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An Evidence-Based Clinical Textbook in Obstetrics & Gynaecology for MRCOG-2
Richa Saxena
SECTION 1: GENERAL PRINCIPLES
CHAPTER 1:
Principles of Clinical Practice
INTRODUCTION
ETHICAL PRACTICE OF MEDICINE
Ethical Principles for Medical Research and Practice
Respect for the Patients
Beneficence
Justice
The Ethical Confidentiality
Informed Consent
Elements of Informed Consent
Surgical Competence as a Moral Commitment
PATIENT COMMUNICATION AND COUNSELLING
Verbal Communication
Non-verbal Communication
Written Communication
Clinical Records
Communication with an Angry or Complaining Patient
Patient Counselling
Insecurity
Anxiety or Fear
Regression and Dependency
Grief and Depression
CLINICAL GOVERNANCE
Practice of Evidence-based Medicine
Steps of Evidence-based Medicine
Research and Development
Different Types of Trials or Research Studies in Clinical Practice
Risk Management
Process of Risk Management
Clinical Audit
Definition
Steps of Audit Cycle
Education, Training and Continuing Professional Development
Stimulation Training
Levels of Training
Openness or Accountability
LEGAL RIGHTS OF WOMAN, UNBORN AND NEWBORN CHILDREN
The Mental Capacity Act 2005
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 2:
General Principles of Surgery
INTRODUCTION
PREOPERATIVE PRINCIPLES IN SURGERY
Confidentiality and Informed Consent
History
Clinical Examination
General Physical Examination
Systemic Examination
Laboratory Investigations
Routine Investigations
Other Investigations
Preoperative Management Prior to Surgery17
One Day Prior to Surgery
ROLE OF THE ANAESTHETIST
Types of Anaesthesia
General Anaesthesia
Local Anaesthesia
Conscious Sedation
Preparation Just Prior to Surgery
INTRAOPERATIVE CARE PRINCIPLES
Principles of Asepsis
SURGICAL EQUIPMENT
Diathermy
Precautions
Complications of Diathermy
Laparoscopy
Hysteroscopy
POSTOPERATIVE CARE
Introduction
1. Immediate Postoperative Care (Theatre Recovery)
2. Early Postoperative Care
3. Late Postoperative Care
Wound Care
Requirement for Hormone Replacement Therapy
Physical Activity
Discharge from the Hospital
Follow-up Visits
POSTOPERATIVE COMPLICATIONS
Haemorrhage
Primary Haemorrhage
Secondary Haemorrhage
Postoperative Febrile Morbidity
Pulmonary Complications
Urinary Tract Complications
Urinary Infection
Urinary Retention
Gastrointestinal Complications
Postoperative Ileus
Intestinal Obstruction
Venous Thrombotic Events
Prevention
Postoperative Infection
Prevention
Wound Infection at the Incision Site
Cystitis
POSTOPERATIVE ANALGESIA
Effects of Postoperative Pain
Non-pharmacological Methods
Pharmacological Management
Non-steroidal Anti-inflammatory Agents
Opiates
Patient-Controlled Analgesia
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
SECTION 2: ANTENATAL PERIOD
CHAPTER 3:
Routine Antenatal Care
INTRODUCTION
ANTENATAL APPOINTMENTS
Frequency of Antenatal Appointments
PRINCIPLES OF MATERNAL RISK ASSESSMENT
AIMS
DIAGNOSIS
Clinical Examination
Breast Examination
Abdominal Examination
Pelvic Examination
Investigations
Screening Tests
MANAGEMENT
Nutritional Advice
Travelling during Pregnancy
Management of Common Symptoms of Pregnancy
Antenatal Foetal Monitoring
Provision of Antenatal Information
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 4:
Biochemical and Ultrasound Screening for Foetal Anomalies
BIOCHEMICAL SCREENING FOR NEURAL TUBE DEFECTS
Levels of Alpha-foetoprotein
BIOCHEMICAL SCREENING FOR DOWN'S SYNDROME
First Trimester Biochemical Screening
Second Trimester Biochemical Screening
Integrated Screening
National Recommendations for Down's Syndrome Screening
Preimplantation Genetic Diagnosis
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
EARLY PREGNANCY SCAN
Routine Ultrasound Scan at 18 to 20+6 Weeks
Cardiac Anomalies
Thoracic Malformations
Gastrointestinal and Abdominal Wall Malformations
Urogenital Malformations
Skeletal Malformations
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 5:
Invasive Prenatal Diagnosis
INTRODUCTION
OVERVIEW OF SURGERY
Amniocentesis
Chorionic Villus Biopsy
Cordocentesis
INDICATIONS
DIAGNOSIS
Investigations
SURGICAL MANAGEMENT
Preoperative Preparation
Surgical Steps
Amniocentesis
Chorionic Villus Sampling
Cordocentesis
Postoperative Care
COMPLICATIONS
Amniocentesis
Miscarriage
Chorioamniotic Separation
Infection
Rare Injuries
Preterm Premature Rupture of Membranes and Preterm Labour
Amniotic Fluid Leakage
Vertical Transmission
Chorionic Villus Sampling
Cordocentesis
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 6:
Tests for Foetal Well-Being
INTRODUCTION
INDICATIONS
MANAGEMENT
Biochemical Tests of Placental Function
Ultrasound Examination
Ultrasound Grading of Placenta
Doppler Sonography
Foetal Movement Count
Cardiotocography
Non-stress Test
Indications for Doing a Non-stress Test
Contraction Stress Test
Biophysical Profile
Modified Biophysical Profile
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
SECTION 3: MEDICAL DISORDERS DURING PREGNANCY
