دانلود کتاب Essential Obstetrics and Gynaecology

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Front cover
Half title page
Dedication
Essential Obstetrics and Gynaecology
Copyright page
Preface to fifth edition
Preface to fourth edition
Contributors
Table of Contents
1 Essential reproductive science
1 Anatomy of the female pelvis
The bony pelvis
The external genitalia
The internal genital organs
The vagina
The uterus
Supports and ligaments of the uterus
The Fallopian tubes
The ovaries
The blood supply to the pelvic organs
Internal iliac arteries
Anterior division
Posterior division
The ovarian vessels
The pelvic lymphatic system
Nerves of the pelvis
Somatic innervation
Autonomic innervation
The pelvic floor
The perineum
2 Conception and nidation
Oogenesis
Meiosis
Follicular development in the ovary
Hormonal events associated with ovulation
The action of gonadotrophins
The endometrial cycle
Production of sperm
Spermatogenesis
Structure of the spermatozoon
Seminal plasma
Fertilization
Sperm transport
Capacitation
Fertilization and implantation
The physiology of coitus
3 Physiological changes in pregnancy
Immunology of pregnancy
The uterus
The cervix
The isthmus
The corpus uteri
Uterine contractility
The development of myometrial activity
The vagina
The cardiovascular system
Cardiac position and size
Cardiac output
Total peripheral resistance
Arterial blood pressure
The blood
Erythrocytes
The white cells
Platelets
Clotting factors
Respiratory function
Renal function
Anatomy
Physiology
The alimentary system
Nutrients in blood
Maternal carbohydrate metabolism
Changes in plasma proteins
Amino acids
Lipids
Calcium
Maternal weight gain
Postpartum weight
The breasts
Breast development during pregnancy
The initiation of lactation
The skin
Endocrine changes
Placental hormones
The pituitary gland
Anatomy
Anterior pituitary
Posterior pituitary
Hypothalamus
The thyroid
The parathyroids
The renin–angiotensin system (RAS)
The adrenal gland
Conclusion
4 Placental and fetal growth and development
Early placental development
Further placental development
The villus
Structure of the umbilical cord
Uteroplacental blood flow
Factors that regulate fetoplacental and uterine blood flow
Placental transfer
Simple diffusion
Facilitated diffusion
Active transport
Pinocytosis
Transport of intact cells
Water and electrolyte transfer
Sodium
Potassium
Calcium
Placental function
Gaseous exchange
Oxygen transfer
Carbon dioxide transfer
Acid–base balance
Fetal nutrition and removal of waste products
Carbohydrate metabolism
Fat metabolism
Protein metabolism
Urea and ammonia
Placental hormone production
Protein hormones
Chorionic gonadotrophin
Human placental lactogen
Steroid hormones
Progesterone
Oestrogens
Corticosteroids
Corticotrophin-releasing hormone
Fetal development
Growth
The cardiovascular system
The respiratory system
The gastrointestinal tract
The kidney
The special senses
Amniotic fluid
Formation
Volume
Clinical significance of amniotic fluid volume
Oligohydramnios
Polyhydramnios
Clinical value of tests on amniotic fluid
Amniocentesis
Indications for amniocentesis
Chromosomal abnormalities and sex-linked diseases
Metabolic disorders
Estimation of fetal lung maturity
5 Perinatal and maternal mortality
Perinatal mortality
Introduction
Definitions
Mortality rates
Incidence
Sociodemographic factors and perinatal mortality
Maternal age
Deprivation
Ethnicity
Other maternal characteristics
Causes of stillbirths
Intrapartum stillbirth
Causes of neonatal deaths
Maternal mortality
Definition
Maternal mortality rates
Major causes of maternal death in the UK
2 Essential obstetrics
6 History taking and examination in obstetrics
Taking a relevant and comprehensive history
Obstetric history
History of present pregnancy
Symptoms of pregnancy
Pseudocyesis
Previous obstetric history
Previous medical history
Family history
Examination
General and systemic examination
Heart and lungs
Head and neck
Breasts
Abdomen
Limbs and skeletal changes
Pelvic examination
Assessment of the bony pelvis
The planes of the Pelvis
Plane of the pelvic inlet
Plane of greatest pelvic dimensions
Plane of least pelvic dimensions
Outlet of the pelvis
Obstetrical examination at subsequent routine visits
Abdominal palpation
Palpation of the uterine fundus
