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 |