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Book Details
Abstract
Examination Obstetrics & Gynaecology is an accessible rapid reference appropriate for daily use in a busy ward, clinic or surgery. Fully revised and updated, this practical guide is a definitive resource for medical trainees undertaking speciality training.
Building on resources developed during the authors' specialist training in Obstetrics & Gynaecology, and refined by practical clinical experience, it provides a summary of important and essential information needed in women's health. Organised in a note and checklist format, it utilises a step-by-step guide to diagnosis, investigations and suggested treatments appropriate to primary consultation prior to specialist referral.
- Sample Objective Structured Clinical Examination OSCE cases from O&G examiner's perspectives to assist with examination preparation
- 24 chapters dedicated to gynaecology, and 32 chapters to obstetrics
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| IFC_Expert Consult | IFC-1 | ||
| Examination Obstetrics & Gynaecology | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Table Of Contents | vii | ||
| Preface to the 4th edition | ix | ||
| Contributors | xi | ||
| Reviewers | xiii | ||
| Gynaecology | 1 | ||
| 1 Gynaecological history and examination | 2 | ||
| History | 2 | ||
| Examination | 3 | ||
| General | 3 | ||
| Genital examination | 3 | ||
| Conclusion | 3 | ||
| 2 Amenorrhoea | 4 | ||
| Puberty | 4 | ||
| Endocrinology of puberty | 4 | ||
| Secondary sexual characteristics | 4 | ||
| Major physical changes during puberty | 4 | ||
| Secondary female characteristics | 4 | ||
| Primary amenorrhoea | 5 | ||
| Management of primary amenorrhoea | 5 | ||
| When to investigate | 5 | ||
| History | 5 | ||
| Examination | 5 | ||
| Investigations | 6 | ||
| Classification of primary amenorrhoea | 6 | ||
| Sexually infantile | 6 | ||
| Feminising secondary sexual characteristics | 6 | ||
| Masculinising secondary sexual characteristics | 6 | ||
| Causes of primary amenorrhoea | 6 | ||
| Hypogonadotrophic hypogonadism | 6 | ||
| Hypergonadotrophic hypogonadism (gonadal dysgenesis) | 6 | ||
| Androgen insensitivity syndrome (testicular feminisation) | 7 | ||
| Müllerian anomalies | 7 | ||
| Other causes of primary amenorrhoea | 7 | ||
| Constitutional delay in puberty | 7 | ||
| Principles of management of primary amenorrhoea | 8 | ||
| Fertility | 8 | ||
| Physical/emotional development | 8 | ||
| Secondary amenorrhoea | 8 | ||
| Causes of secondary amenorrhoea | 8 | ||
| Oestrogen deficiency | 8 | ||
| Unopposed oestrogen | 8 | ||
| Other causes | 8 | ||
| History | 8 | ||
| Examination | 9 | ||
| Investigations | 9 | ||
| Management and further investigations of secondary amenorrhoea | 9 | ||
| Premature ovarian failure | 9 | ||
| Hypothalamic amenorrhoea | 9 | ||
| Polycystic ovarian syndrome | 9 | ||
| Asherman’s syndrome | 9 | ||
| Medical problems | 9 | ||
| Tumours | 10 | ||
| Further reading | 10 | ||
| 3 Abnormal uterine bleeding | 11 | ||
| Terminology for disorders of menstruation | 11 | ||
| Disturbances of regularity | 11 | ||
| Disturbances of frequency | 11 | ||
| Disturbances of flow | 11 | ||
