in the first 10 days 206
Late postnatal examination 206
Postnatal problems 206
Physical problems 206
Anaemia 206
Bowel problems 206
Breast problems 206
Perineal breakdown 207
Incontinence 207
Puerperal pyrexia 207
Secondary postpartum haemorrhage 207
Venous thromboembolism (VTE) 208
Mental health problems 208
Signs and symptoms of postnatal depression 208
Cognitive 208
Emotional 208
Behavioural 208
Postpartum psychosis 208
23 Maternal medicine 211
Introduction 211
Diabetes mellitus 211
Effects of pregnancy on diabetes 211
Effects of diabetes on pregnancy 212
Screening for gestational diabetes 212
Management of gestational diabetes 212
Antenatal management of established diabetes 212
Delivery 212
Venous thromboembolic disease 212
Antenatal 212
Antenatal and postnatal risk assessment 213
Cardiac disease 214
Connective tissue disease 214
Systemic lupus erythematosus (SLE) 214
Epilepsy 215
Hepatic disorders 215
Renal disorders 216
Infection 216
Obstruction 217
Chronic kidney disease (CKD) 217
Respiratory disorders 217
Thrombocytopenia 218
Maternal thrombocytopenia in pregnancy 218
Fetal (alloimmune) thrombocytopenia 218
Thyroid disorders 218
Hypothyroidism 218
Hyperthyroidism 218
Postpartum thyroiditis 218
24 Fetal medicine 219
Introduction 219
Assessing the chance of abnormalities 219
Screening for chromosomal abnormalities 220
First trimester combined screening test 220
Serological screening 220
Non-invasive prenatal screening test (NIPT) 220
Ultrasound scanning 221
Diagnosis of chromosomal abnormalities 221
Amniocentesis 221
Chorionic villus sampling 222
Chromosomal abnormalities 222
Down syndrome (trisomy 21) 222
Edwards syndrome (trisomy 18) 222
Patau syndrome (trisomy 13) 222
Triploidy 222
Turner syndrome (45,XO) 223
47,XXX 223
Klinefelter syndrome (47,XXY) 223
Jacobs syndrome (47,XYY) 223
Single gene disorders 223
Cystic fibrosis 223
Huntington disease 223
Tay-Sachs disease 223
Fragile X syndrome 224
Structural abnormalities 224
Cystic hygroma 224
Congenital heart disease 224
Neural tube defects 224
Anencephaly 225
Encephalocele 225
Spina bifida 225
Ventriculomegaly 226
Hydrocephalus 226
Abdominal wall defects 226
Exomphalos (omphalocele) 226
Gastroschisis 226
Genitourinary abnormalities 226
Multicystic dysplastic kidney disease 226
Polycystic kidney disease 227
Renal tract dilatation 227
Bilateral renal agenesis (Potter syndrome) 228
Lung disorders 228
Pulmonary hypoplasia 228
Diaphragmatic hernia 228
Prenatal congenital infection 228
Risk factors 228
Specific infections (see also Table 24.2) 229
Varicella-zoster virus (VZV/chickenpox) 229
Hepatitis 229
Herpes simplex virus (HSV) 229
Rubella 229
Erythrovirus (parvovirus B19) 229
Listeria monocytogenes 231
Beta-haemolytic streptococci – group B 231
Syphilis 231
Zika 231
Termination of pregnancy for fetal abnormality 231
Haemolytic disease of the newborn 231
The blood group system 231
Pathophysiology of haemolytic disease 232
Incidence 232
Aetiology and predisposing factors 233
Prevention of haemolytic disease 233
Prediction of at-risk pregnancies 233
Routine maternal screening 233
Clinical significance of the antibody 234
Fetal assessment and therapy 234
Non-invasive testing 234
Fetal blood sampling and intrauterine transfusion 234
Additional measures 235
Delivery 235
Prognosis 235
25 Obstetric haemorrhage 237
Introduction 237
Definitions 237
Antepartum haemorrhage 237
Causes 237
Local 237
Placental 237
Placenta praevia 237
Placental abruption 238
Unexplained antepartum haemorrhage 240
Clinical presentations 240
Minor haemorrhage with a soft uterus and normal cardiotocography 240
Minor or major haemorrhage, but with a hard, tender uterus 240
Antepartum haemorrhage requiring maternal resuscitation 240
Intrapartum haemorrhage 240
Causes 240
Placental abruption 240
Placenta praevia 240
Uterine rupture 240
Vasa praevia 240
Postpartum haemorrhage 241
Definitions 241
Primary postpartum haemorrhage 241
Prevention 241
Causes 241
Clinical presentation 241
Management 241
Assessment 242
Treatment 242
Secondary postpartum haemorrhage 243
26 Fetal growth and surveillance 245
Introduction 245
Accuracy of dating 245
Small for gestational age 245
Fetal growth restriction 245
Aetiology 245