Measurement of symphysial–fundal height
Measurement of abdominal girth
Palpation of fetal parts
Lie
Presentation
Position
Station and engagement
Auscultation
7 Normal pregnancy and antenatal care
Aims and patterns of routine antenatal care
Preconceptual care and vitamin supplementation
The risk of substance abuse in pregnancy
Smoking
Alcohol intake
Illicit drug use
Changing demographics of pregnancy
The booking visit
Consideration of past obstetric history, including mode of delivery
Recommended routine screening tests
Haematological investigations
Blood group and antibodies
The use of anti-D immunoglobulin
Infection screening
Rubella
Syphilis
Non-specific tests
Specific tests
Hepatitis (see Chapter 9)
Human immunodeficiency virus
Group B Streptococcus
Urinary tract infection
Gestational diabetes
Screening for fetal anomaly
Nuchal translucency and biochemical screening
Schedules of routine antenatal care
Subsequent visits
Antenatal education
Dietary advice
Energy intake
Protein
Fats
Carbohydrates
Minerals and vitamins
Exercise in pregnancy
Coitus in pregnancy
Breast care
Social and cultural awareness
Safe prescribing in pregnancy
8 Obstetric disorders
Hypertensive disorders of pregnancy
Definitions
Classification
Pathogenesis and pathology of pre-eclampsia and eclampsia
The renal lesion
Placental pathology
Disseminated intravascular coagulation (DIC)
Other associations with pregnancy hypertension
The HELLP syndrome
Management of gestational hypertension and pre-eclampsia
Blood pressure measurement
Antihypertensive drug therapy
Maternal investigations
Laboratory investigations
Fetoplacental investigations
Prevention of pre-eclampsia
Symptoms of pre-eclampsia and eclampsia
Induction of labour
Complications
Eclampsia
Management of eclampsia
Control of fits
Control of blood pressure
Delivery of the infant
Management after delivery
Antepartum haemorrhage
Placenta praevia
Incidence
Aetiology
Classification
Symptoms and signs
Diagnosis
Clinical findings
Abdominal examination
Diagnostic procedures
Management
Abruptio placentae
Aetiology
Clinical types and presentation
Haemorrhage
Clinical assessment/differential diagnosis
Management
Complications
Afibrinogenaemia
Renal tubular or cortical necrosis
Other causes of antepartum haemorrhage
Vasa praevia
Unexplained antepartum haemorrhage
Vaginal infections
Cervical lesions
Multiple pregnancy
Prevalence
Types of twinning and determination of chorionicity
Monozygotic multiple pregnancy
Dizygotic twins
Complications of twin pregnancy
Complications unrelated to zygosity
Nausea and vomiting
Anaemia
Miscarriage
Antepartum haemorrhage
Pre-eclampsia
Intra-uterine growth restriction (IUGR)
Preterm labour
Complications related to zygosity
Twin-to-twin transfusion syndrome (TTTS)
Monoamniotic and conjoined twinning
Prenatal diagnosis
Management of twin pregnancy
Management of labour and delivery
Presentation at delivery
Method of delivery
Caesarean section
Vaginal delivery
Complications of labour
Locked twins
Conjoined twins
Perinatal mortality
Prolonged pregnancy
Aetiology
Management
Labour management
Breech presentation
Types of breech presentation
Causation and hazards of breech presentation
Management
Antenatal management
External cephalic version (ECV)
Indication
Contraindications
Technique
Complications
Method of delivery
Vaginal breech delivery
Technique
Caesarean section
Unstable lie, transverse lie and shoulder presentation
Complications
Management
9 Maternal medicine
Introduction
Minor complaints of pregnancy
Abdominal pain
Heartburn
Constipation
Backache
Syncope
Varicosities
Carpal tunnel syndrome
Pelvic girdle dysfunction (symphyseal pelvic dysfunction, SPD)
Medical problems arising in pregnancy
Anaemia
Aetiology
Risk factors
Clinical features and diagnosis
Implications on pregnancy
Management
Prophylaxis
Gestational diabetes
Aetiology
Risk factors
Clinical features and diagnosis
Implications on pregnancy
Management
Infections acquired in pregnancy
Risk factors
Implications on pregnancy and management
Chicken pox
Parvovirus B19
Influenza H1N1
Human Immunodeficiency Virus (HIV) Infection
Implications of pregnancy on the disease
Implications of the disease on pregnancy
Screening
Management
Acute viral hepatitis
Tuberculosis
Malaria
Acute pyelonephritis and urinary tract infections
Thromboembolic disease
