Table Of Content

DEWHURST’S TEXTBOOK OF OBSTETRICS & GYNAECOLOGY Edmon: “FM” — 2006/12/22 — 18:53 — PAGE i — #1 Dedication This book is dedicated to my wife, Gill, and my children, Alastair, Nicholas and Timothy and to the memory of SirJackDewhurst. Edmon: “FM” — 2006/12/22 — 18:53 — PAGE ii — #2 Dewhurst’s Textbook of Obstetrics & Gynaecology EDITED BY D. KEITH EDMONDS FRCOG,FRACOG ConsultantObstetricianandGynaecologist QueenCharlotte’sandChelseaHospital GoldhawkRoad London,UK SEVENTHEDITION Blackwell Publishing Edmon: “FM” — 2006/12/22 — 18:53 — PAGE iii — #3 ©2007byBlackwellPublishing ©1972,1976,1981,1986,1995,1999BlackwellScience BlackwellPublishing,Inc.,350MainStreet,Malden,Massachusetts02148-5020,USA BlackwellPublishingLtd,9600GarsingtonRoad,OxfordOX42DQ,UK BlackwellPublishingAsiaPtyLtd,550SwanstonStreet,Carlton,Victoria3053,Australia TherightoftheAuthortobeidentifiedastheAuthorofthisWorkhasbeenassertedinaccordancewiththeCopyright,DesignsandPatents Act1988. Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,ortransmitted,inanyformorbyanymeans, electronic,mechanical,photocopying,recordingorotherwise,exceptaspermittedbytheUKCopyright,DesignsandPatentsAct1988, withoutthepriorpermissionofthepublisher. Firstpublished1972 Secondedition1976 Thirdedition1981 Fourthedition1986 Fifthedition1995 Sixthedition1999 Seventhedition2007 12007 LibraryofCongressCataloging-in-PublicationData Dewhurst’stextbookofobstetricsandgynaecology.–7thed./editedbyD.KeithEdmonds.–7thed. p.;cm. Rev.ed.of:Dewhurst’stextbookofobstetricsandgynaecologyforpostgraduates.6thed.1999. Includesbibliographicalreferencesandindex. ISBN-13:978-1-4051-3355-5(hardback:alk.paper) ISBN-10:1-4051-3355-4(hardback:alk.paper) ISBN-13:978-1-4051-3355-5(pbk.:alk.paper) ISBN-10:1-4051-3355-4(pbk.:alk.paper) 1.Gynecology.2.Obstetrics.I.Edmonds,D.Keith.II.Dewhurst,John,Sir,1920-.III.Dewhurst’stextbookofobstetricsandgynaecologyfor postgraduates.IV.Title:Textbookofobstetricsandgynaecology. 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Edmon: “FM” — 2006/12/22 — 18:53 — PAGE iv — #4 Contents Contributors, vii 13 Recurrentmiscarriage, 100 RajRai ProfessorSirJohnDewhurst, xi 14 Ectopicpregnancy, 106 PrefacetotheSeventhEdition, xii DavorJurkovic PrefacetotheFirstEdition, xiii 15 Trophoblastdisease, 117 PhilipSavageandMichaelSeckl 1 Clinicalanatomyofthepelvisandreproductive tract, 1 16 Prenataldiagnosisandgenetics, 125 AlanFarthing SaileshKumar 2 Maternalphysiology, 10 17 Fetalmedicineinclinicalpractice, 132 FionaBroughton-Pipkin R.C.Wimalasundera 3 Theplacentaandfetalmembranes, 19 18 Obstetricemergencies, 145 BertholdHuppertzandJohnC.P.Kingdom SaraPaterson-Brown 19 Disordersoffetalgrowthandassessmentoffetal 4 Normalfetalgrowth, 28 well-being, 159 JasonGardosi G.C.S.SmithandC.C.Lees 5 Pre-conceptioncounselling, 34 20 Multiplepregnancy, 