Clinical Obstetrics and Gynaecology

245 Pages·1996·13.324 MB·English

by  Isabel Stabile, Tim Chard, Gedis Grudzinskas (auth.), Isabel Stabile, Tim Chard, Gedis Grudzinskas (eds.)

CLINICAL OBSTETRICS AND GYNAECOLOGY
Springer
London
Berlin
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Singapore
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Isabel Stabile,
Tim Chard and
Gedis Grudzinskas (Eds.)
Clinical Obstetrics
and Gynaecology
, Springer
Isabel Stabile
Center for Prevention and Early Intervention Policy, The Florida State University,
1118-B Thomasville Road, Tallahassee, Florida 32303, USA
Tim Chard
Department of Obstetrics, Gynaecology and Reproductive Physiology,
St Bartholomew's Hospital Medical College, West Smithfield, London EClA 7BE, UK
Gedis Grudzinskas
Academic Unit of Obstetrics and Gynaecology, 4th Floor, Holland Wing,
The Royal London Hospital, Whitechapel, London El IBB, UK
ISBN-13: 978-3-540-19942-7 e-ISBN-13: 978-1-4471-3374-2
DOl: 10.1007/978-1-4471-3374-2
British Library Cataloguing in Publication Data
Clinical Obstetrics and Gynaecology
I. Stabile, Isabel
618
Library of Congress Cataloging-in-Publication Data
Clinical obstetrics and gynaecology 1 Isabel Stabile, Tim Chard, and Gedis Grudzinskas.
p. cm.
Includes index
1. Generative organs, Female-Diseases. 2. Pregnancy-Complications.
I. Chard, T. II. Grudzinskas, J.G. Ourgis Gediminas) III. Title.
[DNLM: 1. Pregnancy Complications. 2. Genital Diseases, Female.
WQ 240 S775c 1995)
RGI01.S685 1995
618-dc20
DNLM/DLC
for the Library of Congress 95-21300
Apart from any fair dealing for the purposes of research or private study, or criticism or
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Enquiries concerning reproduction outside those terms should be sent to the publishers.
@ Springer-Vedag London Limited 1996
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Typeset by Fox Design, Surrey, England
28/3830-543210 Printed on acid-free paper
Contents
Section I OBSTETRICS
Chapter 1 Obstetric Statistics ..................................................................... 3
Birth Rate ........................................................................................................ 3
Maternal Mortality ........................................................................................ 3
Fetal and Neonatal Mortality ........................................................................ 4
Chapter 2 Diagnosis of Pregnancy ............................................................. 7
Chapter 3 Assessment of Gestational Age .................................................. 9
Crown-Rump Length (CRL) ......................................................................... 9
Biparietal Diameter (BPD) ............................................................................ 9
Other Ultrasound Parameters of Gestational Age .................................... 10
Chapter 4 Antenatal Care .......................................................................... 11
Tests of Fetal Well-being .............................................................................. 11
Chapter 5 Abortion .................................................................................... 15
Causes of Abortion ...................................................................................... 15
Threatened Abortion ................................................................................... 17
Inevitable and Incomplete Abortion .......................................................... 17
Missed Abortion .......................................................................................... 17
Cervical Incompetence ................................................................................ 18
Congenital Anomalies of the Uterus .......................................................... 18
Recurrent Abortion ..................................................................................... 19
Septic Abortion ............................................................................................ 19
Induced Abortion ......................................................................................... 20
Chapter 6 Ectopic Pregnancy .................................................................... 23
Causes of Ectopic Pregnancy ...................................................................... 23
Clinical Features of Ectopic Pregnancy ..................................................... 24
Treatment of Ectopic Pregnancy ................................................................ 24
Abdominal Pregnancy ................................................................................. 25
vi Contents
Chapter 7 Gestational and Trophoblastic Tumours ................................ 27
Hydatidiform Mole ...................................................................................... 27
Choriocarcinoma ......................................................................................... 28
Chapter 8 Congenital Abnormalities ....................................................... 31
Genetic Defects ............................................................................................ 31
Environmentally-Induced Abnormalities ................................................. 35
Multisystem Abnormalities ......................................................................... 35
Screening for Congenital Abnormalities ................................................... 49
Chapter 9 Hyperemesis Gravidarum ........................................................ 51
Chapter 10 Rhesus Isoimmunisation ....................................................... 53
Diagnosis ...................................................................................................... 53
Management ................................................................................................. 53
Prognosis ...................................................................................................... 54
Chapter 11 Hypertensive Disorders of Pregnancy .................................. 55
Classification ................................................................................................ 55
Pregnancy-Induced Hypertension ............................................................. 56
Gestational Hypertension ........................................................................... 56
Pre-eclampsia ............................................................................................... 56
Eclampsia ...................................................................................................... 58
Management of Fluid Retention in Pregnancy ......................................... 59
Prognosis of Hypertensive Disease of Pregnancy ..................................... 59
Chapter 12 Antepartum Haemorrhage .................................................... 61
Abruptio Placentae ...................................................................................... 61
Placenta Praevia ........................................................................................... 62
"Indeterminate" APH .................................................................................. 63
Disseminated Intravascular Coagulation .................................................. 63
Chapter 13 Disorders Involving Amniotic Fluid ..................................... 65
Polyhydramnios ........................................................................................... 65
Oligohydramnios ......................................................................................... 65