Aetiology
Risk factors
Clinical features and diagnosis
Implications on pregnancy
Management
Liver disease
Obstetric cholestasis
Aetiology
Risk factors
Clinical features and diagnosis
Implications on pregnancy
Management
Acute fatty liver of pregnancy
Aetiology
Risk factors
Clinical features and diagnosis
Implications on pregnancy
Management
Pre-existing medical conditions and pregnancy
Renal disease in pregnancy
Implications of pregnancy on the disease
Implications of the disease on pregnancy
Management
Special circumstances
Renal calculi
Diabetes mellitus
Implications of pregnancy on the disease
Implications of the disease on pregnancy (Table 9.5)
Management
Thyroid disease in pregnancy
Hypothyroidism
Implications of pregnancy on the disease
Implications of the disease on pregnancy
Management
Hyperthyroidism
Implications of pregnancy on the disease
Implications of the disease on pregnancy
Management
Obesity
Implications of pregnancy on obesity
Implications of obesity on pregnancy (Table 9.6)
Management
Thrombophilia
Implications of pregnancy on the disease
Implications of the disease on pregnancy
Screening
Management
Epilepsy
Implications of pregnancy on the disease
Implications of disease on pregnancy
Medications
Management
Migraine
Cardiac disease
Implications of pregnancy on the disease
Implications of the disease on pregnancy
Management
Respiratory disorders
Asthma
Implications of pregnancy on the disease
Implications of the disease on pregnancy
Management
Cystic fibrosis
Implications of pregnancy on the disease
Implications of the disease on pregnancy
Management
Autoimmune disease
Systemic lupus erythematosis
Implications of pregnancy on the disease
Implications of the disease on pregnancy
Management
Haemoglobinopathies
Sickle cell syndromes
Implications of pregnancy on the disease
Implications of the disease on pregnancy
Management
The thalassaemias
Implications of pregnancy on the disease
Implications of the disease on pregnancy and management
Conclusions
10 Congenital abnormalities and assessment of fetal wellbeing
Congenital abnormalities
Neural tube defects
Congenital cardiac defects
Defects of the abdominal wall
Chromosomal abnormalities
Down’s syndrome
Assessing fetal normality
Screening
Clinical risk factors: early pregnancy
Clinical risk factors: late pregnancy
Ultrasound
Biochemistry
Counselling in advance of US and biochemical testing
Management options with an ‘abnormal’ or ‘positive’ test
Further counselling
Further assessment
Options for pregnancy
Possible interventions
Surveillance in pregnancy
Delivery issues
Assessing the health of a normally formed fetus
Screening for fetal health
Surveillance of fetal health in at-risk pregnancies
Doppler recordings of blood flow in the umbilical artery (UA)
Fetal growth
Small fetuses
Big fetuses
Amniotic fluid volume (AFV)
Biophysical measurements
Interventions
Non-specific risk
Specific risk
Conclusions
11 Management of labour
Stages of labour
Onset of labour
The initiation of labour
Uterine activity in labour: the powers
The passages
The mechanism of labour
The third stage of labour
Pain in labour
The management of normal labour
Examination at the commencement of labour
General principles of the management of the first stage of labour
Observation: the use of the partogram
Fetal condition
Progress in labour
Fluid and nutrition during labour
Pain relief in labour
Narcotic analgesia
Inhalational analgesia
Non-pharmacological methods
Regional analgesia
Other forms of regional anaesthesia
Posture in labour
Water births
Fetal monitoring
Intermittent auscultation
Fetal cardiotocography
Basal heart rate
Baseline variability
Transient changes in fetal heart rate (Tables 11.2 and 11.3)
Accelerations
Decelerations
Early decelerations
Late decelerations
Variable decelerations
The fetal electrocardiogram
Fetal acid–base balance
Preterm delivery
Spontaneous preterm labour
Aetiology
The role of genital tract infection
The preterm infant
Survival
Complications of preterm birth
The management of preterm labour
Prevention
Treatment
β-Adrenergic agonists
Prostaglandin synthetase inhibitors
Calcium antagonists
Corticosteroids
Neuroprotection by magnesium sulphate
Method of delivery
Prelabour rupture of the membranes
Pathogenesis
Management
Induction of labour