166 AndrewMcCarthy NicholasM.Fisk 6 Antenatalcare, 39 21 Pretermlabour, 177 TimothyG.Overton PhillipBennett 7 Normallabour, 46 22 Prolongedpregnancy, 192 A.A.Calder PatriciaCrowley 8 Fetalmonitoringduringlabour, 56 23 Inductionandaugmentationoflabour, 205 JamesA.Low G.JustusHofmeyr 9 Analgesiaandanaesthesia, 63 24 Malpresentation,malposition,cephalopelvic JohnA.Crowhurst disproportionandobstetricprocedures, 213 S.Arulkumaran 10 Puerperiumandlactation, 69 25 Hypertensivedisorders, 227 D.KeithEdmonds AndrewShennan 11 Neonatalcareforobstetricians, 81 26 Heartdiseaseinpregnancy, 236 M.A.ThomsonandA.D.Edwards CatherineNelson-Piercy 12 Spontaneousmiscarriage, 94 27 Diabetesandendocrinediseaseinpregnancy, 246 JoanneToppingandRoyG.Farquarson AnneDornhorstandCatherineWilliamson v Edmon: “FM” — 2006/12/22 — 18:53 — PAGE v — #5 vi Contents 28 Renaldisease, 260 46 Assistedreproduction, 461 JohnDavison GeoffreyTrew 29 Haematologicalproblemsinpregnancy, 270 47 Menopauseandthepostmenopausal P.Clark,A.J.ThomsonandI.A.Greer woman, 479 NickPanay 30 Miscellaneousmedicaldisorders, 282 AndrewMcCarthy 48 PelvicfloordysfunctionI:uterovaginal prolapse, 496 31 Obstetricstatistics, 289 AnthonyR.B.Smith JimG.Thornton 49 Urinaryincontinence, 504 32 Contraception, 299 D.RobinsonandL.Cardozo AnnaGlasier 50 Hysteroscopyandlaparoscopy, 560 33 Terminationofpregnancy, 318 AdamMagos GillianFlettandAllanTempleton 51 Benigndiseaseofthevulva, 578 34 Normalandabnormaldevelopmentofthegenital RichardStaughton tract, 327 D.KeithEdmonds 52 Malignantdiseaseofthevulvaandthevagina, 591 35 Themenstrualcycle, 348 DavidM.Luesley WilliamL.Ledger 53 Benigndiseasesofthevagina,cervix 36 Theroleofultrasoundingynaecology, 356 andovary, 606 JoanneTopping D.KeithEdmonds 37 Gynaecologicaldisordersofchildhoodand 54 Premalignantandmalignantdiseaseof adolescence, 364 thecervix, 614 D.KeithEdmonds MahmoodI.Shafi 38 Primaryamenorrhoea, 369 55 Epithelialovariancancer, 625 D.KeithEdmonds HaniGabra 39 Polycysticovarysyndromeandsecondary 56 Benigndiseaseoftheuterus, 636 amenorrhoea, 377 MaryAnnLumsden AdamH.Balen 57 Canceroftheuterinecorpus, 645 40 Menstrualproblems:menorrhagiaandprimary HenryC.Kitchener dysmenorrhagia, 399 MargaretC.P.Rees 58 Sexualdysfunction, 651 FranReader 41 Premenstrualsyndrome, 408 P.M.S.O’Brien 59 Ethicaldilemmasinobstetricsandgynaecology, 658 GordonM.Stirrat 42 Pelvicinfection, 414 JonathanD.C.RossandPeterStewart 60 Thelawandtheobstetricianandgynaecologist, 684 43 Chronicpelvicpain, 423 BertieLeigh R.WilliamStones 61 Domesticviolenceandsexualassault, 692 44 Endometriosis, 430 MaureenDalton StephenKennedyandPhilippeKoninckx Index, 699 45 Infertility, 440 SiladityaBhattacharya Platesectioncanbefoundfacingp.562 Edmon: “FM” — 2006/12/22 — 18:53 — PAGE vi — #6 Contributors S.Arulkumaran JohnA.Crowhurst