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Clinical Obstetrics and Gynaecology PDF

245 Pages·1996·13.324 MB·English
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CLINICAL OBSTETRICS AND GYNAECOLOGY Springer London Berlin Heidelberg New York Barcelona Budapest Hong Kong London Milan Paris Santa Clara Singapore Tokyo 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 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 oflicences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. @ Springer-Vedag London Limited 1996 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 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

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