Indications
Cervical assessment
Methods of induction
Forewater rupture
Hindwater rupture
Medical induction of labour following amniotomy
Medical induction of labour and cervical ripening
Syntocinon infusion
Prostaglandins
Mechanical cervical ripening
Precipitate labour
Uterine hyperstimulation
Delay in progress in labour
Inefficient uterine activity
Hypotonic uterine activity
Hypertonic uterine activity
Management
Cephalopelvic disproportion
Management
Cord presentation and cord prolapse
Predisposing factors
Management
12 Management of delivery
Normal vaginal delivery
Repair of episiotomy or perineal injury
Third and fourth degree injuries
Repair and management of third and fourth degree tears
Malpresentations
Face presentation
Diagnosis
Management
Brow presentation
Diagnosis and management
Malposition of the fetal head
The occipitoposterior position
Diagnosis and management
Deep transverse arrest
Diagnosis and management
Instrumental delivery
Indications for instrumental delivery
Prerequisites for instrumental delivery
Method of instrumental delivery
Non-rotational instrumental delivery
Forceps
Vacuum delivery
Rotational instrumental delivery
Trial of instrumental delivery
Caesarean section
Indications for caesarean section
Complications
Shoulder dystocia
Abnormalities of the third stage of labour
Postpartum haemorrhage
Primary postpartum haemorrhage
Predisposing causes
Management
Controlling the haemorrhage
Secondary postpartum haemorrhage
Causes and predisposing factors
Management
Vaginal wall haematomas
Uterine inversion
Perineal wound breakdown
Amniotic fluid embolism
13 Postpartum problems
The normal postpartum period
Physiological changes
Genital tract
Cardiovascular system
Endocrine changes
The importance of breastfeeding
Colostrum
Breastfeeding
Complications of the postpartum period
Puerperal infections
Endometritis
Urinary tract infections (UTIs)
Mastitis and breast abscess
Caesarean wound infections and perineal infections
Other infections
Thromboembolism
Thrombophlebitis
Phlebothrombosis (see also Chapter 9)
Postnatal anticoagulation
Primary and secondary postpartum haemorrhage (PPH)
Anaemia
Maternal collapse
Contraception in the postnatal period
Neonatal problems
Conducting a routine postnatal clinical review
14 Psychiatric disorders of childbirth
Introduction
The relevance of maternal mental health to obstetricians
Perinatal psychiatry
Antenatal psychiatric disorders
Mild to moderate psychiatric disorder
Management
Serious mental illness
Management
Psychiatric medication in pregnancy
Antidepressant medication
Monoamine oxidase inhibitors (MAOIs)
Tricyclic antidepressants (TCAs)
Current guidelines support the use of TCAs in pregnancy
Selective serotonin reuptake inhibitors (SSRIs)
Current guidelines support the use of fluoxetine and sertraline in pregnancy
Serotonin–norepinephrine reuptake inhibitors (SNRIs)
Antipsychotic medication
Older ‘typical’ antipsychotics
Newer ‘atypical’ antipsychotics
Mood stabilizers
Anti-epileptic drugs
Antenatal screening
Screening for risk of postnatal depression (PND)
Postnatal psychiatric conditions
Normal emotional changes
The blues
Postnatal psychiatric disorders
Aetiology
Postpartum (puerperal) psychosis
Management
Prevention
Primary prevention
Secondary prevention
Postnatal depressive illness
Severe postnatal depression
Management
Mild to moderate postnatal depression
Management
Effects on the child
Prevention
Secondary prevention
Primary prevention
Hormones
Psychiatric medication in breastfeeding
Antidepressant medication
TCAs
SSRIs
Antipsychotic medication
Mood stabilizers
Anti-epileptic drugs
Benzodiazepines
UK confidential enquiries into maternal deaths
Maternal death due to suicide
Most suicides were seriously ill
They died violently
Previous history and the risk of recurrence
The women who died
Communication
The care received
Other causes of maternal death associated with psychiatric disorder
Substance misuse
Cause of death
Deaths from accidental overdose
Deaths from physical consequences of substance misuse
Avoidance of care
The women who died
Other maternal deaths from medical conditions associated with psychiatric disorder
Back to basics
Anxiety and distress in pregnancy and following delivery
Unexplained physical symptoms
Recommendations
Preconception counselling