| Disturbance of the duration of flow | 11 | ||
| Irregular non-menstrual bleeding | 12 | ||
| Bleeding outside of the reproductive age | 12 | ||
| Acute AUB | 12 | ||
| Chronic AUB | 12 | ||
| Causes of AUB: the PALM-COEIN classification system | 12 | ||
| Anatomical and structural (PALM) | 12 | ||
| Polyps (AUB-P) | 12 | ||
| Adenomyosis (AUB-A) | 13 | ||
| Leiomyomas (AUB-Lsm or AUB-Lo) | 13 | ||
| Malignancy (AUB-M) | 13 | ||
| Unrelated to structural anomalies (COEI) | 13 | ||
| Coagulopathies (AUB-C) | 13 | ||
| Ovulatory dysfunction (AUB-O) | 13 | ||
| Endometrial causes (AUB-E) | 13 | ||
| Iatrogenic (AUB-I) | 13 | ||
| Not yet classified (AUB-N) | 13 | ||
| Assessment of AUB | 13 | ||
| History | 13 | ||
| Examination | 14 | ||
| Investigations | 14 | ||
| Management of AUB: HMB | 14 | ||
| Prostaglandin inhibitors | 14 | ||
| Antifibrinolytics and haemostatics | 14 | ||
| Hormonal therapy | 14 | ||
| Combined oral contraceptive pill | 14 | ||
| Progesterone | 15 | ||
| Surgical management of menorrhagia | 15 | ||
| Hysteroscopic removal of polyps and fibroids | 15 | ||
| Endometrial ablation/resection | 15 | ||
| Hysterectomy | 15 | ||
| Uterine artery embolisation | 15 | ||
| 4 Endometriosis | 16 | ||
| Risk factors | 16 | ||
| Aetiology | 17 | ||
| Genetics | 17 | ||
| Pathology | 17 | ||
| Pathogenesis | 18 | ||
| Clinical presentation | 18 | ||
| Diagnosis | 18 | ||
| Staging | 19 | ||
| Treatments | 19 | ||
| Medical treatment | 19 | ||
| Contraceptive | 19 | ||
| Options | 19 | ||
| Surgical treatment | 19 | ||
| Alternative treatment | 20 | ||
| Prognosis | 20 | ||
| Special areas | 20 | ||
| Endometriosis in adolescence | 20 | ||
| Endometriosis and fertility | 20 | ||
| Impact on fertility | 20 | ||
| Medical therapies contraceptive | 21 | ||
| Impact on and role of assisted reproductive technology (ART) | 21 | ||
| Deep infiltrating endometriosis | 21 | ||
| Extrapelvic disease | 21 | ||
| References and further reading | 21 | ||
| 5 Polycystic ovarian syndrome | 23 | ||
| Clinical presentation | 23 | ||
| Aetiology | 24 | ||
| Pathophysiology | 24 | ||
| Ovaries | 24 | ||
| Hypothalamus–pituitary | 24 | ||
| Peripheral compartment | 24 | ||
| Adrenal compartment | 24 | ||
| Consequences of PCOS | 25 | ||
| Reproductive consequences | 25 | ||
| Metabolic consequences | 25 | ||
| Neoplasia | 25 | ||
| Cardiovascular disease | 25 | ||
| Other | 25 | ||
| Differential diagnosis | 26 | ||
| Assessment | 26 | ||
| History | 26 | ||
| Examination | 26 | ||
| Investigations | 26 | ||
| Management | 27 | ||
| Supportive | 27 | ||
| Not wanting to conceive | 27 | ||
| COCP | 27 | ||
| Progesterone (cyclical oral or depot medroxyprogesterone acetate, DMPA) | 27 | ||
| Insulin-sensitising drugs | 27 | ||
| Wanting to conceive | 28 | ||
| Medical | 28 | ||
| Metformin | 28 | ||
| Other medical treatment | 28 | ||
| References and further reading | 30 | ||
| 6 Hirsutism | 31 | ||
| Physiology of hair growth | 31 | ||
| Hair growth and hirsutism | 31 | ||
| Causes of hirsutism | 32 | ||
| Common | 32 | ||
| Uncommon | 32 | ||
| Non-androgenic | 32 | ||
| Androgenic | 32 | ||
| Adrenals | 32 | ||
| Ovarian | 33 | ||
| Drugs | 33 | ||
| Investigation and diagnosis | 34 | ||
| History | 34 | ||