CHAPTER 7:
Hypertensive Disorders during Pregnancy
INTRODUCTION
AETIOLOGY
Risk Factors for Pre-eclampsia
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Investigations
OBSTETRIC MANAGEMENT
Prevention
Antenatal Care
Antihypertensive Medications
Fluid Therapy
Mode of Birth
Foetal Monitoring
Timing of Birth
Anticonvulsants
Anaesthesia
Intrapartum Care
Postnatal Period
Breastfeeding
Weight Management
Medical Care
COMPLICATIONS
HELLP Syndrome
CLINICAL PEARLS
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Symptoms
Investigations
DIFFERENTIAL DIAGNOSIS
OBSTETRIC MANAGEMENT
Immediate Management
Intrapartum Management
Postnatal Period
COMPLICATIONS
Maternal
Foetal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Investigations
OBSTETRIC MANAGEMENT
Antenatal Care
Foetal Monitoring
Timing of Birth
Intrapartum Care
For Women with Mild or Moderate Hypertension
For Women with Severe Hypertension
Postnatal Care
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Physical Examination
Investigations
OBSTETRIC MANAGEMENT
Prevention
Antenatal Care
Timing of Birth
Foetal Monitoring
Antihypertensive Treatment
Intrapartum Care
Mild or Moderate Hypertension
Severe Hypertension
Postnatal Care
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 8:
Cardiac Disease in Pregnancy
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
General Physical Examination
Abdominal Examination
Examination of Cardiovascular System
Investigations
MANAGEMENT
Antenatal Care
Intrapartum Care
Postpartum Period
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 9:
Thyroid Disorders during Pregnancy
INTRODUCTION
Functioning of the Thyroid Gland
Changes in the Thyroid Gland during Pregnancy
Thyroid Function Tests during Pregnancy
AETIOLOGY
Hyperthyroidism
Hyperemesis Gravidarum and Hyperthyroidism
Hypothyroidism
Postpartum Thyroiditis
Thyroid Cancer in Pregnancy
DIAGNOSIS
Clinical Presentation
Hypothyroidism
Hyperthyroidism
Investigations
Hyperthyroidism
Hypothyroidism
MANAGEMENT
Hyperthyroidism
Hypothyroidism
COMPLICATIONS
Hyperthyroidism
Hypothyroidism
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 10:
Connective Tissue Disorders (Autoimmune Disorders)
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
OBSTETRIC MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Physical Examination
Investigations
Imaging Studies
MANAGEMENT
COMPLICATIONS
EVIDENCE-BASED MEDICINE
CHAPTER 11:
Respiratory Diseases in Pregnancy
INTRODUCTION
AETIOLOGY
Changes in the Respiratory System during Pregnancy
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Antepartum Period
Intrapartum Period
Postpartum Period
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
Risk Factors
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Antepartum Period
Intrapartum Period
COMPLICATIONS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 12:
Epilepsy and Other Neurological Disorders
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Antepartum Period
Intrapartum Care
Postpartum Care
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Postpartum Period
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Antepartum Period
Intrapartum Period
Postpartum Period
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 13:
Hepatic and Gastrointestinal Diseases
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
MANAGEMENT
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 14:
Anaemia and Other Haematological Abnormalities
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
General Physical Examination
Investigations
MANAGEMENT
Antenatal Period
Antenatal Visits
Dietary Changes
Iron Supplements
Blood Transfusion
Erythropoietin
Prevention or Prophylaxis
Intrapartum Period
COMPLICATIONS
Maternal
Foetal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
General Physical Examination
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
Peripheral Smear
Screening and Counselling Prepregnancy
MANAGEMENT
Periconceptional Care
Antenatal Care
Intrapartum Care
Postpartum Care
COMPLICATIONS
Maternal
Foetal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
Neonatal Disease Screening
Peripheral Smear
MANAGEMENT
Preconceptual Care
Antenatal Period
Intrapartum Care
Postpartum Period
COMPLICATIONS
Maternal
Foetal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
DEEP VEIN THROMBOSIS
INTRODUCTION
AETIOLOGY
Causes of Deep Vein Thrombosis during Pregnancy
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
PULMONARY EMBOLISM
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 15:
Diabetes Mellitus and Gestational Diabetes
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Investigations
MANAGEMENT
Antenatal Period
Management during the Intrapartum Period
Neonatal Care
Postnatal Care
COMPLICATIONS
Effect of Diabetes on the Foetus
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 16:
Abdominal Pain during Pregnancy
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Investigations
MANAGEMENT