Implications for psychiatric services
Maternity services
Communication and working with other services
Child safeguarding
Substance misusers
3 Essential gynaecology
15 Basic clinical skills in gynaecology
History
The presenting complaint
Menstrual history
Previous gynaecological history
Previous medical history
Family and social history
Examination
Breast examination
Examination of the abdomen
Pelvic examination
Bimanual examination
Special circumstances
Rectal examination
Presenting your findings
16 Gynaecological disorders
Introduction
Benign conditions of the upper genital tract
The uterus
Symptoms and signs
Diagnosis and management
Surgical treatment
Endometrial polyps
Symptoms
Signs
Pathology
Treatment
Benign tumours of the myometrium
Histopathology
Pathological changes
Symptoms and signs
Management
Medical treatment
Uterine artery embolization (UAE)
Surgical treatment
Treatments in development
Adenomyosis
Symptoms and signs
Pathology
Treatment
Lesions of the ovary
Symptoms
Signs
Endometriosis
Pathophysiology
Diagnosis
Management
Abnormal uterine bleeding
Intermenstrual bleeding
Postcoital bleeding
Postmenopausal bleeding
Heavy menstrual bleeding
Causes
Structural
Non structural
History and examination
Investigations
Management
Medical treatment
Non-hormonal treatments
Hormonal treatments
Surgical treatment
Endometrial resection or ablation
Hysterectomy
Secondary amenorrhoea and oligomenorrhoea
Aetiology
Physiological
Pathological
Hypothalamic disorders
Pituitary disorders
Ovarian disorders
Ovarian failure
Polycystic ovary syndrome
Pathogenesis
Diagnosis
Uterine causes
Cryptomenorrhoea (literally ‘hidden menstruation’)
Investigations in women with amenorrhoea or oligomenorrhoea
Management
Dysmenorrhoea
Investigations
Management
Pharmacological
Premenstrual syndrome
Symptoms and signs
Pathogenesis
Management
Pharmacological
Disorders of puberty
Puberty and menarche
Thelarche
Adrenarche
Menarche
Growth spurt
Precocious puberty
Evaluation
Investigations
Management
Variations on normal puberty
Premature adrenarche
Premature thelarche
Precocious menarche
Delayed puberty
Investigations
Management
Menopause
Menopause transition
Hormone changes after the menopause
Symptoms and signs of menopause
Physical symptoms
Vascular disturbances
Urogenital tract
Other physical symptoms
Psychological and emotional symptoms
Other symptoms
Headaches
Bone and joint pain
Consequences of menopause
Bone changes
Cardiovascular complications
Treatment of the menopause
Hormone replacement therapy
Oral therapy
Parenteral therapy
Topical therapy
Contraindications
Risks
Benefits
Alternatives to oestrogen-containing HRT
Benign conditions of the lower genital tract
Vulval pruritus
Vulval neoplasia
Vaginal discharge
Cervical polyps
Benign tumours of the vulva and vagina
Vaginal cysts
Congenital
Vaginal inclusion cysts
Endometriosis
Solid benign tumours
Neoplastic lesions of the vaginal epithelium
Vaginal intraepithelial neoplasia
Vaginal adenosis
Emergency gynaecology
Pelvic infection
Bartholin’s abscess/cyst
Vulval and vaginal trauma
Acute abdominal pain of uncertain origin
Acute appendicitis
Acute and excessively heavy unscheduled vaginal bleeding
17 Infertility
History and examination
Female infertility
Disorders of ovulation
Tubal factors
Uterine factors
Endometriosis
Cervical factors
Investigation of infertility
Investigation of the female partner
Detection of ovulation
Ultrasonography
Investigation of anovulation
Assessment of ovarian reserve
Investigation of tubal patency
Hysterosalpingography
Hysterosonocontrast sonography
Laparoscopy and dye insufflation
Investigation of cervical factor infertility
Investigation of the male partner
Analysis of sperm DNA
Endocrine assessment of the male
Cytogenetic studies
Testicular/epididymal biopsy
Retrograde ejaculation
Immunological tests for male infertility
Treatment of female subfertility
Anovulation
Tubal pathology
Intrauterine insemination
In vitro fertilization and embryo transfer
Ovarian hyperstimulation syndrome
Treatment
Treatment of male infertility
Donor insemination
18 Early pregnancy care
Bleeding in early pregnancy
Miscarriage
The aetiology of miscarriage
Genetic abnormalities
Endocrine factors
Maternal illness and infection
Maternal lifestyle and drug history