Fetal factors affecting fetal growth 245
Maternal factors affecting fetal growth 246
Placental factors affecting fetal growth 246
Screening and diagnosis 246
Clinical examination 246
Ultrasound examination 247
Small for gestational age or fetal growth restriction? 247
Management 247
Fetal movement monitoring 248
Fetal cardiotocography 248
Biophysical profile (BPP) 248
Doppler ultrasound 248
Overall strategy 248
Long-term implications of fetal growth restriction 251
27 Hypertension in pregnancy 253
Definitions 253
Hypertension 253
Chronic hypertension 253
Gestational hypertension 253
Pre-eclampsia 253
Eclampsia 253
Pathophysiology 253
Phase 1: abnormal placentation 253
Phase 2: endothelial dysfunction 254
Epidemiology of hypertensive disorders in pregnancy 254
Chronic hypertension 254
History and examination 254
Investigations 255
Chronic kidney disease 255
Endocrine 255
Management 255
Pre-pregnancy counselling 255
Maternal complications 255
Timing of delivery 255
Neonatal complications 255
Postpartum management 255
Gestational hypertension and pre-eclampsia 256
Risk factors 256
Clinical assessment 256
1. Blood pressure measurement (Fig. 27.2A) 257
2. Urine dipstick (Fig. 27.2B) 257
3. Blood tests 257
4. Fetal assessment 258
5. Prediction of pre-eclampsia 258
Prophylaxis 258
Clinical management of hypertension in pregnancy without proteinuria 258
Clinical management of pre-eclampsia 258
Complications 259
Global challenges 260
28 Prematurity 261
Introduction 261
Definitions 261
Aetiology and predisposing factors 261
Identifying women at increased risk of pre-term birth 261
Prevention of the onset of pre-term labour 263
Antibiotics 263
Cervical cerclage 263
Progesterone 263
Diagnosis and management of pre-term labour 263
Inhibition of pre-term labour 263
Nifedipine 264
Oxytocin antagonist 264
Cyclo-oxygenase inhibitors 264
Beta-sympathomimetics 264
Pre-term pre-labour rupture of the membranes (PPROM) 264
Management of pre-term pre-labour rupture of the membranes 265
Delivery and optimising neonatal outcome 265
Mode of delivery 265
Corticosteroids 265
Prevention of infection 265
Magnesium sulphate 266
Intrapartum monitoring 266
29 Multiple pregnancy 267
Introduction 267
The nature of twinning and chorionicity 267
Dizygotic twinning (non-identical) 267
Monozygotic twinning (identical) 267
Maternal complications 270
Hyperemesis 270
Anaemia 270
Pre-eclampsia 270
Antepartum haemorrhage 270
Thromboembolic disease 270
Other maternal complications 270
Fetal complications 270
Chromosomal abnormalities 270
Structural defects 270
Premature birth 271
Fetal growth restriction 271
Twins with one fetal death 271
Antenatal problems specific to monochorionic twin pregnancies 271
Twin-to-twin transfusion syndrome 271
Twin anaemia polycythaemia sequence 271
Severe selective intrauterine growth restriction (sIUGR) 273
Monoamniotic twins 273
Twin reversed arterial perfusion sequence 273
Management of pregnancy 273
Initial visit 273
Subsequent visits 273
Management of twin delivery 273
Triplets and higher multiples 274
30 Labour and analgesia 275
Normal labour 275
Introduction 275
Evolution and human labour 275
Primigravid compared with multigravid labour 275
The uterus during pregnancy 276
The initiation of labour 276
Pro-pregnancy factors 277
Pro-labour factors 277
The mechanism of normal labour and delivery 277
Cervical ripening 277
Activation of the myometrium 278
Descent and delivery of fetus 278
Diagnosis of labour 279
Rupture of the membranes 279
Clinical progress in labour 283
First stage 283
Second stage 285
Third stage 285
Episiotomies and perineal tears 285
Repair of episiotomies and perineal tears 286
Repair of episiotomy and first- or second-degree tears 287
Repair of third- or fourth-degree tears 287
Analgesia in labour 287
Factors influencing pain 287
Physiology of labour pain 287
Psychology of labour pain 288
Methods of pain relief 288
Non-pharmacological methods 288
Maternal support 288
Environment 288
Birthing pools 288
Education 288
Pharmacological methods 288
Inhaled analgesics 288
Systemic opioid analgesia 288
Pudendal analgesia 288
Regional analgesia 289
Epidural analgesia for labour 289
Spinal anaesthesia 290
General anaesthesia 290
