Oxford handbook of obstetrics and gynaecology

857 Pages·2013·5.172 MB·English

by  Sally Collins, (Obstetrics specialist)

OXFORD MEDICAL PUBLICATIONS
Oxford Handbook of
Obstetrics and
Gynaecology
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Oxford Handbook of
Obstetrics and
Gynaecology
Third Edition
Edited by
Sally Collins
Specialist Registrar in Obstetrics and Gynaecology,
The John Radcliffe Hospital,
Oxford, UK
Sabaratnam Arulkumaran
Professor of Obstetrics and Gynaecology,
St George’s Hospital Medical School,
University of London, UK
Kevin Hayes
Senior Lecturer/Honorary Consultant in Obstetrics
and Gynaecology, and Medical Education,
St George’s Hospital Medical School,
University of London, UK
Simon Jackson
Consultant Gynaecologist,
The John Radcliffe Hospital,
Oxford, UK
Lawrence Impey
Consultant in Obstetrics and Fetal Medicine,
The John Radcliffe Hospital,
Oxford, UK
1
3
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© Oxford University Press, 2013
The moral rights of the authors have been asserted
First edition published 2005
Second edition published 2008
Third edition published 2013
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ISBN 978–0–19–969840–0
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Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check the
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not accept responsibility or legal liability for any errors in the text or for the misuse
or misapplication of material in this work. Except where otherwise stated, drug
dosages and recommendations are for the non-pregnant adult who is not
breast-feeding.
v
Contents

Preface vi
Acknowledgements vii
Abbreviations ix
Contributors xxiii
1 Normal pregnancy 1
2 P regnancy complications 49
3 F etal medicine 107
4 I nfectious diseases in pregnancy 155
5 M edical disorders in pregnancy 185
6 L abour and delivery 263
7 O bstetric anaesthesia 327
8 N eonatal resuscitation 339
9 P ostnatal care 349
10 O bstetric emergencies 373
11 P erinatal and maternal mortality 403
12 B enign and malignant tumours in pregnancy 419
13 S ubstance abuse and psychiatric disorders 429
14 G ynaecological anatomy and development 457
15 N ormal menstruation and its disorders 501
16 E arly pregnancy problems 525
17 G enital tract infections and pelvic pain 549
18 S ubfertility and reproductive medicine 569
19 S exual assault 613
20 C ontraception 621
21 M enopause 635
22 U rogynaecology 653
23 B enign and malignant gynaecological conditions 685
24 M iscellaneous gynaecology 771
Index 799
vi
Preface
Welcome to the third edition of this Oxford Handbook. In obstetrics and
gynaecology, as in all fi elds of medicine, the available evidence, technology
and guidelines can move forward at a rapid pace and often prove diffi cult
to keep up with. As the majority of junior doctors are well aware, the
gaps in our knowledge often become apparent at the most inopportune
moments; this book seeks to fi ll those gaps rapidly and effectively. It uses
the well-known Oxford Handbook format to facilitate easy navigation
around concise, clinically relevant, evidence-based information. It can be
quickly dipped into for specifi c answers between seeing patients in clinic or
on delivery suite, as well as providing a solid, general grounding for those
just beginning in the specialty. It also has suffi cient depth and detail to pro-
vide a good starting point in the preparation for postgraduate exams. To
ensure the most up-to-date information is always available, emphasis has
been placed on providing relevant web addresses, especially for guidelines
and useful organizations. Text boxes have also been employed to help
highlight some of the more important pieces of information.
Although this handbook is most likely to be used by trainees within the
specialty, we envisage it will be useful for all those involved in women’s
health, including GPs, midwives, and medical students. We hope you fi nd it
a helpful resource and that it proves to be a valuable companion and guide
in your everyday practice of obstetrics and gynaecology.
vii
Acknowledgements
We would like to thank all our second edition authors, especially the
trainees at the John Radcliffe and St George’s hospitals. Additionally, we
are very grateful to those who have gone the extra mile to ensure that
our third edition chapters are up to date, especially Charlotte Bennett,
Lucy MacKillop, and Jo Morrison who reviewed the highly specialized
areas of neonatology, maternal medicine, and oncology to ensure that
they contained the best available evidence. We would also like to thank
the doctors of all grades who anonymously reviewed some of the text,
providing valuable feedback and further fi ne-tuning the fi nished manu-
script. To conform to the Oxford Handbook style and to avoid overlap
and repetition, some contributions have been considerably edited and we
thank all our authors for their understanding. We are most grateful to
Prof. Basky Thilaganathan for providing many of the ultrasound images
and Ms Penny Trotter for the colposcopy pictures. Last, but defi nitely
not least, we would like to thank our partners and families who continue
to remain so patient and supportive throughout this project, especially
Berni O’Connor ‘for doing all the real work on the home front’ and David
Reynard ‘for putting up with all this’.
Sally Collins, Sabaratnam Arulkumaran,
Kevin Hayes, Simon Jackson, and Lawrence Impey
London and Oxford, October 2012
This page intentionally left blank
ix
Abbreviations

p primary
s secondary
+ve positive
–ve negative
A&E Accident and Emergency
AA Alcoholics Anonymous
AAT aspartate aminotransferase
ABC airway, breathing, and circulation
ABG arterial blood gases
AC abdominal circumference
ACE angiotensin converting enzyme
ACEI a ngiotensin-converting enzyme inhibitor
ACL anticardiolipin
ACTH adrenocorticotrophic hormone
ADH antidiuretic hormone
AEDF absent end diastolic fl ow
AF atrial fi brillation
AFE amniotic fl uid embolism
AFI amniotic fl uid index
AFLP acute fatty liver of pregnancy
AFP a lpha-fetoprotein
AIN peri-anal intraepithelial neoplasia
AIS androgen insensitivity syndrome
AJCC American Joint Committee on Cancer
ALP alkaline phosphatase
ALT alanine transaminase
AMH antimüllerian hormone
AN antenatal
ANA antinuclear antibody
APH antepartum haemorrhage