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 17:
Malignancy during Pregnancy
INTRODUCTION
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Effect of Radiotherapy during Pregnancy
Effect of Chemotherapy during Pregnancy
Symptomatic Management
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Management of Pregnancy Following Treatment for Breast Cancer
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Physical Examination
Investigations
MANAGEMENT
Management of Preinvasive Lesions
Management of Invasive Disease
Gestational Age at or before 16 Weeks
Gestational Age of More Than 16 Weeks
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
Serum CA-125 Levels
Ultrasonography
Computed Tomography and Magnetic Resonance Imaging
Estimation of the Risk of Malignancy
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 18:
Dermatological Disorders during Pregnancy
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation and Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 19:
Renal Disease during Pregnancy
INTRODUCTION
AETIOLOGY
Risk Factors
DIAGNOSIS
Clinical Presentation
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Asymptomatic Bacteriuria
Acute Pyelonephritis
COM PLICATIONS
CLINICAL PEARLS
EVID ENCE-BASED MEDICINE
IN TRODUCTION
A ETIOLOGY
DIAG NOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 20:
Infection during Pregnancy
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Antepartum Period
Intrapartum Period
Postpartum Period
COMPLICATIONS
Maternal
Foetal
Neonatal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Investigations
MANAGEMENT
Intrapartum Management
Postpartum Period
Management of the Neonate
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Investigations
MANAGEMENT
Antenatal Period
Intrapartum Period
Postpartum Period
Care of the Newborn
COMPLICATIONS
Maternal
Foetal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Intrapartum Period
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Hepatitis A
Hepatitis B
General Management
Antepartum Period
Intrapartum Period
Postpartum Period
Hepatitis C and Pregnancy
Antepartum Period
Intrapartum Period
Postpartum Period
Hepatitis D
Hepatitis E
Hepatitis G
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 21:
Smoking during Pregnancy
INTRODUCTION
AETIOLOGY
Mechanism of Effect of Cigarette Smoke
Effects of Nicotine on the Body
DIAGNOSIS
History and Clinical Presentation
Investigations
Carbon Monoxide Test
MANAGEMENT
Nicotine Replacement Therapy
COMPLICATIONS
Maternal Effects
Pre-eclampsia
Abruptio Placentae
Increased Incidence of Spontaneous Abortions and Ectopic Pregnancy
Adverse Effect of Smoking on Lactation
Foetal Effects
Risk of Low-birthweight Babies, Prematurity and IUGR
Congenital Anomalies
Neonatal Effects
Problems Related to Cessation of Smoking
Addiction to Smoking
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 22:
Alcohol and Drug Usage during Pregnancy
INTRODUCTION
AETIOLOGY
Safe Drinking Limit during Pregnancy
DIAGNOSIS
History and Clinical Presentation
Investigations
MANAGEMENT
Prevention
Assisting People Born with Foetal Alcohol Syndrome and Alcohol-related Neurodevelopmental Disorders
COMPLICATIONS
Adverse Outcomes of Alcohol Consumption on the Reproductive Process
Relationship between Alcohol Consumption and Infertility
Adverse Effect of Alcohol in Pregnancy
Maternal Effects
Foetal Effects
FOETAL ALCOHOL SPECTRUM DISORDERS
Category 1: Foetal Alcohol Syndrome with Confirmed Maternal Alcohol Exposure
Category 2: Foetal Alcohol Syndrome without Confirmed Maternal Alcohol Exposure
Category 3: Partial Foetal Alcohol Syndrome
Category 4: Alcohol-related Birth Defects
Category 5: Alcohol-related Neurodevelopmental Disorder
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
Most Common Drugs
Cocaine
Narcotics and Opiates
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Antenatal Care
History
Clinical Tests
Counselling
Intrapartum Care
Postnatal Period
Pharmacotherapy for Drug Abuse
Methadone Maintenance Treatment
Newborn Opiate Withdrawal
COMPLICATIONS
Effect of Abuse of Opiates and Narcotics
Cocaine Use during Pregnancy
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
SECTION 4: COMPLICATIONS SPECIFIC TO PREGNANCY
CHAPTER 23:
Multifoetal Gestation
INTRODUCTION
AETIOLOGY
Types of Twin Gestation
Different Types of Monozygotic Twins
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Antenatal Period
Intrapartum Period
Time of Delivery
Delivery of the First Baby
Delivery of Second Baby
Mode of Delivery
COMPLICATIONS
Maternal
Antenatal Period
Labour
Puerperium
Foetal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 24:
Preterm Labour and Premature Rupture of Membranes
INTRODUCTION
AETIOLOGY
Risk Factors
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Investigations
MANAGEMENT
Obstetric Management
Medical Management
COMPLICATIONS
Maternal
Foetal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
Maternal
Foetal/Neonatal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 25:
Antepartum Haemorrhage
INTRODUCTION
AETIOLOGY
Risk Factors
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Vaginal Examination
Investigations
Maternal Investigations
Foetal Investigation
OBSTETRIC MANAGEMENT
Antepartum Period
Intrapartum Care
COMPLICATIONS
Maternal
Foetal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
Risk Factors
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Vaginal Examination
Investigations
OBSTETRIC MANAGEMENT
COMPLICATIONS
Maternal
Foetal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 26:
Rhesus Isoimmunisation
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Antenatal Period
Rh-negative Non-immunised Women
Administration of anti-D IgG
Rh-negative Immunised Women
Intrapartum Management
Precautions to be Taken at the Time of Delivery
COMPLICATIONS
Foetal
Maternal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 27:
Abnormal Presentation
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Vaginal Examination
Investigations
OBSTETRIC MANAGEMENT
Choosing the Route of Delivery for a Woman with Breech Presentation at Term
Management of Preterm Breech
Management of Twin Breech
External Cephalic Version
Timing of External Cephalic Version
Complications of External Cephalic Version
Contraindications to External Cephalic Version
Procedure of External Cephalic Version
Prerequisites for External Cephalic Version
Obstetric Procedure
Post-procedural Care
Elective Caesarean Delivery
Trial of Breech (Vaginal Breech Delivery)
Intrapartum Care for Patients Undergoing Breech Vaginal Delivery
Steps for Assisted Breech Vaginal Delivery
Manoeuvres for Delivery of the After-coming Head
Delivery of Baby's Shoulders
Delivery of the Posterior Shoulder
Delivery of Baby's Legs
Postdelivery Care
COMPLICATIONS
Complications Related to External Cephalic Version
Complications Related to Breech Presentation Per se
Foetal Complications
Maternal Complications
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Vaginal Examination
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
Maternal
Foetal Causes
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
OBSTETRIC MANAGEMENT
COMPLICATIONS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
Maternal Causes
Foetal Causes
DIAGNOSIS
Clinical Examination
Investigations
DIFFERENTIAL DIAGNOSIS
OBSTETRIC MANAGEMENT
COMPLICATIONS
Maternal
Foetal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Abdominal Examination
Vaginal Examination
Investigations
OBSTETRIC MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Vaginal Examination
Investigations
OBSTETRIC MANAGEMENT
Expectant Management
Intrapartum Management
First Stage of Labour
Second Stage of Labour and Delivery of the Baby
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Prevention and First Aid
Definitive Management
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 28:
Intrauterine Death
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
General Physical Examination
Abdominal Examination
Investigations
Confirmation of Intrauterine Foetal Death
Other Tests for Investigating the Cause of Intrauterine Foetal Death
Sexing the Baby
Cytogenetic Analysis of the Baby
Perinatal Postmortem Examination
MANAGEMENT
Prevention
Obstetric Management
Patient Counselling
Mode of Delivery of the Dead Foetus
Labour and Delivery
Psychological and Social Aspects of Care
Parental Contact with the Dead Baby
Legal Requirements for Medical Certification of Stillbirth
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 29:
Recurrent Miscarriage
INTRODUCTION
AETIOLOGY
Genetic Causes
Parental Chromosomal Abnormalities
Embryonic Chromosomal Abnormalities
Endocrine Factors
Luteal Phase Defect
Polycystic Ovary Syndrome
Hypothyroidism
Diabetes Mellitus
Hyperprolactinaemia
Maternal Infection
TORCH Group of Infections
Bacterial Vaginosis
Syphilis
Chronic Endometritis
Environmental Factors
Immune Causes
Autoimmune Factors
Alloimmune Factors
Anatomical Causes
Uterine Malformations
Asherman's Syndrome
Uterine Fibroids
Endometrial Polyps
Cervical Incompetence
Epidemiological Factors
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Psychological Support
Genetic Counselling
Control of Diabetes and Thyroid Dysfunction
Operative Hysteroscopy
Treatment of Endocrine Problems
Luteal Phase Defects
Progesterone Supplementation
Supplementation with Human Chorionic Gonadotrophin
Polycystic Ovarian Disease
Antiphospholipid Antibody Syndrome
Cervical Incompetence
Immunotherapy
Inherited Thrombophilia
Unexplained Recurrent Miscarriage
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 30:
Pregnancy after Previous Caesarean Delivery
INTRODUCTION
DIAGNOSIS
Clinical Presentation
General Physical Examination
Abdominal Examination
Investigations
MANAGEMENT
Antepartum Period
Antenatal Counselling
Women with History of Two or More Prior Caesareans
Intrapartum Period
Vaginal Birth after Caesarean
Elective Repeat Caesarean Section
COMPLICATIONS
Uterine Rupture