ProfessorandHead,StGeorge’sHospitalMedicalSchool, ConsultantAnaesthetist,MercyHospitalforWomen, CranmerTerrace,London,SW170RE,UK Melbourne,Australia;andFormerlyReaderinObstetric Anaesthesia,ImperialCollege;andDirectorofObstetric AdamH.Balen Anaesthesia,QueenCharlotte’sandChelseaHospital, ProfessorofReproductiveMedicineandSurgery,Department London,UK ofObstetricsandGynaecology,ClarendonWing,Leeds PatriciaCrowley GeneralInfirmary,UnitedLeedsTeachingHospitals,Leeds, DepartmentofObstetricsandGynaecology,TrinityCollege LS29NS,UK Dublin,CoombeWomen’sHospital,Dublin8,Ireland PhillipBennett MaureenDalton ProfessorofObstetricsandGynaecology,ParturitionResearch ConsultantObstetricianandGynaecologist,RoyalDevonand Group,FacultyofMedicine,ImperialCollegeLondon;and ExeterHospital,BarrackRoad,Exeter,EX25DW,UK InstituteofReproductiveandDevelopmentalBiology, HammersmithHospitalCampus,DuCaneRoad,London, JohnDavison W120NN,UK ConsultantObstetrician,DepartmentofObstetricsand Gynaecology,DirectorateofWomen’sServices,RoyalVictoria SiladityaBhattacharya Infirmary,QueenVictoriaRoad,NewcastleuponTyne, SeniorLecturer,DepartmentofObstetricsandGynaecology, NE14LP,UK UniversityofAberdeen,AberdeenMaternityHospital, AnneDornhorst Foresterhill,Aberdeen,AB252ZL,UK ConsultantPhysicianandHonorarySeniorLecturer, FionaBroughton-Pipkin MetabolicMedicine,ImperialCollegeLondon,DuCaneRoad, London,W120NN,UK ProfessorofPerinatalPhysiology,SchoolofHuman Development,NottinghamUniversityHospital,Queen’s D.KeithEdmonds MedicalCentre,DerbyRoad,Nottingham,NG72UH,UK ConsultantObstetricianandGynaecologist,QueenCharlotte’s andChelseaHospital,GoldhawkRoad,London,W60XG,UK A.A.Calder ProfessorofObstetricsandGynaecology,Universityof A.D.Edwards Edinburgh,ReproductiveandDevelopmentalSciences, ConsultantPaediatrician,DepartmentofPaediatrics, SimpsonCentreforReproductiveHealth,51LittleFrance HammersmithHospital,DuCaneRoad,London, Crescent,Edinburgh,EH164SA,UK W120HS,UK RoyG.Farquarson L.Cardozo ClinicalDirector,LiverpoolWomen’sHospital,CrownStreet, DepartmentofUrogynaecology,KingsCollegeHospital, Liverpool,L87SS,UK London,UK AlanFarthing P.Clark ConsultantGynaecologicalSurgeon,WestLondon ConsultantHaematologist,NinewellsHospitalDundee;and GynaecologicalCancerCentre,QueenCharlotte’sandChelsea HonorarySeniorLecturer,UniversityofDundee,UK Hospital,DuCaneRoad,London,W120HS,UK vii Edmon: “FM” — 2006/12/22 — 18:53 — PAGE vii — #7 viii Contributors NicholasM.Fisk StephenKennedy ProfessorofObstetricsandGynaecology,Instituteof ClinicalReader,NuffieldDepartmentofObstetricsand ReproductiveandDevelopmentalBiology,ImperialCollege, Gynaecology,UniversityofOxford,UK London; andCentreforFetalCare,QueenCharlotte’sand ChelseaHospital,London,UK JohnC.P.Kingdom DepartmentofObstetricsandGynecology,SamuelLunenfeld GillianFlett ResearchInstitute,MountSinaiHospital,Universityof