Additional Information
Book Details
Abstract
- Extensively revised and updated to incorporate the latest changes and development of newer concept.
- Written in a narrative manner which is easier to understand.
- Bulleted text and key highlights/ important points in boxes for extra emphasis and retention.
- Inclusion of more flowcharts and colored pictures.
- Covers the entire course curriculum in an easy to understand, retain and reproducible manner; including assessment questions to help in rapid revision and exam preparation.
- 13 videos to help for better understanding.
- 6 Lecture notes on challenging topics.
This book has a seamless narration with bulleted key points, important highlights in boxes, well-illustrated text and self-assessment questions.
It is an enhanced book with videos and lecture notes on challenging procedures to help them better visualize, understand, and retain information
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | Cover | ||
| Front matter | i | ||
| Howkins & bourne shaw’s textbook of gynaecology 17th edition | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| Preface to the 17th edition | vi | ||
| Preface to the 16th edition | vii | ||
| Preface to the 10th edition | viii | ||
| Table of Content | ix | ||
| 1 Approach to a gynaecological patient | 1 | ||
| History | 1 | ||
| Present illness | 1 | ||
| Past and personal history | 1 | ||
| Family history | 2 | ||
| Marital and sexual history | 2 | ||
| Menstrual history | 2 | ||
| Obstetric history | 3 | ||
| Physical examination | 3 | ||
| General examination | 3 | ||
| Systemic examination | 3 | ||
| Abdominal examination | 3 | ||
| Inspection | 3 | ||
| Palpation | 4 | ||
| Percussion | 4 | ||
| Auscultation | 4 | ||
| Gynaecological examination | 4 | ||
| Examination of external genitalia | 4 | ||
| Speculum examination | 4 | ||
| Bimanual examination | 4 | ||
| Rectal examination | 6 | ||
| Investigations | 6 | ||
| Special tests | 7 | ||
| Hanging drop preparation | 7 | ||
| Papanicolaou test | 7 | ||
| Screening for cancer | 7 | ||
| Visual inspection after acetic acid application (via) | 8 | ||
| Schiller test (visual inspection after lugol’s iodine application – vili) | 8 | ||
| Cytohormonal evaluation | 10 | ||
| Uterine aspiration cytology | 10 | ||
| Colposcopy | 10 | ||
| Endometrial biopsy (fig. 1.14a and b) | 10 | ||
| Hormonal assays | 11 | ||
| Ultrasonography | 11 | ||
| Other imaging modalities | 11 | ||
| Gynaecological endoscopy | 11 | ||
| Pregnancy test | 11 | ||
| Self-assessment | 11 | ||
| Suggested reading | 11 | ||
| SECTION 1 ANATOMY, PHYSIOLOGY AND DEVELOPMENT OF FEMALE REPRODUCTIVE ORGANS | 12 | ||
| 2 Anatomy of female genital tract | 13 | ||
| The vulva | 13 | ||
| Labia majora | 13 | ||
| Labia minora | 13 | ||
| Bartholin’s gland | 15 | ||
| The vagina | 15 | ||
| Relations of vagina | 16 | ||
| Anterior relation | 16 | ||
| Posterior relations | 17 | ||
| Lateral relations | 17 | ||
| Superior relations | 17 | ||
| The uterus | 18 | ||
| Peritoneal covering | 18 | ||
| Myometrium | 18 | ||
| Endometrium | 18 | ||
| Position of the uterus | 20 | ||
| The uterine appendages | 21 | ||
| Fallopian tubes | 21 | ||
| The ovaries | 23 | ||
| The urethra | 23 | ||
| Relations | 23 | ||
| The bladder | 24 | ||
| Nerve supply | 24 | ||
| The ureters | 24 | ||
| The rectum and anal canal | 25 | ||
| The lymphatics | 25 | ||
| The pelvic musculature | 25 | ||
| Pelvic diaphragm | 25 | ||
| Urogenital diaphragm | 26 | ||
| Superficial muscles | 26 | ||
| The pelvic cellular tissue | 28 | ||
| The pelvic blood vessels | 29 | ||
| The vaginal arteries | 31 | ||
| The arteries of the vulva and perineum | 31 | ||
| The pelvic veins | 31 | ||
| The lymphatic system | 31 | ||
| The lymphatic glands or nodes | 31 | ||
| The inguinal glands | 32 | ||
| The glands of the parametrium | 32 | ||
| External iliac glands | 32 | ||
| Common iliac glands | 32 | ||
| The sacral group | 32 | ||
| The lumbar group of glands | 32 | ||
| The nerve supply | 33 | ||
| Applied anatomy and its clinical significance | 33 | ||
| Self-assessment | 35 | ||
| Suggested reading | 36 | ||
| 3 Normal histology of ovary and endometrium | 37 | ||