31 Monitoring of the fetus in labour 293
Introduction 293
Fetal physiology 293
Maternal blood supply to the placenta 293
Functional capacity of the placenta 293
Fetal circulation 293
Risk assessment 293
Meconium staining of the amniotic fluid 293
Fetal heart rate recording 294
Intermittent monitoring (intermittent auscultation) 294
Continuous monitoring (cardiotocography) 294
Fetal electrocardiogram 296
Fetal blood sampling 296
Technique of fetal blood sampling 296
Interpretation of results 296
Fetal monitoring scenarios (Figs 31.2–31.9) 297
Long-term prognosis following delivery 298
Prospective prediction 298
Retrospective evaluation 301
32 Induction of labour 303
Introduction 303
Indication 303
Potential indications for induction 303
Contraindications 303
Methods 303
Unfavourable cervix 304
Prostaglandins 304
Favourable cervix 304
Artificial rupture of the membranes 304
Syntocinon 305
Other methods of induction 305
Membrane sweep 305
Anti-progesterones 305
Mechanical methods of induction 305
Complications 305
Unsuccessful induction 306
33 Malpresentation and slow labour 307
Introduction 307
Precipitate labour 307
Slow labour 308
Prolonged latent phase 309
Prolonged active phase and secondary arrest 309
Inadequate uterine activity 309
Cephalopelvic disproportion 310
Pelves with normal shape and bone development 310
Pelves with abnormal shape and bone development 310
Defects of nutrition and environment 310
Minor 310
Major 311
Disease or injury 311
Congenital malformations 311
Management of slow labour 312
Malpresentation 312
Face presentation 313
Brow presentation 313
Breech presentation 313
Mode of delivery 313
External cephalic version 315
Procedure 315
Caesarean section for breech presentation 316
Pre-term breech 316
Vaginal delivery for breech presentation 316
Transverse lie and oblique lie 316
Unstable lie 319
Malposition 319
34 Obstetric emergencies 323
Introduction 323
Principles of management 323
Resuscitation 323
Amniotic fluid embolism 324
Epidemiology 324
Aetiology 324
Risk factors 324
Clinical features 325
Diagnosis 325
Management 325
Prognosis 325
Prolapsed umbilical cord 325
Definition 325
Epidemiology 325
Clinical features/investigation 326
Management 326
Prognosis 327
Retained placenta 327
Definition 327
Epidemiology 327
Pathology 327
Management 328
Sepsis 329
Shoulder dystocia 329
Definition 329
Risk factors 329
Clinical features 329
Management 330
Uterine inversion 330
Definition 330
Pathology 330
Clinical presentation 330
Management 333
Uterine rupture 334
Epidemiology 334
Pathology 334
Risk factors 335
Clinical features 335
Management 335
Prognosis 335
35 Operative delivery 337
Introduction 337
Instrumental vaginal delivery 337
Complications 337
Forceps delivery 338
Low- or mid-cavity non-rotational forceps 338
Rotational forceps 338
Ventouse 338
Caesarean section 341
Complications 341
Subsequent births 341
Caesarean section on maternal request 344
36 Stillbirth and neonatal mortality 345
Introduction 345
Incidence 345
Stillbirth causes and associations 345
Management 345
Diagnosis 345
Immediate management 346
Delivery 346
Psychological care 346
Investigations 347
Post-mortem 347
Legal issues 348
Follow-up and next pregnancy 348
Learning from adverse events 348
Neonatal death 348
Preventing pre-term birth and its consequences 349
Legal aspects 349
Global perspective 349
Causes of death 349
Congenital anomalies 349
Intrapartum care 349
Prematurity 349
Infections 349
Conclusions 350
37 Neonatal resuscitation 351
Physiology 351
Physiology of acute hypoxia 351
Practical aspects of neonatal resuscitation 351
Before the baby arrives 351
Dry, wrap, keep the baby warm and assess 351
Apgar score 351
Airway 353
Breathing 353
Circulation 354
Drugs 354
Monitoring in neonatal resuscitation 354
Pre-term babies 355
Discontinuation of resuscitation 355
Debrief and parental communication 355
5 On call for obstetrics and gynaecology 357
38 Practical gynaecology and obstetrics 357
Introduction 357
Common pitfalls 357
Lower abdominal pain in gynaecology 357
Adnexal torsion 358
Bleeding in early pregnancy 358
Causes 358
Common 358
Uncommon but important 358
Assessment 358
History 358
Examination 358
Treatment 359
Caveats, tips and pitfalls 359
Nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum (HG) 360
Termination of pregnancy 360
Tips/pitfalls 361
General principles of antenatal patients seen when on call 362
Hypertensive disorders of pregnancy 362
Sepsis in pregnancy 363
Shortness of breath in pregnancy and suspected venous thromboembolism (VTE) 363
Small vaginal bleed in later pregnancy 364
Tips/pitfalls 364
Antenatal vaginal discharge and suspected pre-term pre-labour rupture of membranes 365
Admission for induction of labour 365
Initial assessment 365
The principle of the process 366
Tips/pitfalls 366
Labour ward emergencies 366
General principles 366
Fetal bradycardia and how to manage it 368
Shoulder dystocia 369
Impacted fetal head at caesarean section 369
After an emergency 369
6 Online-only chapters e1
39 Human embryology e1
Introduction e1
Nomenclature e1
Fertilization to implantation (0–6 GD) e1
Implantation and formation of the germ layers (7–18 GD) e1
Organogenesis (19–56+ GD) e2
Neural tube and brain e3
The forebrain e4
The midbrain e5
The hindbrain e5
The spinal cord e5
Gut tube and its derivatives e5
Thyroid and pituitary glands e5
The lungs e6
The pancreas e6
The urogenital system e6
Heart and liver e7
Craniofacial structures e8
The paired sensory placodes e8
The facial processes e10
Limbs and skeletal muscle e10
40 Imaging in obstetrics and gynaecology e12
Introduction e12
Obstetrics e12
Fetal assessment e12
Maternal assessment e13
Risks of radiation e13
Gynaecology e13
41 The physiology of pregnancy e15
Introduction e15
Respiratory system e15
Cardiovascular system e15
Blood, plasma and extracellular fluid volume-3 e16
Blood constituents and anaemia e16
Folate metabolism e16
Haemostasis in pregnancy e16
Renal system e17
Endocrine system e18
Placental hormonal production e18
Thyroid function e18
Pituitary function e18
Gastrointestinal system e19
Liver and bile ducts e19
Skin and appendages e19
Metabolic changes e19
Calcium homeostasis e20
Placental transfer e20
Respiration e21
Nutrition e21
Immunology e22
Summary e22
42 Strategies to improve global maternal and neonatal health e23
Estimates of global maternal and neonatal mortality e23
Obstetric causes of maternal mortality e23
Haemorrhage e23
Obstructed labour e23
Sepsis e25
Eclampsia e26
Unsafe abortion e28
Medical conditions contributing to maternal mortality and morbidity e28
Anaemia e28
Malaria e29
HIV/AIDS e29
Tuberculosis e29
Strategies to improve global maternal and newborn health e29
Skilled birth attendance e30
Essential (or emergency) obstetric care e30
Early newborn care e31
Availability and quality of care e31
43 Neonatal care e33
Introduction e33
The transition at birth e33
Respiratory system e33
Cardiovascular system e33
Genitourinary system e34
Gastrointestinal (GI) system e34
Haematological system e34
Routine care at birth e34
Assessment e34
Preventing hypothermia e34
Examination e35
Weighing and measuring e35
The umbilical cord e35
Preventing haemorrhagic disease of the newborn e35
Perinatal asphyxia e35
Neonatal examination e36
Developmental dysplasia of the hip e36
Biochemical screening e36
Physical birth injury e36
Nerve palsies e37
Brachial plexus e37
Facial nerve e37
Skeletal injury e37
Soft tissue injury e37
Caput succedaneum e37
Chignon e37
Cephalhaematoma e37
Subaponeurotic haemorrhage e37
Sternomastoid tumour e37
Congenital abnormalities e37
Feeding e38
Signs of illness e38
Jaundice e39
Physiological jaundice e39
Pathological jaundice e39
Breast milk jaundice e39
Obstructive jaundice e39
Jaundice due to haemolysis e39
Treatment of pathological jaundice e40
Low birth weight (LBW) babies e40
Prematurity-related problems e40
Problems with being small for gestational age e40
Infection e40
Conjunctivitis e41
Candida e41
Skin sepsis e41
Urinary tract infection e42
Meningitis e42
7 Self-assessment 371
Questions 371
Gynaecology Multiple-choice questions (MCQs) 371
Obstetrics Multiple-choice questions (MCQs) 374
Case-based questions 375
Answers 377
Gynaecology MCQ answers 377
Obstetrics MCQ answers 377
Case-based answers 378
Index 381
A 381
B 382
C 383
D 385
E 386
F 387
G 388
H 389
I 391
J 392
K 392
L 392
M 393
N 394
O 395
P 396
Q 399
R 399
S 399
T 401
U 402
V 403
W 403
X 404
Y 404
Z 404