| Examination | 34 | ||
| Investigations | 34 | ||
| Management | 34 | ||
| Principles | 34 | ||
| Counselling | 34 | ||
| Hair therapy | 34 | ||
| Permanent hair reduction | 35 | ||
| Topical treatment | 35 | ||
| Pharmacological | 35 | ||
| Oral contraceptives | 35 | ||
| Spironolactone | 35 | ||
| Cyproterone acetate | 35 | ||
| Finasteride | 35 | ||
| Flutamide | 35 | ||
| Insulin-lowering medications | 35 | ||
| Glucocorticoids | 36 | ||
| Gonadotropin-releasing hormone agonist (GnRH) agonist | 36 | ||
| 7 Contraception | 37 | ||
| Natural methods | 37 | ||
| Barrier methods | 37 | ||
| Diaphragm | 37 | ||
| Function | 37 | ||
| Effectiveness | 38 | ||
| Cervical/vault caps | 38 | ||
| Advantages | 38 | ||
| Sponge | 38 | ||
| Condoms | 38 | ||
| Female condoms | 38 | ||
| Spermicides | 38 | ||
| Intrauterine contraceptive devices | 38 | ||
| Types | 38 | ||
| Mechanisms of action | 39 | ||
| Effectiveness | 39 | ||
| Counselling | 39 | ||
| Before insertion | 39 | ||
| Insertion | 39 | ||
| Change of the contraceptive device | 39 | ||
| Risks | 39 | ||
| Oral contraceptives | 40 | ||
| Combined oral contraceptive pill (COCP) | 40 | ||
| Two formulations | 40 | ||
| Mechanisms of action | 40 | ||
| Effectiveness | 40 | ||
| Assessment before commencing COCP | 40 | ||
| Side effects and risks | 40 | ||
| Missed pills | 41 | ||
| Problems and solutions | 41 | ||
| Progestogen-only pills | 41 | ||
| Contraceptive implants | 41 | ||
| Depot medroxyprogesterone acetate (DMPA) | 41 | ||
| Mechanisms of action | 41 | ||
| Side effects | 41 | ||
| Subcutaneous progestogen implants | 42 | ||
| Combined vaginal ring | 42 | ||
| Assessment | 42 | ||
| Side effects and risks | 42 | ||
| Pregnancy interception (emergency contraception) | 42 | ||
| Hormonal methods | 42 | ||
| Non-hormonal methods | 43 | ||
| Male contraception | 43 | ||
| Gonadotropin-releasing hormone (GnRH) analogues | 43 | ||
| Steroids | 43 | ||
| Antiandrogen (cyproterone acetate) | 43 | ||
| Gossypol | 43 | ||
| Sterilisation | 43 | ||
| Female sterilisation | 43 | ||
| Abdominal/laparoscopic | 43 | ||
| Hysteroscopic | 43 | ||
| Male sterilisation | 43 | ||
| Further reading | 43 | ||
| 8 Miscarriage and abortion | 44 | ||
| Aetiology of spontaneous miscarriage | 44 | ||
| Presentation and management | 45 | ||
| Presentation (spontaneous miscarriage) | 45 | ||
| Examination | 45 | ||
| Investigations | 45 | ||
| Management | 45 | ||
| Recurrent pregnancy loss | 45 | ||
| Risk of miscarriage | 46 | ||
| Investigations for recurrent pregnancy loss | 46 | ||
| Management of recurrent pregnancy loss | 46 | ||
| Abortions due to uterine abnormalities | 46 | ||
| Abortions due to endocrine abnormalities | 46 | ||
| Support and counselling | 46 | ||
| Induced abortion | 46 | ||
| Surgical abortion | 46 | ||
| Medical abortion | 46 | ||
| Support and counselling | 47 | ||
| References | 47 | ||
| 9 Ectopic pregnancy | 48 | ||
| Tubal ectopic pregnancy | 48 | ||
| Aetiology and risk factors | 48 | ||
| Presentation | 49 | ||
| Investigations | 49 | ||
| Quantitative serum human chorionic gonadotrophin (hCG) | 49 | ||
| Ultrasound | 49 | ||
| Laparoscopy | 49 | ||
| Management | 49 | ||
| Surgical | 49 | ||
| Salpingectomy and salpingostomy | 49 | ||