| The ovary | 37 | ||
| The primordial follicle | 37 | ||
| The graafian follicle (fig. 3.2) | 37 | ||
| The fate of the graafian follicle | 39 | ||
| Ovulation | 39 | ||
| Corpus luteum (fig. 3.7a and b) | 40 | ||
| Menstruation | 41 | ||
| Corpus luteum of pregnancy | 41 | ||
| The endometrium | 41 | ||
| The proliferative phase | 41 | ||
| The secretory phase | 42 | ||
| The menstruating endometrium | 43 | ||
| Endometrial regeneration | 44 | ||
| Functional layers of endometrium | 45 | ||
| The decidua of pregnancy | 45 | ||
| Ectopic decidual cells | 45 | ||
| Vaginal epithelium | 45 | ||
| Ovarian functions | 45 | ||
| Pregnancy | 46 | ||
| Menopausal endometrium | 46 | ||
| Cervical mucus | 46 | ||
| Process of fertilization | 46 | ||
| Self-assessment | 47 | ||
| Suggested reading | 47 | ||
| 4 Physiology of ovulation and menstruation | 48 | ||
| Hypothalamic–pituitary–ovarian axis | 48 | ||
| Hypothalamus | 48 | ||
| Pituitary gland | 50 | ||
| Anterior pituitary gland (adenohypophysis) | 50 | ||
| Follicle-stimulating hormone | 50 | ||
| Luteinizing hormone | 50 | ||
| Human chorionic gonadotropin | 51 | ||
| Prolactin | 51 | ||
| Posterior pituitary gland (neurohypophysis) | 51 | ||
| Oxytocin | 51 | ||
| Vasopressin | 51 | ||
| Ovarian steroidogenesis | 51 | ||
| Oestrogen | 51 | ||
| Actions of oestrogens (fig. 4.4) | 52 | ||
| Progesterone | 53 | ||
| Actions of progesterones | 53 | ||
| Side effects | 53 | ||
| Relaxin | 54 | ||
| Inhibin | 54 | ||
| Activin | 54 | ||
| Anti-müllerian hormone | 54 | ||
| Sex hormone–binding proteins | 54 | ||
| Testosterone | 54 | ||
| Physiology of menstruation | 54 | ||
| Feedback mechanism in the H–P–O axis | 56 | ||
| Leptin | 58 | ||
| Menstruation | 58 | ||
| Menstrual fluid in ‘stem cell’ therapy | 60 | ||
| Self-assessment | 60 | ||
| Suggested reading | 60 | ||
| 5 Development of female reproductive organs and related disorders | 61 | ||
| Development of the female genital organs | 61 | ||
| Development of urinary system | 61 | ||
| Development of the uterus, cervix and vagina | 61 | ||
| Development of vagina | 63 | ||
| Development of the external genital organs (figs 5.6 and 5.7) | 63 | ||
| Development of the ovaries | 64 | ||
| Gonads | 65 | ||
| Müllerian ducts | 66 | ||
| Detailed consideration of müllerian defects | 67 | ||
| Introduction | 67 | ||
| Defining features | 68 | ||
| Characteristic features | 68 | ||
| Differential diagnosis | 69 | ||
| Investigations | 69 | ||
| Management | 69 | ||
| Complete nonfusion of the müllerian ducts results in duplication of the genital tract | 70 | ||
| Detailed consideration of relevant anomalies of the müllerian ducts | 70 | ||
| Classification | 70 | ||
| Prevalence | 72 | ||
| Background | 72 | ||
| Diagnosis | 72 | ||
| Adverse obstetric outcomes | 72 | ||
| Surgical resection of the intrauterine septum (metroplasty) | 72 | ||
| Malformations of the rectum and anal canal | 73 | ||
| Imperforate anus | 73 | ||
| Atresia recti | 73 | ||
| Congenital rectovaginal fistula | 73 | ||
| Wolffian duct anomalies | 73 | ||
| Renal tract abnormalities | 73 | ||
| Self-assessment | 74 | ||
| Suggested reading | 74 | ||
| 6 Puberty, adolescence and related gynaecological problems | 75 | ||
| Introduction | 75 | ||
| Reproductive endocrinology of the growing girl child | 75 | ||
| The newborn female infant | 76 | ||
| The growing girl child | 76 | ||
| Common paediatric gynaecologic problems | 77 | ||
| Puberty and adolescence | 79 | ||
| Biological sequential events observed during puberty | 79 | ||
| Factors affecting time of onset of puberty | 80 | ||
| Physical growth and body weight | 80 | ||
| Secondary sex characters (ssc) – tanner classification of the sequence of development | 80 | ||
| Thelarche | 80 | ||
| Adrenarche | 80 | ||
| Pubic hair development | 80 | ||
| Axillary hair development | 82 | ||
| Genital organs | 82 | ||
| Menarche | 82 | ||
| Skeletal age | 82 | ||
| Management | 82 | ||
| Puberty – anomalies of gonadal function | 82 | ||
| Treatment of delayed puberty | 83 | ||
| Adolescent contraception | 84 | ||
| Miscellaneous problems | 85 | ||
| Self-assessment | 85 | ||