Consultant,SexualandReproductiveHealth,13Golden Toronto,Canada Square,Aberdeen,AB101RH,UK;andGynaecology Department,AberdeenRoyalInfirmary,Foresterhill, HenryC.Kitchener Aberdeen,UK ProfessorofGynaecologicalOncology,Universityof Manchester,AcademicUnitofObstetrics/Gynaecology, HaniGabra StMary’sHospital,WhitworthPark,Manchester, ProfessorofMedicalOncologyandHeadofSectionof M130JH,UK MolecularTherapeutics,ImperialCollegeLondon;and DirectoroftheHeleneHarrisMemorialTrustOvarianCancer PhilippeKoninckx ActionResearchUnit;andChiefofService,WestLondon NuffieldDepartmentofObstetricsandGynaecology, GynaecologicalCancerCentre,HammersmithHospitals UniversityofOxford;andDepartmentofObstetricsand NHSTrust,London,UK Gynecology,UniversityofLeuven,Belgium JasonGardosi SaileshKumar WestMidlandsPerinatalInstitute,CrystalCourt,Aston ConsultantinFetalMedicine,ObstetricsandGynaecology, Cross,Birmingham,B65RQ,UK CentreforFetalCare,QueenCharlotte’sandChelseaHospital, DuCaneRoad,London,W120HS,UK AnnaGlasier DirectorofNHSLothianFamilyPlanningandWellWomen WilliamL.Ledger Service;andHonoraryProfessorUniversityofEdinburgh ClinicalSciencesandCommunityHealth;andUniversityof ProfessorofObstetricsandGynaecology,AcademicUnitof London,SchoolofHygieneandTropicalMedicineDepartment ReproductiveandDevelopmentalMedicine,TheJessopWing, ofPublicHealthPolicy,UK TreeRootWalk,Sheffield,S102SF,UK I.A.Greer C.C.Lees RegiusProfessorofObstetricsandGynaecology,Universityof ConsultantinObstetricsandMaternalandFetalMedicine, Glasgow,ReproductiveandMaternalMedicine,Glasgow TheRosieHospital,AddenbrookesNHSTrust,Cambridge, RoyalInfirmary,10AlexandraParade,Glasgow, CB22QQ,UK G312ER,UK BertieLeigh G.JustusHofmeyr Solicitor,SeniorPartneratHempsons,HempsonsHouse, Consultant,EastLondonHospitalComplex;andDirector, 40VilliersStreet,London,WC2N6NJ,UK EffectiveCaseResearchUnit,EasternCapeDepartmentof Health; andUniversityoftheWitwatersrand/Universityof JamesA.Low FortHare,SouthAfrica DepartmentofObstetricsandGynaecology,Queen’s University,Kingston,Ontario,K7L3N6,Canada BertholdHuppertz UniversityProfessorofCellBiology,DepartmentofCell DavidM.Luesley Biology,HistologyandEmbryology,CenterofMolecular Medicine,Harrachgasse21/7,MedicalUniversityofGraz, Lawson-TaitProfessorofGynaecologicalOncology,City 8010Graz,Austria Hospital,DudleyRoad,Birmingham,B187QH,UK DavorJurkovic MaryAnnLumsden ConsultantObstetricianandGynaecologist,HeadEarly Professor of Gynaecology and Medical Education, Division of PregnancyandGynaecologyAssessmentUnit,King’sCollege DevelopmentalMedicine,UniversityofGlasgow,QueenEliza- Hospital,DenmarkHill,London,SE59RS,UK bethBuilding,10AlexandraParade,Glasgow,G312ER,UK Edmon: “FM” — 2006/12/22 — 18:53 — PAGE viii — #8 Contributors ix AdamMagos JonathanD.C.Ross MinimallyInvasiveTherapyUnitandEndoscopyTraining