| Local injection of ectopic pregnancy | 50 | ||
| Medical | 50 | ||
| Systemic methotrexate | 50 | ||
| Expectant management | 50 | ||
| Anti-D | 50 | ||
| Contraception and future pregnancies | 50 | ||
| Abdominal pregnancy | 50 | ||
| Management | 50 | ||
| Reference | 51 | ||
| 10 Infertility | 52 | ||
| Conception | 52 | ||
| Probability of conception | 52 | ||
| Aetiology | 53 | ||
| History | 53 | ||
| Female | 53 | ||
| Obstetrics | 157 | ||
| 25 Antenatal care | 158 | ||
| Prepregnancy care | 158 | ||
| Aims of counselling before conception | 158 | ||
| Antenatal care | 158 | ||
| Aims of antenatal care | 158 | ||
| Booking assessment | 159 | ||
| Examination | 159 | ||
| Investigations | 159 | ||
| First visit | 159 | ||
| Discussion of antenatal screening | 159 | ||
| Obstetric ultrasound scan at 18–20 weeks gestation | 160 | ||
| At the end of the second trimester: | 160 | ||
| Group B streptococcus disease (GBS) | 160 | ||
| Continuing antenatal visits | 160 | ||
| Indications for ultrasound scan in antenatal care | 160 | ||
| 26 Antenatal diagnosis of fetal and chromosomal abnormalities | 161 | ||
| Genetic counselling | 161 | ||
| Aims of genetic counselling | 161 | ||
| Indications for prenatal diagnosis | 162 | ||
| Preimplantation genetic diagnosis (PGD) | 162 | ||
| Tests available for antenatal diagnosis | 162 | ||
| Screening | 162 | ||
| Diagnostic | 163 | ||
| Distribution of chromosomal abnormalities | 163 | ||
| Screening | 164 | ||
| Maternal age | 164 | ||
| Combined nuchal translucency and biochemical screening | 164 | ||
| Non-invasive prenatal testing (NIPT) | 165 | ||
| Second-trimester screening | 165 | ||
| Ultrasound screening | 166 | ||
| Morphology ultrasound assessment | 166 | ||
| Trisomy 21 | 166 | ||
| Trisomy 18 | 166 | ||
| Trisomy 13 | 166 | ||
| Definitive diagnostic tests | 166 | ||
| Amniocentesis | 167 | ||
| Chorionic villus sampling | 167 | ||
| Cordocentesis/fetal blood sampling | 167 | ||
| Chromosomal abnormalities | 167 | ||
| Trisomies | 167 | ||
| Translocations | 168 | ||
| Reciprocal translocation | 168 | ||
| Robertsonian translocation | 168 | ||
| Sex chromosome abnormalities | 168 | ||
| Turner’s syndrome | 168 | ||
| Klinefelter’s syndrome | 168 | ||
| Other genetic syndromes | 168 | ||
| Fragile X syndrome | 168 | ||
| Cystic fibrosis | 169 | ||
| Muscular dystrophies | 169 | ||
| Phenylketonuria | 169 | ||
| Marfan’s syndrome | 169 | ||
| Neurofibromatosis | 169 | ||
| Thalassaemia | 169 | ||
| Incidence in ethnic and racial groups | 170 | ||
| Neural tube defects | 170 | ||
| Gastrointestinal anomalies | 170 | ||
| Renal tract anomalies | 170 | ||
| Cardiac abnormalities | 170 | ||
| Dwarfism | 171 | ||
| Cleft lip/palate | 171 | ||
| References and further reading | 171 | ||
| 27 Assessing fetal wellbeing | 172 | ||
| Tests available for assessing fetal wellbeing | 172 | ||
| Fetal movement | 172 | ||
| Fetal movement in late pregnancy | 172 | ||
| Cardiotocography (CTG) | 173 | ||
| Fetal scalp pH or lactate | 173 | ||
| Fetal pulse oximetry | 173 | ||
| Biophysical assessment | 173 | ||
| Amniotic fluid volume assessment | 174 | ||
| Growth | 174 | ||
| Doppler flow studies | 174 | ||
| Biochemical markers of placental function | 175 | ||