| Suggested reading | 85 | ||
| 7 Menopause and related problems | 86 | ||
| Introduction | 86 | ||
| Perimenopause (climacteric) | 86 | ||
| Diagnosis of approaching menopause | 86 | ||
| Menopause | 86 | ||
| Demography | 87 | ||
| Age | 87 | ||
| Pathophysiology | 87 | ||
| Hormone levels | 87 | ||
| Anatomical changes | 87 | ||
| Menopausal symptoms (table 7.2) | 88 | ||
| Menstrual | 88 | ||
| Hot flushes | 88 | ||
| Other symptoms | 88 | ||
| Neurological | 88 | ||
| Libido | 89 | ||
| Urinary tract | 89 | ||
| Genital | 89 | ||
| Neurological | 89 | ||
| Late effects of menopause | 89 | ||
| Osteoporosis (fig. 7.2) | 89 | ||
| Pathophysiology. | 89 | ||
| Cardiovascular diseases | 90 | ||
| Stroke | 90 | ||
| Skin | 90 | ||
| Alzheimer disease | 90 | ||
| Endocrine system | 90 | ||
| Pyometra | 90 | ||
| Approach to a menopausal woman | 90 | ||
| Management | 90 | ||
| Counselling | 90 | ||
| Mild tranquillizers | 90 | ||
| Hormone replacement therapy | 91 | ||
| Who needs HRT? | 91 | ||
| Uses of HRT | 91 | ||
| Osteoporosis | 91 | ||
| Prophylaxis of osteoporosis | 91 | ||
| Cardioprotective effect of HRT | 91 | ||
| Drugs, dosage and route of administration | 92 | ||
| Oestrogen therapy | 92 | ||
| Long-term therapy. | 92 | ||
| Oral route. | 92 | ||
| Transdermal patch (estraderm). | 92 | ||
| Vaginal cream. | 92 | ||
| Vaginal ring. | 92 | ||
| Implant. | 92 | ||
| Progestogens | 93 | ||
| Other drugs | 93 | ||
| Suggestions for HRT | 94 | ||
| Hormone replacement therapy and risk of breast cancer | 94 | ||
| Hormone replacement therapy and endometrial carcinoma | 94 | ||
| Premature menopause (premature ovarian failure) | 94 | ||
| Aetiology | 95 | ||
| Pathophysiology | 95 | ||
| Clinical features | 95 | ||
| Investigations | 95 | ||
| Complications | 95 | ||
| Management | 95 | ||
| Late menopause | 95 | ||
| Postmenopausal bleeding | 96 | ||
| Cause of postmenopausal bleeding | 96 | ||
| Clinical features | 96 | ||
| History | 96 | ||
| Examination | 96 | ||
| Investigations | 96 | ||
| Management | 97 | ||
| Self-assessment | 98 | ||
| Suggested reading | 98 | ||
| 8 Breast and gynaecologist | 99 | ||
| Congenital deformities | 99 | ||
| Benign tumours | 100 | ||
| Breast cancer | 102 | ||
| Self-assessment | 105 | ||
| Suggested reading | 105 | ||
| 9 Sexual development and disorders of sexual development | 106 | ||
| Principles of sexual development (fig. 9.1) | 106 | ||
| Summary of sex organs development | 106 | ||
| Gonads | 106 | ||
| Internal genitalia | 108 | ||
| External genitalia | 108 | ||
| Facets of sexual differentiation | 108 | ||
| Classification of intersex disorder | 108 | ||
| Gender identity disorders associated with normal sex chromosome constitutions | 108 | ||
| Gender identity disorders associated with abnormal sex chromosome constitutions | 109 | ||
| Factors influencing designation of sex | 109 | ||
| Genetic sex | 109 | ||
| External anatomical sex | 110 | ||
| Internal anatomical sex | 110 | ||
| Gonadal sex | 110 | ||
| Hormonal influences | 110 | ||
| Psychological sex | 110 | ||
| Environment and upbringing | 110 | ||
| Clinical diagnosis of sex | 111 | ||
| External appearance | 111 | ||
| External genitalia | 111 | ||
| Internal genitalia | 112 | ||
| Signs of feminism in the male | 112 | ||
| External appearance | 112 | ||
| External genitalia | 112 | ||
| Clinical examples | 112 | ||
| Disorders of female sexual differentiation | 112 | ||
| Swyer syndrome | 112 | ||
| Turner syndrome | 112 | ||
| Superfemale (triple X chromosome) | 113 | ||
| Male pseudohermaphrodite | 113 | ||
| Aetiology | 113 | ||
| Management | 113 | ||
| Partial androgen insensitivity syndrome | 114 | ||
| Enzyme errors in androgen production | 114 | ||
| Masculinization | 114 | ||
| Klinefelter syndrome | 114 | ||
| Virilism | 114 | ||
| Clinical features | 114 | ||
| Clinical varieties | 114 | ||
| Adrenogenital syndrome | 114 | ||
| Congenital or intrauterine adrenogenital syndrome | 114 | ||
| Postnatal adrenogenital syndrome | 115 | ||
| Virilizing tumours and other conditions of the ovary | 116 | ||
| Treatment | 116 | ||
| Female pseudohermaphroditism | 116 | ||
