Textbook of Obstetrics and Gynaecology

644 Pages·2019·131.192 MB·English

by  Eric A.P. Steegers, Bart C.J.M. Fauser, Carina G.J.M. Hilders, Vincent W.V. Jaddoe, Leon F.A.G. Massuger, Joris A.M. van der Post, Sam Schoenmakers

Textbook of
Obstetrics and
Gynaecology

A life course approach
Editors:
Eric A.P. Steegers (editor-in-chief)
Bart C.J.M. Fauser
Carina G.J.M. Hilders
Vincent W.V. Jaddoe
Leon F.A.G. Massuger
Joris A.M. van der Post
Sam Schoenmakers
Textbook of Obstetrics and Gynaecology
Editors:
Eric A.P. Steegers (editor-in-chief)
Bart C.J.M. Fauser
Carina G.J.M. Hilders
Vincent W.V. Jaddoe
Leon F.A.G. Massuger
Joris A.M. van der Post
Sam Schoenmakers
Textbook of Obstetrics
and Gynaecology
A life course approach
ISBN 978-90-368-2130-8 ISBN 978-90-368-2131-5 (eBook)
https://doi.org/10.1007/978-90-368-2131-5
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V
Life cycle and structure of the book
The cover of the book shows a figure of the human woman’s body adapts to the needs of the growing
life cycle. It depicts a series of distinct, bounded life foetus. This affects reproductive aging and perimeno -
stages through which an individual passes his or her pausal and postmenopausal health. Towards the end
lifetime. A life course approach to women’s health of life, there is a decline in functional capacity and
recognizes the long-term effects during these stages health. The rate of decline depends on both contem-
of biological, behavioural – including lifestyle – and porary influences and the level of peak function
social exposures on health later in life and across attained earlier in life.
generations. Life time health starts with preconcep-
tion parental gametogenesis and subsequent foetal Applying the life course approach to a new textbook
growth and development. After birth, neonatal of Obstetrics and Gynaecology implicates a funda-
health is further built on during infancy and child- mental change in the structure and contents of such
hood. Health also becomes dependent on learned a volume. After an introduction to this approach,
habits and behaviours. During adolescence, the parts II, III and IV of the book follow the inner cir-
child reaches puberty and becomes sexually aware. cle of parental health, conception, foetal life, birth
This represents the inner circle of the cover figure. and subsequent growth and development up to and
In early adulthood the life cycle is initiated again – including reproductive age. Parts V, VI and VII of
in many but not all people – by the conception and the book follow the aging woman towards the post-
birth of one’s own children. With pregnancy the menopause and old age.
conception childhood
and and reproductive
foetal health adolescence health
introduction to
a life course
approach
maternal peri- & post-
reproductive
adaptation to menopausal
aging
pregnancy health
Foreword by Lucilla Poston
I find it immensely refreshing to see a textbook of none can be considered in isolation to the other.
obstetrics and gynaecology that, uniquely, encom- Pregnancy may be just nine months in duration, but
passes the continuum of health in women from the complications in pregnancy do not inevitably end at
early reproductive years through to the menopause delivery, and may adversely influence the mother’s
and beyond. I congratulate the editors and authors health for many years beyond. By emphasizing that
for their vision, as it fulfils the need for a clinical we should look back across the life course of repro-
and educational response to modern thinking. The ductive health, as well as understand societal and
traditional clinical ‘silos’ of obstetrics and gynaecol- demographic health factors, this book also under-
ogy do no service to the now widely appreciated ‘life pins the need for healthy aging and quality of life in
course’ approach to health, and thereby to disease, the contemporary management of postmenopausal
which has arisen from more than two decades of women, and those with gynaecological disease.
intensive research into the ‘Developmental Origins
of Health and Disease hypothesis’. As the health of Unquestionably, as they read the chapters of this
the early embryo is potentially the most modifiable well-constructed book, healthcare practitioners with
and effective means of ensuring a healthy start in life the responsibility for looking after women, whether
for the next generation of children, all students and as adolescents, in pregnancy or in the post repro-
healthcare professionals, and indeed all young peo- ductive years, will be left in no doubt that optimal
ple, should understand the importance of the health patient care will be predicated by both a multidisci-
of young women (and men) well before conception. plinary and life course approach.