| Further reading | 175 | ||
| 28 Drugs and drugs of abuse in pregnancy | 176 | ||
| Teratogens | 176 | ||
| Drug pharmacokinetics and pregnancy | 177 | ||
| Drug absorption | 177 | ||
| Drug distribution | 178 | ||
| Protein binding | 178 | ||
| Drug elimination | 178 | ||
| Placental–fetal compartment | 178 | ||
| Specific drugs in pregnancy | 178 | ||
| Anticonvulsants | 178 | ||
| Carbamazepine | 178 | ||
| Phenytoin | 178 | ||
| Valproic acid | 179 | ||
| Antibiotics | 179 | ||
| Penicillins/cephalosporins | 179 | ||
| Tetracycline | 179 | ||
| Nitrofurantoin | 179 | ||
| Sulfonamides | 179 | ||
| Doxycycline | 179 | ||
| Metronidazole | 179 | ||
| Azithromycin | 179 | ||
| Methotrexate | 179 | ||
| Warfarin | 179 | ||
| Lithium | 179 | ||
| Retinoids | 180 | ||
| Angiotensin-converting enzyme (ACE) inhibitors | 180 | ||
| Selective serotonin reuptake inhibitors (SSRIs) | 180 | ||
| Drugs of abuse in pregnancy | 180 | ||
| Alcohol | 180 | ||
| Cigarette smoking | 180 | ||
| Cocaine | 180 | ||
| Cannabis | 180 | ||
| Amphetamines | 181 | ||
| Lysergic acid diethylamide (LSD) | 181 | ||
| Glue/petrol | 181 | ||
| Opiates | 181 | ||
| Management of opiate abuse in pregnancy | 181 | ||
| References | 181 | ||
| 29 Infections in pregnancy | 182 | ||
| Urinary tract infection | 182 | ||
| Asymptomatic bacteriuria | 182 | ||
| Acute symptomatic urinary tract infection | 182 | ||
| Management | 182 | ||
| Relapses and reinfection | 183 | ||
| Management | 183 | ||
| Syphilis | 183 | ||
| Screening | 183 | ||
| Clinical syndromes | 183 | ||
| Primary syphilis | 183 | ||
| Secondary syphilis | 183 | ||
| Latent syphilis | 183 | ||
| Tertiary syphilis | 183 | ||
| Management of syphilis | 184 | ||
| Toxoplasmosis | 184 | ||
| Rubella | 184 | ||
| Possible outcomes of maternal rubella infection | 184 | ||
| Risk to fetus of maternal infection | 185 | ||
| Diagnosis of maternal rubella | 185 | ||
| Diagnosis of intrauterine/congenital rubella | 185 | ||
| Vaccination | 185 | ||
| Hepatitis B | 185 | ||
| Hepatitis B virus (HBV) | 185 | ||
| Factors in perinatal transmission | 186 | ||
| Prevention of hepatitis B | 186 | ||
| Hepatitis C | 186 | ||
| Human immunodeficiency virus (HIV) and pregnancy | 186 | ||
| Maternal to child transmission (MTCT) | 186 | ||
| Managing HIV in pregnancy | 187 | ||
| Cytomegalovirus | 187 | ||
| Fetal complications | 187 | ||
| Diagnosis | 187 | ||
| Pathogenesis of fetal complications | 187 | ||
| Antenatal advice | 188 | ||
| Listeriosis | 188 | ||
| Complications of listeriosis in pregnancy | 188 | ||
| Varicella zoster | 188 | ||
| Infection in late pregnancy | 188 | ||
| Management | 188 | ||
| Exposure in pregnancy | 189 | ||
| Group B streptococcus | 189 | ||
| Management | 189 | ||
| Herpes simplex | 189 | ||
| Risk factors for intrapartum infection | 190 | ||
| Management | 190 | ||
| Further reading | 190 | ||
| 30 Red blood cell and platelet alloimmunisation in pregnancy | 191 | ||
| Red blood cell isoimmunisation | 191 | ||
| Background and pathophysiology | 191 | ||
| Prevention of HDFN | 192 | ||
| Prepregnancy management of RBC alloimmunisation | 192 | ||
| Antenatal management of RBC alloimmunisation | 192 | ||