| Investigations and management of an intersexual patient | 116 | ||
| Hirsutism | 116 | ||
| Endocrinology | 116 | ||
| Causes of hirsutism | 117 | ||
| Clinical features | 117 | ||
| Investigations | 118 | ||
| History | 118 | ||
| Examination | 118 | ||
| Hormonal study | 118 | ||
| Ultrasound scan | 118 | ||
| Management | 118 | ||
| Acne | 120 | ||
| True hermaphrodite | 120 | ||
| Psychological sex | 120 | ||
| Self-assessment | 120 | ||
| Suggested reading | 120 | ||
| SECTION 2 DISORDERS OF MENSTRUATION | 121 | ||
| 10 Common disorders of menstruation | 122 | ||
| Menstrual cycle irregularities | 122 | ||
| Various types of menstrual cycle irregularities | 122 | ||
| Heavy menstrual bleeding (HMB) | 122 | ||
| Oligomenorrhoea and hypomenorrhoea | 123 | ||
| Oligomenorrhoea | 123 | ||
| Hypomenorrhoea | 123 | ||
| Polymenorrhoea or epimenorrhoea | 123 | ||
| Metrorrhagia | 123 | ||
| Dysmenorrhoea | 124 | ||
| Definition | 124 | ||
| Aetiology | 124 | ||
| Types | 124 | ||
| Varieties | 124 | ||
| Aetiology of pain (fig. 10.1) | 124 | ||
| Clinical features (table 10.2) | 124 | ||
| Investigations | 125 | ||
| Treatment | 125 | ||
| Medical measures | 125 | ||
| Surgery | 125 | ||
| Premenstrual syndrome | 126 | ||
| Aetiology | 126 | ||
| Clinical features | 126 | ||
| Diagnosis | 126 | ||
| Treatment (table 10.4) | 126 | ||
| Self-assessment | 127 | ||
| Suggested reading | 127 | ||
| 11 Abnormal uterine bleeding (AUB) | 128 | ||
| Introduction | 128 | ||
| Normal control of menstrual bleeding | 128 | ||
| Causes of abnormal uterine bleeding (table 11.1) | 128 | ||
| General diseases causing heavy menses | 130 | ||
| Local pelvic causes | 130 | ||
| Intrauterine contraceptive device | 131 | ||
| Investigations | 131 | ||
| Management | 131 | ||
| SECTION 3 COMMON CONDITIONS IN GYNAECOLOGY | 201 | ||
| 16 Infertility male and female | 202 | ||
| Physiology of fertilization | 202 | ||
| Infertility | 203 | ||
| Issues involved | 203 | ||
| Initial counselling | 203 | ||
| Male infertility | 203 | ||
| Development and growth in a male | 203 | ||
| Spermatogenesis | 203 | ||
| Structure of the sperm (fig. 16.2) | 204 | ||
| Endocrine control | 204 | ||
| Endocrine control of spermatogenesis | 205 | ||
| Fertilization | 205 | ||
| Male factor infertility | 205 | ||
| Faults in the male | 205 | ||
| Aetiological classification | 205 | ||
| Investigations | 206 | ||
| Semen analysis | 206 | ||
| Postcoital test (sims’ or huhner’s test, PCT) | 207 | ||
| Sperm penetration test | 207 | ||
| Semen–cervical mucous contact test | 207 | ||
| Management of male infertility | 208 | ||
| Hormonal therapies for male infertility | 209 | ||
| Management of azoospermia | 210 | ||
| LVF | 210 | ||
| Psychological considerations | 211 | ||
| Female infertility | 212 | ||
| Aetiology | 212 | ||
| Vaginismus | 212 | ||
| Treatment | 213 | ||
| Dyspareunia | 213 | ||
| Investigations | 214 | ||
| Treatment | 214 | ||
| Work up of female partner | 215 | ||
| History | 216 | ||
| Examination | 216 | ||
| Tests for tubal patency | 216 | ||
| Hysterosalpingography | 216 | ||
| Laparoscopic chromotubation | 218 | ||
| Sonosalpingography (SSG) | 218 | ||
| Newer modalities of tubal tests | 218 | ||
| Management of tubal infertility | 219 | ||
| Tests of ovulation | 220 | ||
| Basal body temperature | 220 | ||
| Endometrial biopsy | 220 | ||
| Fern test | 220 | ||
| Ultrasound follicular monitoring | 221 | ||
| Hormonal assays | 221 | ||
| Plasma progesterone | 221 | ||
| LH | 222 | ||
| Hyperprolactinaemia | 222 | ||
| FSH | 222 | ||
| Thyroid tests | 222 | ||
| Management of anovulation | 222 | ||
| Clomiphene citrate | 222 | ||
| Letrozole | 222 | ||
| Combination of CC + hMG | 222 | ||
| GnRH | 223 | ||
| Prednisolone | 223 | ||
| Hyperprolactinaemia | 223 | ||
| Laparoscopic ovarian drilling | 223 | ||
| Complications of ovulation induction | 223 | ||
| Ovarian hyperstimulation syndrome | 223 | ||
| Pathogenesis | 223 | ||
| Complications | 224 | ||
| Prevention | 224 | ||
| Treatment | 224 | ||
| Investigation and monitoring | 224 | ||
| Peritoneal factors | 224 | ||
| Endometriosis | 224 | ||
| Luteinized unruptured follicular syndrome | 224 | ||