Types of Uterine Rupture
Assessment of Scar Integrity
Ultrasound Imaging for Visualisation of Scar Defects and Measurement of Scar Thickness
Management of Rupture Uterus
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 31:
Post-term Pregnancy (Prolonged Pregnancy)
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 32:
Liquor Abnormalities
OLIGOHYDRAMNIOS
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
OBSTETRIC MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Investigations
MANAGEMENT
COMPLICATIONS
Maternal
Foetal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 33:
Maternal Mortality
INTRODUCTION
Definitions
Maternal Death
Maternity
Maternal Mortality Rate
WORLDWIDE TRENDS IN MATERNAL MORTALITY
TRENDS IN MATERNAL MORTALITY IN THE UK
CONFIDENTIAL ENQUIRIES INTO MATERNAL DEATHS
Prevention of Mortality Related to Cardiovascular Diseases
Prevention of Deaths due to Neurological Disorders
Prevention of Deaths due to Mental Health Problems
Prevention of Deaths due to Pre-eclampsia
Reducing the Mortality Related to Early Pregnancy Complications
Messages Related to Critical Care Support
CONCLUSION
CHAPTER 34:
Medications during Pregnancy
INTRODUCTION
Maternal Physiology during Pregnancy
Medications during Lactation
Drug Pharmacokinetics in Pregnancy
AETIOLOGY
Teratogenesis
Teratogenic Drugs in Pregnancy
Antibiotics to be Avoided during Pregnancy
Safe Drugs during Pregnancy
Drugs Contraindicated during Lactation
Drugs Which can be Used During Breastfeeding
DIAGNOSIS
Prenatal Diagnosis
MANAGEMENT
Counselling and Evaluation of a Drug-exposed Pregnant Patient
Preconceptional Counselling
Counselling the Exposed Gravida
Informed Consent and Postexposure Counselling
COMPLICATIONS
Potential Adverse Effects
Spontaneous Abortion
Congenital Anomalies
Foetal Effects
Neonatal and Postnatal Effects
SECTION 5: COMPLICATIONS IN THE EARLY PREGNANCY
CHAPTER 35:
Ectopic Pregnancy
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
General Physical Examination
Abdominal Examination
Pelvic Examination
Investigations
Blood Group Typing (ABO and Rh Type)
Urine or Serum β-hCG Levels
Imaging Studies
Other Tests
Serum Progesterone Levels
Colour Flow Doppler Examination
Magnetic Resonance Imaging
Diagnostic Procedures
DIFFERENTIAL DIAGNOSIS
Obstetric Causes
Gynaecological Causes
Non-gynaecological Diseases
MANAGEMENT
EXPECTANT MANAGEMENT
Pregnancy of Unknown Location
MEDICAL MANAGEMENT
SURGICAL MANAGEMENT
Salpingostomy versus Salpingectomy
Types of Surgical Approach
Laparoscopic Surgery
Laparotomy
Surgical Procedures at the Time of Laparotomy
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 36:
Spontaneous Miscarriage
INTRODUCTION
Threatened Abortion
Inevitable Abortion
Incomplete Abortion
Missed Abortion
AETIOLOGY
Genetic Causes
Endocrinological Causes
Infections
Immunological Causes
Anatomical Causes
Antiphospholipid Antibody Syndrome
Absence of Blocking Antibodies as a Cause of Miscarriage
Risk Factors
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Abdominal Palpation
Vaginal Examination
Investigations
Diagnosis of Miscarriage Using Ultrasound
Role of Serial Human Chorionic Gonadotrophin Assessment in Predicting Pregnancy Outcome
Role of Serum Progesterone Assay in Predicting Pregnancy Outcome
MANAGEMENT
General Management
Management in Specific Cases
Threatened Abortion
Inevitable Abortion
Incomplete Abortion
Missed Abortion
Treatment of the Underlying Cause
Expectant Management
Medical Management
Surgical Management
Surgical Uterine Evacuation
COMPLICATIONS
Complications Associated with Miscarriage Process
Septic Abortion or Miscarriage with Sepsis
Complications Associated with Surgical Evacuation
Uterine Perforation
Infection
Incomplete Evacuation
Bleeding During and Following Abortion
Failure of Procedure
Hypotension
Minor Complications
Asherman's Syndrome
Cervical Lacerations/Cervical Incompetence
Complications Associated with Medical Method
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 37:
Gestational Trophoblastic Neoplasia
COMPLETE HYDATIDIFORM MOLE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
General Physical Examination
Vaginal Examination
Investigations
DIFFERENTIAL DIAGNOSIS
OBSTETRIC MANAGEMENT
Suction Evacuation
Hysterectomy with Mole in Situ
Follow-up
Investigation for Persistent Gestational Trophoblastic Neoplasia after a Non-molar Pregnancy
Investigation for Persistent Gestational Trophoblastic Neoplasia after Gestational Trophoblastic Disease
Contraception Following Gestational Trophoblastic Disease
Hormone Replacement Therapy for Women after Gestational Trophoblastic Disease
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
COMPLICATIONS
INTRODUCTION
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Non-metastatic Disease
Metastatic Disease
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
SECTION 6: FOETAL COMPLICATIONS (DIAGNOSIS AND MANAGEMENT)
CHAPTER 38:
Foetal Growth Restriction
INTRODUCTION
AETIOLOGY
DIAGNOSIS
History