Amniotic Fluid Embolism ........................................................................... 66
Chapter 14 Premature Labour .................................................................. 67
Management ................................................................................................. 67
Outcome ....................................................................................................... 69
Perinatal Mortality and Morbidity ............................................................. 69
Preterm Premature Rupture of Membranes .............................................. 69
Contents vii
Chapter 15 Multiple Pregnancy ................................................................ 71
Mechanisms of Twinning ............................................................................ 71
Complications of Multiple Pregnancy ....................................................... 72
Antenatal Management of Twins ................................................................ 73
Management of Labour ............................................................................... 73
Chapter 16 Maternal Disease in Pregnancy ............................................. 75
Cardiovascular Disease ............................................................................... 75
Respiratory System ...................................................................................... 79
Neurological Disease ................................................................................... 83
Genitourinary Disease ................................................................................. 88
Musculoskeletal Disease .............................................................................. 94
Gastrointestinal Disease .............................................................................. 97
Endocrine Diseases .................................................................................... 101
Acute Abdominal Pain in Pregnancy ....................................................... 113
Malignant Disease ...................................................................................... 115
Skin Disease ...................................................................... ,. ........................ 118
Haematological Disorders ......................................................................... 121
Haematological Malignancies ................................................................... 128
Chapter 17 Normal Labour ..................................................................... 129
Mechanisms and Course of Labour .......................................................... 129
Normal Delivery ........................................................................................ 130
Induction of Labour .................................................................................. 131
Analgesia .................................................................................................... 131
Chapter 18 Abnormal Labour ................................................................. 133
Prolonged Labour ...................................................................................... 133
Abnormal Presentation ............................................................................. 134
Monitoring of Fetal Well-being During Labour ...................................... 137
Delay in Second Stage ................................................................................ 139
Prolapse of the Cord .................................................................................. 139
Ruptured Uterus ........................................................................................ 140
Impacted Shoulders ................................................................................... 140
Chapter 19 The Puerperium .................................................................... 141
Postpartum Haemorrhage ........................................................................ 141
Infection ..................................................................................................... 142
Other Urinary Tract Problems .................................................................. 143
Psychiatric Disorders ..................... ............... ............................................. 143
Thromboembolism .................................................................................... 144
Breast Feeding and Breast Problems ........................................................ 145
viii Contents
Chapter 20 The Neonate ........................................................................... 147
Examination of the Newborn ................................................................... 147
Asphyxia ..................................................................................................... 147
Resuscitation of the Newborn ................................................................... 149
Specific Problems of the Neonate ............................................................. 149
Chapter 21 Obstetric Operations ............................................................ 155
Amniocentesis ............................................................................................ 155
Termination of Pregnancy ........................................................................ 155
Sterilisation ................................................................................................ 156
Cervical Suture ........................................................................................... 156
Version for Breech Presentation ............................................................... 157
Caesarean Section ...................................................................................... 157
Forceps Delivery ........................................................................................ 158
Ventouse Delivery ...................................................................................... 158
Episiotomy and Repair (including Tears) ................................................ 159
Manual Removal of Placenta ..................................................................... 159
Section II GYNAECOLOGY .................................................. 161
Chapter 22 Menstrual and Other Bleeding Disorders .......................... 163
Puberty ....................................................................................................... 163
Menorrhagia ............................................................................................... 163
Mechanisms of Menstruation ................................................................... 164
Primary Amenorrhoea .............................................................................. 167
Secondary Amenorrhoea .......................................................................... 169
Dysmenorrhoea ......................................................................................... 170
Chapter 23 The Premenstrual Syndrome .............................................. 171
Chapter 24 Menopause ............................................................................ 173
Stages of the Climacteric ........................................................................... 173
Postmenopausal Endocrinology .............................................................. 173
Anatomical Changes in the Climacteric .................................................. 174
Pathology of the Climacteric .................................................................... 174