| Unexplained infertility | 224 | ||
| Assisted reproductive technology: An overview | 225 | ||
| Definition | 225 | ||
| Indications | 225 | ||
| Investigations prior to art | 225 | ||
| Types of art procedures in current practice | 225 | ||
| Self-assessment | 226 | ||
| Suggested reading | 226 | ||
| 17 Ectopic gestation | 228 | ||
| Types of ectopic gestation | 228 | ||
| Epidemiology | 228 | ||
| Incidence | 228 | ||
| Aetiology (table 17.1) | 229 | ||
| Aetiopathogenesis | 229 | ||
| Pathology | 230 | ||
| Tubal pregnancy | 230 | ||
| Ovarian pregnancy | 230 | ||
| Abdominal pregnancy | 232 | ||
| Primary abdominal pregnancy | 232 | ||
| Secondary abdominal pregnancy | 232 | ||
| Interstitial pregnancy | 232 | ||
| Pregnancy in an accessory horn of uterus (cornual pregnancy) (fig. 17.11) | 232 | ||
| Co-existing intrauterine pregnancy and ectopic pregnancy (heterotopic pregnancy) | 233 | ||
| Symptoms, signs and diagnosis | 233 | ||
| Symptoms | 233 | ||
| Amenorrhoea | 233 | ||
| Pain | 233 | ||
| Vaginal bleeding | 233 | ||
| Acute retention of urine | 233 | ||
| Fever | 234 | ||
| Physical signs | 234 | ||
| Acute ectopic pregnancy | 234 | ||
| Differential diagnosis | 234 | ||
| Subacute and chronic variety of ectopic pregnancy | 235 | ||
| Differential diagnosis of chronic ectopic pregnancy | 235 | ||
| Pyosalpinx | 235 | ||
| Septic abortion | 235 | ||
| Pelvic abscess | 235 | ||
| Twisted ovarian cyst | 235 | ||
| Rupture of a chocolate cyst | 235 | ||
| Uterine fibroid | 235 | ||
| Corpus luteal haematoma | 235 | ||
| Acute appendicitis | 236 | ||
| Diagnostic investigations (table 17.3) | 236 | ||
| Urinary/serum hCG | 236 | ||
| β-hCG | 236 | ||
| Ultrasound | 236 | ||
| Culdocentesis or aspiration of the pouch of douglas | 237 | ||
| Other hormonal studies | 237 | ||
| Laparoscopy | 237 | ||
| Treatment | 237 | ||
| Medical management | 237 | ||
| Methotrexate therapy | 237 | ||
| Side effects of methotrexate | 238 | ||
| Contraindications | 238 | ||
| Other surgically administered medical (sam) drugs | 238 | ||
| Postmedication management | 239 | ||
| Surgical treatment | 239 | ||
| Types of surgery on the fallopian tube | 239 | ||
| Conservative tubal surgery | 240 | ||
| Interstitial pregnancy | 240 | ||
| Treatment | 240 | ||
| Prognosis | 240 | ||
| Unruptured ectopic gestation | 240 | ||
| Expectant treatment (fig. 17.21) | 241 | ||
| Ovarian pregnancy | 241 | ||
| Cervical pregnancy | 242 | ||
| Ultrasound | 242 | ||
| Treatment of cervical pregnancy | 242 | ||
| Cornual pregnancy | 242 | ||
| Heterotopic pregnancy | 243 | ||
| SECTION 4 BENIGN CONDITIONS IN GYNAECOLOGY | 285 | ||
| 21 Genital prolapse | 286 | ||
| Supports of the uterus | 286 | ||
| Aetiology of prolapse uterus (table 21.1) | 287 | ||
| Classification of prolapse (figs 21.3 and 21.4) | 287 | ||
| Cystocele | 287 | ||
| Prolapse of the uterus | 290 | ||
| Prolapse of the posterior vaginal wall | 290 | ||
| Decubitus ulcer | 290 | ||
| Elongation of the cervix | 291 | ||
| Obstruction of the urinary tract | 291 | ||
| Pop-q system (table 21.2, fig. 21.3) | 291 | ||
| Symptoms of prolapse | 291 | ||
| Investigations | 292 | ||
| Differential diagnosis | 292 | ||
| Complications of pelvic organ prolapse | 292 | ||
| Prevention of prolapse | 292 | ||
| Treatment (table 21.3) | 293 | ||
| Pessary treatment of prolapse | 293 | ||
| Operative treatment of prolapse | 293 | ||
| Preoperative preparation | 293 | ||
| Surgery | 293 | ||
| Anterior colporrhaphy | 294 | ||
| Posterior colporrhaphy and colpoperineorrhaphy | 294 | ||
| Fothergill’s repair (manchester operation) | 294 | ||
| Shirodkar’s procedure | 295 | ||
| Vaginal hysterectomy with pelvic floor repair | 295 | ||
| The steps of vaginal hysterectomy (figs 21.15–21.18) | 295 | ||
| Alternative methods of tying pedicles during surgery | 295 | ||
| Ligasure. | 295 | ||
| Le fort’s repair | 297 | ||
| Abdominal sling operations | 297 | ||
| Abdominal wall cervicopexy | 297 | ||
| Shirodkar’s abdominal sling operation for uterine prolapse | 298 | ||
| Khanna’s sling operation | 298 | ||
| Enterocele | 298 | ||
| Vault prolapse | 298 | ||
| Degrees of vault prolapse | 298 | ||
