Basic Sciences for Obstetrics and Gynaecology

205 Pages·1998·7.343 MB·English

by  Tim Chard MD, FRCOG, Richard Lilford MRCOG, MRCP (auth.)

Basic Sciences for Obstetrics and
Gynaecology
Springer-Verlag London Ltd.
I
Tim Chadr • Richadr Lilford
Basi c Science s fo r
Obstetric s
an d
Gynaecolog y
F I F TH E D I T I ON
With 61 Figures
Springer
Tim Chard, MD, FRCOG
Academic Unit of Obstetrics/Gynaecology and Reproductive Physiology,
St. Bartholomew's Hospital Medical College, West Smithfield,
London EC1A 7BE, UK
Richard Lilford, MRCOG, MRCP
Department of Obsterics and Gynaecology, and Institute of Epidemiology
and Health Services Research, Leeds General Infirmary, Leeds LS2 9LN, UK
British Library Cataloguing in Publication Data
Chard, T. (Tim)
Basic sciences for obstetrics and gynaecology. - 5th ed.
1. Gynecology 2. Obstetrics 3. Medical sciences
I. Title II. Lilford, Richard J.
618
Library of Congress Cataloging-in-Publication Data
Chard, T.
Basic sciences for obstetrics and gynaecology / Tim Chard and
Richard Lilford. - 5th ed.
p. cm.
Includes index.
ISBN 978-3-540-67725-3 ISBN 978-1-4471-0595-4 (eBook)
DOI 10.1007/978-1-4471-0595-4
1. Medical sciences. 2. Obstetrics. 3. Gynecology. I. Lilford,
Richard, 1950- . II. Title.
[DNLM: 1. Obstetrics. 2. Pregnancy-physiology. 3. Genitalia,
Female-anatomy & histology. 4. Drug Therapy-in pregnancy. WQ
100 C471b 1997]
R129.C44 1997
618-dc21
DNLM/DLC 97-17860
for Library of Congress CIP
Apart from any fair dealing for the purposes of research or private study, or criticism or review,
as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be
reproduced, stored or transmitted, in any form or by any means, with the prior permission in
writing of the publishers, or in the case of reprographic reproduction in accordance with the
terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction
outside those terms should be sent to the publishers.
© Springer-Verlag London 1998
Originally published by Springer-Verlag London Berlin Heidelberg in 1998
Softcover reprint of the hardcover 5th edition 1998
First published 1983 Second Edition 1986 Third Edition 1990 Fourth Edition 1995
The use of registered names, trademarks, etc. in this publication does not imply, even in the
absence of a specific statement, that such names are exempt from the relevant laws and
regulations and therefore free for general use.
Product liability: The publisher can give no guarantee for information about drug dosage and
application thereof contained in this book. In every individual case the respective user must
check its accuracy by consulting other pharmaceutical literature.
Typeset by Wilmaset Ltd., Birkenhead, Wirral
28/3830-54321 Printed on acid-free paper
Preface to the Fifth Edition
In the three years since the publication of the 4th edition, this book
has been very well received by those for whom it was intended -
candidates for primary examinations in Obstetrics and Gynaecology.
In consequence, we make no excuse for repeating the formula of
addressing only those facts which are neither speculative nor con
tentious. An attempt to widen this brief would multiply the length of
the book by three or four times and would place it in an identical
category with several much larger texts.
As the underlying philosophy remains the same, the main changes
in the fifth edition are the addition of new material and revision of
exisiting material. Revision of existing material has been extensive
with many detailed changes aimed at expanding the factual base
while retaining or improving the clarity of explanation. Most im
portantly, many of the changes are those which have been suggested
by readers and reviewers of the previous editions; this feedback has
been invaluable to the authors and we now hope will be equally
valuable to readers of the new edition.
In this edition we wish to express our particular gratitude to Louise
Abrahams, Roger Amos, Sheryl Homa, Paul Howells, Ray Iles, Don
Jeffries, Paul Jenkins, David Lowe, Mary Macintosh, Louise Neville,
Michael Prentice, and Basky Thilaganathan for their comments and
suggestions.
London and Birmingham Tim Chard
August 1997 Richard Lilford
Contents
Chapter 1 Cell Biology, Embryology and the Placenta.. ............. 1
The Cell ........................................................................... 1
The Genetic Code.............................................................. 4
Chromosome Abnormalities ............................................... 12
Genetics - Single and Multiple Gene Defects ........................ 15
Fertilisation .............. ............ .......... ........ ................. ......... 16
Cleavage of the Embryo: The Morula and the Blastocyst ........ 18
Implantation of the Blastocyst and Early Development of
the Placenta and Embryo ................................................ 19
Multiple Pregnancy............................................................ 24
Further Development of the Embryo ................................... 24
The Placenta..................................................................... 25
Placental Synthesis ............................................................ 29
Placental Transfer ............................................................. 31
The Membranes ................................................................ 35
Amniotic Fluid (Liquor) ......... ............................................ 36
Chapter 2 Anatomy........................................................... 37
Vulva ............................................................................... 37
Vagina ............................................................................. 39
Uterus .............................................................................. 39
Fallopian Tubes ................................................................ 44
Ovaries ............................................................................ 44
Female Urological System................................................... 45
Levator Ani Muscles (Pelvic Diaphragm) .............................. 48
Perineum ......................................................................... 49
Peritoneum and Ligaments of the Pelvis .............................. 51
Blood Supply to the Female Pelvis....................................... 52
Lymphatic Drainage of the Female Pelvis............................. 53
Nerve Supply to the Female Pelvis....................................... 53
Pelvic Skeleton.................................................................. 54
Fetal Skull ........................................................................ 58
Microstructure and Function of the Non-pregnant
Reproductive Tract ........................................................ 60
viii Contents
Embryology of the Genital System ...................................... 62
Anterior Abdominal Wall .................................................. 66
Chapter 3 General Physiology and Biochemistry ............. ........ 69
Cardiovascular System ...................................................... 69
Lung ............................................................................... 74