Clinical Features ......................................................................................... 175
Types of HRT and its Side-effects ............................................................. 176
Postmenopausal bleeding ......................................................................... 176
Chapter 25 Virilism and Hirsutism ........................................................ 179
Virilism ....................................................................................................... 179
Hirsutism .................................................................................................... 179
Contents ix
Chapter 26 Genital Infections ................................................................. 183
Infections and Related Conditions of the Vulva ...................................... 183
Vaginal Infections ...................................................................................... 185
Cervicitis ..................................................................................................... 187
Pelvic Infections ......................................................................................... 187
Other Infections ......................................................................................... 188
Chronic Pelvic Inflammatory Disease ...................................................... 188
Other Sexually Transmitted Diseases (Non-genital) .............................. 189
Chapter 27 Benign and Malignant Lesions of the Vulva ...................... 191
Benign Tumours of the Vulva ................................................................... 191
Other Benign Vulval Swellings .................................................................. 191
Vulval Dystrophies ..................................................................................... 192
Premalignant Conditions of the Vulva ..................................................... 193
Carcinoma of the Vulva ............................................................................. 193
Rare Malignant Tumours of the Vulva ..................................................... 195
Chapter 28 Benign and Malignant Lesions of the Vagina .................... 197
Benign Tumours of the Vagina ................................................................. 197
Carcinoma of the Vagina ........................................................................... 197
Chapter 29 Benign and Malignant Lesions of the Cervix .................... 199
Benign Tumours of the Cervix ................................................................. 199
Carcinoma-in-Situ of the Cervix .............................................................. 199
Microinvasive Carcinoma ......................................................................... 201
Carcinoma of the Cervix ........................................................................... 201
Carcinoma of the Cervix in Pregnancy .................................................... 203
Chapter 30 Benign and Malignant Lesions of the Endometrium ....... 205
Benign Tumours of the Endometrium ..................................................... 205
Carcinoma of the Endometrium .............................................................. 205
Chapter 31 Benign and Malignant Lesions of the Myometrium ......... 209
Benign Tumours of the Myometrium: Fibroids ...................................... 209
Fibroids During Pregnancy ....................................................................... 210
Metastasising Fibroids ............................................................................... 210
Malignant Non-epithelial Tumours of the Uterus .................................. 210
Chapter 32 Thmours of the Ovary .......................................................... 213
Benign Tumours of the Ovary .................................................................. 213
Special Tumours of the Ovary .................................................................. 214
Malignant Epithelial Tumours of the Ovary ............................................ 216
x Contents
Chapter 33· Infertility ............................................................................... 219
Aetiology ..................................................................................................... 219
Management ............................................................................................... 219
Chapter 34 Contraception ....................................................................... 221
"Natural" Family Planning ........................................................................ 211
Barrier Methods ......................................................................................... 221
The Intrauterine Contraceptive Device ................................................... 222
Hormonal Contraception .......................................................................... 223
Immunological Methods ........................................................................... 226
The Male Pill .............................................................................................. 226
Chapter 35 Urinary Tract Disorders ....................................................... 227
Urodynamic Investigations ....................................................................... 227
Stress Incontinence .................................................................................... 228
Detrusor Instability ................................................................................... 228
Retention of Urine ..................................................................................... 229
Urinary Tract Infections ............................................................................ 229
Fistulae ........................................................................................................ 230
Chapter 36 Prolapse ................................................................................. 231
Chapter 37 Dyspareunia .......................................................................... 233
Chapter 38 Endometriosis and Adenomyosis ....................................... 235
Endometriosis ............................................................................................ 235
Adenomyosis .............................................................................................. 237
Chapter 39 Congenital Uterine and Vaginal Abnormalities ................ 239
Chapter 40 Gynaecological Operations .................................................. 241
Vulvectomy ................................................................................................. 241
Vaginal Repair ............................................................................................ 241
Colposcopy and Cervical Operations ...................................................... 242
Dilatation and Curettage ........................................................................... 242
Hysterectomy ............................................................................................. 242
Tubal Surgery ............................................................................................. 243
Ovarian Surgery ......................................................................................... 243
Laparoscopy ............................................................................................... 244
Pre-and Postoperative Care ...................................................................... 244
Subject Index ............................................................................................. 231