| Prevention | 298 | ||
| Treatment (table 21.4) | 298 | ||
| Vaginal sacrospinous colpopexy | 299 | ||
| Postoperative care | 300 | ||
| Recurrent prolapse and prosthetics | 300 | ||
| Self-assessment | 301 | ||
| Suggested reading | 301 | ||
| 22 Displacements of the uterus | 302 | ||
| Introduction | 302 | ||
| Retroversion | 302 | ||
| Aetiology | 302 | ||
| Mobile retroversion | 302 | ||
| Fixed retroversion | 303 | ||
| Symptoms | 303 | ||
| Dysmenorrhoea | 303 | ||
| Menorrhagia | 303 | ||
| Pressure | 303 | ||
| Backache | 303 | ||
| Dyspareunia | 303 | ||
| Infertility | 303 | ||
| Abortion | 303 | ||
| Retroverted gravid uterus causing retention of urine | 303 | ||
| Diagnosis | 303 | ||
| Treatment | 303 | ||
| Pessary treatment | 304 | ||
| Surgery | 304 | ||
| Indications | 304 | ||
| Ventrosuspension | 304 | ||
| Plication of round ligaments | 304 | ||
| Baldy–webster operation | 304 | ||
| Inversion of the uterus | 304 | ||
| Acute inversion | 304 | ||
| Prevention | 305 | ||
| Treatment | 305 | ||
| Chronic inversion | 305 | ||
| Degrees of inversion (fig. 22.6) | 306 | ||
| Treatment | 306 | ||
| Self-assessment | 306 | ||
| Suggested reading | 307 | ||
| 23 Diseases of the broad ligament, fallopian tubes and parametrium | 308 | ||
| Diseases of broad ligament | 308 | ||
| Broad ligament cysts | 308 | ||
| Anatomical considerations | 308 | ||
| Paraovarian cysts | 308 | ||
| Treatment | 309 | ||
| Tumours of the fallopian tubes | 309 | ||
| Conditions affecting the broad ligament and parametrium | 309 | ||
| Haematoma | 309 | ||
| Parametritis | 309 | ||
| Tumours of the broad ligament and parametrium | 310 | ||
| Myoma | 310 | ||
| Sarcoma | 310 | ||
| Lipoma | 310 | ||
| Retroperitoneal tumours | 310 | ||
| Self-assessment | 311 | ||
| Suggested reading | 311 | ||
| 24 Benign diseases of the ovary | 312 | ||
| Nonneoplastic enlargements of the ovary (table 24.1) | 312 | ||
| Functional cysts in ovary | 312 | ||
| Follicular cysts | 312 | ||
| Follicular haematomas (follicular cyst with haemorrhage) | 313 | ||
| Lutein cysts of the ovary | 313 | ||
| Corpus luteum (granulosa lutein) cysts | 313 | ||
| Theca lutein cysts | 313 | ||
| Multiple functional cysts | 313 | ||
| Pituitary adenoma | 313 | ||
| Ovarian hyperstimulation syndrome | 314 | ||
| Polycystic ovarian syndrome | 314 | ||
| Polycystic ovarian syndrome or disease PCO, PCOS, PCOD | 314 | ||
| Incidence | 314 | ||
| Aetiology and pathogenesis | 314 | ||
| Ovarian steroidogenesis in PCOS | 314 | ||
| Pathology | 315 | ||
| Clinical features (table 24.2) | 315 | ||
| Examination of a girl with PCOS | 315 | ||
| Diagnostic criteria for making a diagnosis of PCOS | 315 | ||
| Differential diagnosis | 316 | ||
| Investigations | 316 | ||
| Treatment | 316 | ||
| Surgery | 317 | ||
| Prevention | 317 | ||
| Self-assessment | 318 | ||
| Suggested reading | 318 | ||
| 25 Benign diseases of the vulva | 319 | ||
| Introduction | 319 | ||
| Benign diseases of the vulva | 319 | ||
| Inflammatory lesions | 319 | ||
| Skin infections | 319 | ||
| Intertrigo and folliculitis | 319 | ||
| Tinea cruris | 319 | ||
| Threadworms | 320 | ||
| Vulvovaginitis | 320 | ||
| Bartholin’s abscess | 320 | ||
| Psoriasis | 320 | ||
| Filariasis | 320 | ||
| Contact vulvitis | 320 | ||
| Pruritus vulva | 320 | ||
| Causes of pruritus vulvae | 320 | ||
| Treatment | 321 | ||
| Ulcers | 321 | ||
| Clinical features | 321 | ||
| Behcet disease | 321 | ||
| Atrophy | 322 | ||
| Vulval pain syndrome | 322 | ||
| Vestibulitis | 322 | ||
| Dysaesthetic vulvodynia | 322 | ||
| Management | 322 | ||
| Vulval dystrophies | 322 | ||
| Hyperplastic dystrophy (squamous cell hyperplasia), previously known as leukoplakia | 322 | ||
| Lichen sclerosus (atrophic dystrophy) | 323 | ||
| Cysts and neoplasms | 325 | ||
| Vulval cysts | 325 | ||
| Sebaceous cyst | 325 | ||
| Bartholin’s cyst | 325 | ||
| Cyst of the canal of nuck | 325 | ||
| Vulval neoplasms | 325 | ||
| Fibroma and lipoma | 325 | ||
| Hidradenoma | 325 | ||
| Pigmented mole or naevi | 325 | ||
| Endometriosis | 325 | ||
| Elephantiasis of vulva (fig. 25.8) | 325 | ||
| Self-assessment | 325 | ||