This textbook emphasizes this essential perspective
on a healthy start to life, but does not stop there, as Professor Lucilla Poston PhD, FRCOG, FMedSci
the reader is taken through the cycle of health in President, International Society for the Developmental
infancy, then adolescence, sexual health and towards Origins of Health and Disease (DOHaD).
pregnancy in the next generation, illustrating that
VII
Foreword by Pauline Meurs
This Textbook of Obstetrics and Gynaecology: a life This textbook gives excellent insight into what is
course approach is one of the first educational text- needed to deliver a good quality of care, care that is
books adopting this approach to women’s health. based on research outcomes, on experiences of the
women treated and on a detailed analysis of the con-
There has been growing recognition that using a life text and preferences involved.
course approach for women’s health is vital for the
prenatal period and has added value in early child- The authors make a very clear and compelling argu-
hood. It also enhances health during reproductive ment for the necessity of working together in teams
aging and perimenopause and postmenopause, and and of trespassing the borders of the disciplines
may affect risks and outcomes of malignant disease. involved. Good care also means working from com-
Focusing on the life course means a paradigmatic munity to hospital and back: seamless care with a
change of our view of how to treat women: it entails responsible multidisciplinary team.
a shift from disease management to health manage-
ment. Treatment and support are based on personal, I am convinced that this textbook with its innova-
participative and context-based factors. Taking into tive approach to women’s health will serve as a guide
account the context means that alongside the evi- for many students and gynaecology residents and
dence based on randomized controlled trials and enable them to systematically take into account the
other scientific research, other types of knowledge perspective of the patient and her context. Hope-
have to be considered: the individual preferences of fully the textbook will also inspire other profession-
women, underlying values, social, ethnic and cul- als who contribute to the improvement of women’s
tural aspects, clinical setting and living conditions at health, and healthcare.
home.
Professor Pauline Meurs
Context-based care is a continuous process of col- Health Care Governance
lective learning and improvement, weighing vari- Erasmus University
ous different resources of knowledge and integrating Chair of the Council for Public Health and Society
them into practice. It is essential to use the ‘patient in the Netherlands
experience’ as an outcome variable when research-
ing the effectiveness of this approach.
The role of the gynaecologist, midwife, nurse, gen-
eral practitioner, social worker and other profes-
sionals involved in the care of (pregnant) women is
to provide information and help women in making
appropriate choices. Information regarding possible
benefits, potential risks and alternatives will allow a
woman to choose the most appropriate treatment in
line with her personal circumstances.
Foreword by Lesley Regan
Over the course of my career as a clinical aca- post reproductive life. These various interactions offer
demic working in the specialty of Obstetrics and multiple opportunities for healthcare professionals
Gynaecology, I have witnessed an important and to provide women with consistent, evidence-based
significant shift in attitudes towards the delivery of information that allows them to make informed deci-
women’s healthcare. When I graduated from medi- sions about their own healthcare choices. It is also an
cal school in 1980, the majority of doctors from my opportunity to promote healthy lifestyles that will
generation had received a traditional training which have a positive impact on that woman’s future health
was geared towards delivering a disease intervention as well as that of any children she may have.
service. With a few notable exceptions, we tended
to see our patients – both girls and women – only Organizations such as the Royal College of Obste-
when they developed a problem that needed to be tricians and Gynaecologists and the World Health
treated during their adolescent, reproductive or Organization have long advocated for a life course
post reproductive years. More recently this perspec- approach to women’s healthcare to be adopted uni-
tive has begun to be challenged, with the realiza- versally. Achieving this goal will require several
tion that clinicians can serve girls and women much important shifts in emphasis and philosophy –
more effectively by adopting a continuous life course within the profession itself, among policy-makers,
approach to the delivery of women’s healthcare. and in the organization of both health and social care
services to ensure they are fully integrated and truly
This life course approach focuses on the promotion woman-centred. Technological advances are help-
of good health, wellbeing and the prevention of ill ing to support these changes in service delivery, with
health, instead of merely providing treatment options more screening, advice, diagnostic services and one
for established disease. It also provides the opportu- stop clinical procedures being delivered in a day case
nity to respond appropriately to any contemporary setting closer to the woman’s home, rather than in a
demographic challenges. For example, thanks to sig- traditional hospital inpatient setting.
nificant improvements in infant and child health our
world now contains the largest population of adoles- This new edition of the Textbook of Obstetrics and
cents in history. We must address their sexual and Gynaecology is an important step towards engaging
reproductive health needs as a matter of urgency, the global medical profession and enthusing them
since we know that this will have an important with the concept and the benefits of a life course
impact on the quality of their lives and future health approach to women’s health. The authors empha-
requirements. Furthermore, as our life expectancy size the importance of a multidisciplinary, public
increases, most women of my generation will need to health approach, demonstrating clearly to clinicians
plan for the fact that they are likely to spend a longer the benefit of a life course perspective and what this
proportion of their lives in a post reproductive state will mean for them in their day to day practice. This
than they did in their reproductive era. is an invaluable addition to the literature on the
life course approach to women’s health, and I hope
Most girls and women have predictable long-term it will do much to inspire current and future gen-
reproductive healthcare needs, which means that the erations of obstetricians and gynaecologists to help
practical implementation of services to accompany make the concept a reality.
a life course approach is a relatively simple plan-
ning exercise, if logical solutions and pathways are Professor Lesley Regan MD, DSc, FRCOG
adopted. Helpfully, women tend to visit healthcare President, Royal College of Obstetricians and
practitioners more than men – frequently when they Gynaecologists
are going through normal everyday life events, such Head of Department of Obstetrics & Gynaecology,
as requesting contraception, seeking advice about St Mary’s Hospital at Imperial College, London
menstrual issues, when trying to conceive, dur- Director Imperial Women’s Health Research Centre
ing pregnancy, after the birth of their baby or while Chair UK National Confidential Enquiry into
experiencing the menopause and transitioning into Patient Outcome and Death (NCEPOD).