Abdominal Examination
Investigations
Biochemical Markers
Ultrasound Biometry
Biophysical Tests
Changes Occurring in Various Doppler Velocity Waveforms in IUGR Foetuses (Flow chart 38.1)
Uterine Artery Doppler
Middle Cerebral Artery Doppler Studies
Umbilical Artery Doppler
Karyotyping
OBSTETRIC MANAGEMENT
ANTENATAL PERIOD
Management of the Diagnosed Cases of IUGR
Normal Findings on Umbilical Artery Waveform Analysis
Abnormal Findings on Umbilical Artery Waveform Analysis
Intrapartum Period
COMPLICATIONS
Foetal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 39:
Foetal Infection
RUBELLA INFECTION IN PREGNANCY
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Prophylaxis
Passive Prophylaxis
Active Prophylaxis
Foetal Management
COMPLICATIONS
CLINICAL PEARLS
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
PARVOVIRUS INFECTION
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CYOTOMEGALOVIRUS INFECTION
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
CLINICAL PEARLS
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
Diagnosis of the Mother
Diagnosis of the Foetus
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
CHAPTER 40:
Non-immune Foetal Hydrops
INTRODUCTION
AETIOLOGY
Disorders Associated with Non-immune Hydrops Foetalis
DIAGNOSIS
Clinical Presentation
Maternal Findings
Investigations
Ultrasound Examination
Maternal Tests
MANAGEMENT
Management in the Antenatal Period
Management in the Intrapartum Period
Treatment of the Underlying Condition
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 41:
Foetal Anomalies and Their Management
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Termination of Pregnancy
Termination of Pregnancy before 21+6 Weeks of Gestation
Termination of Pregnancy after 21+6 Weeks of Gestation
Method for Termination of Pregnancy
Post-termination Follow-up
Postmortem Examination
Decision for Continuation with Pregnancy
Foetal Surgery
1.In Utero Closure of Spina Bifida
2.Clip or Balloon Foetal Endoscopic Tracheal Occlusion (FETO)
3.Percutaneous Vesicoamniotic Shunting
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
SECTION 7: INTRAPARTUM PERIOD
CHAPTER 42:
Normal and Abnormal Progress of Labour
NORMAL LABOUR AND DELIVERY
INTRODUCTION
Latent Phase (Preparatory Phase)
Active Phase
AETIOLOGY
DIAGNOSIS
Clinical Presentation
General Physical Examination
Abdominal Examination
Per Speculum Examination
Vaginal Examination
Investigations
MANAGEMENT OF NORMAL LABOUR AND DELIVERY
Predelivery Preparation
Delivery
Delivery of Foetal Head
Delivery of Shoulders
Delivery of Rest of the Body
Clamping the Cord
Postdelivery Care
CLINICAL PEARLS
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Vaginal Examination
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 43:
Induction of Labour
INTRODUCTION
INDICATIONS
MANAGEMENT
Preprocedure Preparation
METHODS FOR INDUCTION
Pharmacological Methods
Dinoprostone
Misoprostol
Oxytocin
Other Pharmacological Methods for Induction of Labour
Non-pharmacological or Surgical Management
Low Rupture of Membranes
Procedure for Rupture of Membranes
Stripping of Membranes
Mechanical Methods
POSTPROCEDURAL CARE
Artificial Rupture of Membranes
INDUCTION OF LABOUR IN SPECIFIC CIRCUMSTANCES
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 44:
Anaesthesia and Analgesia in Labour
INTRODUCTION
METHODS OF PAIN RELIEF IN LABOUR
Non-pharmacological Methods
Parenteral Narcotics
Inhalation Methods
Entonox
Regional Analgesia in Labour
INDICATIONS
CONTRAINDICATIONS
SURGICAL MANAGEMENT (EPIDURAL ANALGESIA)
Preoperative Preparation
Steps of Surgery
Postoperative Care
COMPLICATIONS
Immediate
Delayed
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
Technical Advances
Combined Spinal Epidural Analgesia Technique
Low-dose Epidural Regimes
Patient-controlled Epidural Analgesia
Computer-integrated Patient-controlled Epidural Analgesia
Continuous Spinal Analgesia with Microcatheters
Newer Local Anaesthetics and Adjuvants
Use of Ultrasound to Study Neuraxial Anatomy and Localise Epidural Space
Myths and Controversies
Epidural Analgesia: Increased Rate of Operative and Instrumental Delivery
Timing of Epidural Analgesia during Labour
Early versus Delayed Pushing
Vaginal Birth after Caesarean and Epidural
SECTION 8: DELIVERY AND ITS COMPLICATIONS
CHAPTER 45:
Caesarean Delivery
INTRODUCTION
INDICATIONS
Maternal Request for Caesarean Delivery
SURGICAL MANAGEMENT
Preoperative Preparation
Surgical Steps
Giving an Abdominal Skin Incision
Excision of Previous Scar
Dissecting the Rectus Sheath
Opening the Peritoneum
Insertion of the Doyen's Retractor
Giving a Uterine Incision
Location of the Uterine Incision
Delivery of the Infant
Placental Removal
Closing the Uterine Incision
Peritoneal Closure
Closure of the Rectus Sheath
Closure of Subcutaneous Space
Skin Closure
Postoperative Care
Immediate Postoperative Care
Pain Management after Caesarean Section
Fluids and Oral Food after Caesarean Section
Ambulation after Caesarean Section
