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www.myuptodate.com www.myuptodate.com www.myuptodate.com @MehrsysSupport @MehrsysSupport Eugene C. oy, MD Assistant Dean or Educational Programs Director o Doctoring Courses Program Director o the Scholarly Concentrations in Women’s Health Pro essor and Vice Chair o Medical Education Department o Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Benton Baker III, MD Fellow, American College o Obstetricians and Gynecologists Retired, Pro essor o Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Patti Jayne Ross, MD Pro essor University o exas Health Science Center Department o Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas John C. Jennings, MD Pro essor o Obstetrics and Gynecology exas ech University Health Sciences Center Odessa, exas New York Chicago San Francisco Athens London Madrid Mexico City Milan New Delhi Singapore Sydney oronto CASE FILES® Obstetrics and Gynecology FIFTH EDITION www.myuptodate.com Copyright © 2016 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-184379-9 MHID: 0-07-184379-5 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-184872-5, MHID: 0-07-184872-X. eBook conversion by codeMantra Version 1.0 All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the bene t of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill Education books are available at special quantity discounts to use as premiums and sales promotions or for use in corporate training programs. To contact a representative, please visit the Contact Us pages at www.mhprofessional.com. Previous editions’ copyright © 2013, 2009, 2007, 2003 by The McGraw-Hill Companies, Inc. All rights reserved. Case Files® is a registered trademark of McGraw-Hill Education. All rights reserved. Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to con rm the information contained herein with other sources. 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You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms. THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill Education and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. www.myuptodate.com T is f th edition o Case Files®: Obstetrics and Gynecology is dedicated to Dr. Sean C. Blackwell, who is my chairman, and whose leadership and riendship I cherish. I have watched him work tirelessly rom be ore dawn to well a ter dusk, and be available or telephone calls and consultation regardless o the hour. He is the reason I am able to continue to grow as an educator, writer, and teacher. Most precious to me, he strongly supported me (shortly a ter joining the department ull time) to keep my commitment to lead our medical mission team to Cambodia to serve hun- dreds in the rural province o Kratie. He is probably the biggest reason this edition o Case Files®: Obstetrics and Gynecology could see print. Sean C. Blackwell, MD is a Pro essor and Chair (appointed 2011) o the Depart- ment o Obstetrics, Gynecology and Reproductive Sciences at McGovern Medical School at T e University o exas Health Science Center at Houston (U Health). Dr. Blackwell completed his undergraduate degree as a double major in the classics and biology at Wabash College in Craw ordsville, Indiana. He matriculated medical school at the University o Illinois College o Medicine in 1993 and completed both his obstetrics and gynecology residency and maternal etal medicine ellowship at Wayne State University in Detroit, Michigan. He joined U Health in 2007, and also serves as the Director o the Larry C. Gilstrap MD Center or Perinatal and Women’s Health Research and as an Assistant Dean or Healthcare Quality in Perinatal Medicine and Women’s Health. Dr. Blackwell is the Chie o Service or Obstetrics and Gynecology or Children’s Memorial Hermann Hospital– exas Medical Center. In 2014, Dr. Blackwell earned his Six Sigma-Lean Black Belt at the University o Houston. Eugene C. oy, MD DEDICATION www.myuptodate.com iv DEDICATION o my Chairman o Obstetrics o Gynecology, Dr. Sean Blackwell, whose work ethic, leadership, and vision inspire everyone around him to excellence and whose heart o generosity touches thousands o pregnant women and their babies. —ECT With love and gratitude, to Mom, Joy, Ben, Anne, Jessica, Jim, John, and Col. Alvin Sholk. —BB III o Dr. James Knight, and ulane Medical School, or giving me the opportunity to ulf ll my dreams. o my parents, Mary and Jimmy Ross, or their love, inspiration, and devotion. —PJR o my wi e, Sue Ellen, my three daughters, Beth, Allison, and Amy, their husbands, and my f ve grandchildren. —JCJ Finally, to the wonder ul medical students rom the McGovern Medical School at T e University o exas Health Science Center at Houston (U Health), who graciously gave constructive eedback and enthusiastically received this curriculum. —THE AUTHORS www.myuptodate.com CONTENTS Contributors / vii Pre ace / xiii Acknowledgments / xv Introduction / xvii Listing o Cases / xix Section I How to Approach Clinical Problems ...................................................................1 Part 1. Approach to the Patient .................................................................................................3 Part 2. Approach to Clinical Problem Solving ....................................................................11 Part 3. Approach to Reading ....................................................................................................13 Part 4. Approach to Surgery .....................................................................................................18 Section II Cases...................................................................................................................19 Obstetric Topics (Cases 1-28) ...............................................................................................19 Gynecologic Topics (Cases 29-60) ...................................................................................289 Section III Review Questions ......................................................................................................................565 Index / 577 www.myuptodate.com 00_Toy-ObGyn _FM_p00i-xxii.indd 6 5/6/16 4:59 PM This page intentionally left blank www.myuptodate.com vii CONTRIBUTORS Mazen Elias Abdallah, MD Assistant Pro essor o Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Delayed Puberty Michael . Adler, MD Assistant Pro essor o Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Amenorrhea, Intrauterine Adhesions Elizabeth E. Brackett Medical Student McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Herpes Simplex Virus In ection in Pregnancy Shao-Chun R. Chang-Jackson, MD Assistant Pro essor o Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Ectopic