| Determination of fetal Rh type | 193 | ||
| Antibody quantification | 193 | ||
| Non-invasive assessment of fetal anaemia | 193 | ||
| Intrauterine transfusion | 193 | ||
| RBCs for intrauterine transfusion should be: | 194 | ||
| Platelet isoimmunisation | 194 | ||
| Pathophysiology | 194 | ||
| Diagnosis | 194 | ||
| Parental and fetal/neonatal platelet antigen typing | 195 | ||
| Management of pregnancies at risk of FNAIT | 195 | ||
| Further reading | 195 | ||
| 31 Antepartum haemorrhage | 197 | ||
| Aetiology | 197 | ||
| Placenta praevia | 197 | ||
| Classification | 197 | ||
| Risk factors | 198 | ||
| Management | 198 | ||
| Placenta accreta | 198 | ||
| Placental abruption | 199 | ||
| Risk factors | 199 | ||
| Differential diagnosis | 199 | ||
| Complications of placental abruption | 199 | ||
| Management | 199 | ||
| Vasa praevia | 200 | ||
| Diagnosis | 200 | ||
| Local causes | 200 | ||
| Further reading | 200 | ||
| 32 Fetal complications in later pregnancy | 201 | ||
| Intrauterine fetal death (IUFD) | 201 | ||
| Aetiology | 201 | ||
| Complications | 201 | ||
| Coagulopathy and disseminated intravascular coagulopathy | 201 | ||
| Investigations | 202 | ||
| Delivery of the dead fetus | 202 | ||
| Prostaglandins | 202 | ||
| Prostaglandin pessaries or gel | 202 | ||
| Vaginal | 202 | ||
| Misoprostol (prostaglandin E1 analogue) | 202 | ||
| Oxytocin | 202 | ||
| Caesarean section | 202 | ||
| Fetal growth restriction (FGR) | 202 | ||
| Causes | 203 | ||
| Screening | 203 | ||
| Diagnosis | 203 | ||
| Management | 203 | ||
| Disorders of amniotic fluid volume | 203 | ||
| Screening | 204 | ||
| Diagnosis | 204 | ||
| Polyhydramnios | 204 | ||
| Risk factors | 204 | ||
| Complications of polyhydramnios | 204 | ||
| Management | 204 | ||
| Oligohydramnios | 204 | ||
| Factors associated with reduced amniotic fluid volume | 204 | ||
| Complications of oligohydramnios | 204 | ||
| Management | 205 | ||
| Further reading | 205 | ||
| 33 Breech presentation | 206 | ||
| Types | 206 | ||
| Risk factors | 206 | ||
| External cephalic version | 206 | ||
| Management of breech presentation | 207 | ||
| Diagnosis | 207 | ||
| Term breech trial | 207 | ||
| Delivery of the breech presentation diagnosed in late labour | 207 | ||
| Breech born by maternal expulsive efforts up to the umbilicus | 207 | ||
| Lövset’s manoeuvre | 208 | ||
| Possible hazards in vaginal delivery | 208 | ||
| Preterm breech presentation | 208 | ||
| Further reading | 208 | ||
| 34 Multiple pregnancy | 209 | ||
| Mechanism of twinning | 209 | ||
| Dizygotic twins | 209 | ||
| Monozygotic twins | 209 | ||
| Diagnosis of chorionicity and amnionicity | 210 | ||
| Prenatal diagnosis | 210 | ||
| Complications of twin pregnancy | 210 | ||
| General | 210 | ||
| Specific: monochorionic twinning | 211 | ||
| Twin-to-twin transfusion syndrome (TTTS) | 211 | ||
| Staging (Quintero) | 211 | ||
| Management | 211 | ||
| Selective intrauterine growth restriction (sIUGR) | 211 | ||
| Twin reversed arterial perfusion sequence (TRAP) or acardiac twinning | 211 | ||
| Antenatal management of twin pregnancy | 211 | ||
| Diagnosis | 211 | ||
| Antenatal care | 212 | ||
| Ultrasound role | 212 | ||
| Prevention of premature labour | 212 | ||