Abnormalities of the uterus
Cervical incompetence
Autoimmune factors
Thrombophilic defects
Alloimmune factors
Clinical types of miscarriage
Threatened miscarriage
Inevitable/incomplete miscarriage
Complete miscarriage
Miscarriage with infection (sepsis)
Missed miscarriage (empty gestation sac, embryonic loss, early and late fetal loss)
Spontaneous second trimester loss
Recurrent miscarriage
Management
Surgical management
Medical management
Conservative Management
Sensitive disposal of fetal tissues
Recurrent miscarriage
Ectopic pregnancy
Predisposing factors (Table 18.1)
Clinical presentation
Acute presentation
Subacute presentation
Pathology
Diagnosis
Management
Surgical management
Medical management
Pregnancy of unknown location
Management of other forms of extrauterine pregnancy
Abdominal pregnancy
Cervical pregnancy
Trophoblastic disease
Incidence
Pathology
Clinical presentation
Management
Vomiting in early pregnancy
Aetiology
Diagnosis
Management
19 Sexual and reproductive health
Contraception and termination of pregnancy
Barrier methods of contraception
Male condoms
Female condoms
Diaphragms and cervical caps
Spermicides and sponges
Intrauterine contraceptive devices
Types of devices
Inert devices
Pharmacologically active devices
Devices containing progestogen
Life span of devices
Insertion of devices
Complications
Pregnancy rates
Perforation of the uterus
Pelvic inflammatory disease
Abnormal uterine bleeding
Pelvic pain
Vaginal discharge
Ectopic pregnancy
Hormonal contraception
Combined pill
Progestogen-only pill
Mode of action of the contraceptive pills
Contraindications
Other therapeutic uses
Major side effects
Beneficial effects
Interaction between drugs and contraceptive steroids
Failure rates
The pill and surgery
The pill and lactation
Injectable compounds
Newer methods of hormonal contraception
Emergency contraception
Non-medical methods of contraception
Sterilization
Counselling
Timing of sterilization
Techniques
Female sterilization
Laparoscopic sterilization
Tubal ligation (Fig. 19.7)
The Essure® procedure
Complications
Vasectomy
Psychological implications of sterilization
Termination of pregnancy
Methods
Surgical termination
Medical termination
Complications
Psychological sequelae of termination
Risk factors for adverse sequelae of first-trimester abortion
Later terminations of pregnancy
Contraception following termination
Criminal abortion
Genital tract infections
Lower genital tract infections
Symptoms
Signs
Common organisms causing lower genital tract infections
Vaginal candidiasis
Trichomoniasis
Genital herpes
Bacterial vaginosis
Gonococcal and chlamydial vulvovaginitis
Syphilis
Genital warts (condylomata acuminata)
Treatment of lower genital tract infections
Upper genital tract infections
Symptoms and signs
Common organisms
Chlamydia
Gonorrhoea
Differential diagnosis
Investigations
Management
Indications for surgical intervention
Chronic pelvic infection
Symptoms and signs
Management
Human immunodeficiency virus
Disorders of female sexual function
Dyspareunia
Superficial dyspareunia
Deep dyspareunia
Apareunia
Treatment
Vaginismus
Loss of libido
Treatment
Orgasmic dysfunction
Disorders of male sexual function
Erectile dysfunction
Treatment
Ejaculatory problems
Treatment
20 Gynaecological oncology
Lesions of the vulva
Vulval intraepithelial neoplasia
Management
Cancers of the vulva
Symptoms
Mode of spread
Treatment
Prognosis
Neoplastic lesions of the vaginal epithelium
Vaginal intraepithelial neoplasia
Vaginal adenosis
Vaginal malignancy
Symptoms
Method of spread
Treatment
Prognosis
Lesions of the cervix
Screening for cervical cancer
Classification of cervical cytology
Colposcopy
Pathophysiology
Colposcopic appearances
Human papilloma virus
Cervical intraepithelial neoplasia
Treatment
Complications of cone biopsy
Follow-up
Cervical cancer
Pathology
The spread of tumour
Clinical features
Investigation
Treatment of invasive carcinoma
Surgery – radical hysterectomy and pelvic lymph node dissection
Radiotherapy/Chemoradiation
Prognosis
Malignant disease of the uterus
Endometrial carcinoma
Symptoms
Pathology
Investigations
Treatment
Prognosis
Malignant mesenchymal tumours of the uterus
Stromal sarcomas
Mixed müllerian tumours (carcinosarcomas)
Leiomyosarcoma
Treatment
Lesions of the ovary
Symptoms
Signs