Pregnancy amika K. Cross, MD Resident in Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Domestic Abuse and Sexual Abuse Cynthia Donna, MD Resident in Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Contraception Erin G. Dressel Medical Student McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Hypertensive Disease in Pregnancy www.myuptodate.com viii CONTRIBUTORS Amy E. Dudley Medical Student McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Bacterial Vaginosis Jenny Duret-Uzodinma, MD Assistant Pro essor o Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Pyelonephritis in Pregnancy Russell Edwards, MD, FACOG Faculty, Obstetrics and Gynecology Residency Program T e Methodist Hospital—Houston Houston, exas Galactorrhea and Hypothyroidism Konrad Harms, MD, FACOG Assistant Clinical Pro essor o Obstetrics and Gynecology Weill Cornell Medical College Program Director, Obstetrics and Gynecology Residency T e Methodist Hospital—Houston Houston, exas Shoulder Dystocia Sara B. Holcombe, DO Assistant Pro essor o Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Domestic Abuse and Sexual Assault Steven Blaine Holloway Medical Student McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Cystitis Katlyn Hoover Medical Student McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Placental Abruption www.myuptodate.com CONTRIBUTORS ix Lina Wael Irshaid Medical Student Weill Cornell Medical - Qatar Dohn, Qatar Intrauterine Growth Restriction Randa J. Jalloul, MD, FACOG Assistant Pro essor o Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Breast Cancer Erin Josserand Medical Student McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Pulmonary Embolism in Pregnancy Joy Y. Kim, MD Assistant Pro essor o Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Contraception Patricia C. Lenihan Medical Student McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Approach to Labor Hypertension in Pregnancy Pelvic Organ Prolapse Principal manuscript reviewer Chunhua Lu, MD, PhD Resident in Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Breast Cancer Fangxian Lu, MD, PhD Assistant Pro essor o Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Postpartum Hemorrhage www.myuptodate.com x CONTRIBUTORS Michael S. MacKelvie, DO Resident in Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Placenta Accreta Violet Maldonado Medical Student McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Preterm Labor Dalia M. Moghazy, MD Resident in Obstetrics and Gynecology T e Methodist Hospital—Houston Houston, exas Intrahepatic Cholestasis o Pregnancy Alyxandra O’Brien, MD Resident in Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Ectopic Pregnancy Christine Pan, MD Resident in Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Postpartum Hemorrhage Urinary Incontinence Virginia A. Rauth, MD, MBA Pro essor o Obstetrics and Gynecology Chie o Women’s HealthCare at Galveston University o exas Medical Branch Galveston, exas Approach to Perimenopause John W. Riggs, MD, MS, FACOG Pro essor o Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Postpartum Endometritis www.myuptodate.com CONTRIBUTORS xi Reem Sabouni, MD Resident in Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Amenorrhea, Intrauterine Adhesions Placenta Previa Mary Alice Sallman Medical Student McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Manuscript reviewer Viviana C. Salom-Ellis Medical Student McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Placenta Previa Priti P. Schachel, MD, FACOG Associate Program Director Obstetrics and Gynecology Residency Program T e Methodist Hospital—Houston Houston, exas Intrahepatic Cholestasis o Pregnancy Nicholas R. Spencer Medical Student McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Parvovirus In ection in Pregnancy Lauren Jane T arp, MD Administrative Chie Resident in Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Postpartum Endometritis Aida L. Vigil, MD, MPH Resident in Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Pyelonephritis in Pregnancy www.myuptodate.com xii CONTRIBUTORS Joaquin Andres Villegas Inurrigarro Medical Student McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Septic Abortion Cristina M. Wallace, MD Assistant Pro essor o Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Polycystic Ovarian Syndrome Amberly Nesbitt Winley, MD Resident in Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Polycystic Ovarian Syndrome Nikolaos Zacharias, MD, FACOG Assistant Pro essor o Obstetrics and Gynecology McGovern Medical School at T e University o exas Health Science Center at Houston (U Health) Houston, exas Placenta Accreta www.myuptodate.com xiii I have been deeply amazed and grate ul to see how the Case Files® books have been so well received, and have helped students to learn more e ectively. In the 13 short years since Case Files®: Obstetrics and Gynecology irst made it in print, the series has now multiplied to span most o the clinical and basic science disciplines, and been translated into nearly 20 oreign languages. Numerous students have sent encouraging remarks about the changes in the ourth edition, which divided up into Obstetrics in the irst hal , and Gynecology in the second hal to be more “user- riendly” during the clerkship since most students have their rotation divided in those two categories. In this i th edition, we have retained the grouping o related cases closer together to allow students to use in ormation rom one case to rein- orce principles to another case, and cross-re erenced-related cases. Although space is always a premium, we have also retained and expanded Section III which is a col- lection o strategic questions that can be used or review, but also to tie in the principles rom the cases. Questions have been improved to better re lect the USMLE ormat, and explanations have been expanded to help the student understand the mechanisms and the reason that the other choices are incorrect. wo completely new cases (Sexual Abuse/ Intimate Partner Violence, and Chronic Pelvic Pain) have been written. Updated or new sections include cervical cytology screening, contraception, labor management, hypertension in pregnancy, etal assessment, and ovarian cancer. his i th edition has been a collaborative work with my wonder- ul coauthors and contributors, and with the suggestions rom ive generations o students. ruly, the enthusiastic encouragement rom students throughout not just the United States but worldwide provides me with the inspiration and energy to continue to write. It is thus with humility that I o er my sincere thanks to students everywhere … or without students, how can a teacher teach? Eugene C. oy PREFACE www.myuptodate.com