Acid-Base Balance ......................................................... '" 78
Kidney ............................................................................ 79
Nervous System ........ ............... ...... .... ........... ....... ....... ..... 80
Gut and Nutrition ............................................................ 80
Metabolism...................................................................... 82
Immunology.................................................................... 87
Chapter 4 Endocrinology.................................................... 93
Basic Concepts in Endocrinology........................................ 93
Hypothalamus.................................................................. 95
Anterior Pituitary............................................................. 97
Posterior Pituitary.... ......... ..... ....... .... ... ...... ............. ... ...... 102
Breast and Lactation. .... ... ........ .............. ..... ........ ..... ......... 103
Sex Steroids ..... ........ ....... ...... ....... ...... ....... .... ... ........ ..... ... 105
Ovary .............................................................................. 110
Testis .............................................................................. 115
Thyroid Gland ................................................................. 117
Adrenal Cortex ................................................................. 121
Adrenal Medulla ............................................................... 123
Hormones Involved in Calcium Homeostasis ....................... 125
Puberty ........................................................................... 125
Menopause ...................................................................... 126
Initiation of Labour.................. ..... ..... ....... ....... ...... .......... 127
Pineal Gland .................................................................... 128
Atrial Natriuretic Peptide (ANP) ...... ....... ...... ...... ....... ........ 128
Chapter 5 Pathology......................................................... 129
Inflammation................................................................... 129
Wound Healing ................................................................ 131
Metabolic Response to Injury............................................. 133
Shock .............................................................................. 134
Abnormal Tissue Growth .................................................. 135
Tumours ......................................................................... 136
Thrombosis and Embolism ................................................ 145
Deposition of Salts and Pigments ....................................... 147
Effects of Radiation .......................................................... 148
Chapter 6 Microbiology..................................................... 151
Bacteria ........................................................................... 151
Viruses ......... ..... .................... ....... ............. ............. ......... 155
Rickettsial Organisms ....................................................... 160
Mycoplasma and Ureaplasma.................. ............................ 160
Fungal Infections .............................................................. 161
Protozoal Infections ........................................................... 161
Some Characteristics of Infections at Special Sites................. 162
Chapter 7 Pharmacology.................................................... 163
Sedative, Hypnotic and Anxiolytic Agents ............................ 163
Antipsychotic Agents ......................................................... 163
Antidepressive Agents ........................................................ 164
Analgesics ........................................................................ 165
Antacids ........................................................................... 166
Laxatives .......................................................................... 166
Anti-emetics.. ...... ................. ............................................ 167
Antihistamines .................................................................. 167
Diuretics .......................................................................... 167
Antihypertensive Agents ..................................................... 167
Drugs Affecting Blood Coagulation ...................................... 169
Drugs Used for Treatment of Osteoporosis ........................... 170
Chemotherapy of Infection ................................................. 170
Pharmacology of Sex Steroids ............................................. 174
Drugs Affecting Contraction of the Uterus ........................... 178
Anticancer Drugs (Cytotoxic Agents) ................................... 181
General Anaesthetic Agents ................................................ 183
Local Anaesthetic Agents .................................................... 185
Drugs of Abuse ................................................................. 186
General Aspects of Pharmacology in Pregnancy.................... 186
General Aspects of Pharmacology During Breast Feeding ....... 187
Appendix A Statistics ......................................................... 189
Appendix B Ultrasound................ .............. ........................ 191
Index ................................................................................ 193
Chapter 1
Cell Biology, Embryology and
the Placenta
The cell
The cell consists of a nucleus, cytoplasm and a cell membrane. The cytoplasm
includes organelles such as mitochondria and the Golgi apparatus, supported by
a frame of cytoskeleton.
The nucleus
The nucleus consists of DNA supercoiled around proteins (histones and acidic
proteins), and one or more nucleoli (largely made up of RNA), and a surround
ing bilayer membrane which is similar in composition to the endoplasmic
reticulum. This membrane has pores which allow the inward transfer of
regulatory DNA binding proteins and the outward transfer of mRNA.
The cytoplasm
The cytoplasm contains a variety of organelles:
1. Mitochondria: These have inner and outer bilayer membranes. The inner
membrance has numerous folds (cristae) which contain the respiratory enzymes
and cytochromes of the electron transport chain. The enzymes of the Krebs cycle
are found in the matrix of the mitochondria. They produce substrates (NAD,
FADH for the electron transport chain and hence production of ATP. They also
2)
provide substrates for fatty acids, nucleic acid, lipid and steroid biosynthesis.
Mitochondria also contain self-replicating circular DNA inherited exclusively
from the mother. This codes for mitochondrial enzymes such as cytochrome
oxidase and ATP synthetase.
2. The cytoskeleton: A system of filaments which are responsible for shape,
motility and contact inhibition. Three kinds of filaments occur: microtubules
(20-27 nm in diameter, which contain tubulin and are responsible for migration