ProfessorofSexualHealthandHIV,WhittallStreetClinic, Centre,UniversityDepartmentofObstetricsand Birmingham,UK Gynaecology,TheRoyalFreeHospital,PondStreet, Hampstead,London,NW32QG,UK PhilipSavage DepartmentofMedicalOncology,CharingCrossHospital, AndrewMcCarthy FulhamPalaceRoad,London,W68RF,UK ConsultantObstetrician,HammersmithandQueen Charlotte’sandChelseaHospital,DuCaneRoad,London, MichaelSeckl W120HS,UK Director,CharingCrossHospitalTrophoblasticDisease Centre,FulhamPalaceRoad,London,W68RF,UK CatherineNelson-Piercy ConsultantObstetricPhysician,Guy’sandStThomas’ MahmoodI.Shafi HospitalsFoundationTrust,andQueenCharlotte’sHospital, ConsultantGynaecologicalSurgeonandOncologist, London,UK Addenbrooke’sHospital,HillsRoad,Cambridge,CB22QQ, UK P.M.S.O’Brien ConsultantObstetricianandGynaecologist,AcademicUnitof AndrewShennan ObstetricsandGynaecology,KeeleUniversityMedicalSchool, ProfessorofObstetrics,King’sCollegeLondon,Guy’s,King’s UniversityHospitalofNorthStaffordshireNHSTrust,Stoke andSt.Thomas’SchoolofMedicine,LambethPalaceRoad, onTrent,ST46QG,UK London,SE17EH,UK TimothyG.Overton AnthonyR.B.Smith ConsultantinObstetricsandFetalMedicine,HonorarySenior ConsultantUrogynaecologist,TheWarrellUnit,StMary’s ClinicalLecturer,UniversityofBristol,StMichael’sHospital, Hospital,HathersageRoad,Manchester,M130JH,UK SouthwellStreet,Bristol,BS28EG,UK NickPanay G.C.S.Smith ConsultantObstetricianandGynaecologist,Queen HeadofDepartmentandConsultantinMaternal–Fetal Charlotte’sandChelseaHospital,HammersmithHospitals Medicine,DepartmentofObstetricsandGynaecology,The NHSTrust;andHonorarySeniorLecturer,ImperialCollege, RosieHospital,RobinsonWay, London,UK Cambridge,CB22QQ,UK SaraPaterson-Brown RichardStaughton ConsultantObstetricianandGynaecologist,Queen ConsultantDermatologist,ChelseaandWestminsterHospital, Charlotte’sandChelseaHospital,DuCaneRoad,London, 369FulhamRoad,London,SW109NH,UK W120HS,UK PeterStewart RajRai ConsultantObstetricianandGynaecologist,Royal SeniorLecturer/ConsultantGynaecologist,Sub-specialistin HallamshireHospital,Sheffield,UK ReproductiveMedicine,ImperialCollegeLondon,MintWing, StMary’sHospital,London,W21PG,UK GordonM.Stirrat FranReader EmeritusProfessorofObstetricsandGynaecology,andSenior ResearchFellowinEthicsinMedicine,CentreforEthicsin ConsultantinReproductiveHealth,IpswichHospital,Heath Medicine,UniversityofBristol,73StMichael’sHill,Bristol, Road,Ipswich,Suffolk,IP45PD,UK BS28BH,UK MargaretC.P.Rees R.WilliamStones ReaderinReproductiveMedicine,NuffieldDepartmentof ObstetricsandGynaecology,JohnRadcliffeHospital,Oxford, SeniorLecturerinObstetricsandGynaecology,Universityof OX39DU,UK Southampton,Southampton,SO165YA,UK D.Robinson AllanTempleton DepartmentofUrogynaecology,KingsCollegeHospital, GynaecologyDepartment,AberdeenRoyalInfirmary, London,UK Forresterhill,Aberdeen,UK Edmon: “FM” — 2006/12/22 — 18:53 — PAGE ix — #9