Dressing and Wound Care
Length of Hospital Stay
ALTERNATIVE TECHNIQUES FOR CAESAREAN DELIVERY
Misgav-Ladach Technique
Pelosi's Technique
Haemostatic Caesarean Section
Classical Caesarean Section
Procedure
Avoiding a Classical Uterine Incision
COMPLICATIONS
Uterine Rupture
Infection
Trauma to the Urinary Tract
Thromboembolism
Obstetric or Caesarean Hysterectomy
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 46:
Instrumental Vaginal Delivery
INTRODUCTION
SURGICAL EQUIPMENT USED
Forceps
Types of Vacuum Devices
INDICATIONS
Maternal Indications
Foetal Indications
Contraindications
Use of Vacuum for Operative Vaginal Delivery
Contraindications for Forceps Application
MANAGEMENT
Forceps Delivery
Prerequisites for Forceps Delivery
Steps for Application of the Forceps13,14
Identification of the Forceps Blades
Steps of Vacuum Extraction in Occipitoanterior Position
Placement of Vacuum Cup over the Foetal Head
Creation of Vacuum Suction
Force of Traction
Using the ‘ABCDEFGHIJ’ Mnemonic
Postdelivery Examination
Maternal Examination
Neonatal Examination
Follow-up
COMPLICATIONS
Forceps
Maternal Complications
Injuries to Baby
Vacuum
Cephalohaematomas
Subgaleal or Subaponeurotic Haematomas
Intracranial Haemorrhage
Shoulder Dystocia
Retinal Haemorrhage
Transient Neonatal Lateral Rectus Palsy
CLINICAL PEARLS
Vacuum versus Forceps
EVIDENCE-BASED MEDICINE
Forceps versus Vacuum44–49
CHAPTER 47:
Shoulder Dystocia
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
MANAGEMENT
McRobert's Manoeuvre
Suprapubic Pressure
Enter the Pelvis Manoeuvres15
Delivery of the Posterior Arm
All-Four Manoeuvre16
Third-Line Manoeuvres
COMPLICATIONS
Foetal and Neonatal Complications
Brachial Plexus Injuries20
Fractured Clavicle
Neurological Injury
Maternal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 48:
Perineal Injuries
INTRODUCTION
AETIOLOGY
Anatomical Considerations
Risk Factors
MANAGEMENT
Repair of Perineal Tears
Preoperative Preparation
Surgical Steps
Postoperative Care
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 49:
Antepartum and Intrapartum Foetal Asphyxia
INTRODUCTION
AETIOLOGY
DIAGNOSIS
FOETAL HYPOXIA IN THE ANTEPARTUM PERIOD
Electronic Foetal Monitoring
Features of the Heart Rate Observed on the Cardiotocograph
Sinusoidal Pattern
Categorisation of FHR Traces and Outcome
FOETAL HYPOXIA IN THE INTRAPARTUM PERIOD
Intermittent Auscultation
Adjuvant Tests of Foetal Well-being
Foetal Scalp Blood Sampling
Foetal Scalp Lactate Measurement
Foetal Pulse Oximetry
Foetal Electrocardiogram Analysis
Other Tests
MANAGEMENT
General Management
Definite Management
Planning Delivery
COMPLICATIONS
Meconium Aspiration Syndrome
Cerebral Palsy
Hypoxic-ischaemic Encephalopathy
Diagnosis
Pathophysiology:33–37
Classification of the Degree of Encephalopathy
Treatment39
Medical Treatment
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
SECTION 9: POSTPARTUM PERIOD
CHAPTER 50:
Postpartum Haemorrhage and Postpartum Collapse
POSTPARTUM HAEMORRHAGE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
General Physical Examination
Abdominal Examination
Per Speculum Examination
Investigations
MANAGEMENT
Antenatal Period
Intrapartum Period
Management of Atonic Uterus
Repair of Vaginal and Perineal Injuries
The Placenta has yet not Delivered or Non-adherent Placenta
Adherent Placenta
Management of an Adherent Placenta
Management of Secondary Postpartum Haemorrhage
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
UTERINE INVERSION
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Bimanual Examination
Investigations
MANAGEMENT
Conservative Management
Surgical Management
COMPLICATIONS
CLINICAL PEARLS
AMNIOTIC FLUID EMBOLISM
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
PULMONARY EMBOLISM
CHAPTER 51:
Puerperal Pyrexia
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
General Management
Specific Management
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 52:
Psychiatric Disorders in the Puerperium (Mood Disturbances)
INTRODUCTION
Baby Blues and Postpartum Depression
Puerperal Psychosis
AETIOLOGY
Antenatal Psychiatric Disorders
Postpartum Blues
Postpartum Depression
Puerperal Psychosis
DIAGNOSIS
Clinical Presentation
Postpartum Blues
Postpartum Depression
Puerperal Psychosis
Investigations
MANAGEMENT
Preconceptional Period
Antenatal Period
Postpartum Blues
Postpartum Depression
Puerperal Psychosis
COMPLICATIONS
Maternal
Neonatal
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 53:
Problems with Breastfeeding
INTRODUCTION
AETIOLOGY
Normal Lactation
Abnormalities in Lactation
Breast Engorgement
Infective Mastitis
Enforced Separation of the Mother and the Baby
DIAGNOSIS
MASTITIS
Clinical Presentation
Investigations
MANAGEMENT
Breast Engorgement
Mastitis
Breast Abscesses
Enforced Separation of the Mother and the Baby
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
SECTION 10: THE NEWBORN INFANT
CHAPTER 54:
Asphyxia Neonatorum
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Steps for Neonatal Resuscitation