| Suggested reading | 325 | ||
| 26 Benign diseases of the vagina | 326 | ||
| Biology of the vagina | 326 | ||
| Structure of vaginal epithelium | 327 | ||
| Physiological changes in the vaginal epithelium | 327 | ||
| Cytology of the vagina | 328 | ||
| Vaginal acidity | 328 | ||
| Natural defence mechanism of the vagina | 328 | ||
| Flora of the female genital tract | 328 | ||
| Leucorrhoea | 329 | ||
| Excessive cervical secretions (cervical leucorrhoea) | 329 | ||
| Excessive vaginal secretions (nonpathogenic vaginal leucorrhoea) | 329 | ||
| Pathological vaginal infections | 329 | ||
| Vaginitis | 329 | ||
| Candidal vaginitis | 330 | ||
| Trichomonas vaginitis | 330 | ||
| Vaginosis (bacterial) | 330 | ||
| Miscellaneous causes of excessive vaginal discharge | 332 | ||
| Inflammation of the vagina | 332 | ||
| Aetiology | 332 | ||
| Symptoms and signs | 332 | ||
| Diagnosis | 332 | ||
| Treatment | 332 | ||
| General | 332 | ||
| Local | 332 | ||
| Oestrogen deficiency–related vaginitis | 333 | ||
| Vulvovaginitis in children | 333 | ||
| SECTION 5 INFECTIONS IN GYNAECOLOGY | 336 | ||
| 27 Pelvic inflammatory disease | 337 | ||
| Pelvic inflammatory disease | 337 | ||
| Aetiology | 337 | ||
| Pathological anatomy | 339 | ||
| Acute salpingitis | 339 | ||
| Chronic PID | 339 | ||
| Hydrosalpinx (figs 27.6 and 27.7) | 340 | ||
| Chronic pyosalpinx (figs 27.4 and 27.5) | 340 | ||
| Chronic interstitial salpingitis | 341 | ||
| Tubo-ovarian cyst | 341 | ||
| Tuberculous form | 341 | ||
| Staging | 341 | ||
| Symptoms and signs of PID | 341 | ||
| Acute pelvic infection | 341 | ||
| Differential diagnosis | 341 | ||
| Acute appendicitis | 341 | ||
| Ectopic gestation | 342 | ||
| Diverticulitis | 342 | ||
| A twisted ovarian cyst | 342 | ||
| Ruptured endometriotic cyst | 342 | ||
| Septic abortion | 342 | ||
| Cholecystitis | 342 | ||
| Investigations | 342 | ||
| Chronic pelvic inflammatory disease | 343 | ||
| Treatment | 343 | ||
| Treatment of acute PID | 343 | ||
| Surgical treatment | 344 | ||
| Minimal invasive surgery | 345 | ||
| Surgical treatment of chronic PID | 345 | ||
| Prognosis | 345 | ||
| End results | 345 | ||
| Prevention of PID (table 27.5) | 345 | ||
| Rare variety of PID due to actinomyces | 346 | ||
| Self-assessment | 346 | ||
| Suggested reading | 346 | ||
| 28 Tuberculosis of the female genital tract | 347 | ||
| Introduction | 347 | ||
| Pathogenesis | 347 | ||
| Genital tract lesions | 348 | ||
| Clinical features of genital tuberculosis | 350 | ||
| Investigations | 351 | ||
| Differential diagnosis | 352 | ||
| Treatment | 353 | ||
| Chemotherapy | 353 | ||
| Place of surgery in treatment of female genital tuberculosis | 354 | ||
| Types of surgery | 354 | ||
| Follow-up | 354 | ||
| Prognosis | 354 | ||
| In vitro fertilization (IVF) | 354 | ||
| Self-assessment | 354 | ||
| Suggested reading | 354 | ||
| 29 Sexually transmitted diseases including HIV infection | 356 | ||
| Vulvar infections | 356 | ||
| Parasitic infection (pediculosis pubis) | 356 | ||
| Clinical features | 356 | ||
| Diagnosis | 356 | ||
| Treatment | 356 | ||
| Scabies | 357 | ||
| SECTION 6 URINARY AND INTESTINAL TRACT IN GYNAECOLOGY | 371 | ||
| 30 Diseases of the urinary tract | 372 | ||
| Common urinary symptoms | 372 | ||
| Acute retention of urine (table 30.1) | 372 | ||
| Causes | 372 | ||
| Postoperative retention | 372 | ||
| Puerperal retention of urine | 373 | ||
| Obstructive conditions | 373 | ||
| Space-occupying lesions in the pelvis | 373 | ||
| Neurological causes | 373 | ||
| Chronic retention with overflow | 373 | ||
| Treatment of urinary retention | 373 | ||
| Urethral syndrome | 373 | ||
| Difficult micturition | 373 | ||
| Painful micturition | 374 | ||
| Increased frequency of micturition | 374 | ||
| Incontinence of urine | 374 | ||
| Cystitis | 375 | ||
| Symptoms | 375 | ||
| Diagnosis | 375 | ||
| Treatment | 375 | ||
| Chronic cystitis | 375 | ||
| Pyelonephritis (pyelitis) | 376 | ||
| SECTION 7 GYNAECOLOGICAL MALIGNANCIES | 407 | ||
| 33 Preinvasive and invasive carcinoma of cervix | 408 | ||
| Epidemiology (table 33.1) | 408 | ||
| Squamocolumnar junction | 409 | ||