IX
Foreword by Jan MM van Lith
The Dutch College of Obstetrics and Gynaecology Knowledge of these relationships and connections
(NVOG) aims to provide the best quality of care for is of great importance to understand the underlying
women of all ages (7 www.nvog.nl). We have adopted mechanisms. Students, trainees and professionals
Machteld Huber’s (2011) definition of health as our should be educated in this way. This will contrib-
perspective for women’s health. This entails the abil- ute to improving doctors’ skills and ultimately lead
ity to adapt and self-manage in physical, mental to the best quality of care for women of all ages.
and social domains. The college defines and sets the This textbook underlines the importance of this
standards for continuous improvement of care using approach and will help to bring women’s health to
its quality cycle. the next level by providing professionals with the
tools to do so.
Knowledge gaps are identified and defined, the sci-
entific agenda is set, research is stimulated, per- This new textbook, following a long tradition of
formed and monitored. The outcomes are written Dutch textbooks, again proves that the Netherlands
in standards for clinical practice, implementation is in the frontline of translating new insights into
is facilitated and care is validated to close the circle clear concepts and making them available for pre-
towards the identification of new knowledge gaps. sent and future generations of professionals active in
Obstetrics and Gynaecology.
Prevention is one the most important issues in the
future of health, next to personalized and regenera- Indeed, I highly recommend this textbook!
tive medicine. Awareness and understanding of the
social context and its influence on health is of major Professor Jan MM van Lith
importance for professionals. President, Dutch College of Obstetrics and Gynae-
cology
The approach of this textbook underlines and sup-
ports the aims of our college and will contribute to
improve women’s health.
From the perspective of the life course approach
this new textbook is completely in accordance with
social developments and views on medical care of
the future. Obstetrics and Gynaecology are pre-
eminently positioned in the cycle of life. Already
for decades, gynaecologists are involved in the care
of women from cradle to grave. More and more we
are becoming aware that all phases of life are linked.
Events in one phase may influence and/or can be
predictive for events in a later phase and even for
health and disease across generations. Such events
can be illnesses, genetic profiles, environmental
effects and healthy behaviour.
Preface editors
This new ‘Textbook of Obstetrics and Gynaecology: a The same is true now, as the current understanding
life course approach’ marks the end of seven very suc- directs us towards a life course approach to women’s
cessful editions of the Dutch Textbook ‘Obstetrie en health which should be leading in the way care is
Gynaecologie, de voortplanting van de mens’. Since provided. As illustrated by the life cycle figure on the
the first edition was released in 1993, it has not only front cover, a woman’s life is a continuum composed
been the leading textbook in the curricula of Dutch of a series of bounded life stages ‘from the cradle to
medical and midwifery schools but has also played an the grave’. This continuum biologically starts during
important role in the training of gynaecologists and parental preconception gametogenesis and subse-
served as a book of reference for doctors of all speci- quent embryonic and foetal development and will
alities as well as midwives. Its high standards can be transpire throughout life. The different life course
attributed to the vision and dedication of the succes- stages of each individual consecutively prepare and
sive editors Professor P.E. Treffers (first two editions) determine health outcome and wellbeing (. fig. 1).
and Professor M.J. Heineman (third to seventh edi- Intrinsically, this is not limited to one’s own lifetime
tion) and a large team of vastly committed authors, as the reproductive health of couples also affects the
all leading Dutch gynaecologists in their fields. health of future generations.
These editions followed up on the textbook ‘De Such a life course approach in obstetric and gynae-
voortplanting van de mens. Leerboek voor Obstetrie cological patient care provides a path towards
en Gynaecologie’ edited by Professor G.J. Klooster- healthy aging, with specific attention for lifestyle,
man, the first edition of which was released in 1973. prevention and the social context. This requires a
The fast development of translational and clini- change in mindset of women’s healthcare providers
cal research and changing perspectives in how care to feel responsible not only for managing disease but
should be provided made a new standard textbook also for managing health. Both in clinical care and
necessary in 1993. research, development of new strategies will focus
on the earliest origins of life. On the other side of
burden of disease
effects intervention
healthy aging
conception & childhood & reproductive maternal adaptation peri- & post-
reproductive aging
foetal health adolescence health to pregnancy menopausal health
exposures biological, behavioural & social
preconception antenatal
clinical care multidisciplinary care & networking medicine
care care
research developmental origins of women-centred
health and disease
education blended learning programmes
.Figure 1 Shifts in paradigms related to a life course approach