Benign ovarian tumours
Functional cysts of the ovary
Follicular cysts
Management
Lutein cysts
Benign neoplastic cysts
Epithelial tumours
Serous cystadenomas
Mucinous cystadenomas
Brenner cell tumours
Sex cord stromal tumours
Granulosa cell tumours
Arrhenoblastomas or androblastomas
Germ cell tumours
Mature cystic teratoma (dermoid cyst)
Fibromas
Tumour-like conditions
Endometriotic cysts
Ovarian malignancy
Aetiology
Genetic
Parity and fertility
Pathology
Primary ovarian carcinoma
Epithelial type
Sex cord stromal tumours
Germ cell tumours
Secondary ovarian carcinomas
Staging of ovarian carcinoma
Diagnosis
Management
Chemotherapy
Borderline tumours
Germ cell tumours
Follow-up and treatment of recurrence
Prognosis
Screening for ovarian cancer
Principles of palliative care in gynaecological cancer
21 Prolapse and disorders of the urinary tract
Uterovaginal prolapse
Definitions
Vaginal prolapse
Uterine prolapse
Symptoms and signs
Urethrocele and cystocele
Rectocele
Enterocele
Uterine prolapse
Staging/grading of prolapse
Baden–Walker halfway system (Fig. 21.8 and Table 21.2)
Pathogenesis
Management
Prevention
Conservative treatment
Pelvic floor physiotherapy
Surgical treatment
Fascial repairs
Graft repairs
Complications
Urinary tract disorders
Structure and physiology of the urinary tract
Common disorders of bladder function
Incontinence of urine
Urinary frequency
Dysuria
Urinary retention
Nocturnal enuresis or bed-wetting
Diagnosis
Management
Urinary tract fistula
Stress incontinence
The unstable bladder: overactive bladder syndrome (OAB)
Detrusor instability of unknown aetiology
Drug treatment
Pelvic floor physiotherapy: pelvic floor muscle training
Electrical stimulation (interferential therapy)
Biofeedback therapy
Dietary modifications
Timed voiding
Vaginal oestrogen
Bladder outlet obstruction
The neuropathic bladder
Presentation
Aetiology
Diagnosis
Management
Appendices
Appendix A Principles of perioperative care
Preoperative care
Patient counselling and consent (see also Appendix C)
Preoperative assessment
Clinical history and examination
Investigations
Medications
Preoperative preparation
Management of anaemia
Antibiotic prophylaxis
Management of diabetes
Intraoperative complications
Regional and general anaesthesia
Local anaesthesia
Complications secondary to patient positioning
Acute compartment syndrome
Neurological injury
Haemorrhage
Ureteric and bladder injury
Gastrointestinal injury
Postoperative care
Analgesia
Fluid and electrolyte balance
Cardiovascular stability
Bladder care
Oral intake
Postoperative complications
Postoperative haemorrhage
Pyrexia
Surgical site infections
Treatment
Cardiovascular and respiratory complications
Venous thromboembolism
Discharge from hospital
Appendix B Governance, audit and research
Data collection in the national health service
Sources of data collection and computing systems
GP consultations and registrations
Registration of births and deaths
Hospital episode statistics (HES)
Mortality rates statistics
Morbidity rates statistics
Research and data linkage
Data Protection Act
Caldicott principles
Evidence-based healthcare
Clinical audit
Four steps of clinical audit
Defining best practice
Preparing to monitor
Monitoring your achievement
Planning for improvement
National clinical audits
Clinical guidelines
Research
Type of research studies
Descriptive studies
Analytical studies
Clinical trials
Clinical governance
Risk management
Clinical incident reporting
Conclusion
Appendix C Medicolegal aspects of obstetrics and gynaecology
Principles and legal issues around informed consent
Litigation in obstetrics and gynaecology
Patient confidentiality (including data protection)
The rules regarding abortion
The use of assisted reproduction in infertility care
The relevant legal status of the fetus, the pregnant woman, the child and the pubertal girl
The role of the doctor in child protection
Self-assessment: Questions
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Appendix A
Appendix B
Appendix C
Self-assessment: Answers
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Appendix A
Appendix B
Appendix C
Further reading
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Appendix A
Appendix B
Appendix C
Further websites
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
Y
Z