| Original squamocolumnar junction | 409 | ||
| New squamocolumnar junction | 409 | ||
| The transformation zone | 409 | ||
| Cervical intraepithelial neoplasia (CIN) | 409 | ||
| Dysplasia (figs 33.2–33.9) | 409 | ||
| Diagnosis | 411 | ||
| Cytological screening for cancer cervix | 411 | ||
| Other screening techniques | 412 | ||
| Colposcopy | 412 | ||
| Cervicography | 413 | ||
| Cone biopsy | 414 | ||
| HPV testing | 414 | ||
| Treatment of cervical dysplasias and CIN (table 33.4; figs 33.13 –33.19) | 414 | ||
| Cryosurgery | 418 | ||
| Mechanism of action | 418 | ||
| Electrocoagulation | 418 | ||
| Laser ablation | 418 | ||
| Excisional and cone biopsy | 418 | ||
| Punch biopsy | 418 | ||
| Large loop excision of the transformation zone (LLETZ/LEEP) | 418 | ||
| Conization | 419 | ||
| Hysterectomy | 419 | ||
| Follow-up after treatment of HSIL | 419 | ||
| Glandular lesions of cervix | 419 | ||
| Prevention of cancer of the cervix | 420 | ||
| Prophylactic HPV vaccines | 420 | ||
| Reported side effects of vaccine | 420 | ||
| HPV vaccine for males | 420 | ||
| Invasive cancer of the cervix | 420 | ||
| Pathology | 420 | ||
| Histological classification | 420 | ||
| Mode of spread | 421 | ||
| Clinical features | 421 | ||
| Differential diagnosis | 422 | ||
| Staging of cancer of the cervix (figs 33.27–33.39; table 33.6) | 422 | ||
| Incidence of lymph node metastasis in cancer cervix | 422 | ||
| Para-aortic lymph node metastasis | 424 | ||
| Diagnosis | 424 | ||
| Investigations | 425 | ||
| Treatment of invasive cancer | 426 | ||
| Surgical treatment | 426 | ||
| Stagewise treatment of cancer of the cervix | 426 | ||
| Complications of radical hysterectomy | 427 | ||
| Radiotherapy | 427 | ||
| Indications for postoperative radiotherapy | 427 | ||
| Recurrence of cancer | 427 | ||
| Recurrent lesion | 428 | ||
| Follow-up of a treated case of cancer of the cervix | 428 | ||
| Management of recurrences | 428 | ||
| Stagewise treatment of cancer of the cervix | 428 | ||
| Conservative surgery in a young woman | 429 | ||
| Carcinoma in pregnancy | 429 | ||
| Endocervical adenocarcinoma of cervix | 430 | ||
| Results | 430 | ||
| Prognosis | 430 | ||
| Stump cancer | 430 | ||
| Palliative treatment in terminal stages of cancer of the cervix | 430 | ||
| Future development | 430 | ||
| Self-assessment | 431 | ||
| Suggested reading | 431 | ||
| 34 Cancer of the body of the uterus | 432 | ||
| Endometrial cancer | 432 | ||
| Predisposing factors (table 34.1) | 433 | ||
| Pathology (fig. 34.6) | 434 | ||
| Modes of spread | 434 | ||
| Tumour differentiation | 434 | ||
| Types of endometrial cancers | 434 | ||
| Clinical features | 434 | ||
| Investigations | 435 | ||
| Differential diagnosis | 436 | ||
| Endometrial hyperplasia | 436 | ||
| 2014 revised who classification of endometrial hyperplasia | 436 | ||
| SECTION 8 IMAGING MODALITIES, ENDOSCOPIC PROCEDURES AND MAJOR AND MINOR OPERATIONS IN GYNAECOLOGY | 506 | ||
| 40 Imaging modalities in gynaecology | 507 | ||
| Plain radiography | 507 | ||
| Hysterosalpingography | 507 | ||
| Technique | 507 | ||
| Contraindications | 509 | ||
| Complications | 509 | ||
| Advantages | 509 | ||
| Sonosalpingography | 509 | ||
| Intravenous urography | 509 | ||
| Indications | 509 | ||
| Precautions and contraindications | 510 | ||
| Cystography and urethrography | 510 | ||
| Gastrointestinal imaging studies | 510 | ||
| Barium meal and follow through | 510 | ||
| Barium enema | 510 | ||
| Arteriography and arterial embolization | 510 | ||
| Ultrasonography (figs 40.6–40.16) | 511 | ||
| Normal ultrasonic findings | 513 | ||
| Diagnostic indications | 514 | ||
| Interventional ultrasound in gynaecology | 514 | ||
| Computed tomography scan | 515 | ||
| Technique | 516 | ||
| Index | 553 | ||
| A | 553 | ||
| B | 553 | ||
| C | 554 | ||
| D | 555 | ||
| E | 555 | ||
| F | 555 | ||
| G | 556 | ||
| H | 556 | ||
| I | 557 | ||
| J | 557 | ||
| K | 557 | ||
| L | 558 | ||
| M | 558 | ||
| N | 559 | ||
| O | 559 | ||
| P | 559 | ||
| Q | 560 | ||
| R | 560 | ||
| S | 560 | ||
| T | 561 | ||
| U | 561 | ||
| V | 562 | ||
| W | 562 | ||
| X | 562 | ||
| Y | 562 | ||
| Z | 562 |