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 |