| Delivery of twins | 212 | ||
| Indications for elective caesarean section | 212 | ||
| Vaginal delivery | 212 | ||
| Twin with single intrauterine fetal death | 212 | ||
| Triplet pregnancy | 213 | ||
| Complications of triplet pregnancy | 213 | ||
| Delivery | 213 | ||
| Further reading | 213 | ||
| 35 Preterm prelabour rupture of membranes | 214 | ||
| Aetiology of PPROM | 214 | ||
| Risk factors of PPROM | 214 | ||
| Clinical significance of PPROM | 215 | ||
| Maternal risks | 215 | ||
| Fetal risks | 215 | ||
| Diagnosis | 215 | ||
| Management of PPROM | 216 | ||
| Initial management | 216 | ||
| PPROM: 34–37 weeks | 216 | ||
| PPROM: 24–33 weeks | 217 | ||
| PPROM: < 23 completed weeks | 217 | ||
| Antenatal corticosteroids | 217 | ||
| Adjuvant antibiotics | 218 | ||
| Magnesium sulfate | 218 | ||
| Progesterone | 218 | ||
| Tocolysis | 218 | ||
| Emerging therapies | 218 | ||
| Further reading | 218 | ||
| 36 Preterm labour | 220 | ||
| Significance | 220 | ||
| Aetiology | 220 | ||
| Spontaneous preterm labour | 220 | ||
| Indicated preterm labour | 221 | ||
| Prevention of preterm labour | 221 | ||
| Diagnosis of preterm labour | 222 | ||
| Cervical length and morphology | 222 | ||
| Fetal fibronectin (fFN) | 222 | ||
| Management of preterm labour | 222 | ||
| Further reading | 223 | ||
| 37 Induction of labour | 225 | ||
| Mechanism of labour | 225 | ||
| Induction of labour | 225 | ||
| Indications | 225 | ||
| Contraindications | 226 | ||
| Likelihood of successful induction | 226 | ||
| Pre-induction cervical assessment | 226 | ||
| Techniques of induction | 227 | ||
| Mechanical | 227 | ||
| ‘Sweeping’ of the membranes | 227 | ||
| Balloon catheters | 227 | ||
| Amniotomy | 227 | ||
| Medical | 228 | ||
| Prostaglandin | 228 | ||
| Types of prostaglandin agents | 228 | ||
| Actions of prostaglandins | 228 | ||
| Other effects | 228 | ||
| Contraindications to prostaglandin E2 | 228 | ||
| Side effects of prostaglandins | 228 | ||
| Oxytocin | 228 | ||
| Augmentation of labour | 229 | ||
| Aims | 229 | ||
| Methods | 229 | ||
| Considerations in augmentation | 229 | ||
| Further reading | 229 | ||
| 38 Malpresentation and malposition | 230 | ||
| Stages of labour | 230 | ||
| Occipito-posterior position | 230 | ||
| Risk factors for persistent occipito-posterior position | 231 | ||
| Appendix MRANZCOG oral examination (sample questions) | 341 | ||
| Case 1 | 341 | ||
| Encounter 1 | 341 | ||
| Encounter 2 | 341 | ||
| Encounter 3 | 342 | ||
| Model answer for case 1 | 342 | ||
| Encounter 1 | 342 | ||
| Encounter 2 | 342 | ||
| Encounter 3 | 343 | ||
| Case 2 | 344 | ||
| Encounter 1 | 344 | ||
| Encounter 2 | 344 | ||
| Encounter 3 | 344 | ||
| Model answer for case 2 | 345 | ||
| Encounter 1 | 345 | ||
| Encounter 2 | 345 | ||
| Encounter 3 | 345 | ||
| Credit | 346 | ||
| Disclaimer: | 346 | ||
| Index | 347 | ||
| A | 347 | ||
| B | 348 | ||
| C | 348 | ||
| D | 349 | ||
| E | 350 | ||
| F | 350 | ||
| G | 351 | ||
| H | 351 | ||
| I | 352 | ||
| K | 353 | ||
| L | 353 | ||
| M | 353 | ||
| N | 354 | ||
| O | 354 | ||
| P | 355 | ||
| R | 357 | ||
| S | 357 | ||
| T | 358 | ||
| U | 358 | ||
| V | 359 | ||
| W | 359 | ||
| X | 359 | ||
| Y | 359 | ||
| Z | 359 |