Clearing the Airway of Meconium
Further Management
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
Neuroprotective Nature of Hypothermia
CHAPTER 55:
Care of a Newborn Child and Perinatal Mortality
Care of a Newborn Child and Its Associated Common Problems
INTRODUCTION
DIAGNOSIS
Clinical Presentation
General Physical Examination
Investigations
MANAGEMENT
COMPLICATIONS
Transient Tachypnoea of the Newborn
Hypoglycaemia
Hypothermia
Prematurity
Jaundice
Respiratory Distress Syndrome
Meconium Aspiration Syndrome
Necrotising Enterocolitis
Group B Streptococcal Infection in the Baby
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
RECOMMENDATIONS
NATIONAL INITIATIVES
Saving Babies’ Lives Care Bundle
Each Baby Counts
1,000 Lives Improvement
Maternity and Children Quality Improvement Collaborative
Northern Ireland Maternal and Infant Loss Steering Group
SECTION 11: GENERAL GYNAECOLOGY
CHAPTER 56:
Normal and Abnormal Embryological Development
NORMAL EMBRYOLOGICAL DEVELOPMENT
DEVELOPMENT OF GONADS AND INTERNAL GENITALIA
DEVELOPMENT OF EXTERNAL GENITALIA
CLINICAL PEARLS
SEX AND INTERSEXUALITY
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Surgical Management
Sex Steroid Replacement Therapy
Psychosocial Management
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Outcomes of Infant Genital Surgery
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 57:
Karyotypic Abnormalities
GONADAL DYSGENESIS (TURNER'S SYNDROME)
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 58:
Menstrual Cycle
INTRODUCTION
OVARIAN CYCLE
OVULATION
ROLE OF VARIOUS HORMONES IN REGULATION OF MENSTRUAL CYCLES
ROLE OF INHIBINS, ACTIVIN AND FOLLISTATIN
MENSTRUAL CYCLE
Proliferative (Follicular) Phase
Secretory (Luteal) Phase
CLINICAL PEARLS
CHAPTER 59:
Adolescent and Paediatric Gynaecology
PUBERTY
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Physical Examination
Investigations
MANAGEMENT
Sex Education
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
PRECOCIOUS PUBERTY
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Surgical Management
Medical Management
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
Constitutional Growth Delay
DIAGNOSIS
Clinical Presentation
General Physical Examination
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 60:
Menopause and Hormone Replacement Therapy
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Anatomical Changes
General Physical Examination
Investigations
MANAGEMENT
Hormone Replacement Therapy
Different Types of Hormone Replacement Therapy Preparations
Uses of Hormone Replacement Therapy
COMPLICATIONS
Osteoporosis
Cardiovascular Disease
Breast Cancer
Dementia
Stroke
Endometrial Hyperplasia and Endometrial Cancer
Other Complications due to Hormone Replacement Therapy
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 61:
Injuries of the Female Genital Tract and Female Genital Mutilation
INJURIES OF THE FEMALE GENITAL TRACT
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
FEMALE GENITAL MUTILATION
INTRODUCTION
Classification of Female Genital Mutilation
Prevalence of Female Genital Mutilation
INDICATIONS
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Laws in the UK Pertaining to Female Genital Mutilation
Management in Obstetric and Gynaecological Practice
Management of Recently Diagnosed Cases of Female Genital Mutilation
Management of Female Genital Mutilation during Pregnancy
Management during the Antenatal Period
Management during the Intrapartum Period
Postnatal Care
COMPLICATIONS
Short-Term Complications
Long-term Complications
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 62:
Child Abuse, Sexual Assault and Rape
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Ensuring the Victim's Safety
Safeguarding the Children
Consent and Capacity
Medical Care
Medical Aftercare
Psychological Care
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Anogenital Examination
Examination of External Genitalia
Investigations
MANAGEMENT
Ensuring the Victim's Safety
Safeguarding
Not Replicating the Event of Sexual Abuse
Consent and Capacity
The Mental Capacity Act 2005
Referral to Sexual Assault Referral Centres
Medical Care
Medical Aftercare
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 63:
Dyspareunia and Other Psychosexual Problems
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Physical Examination
Investigations
DIFFERENTIAL DIAGNOSIS
Vaginismus
Vulvodynia
Inadequate Lubrication
Postpartum Dyspareunia
MANAGEMENT
Dyspareunia Associated with Vaginal Atrophy in Postmenopausal Women
Role of Testosterone Therapy on Sexual Function
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
SECTION 12: ABNORMALITIES OF MENSTRUATION
CHAPTER 64:
Abnormal Uterine Bleeding
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
General Physical Examination
Abdominal Examination
Pelvic Examination
Investigations
MANAGEMENT
Pharmaceutical Treatments for Heavy Menstrual Bleeding
Surgical Treatments for Heavy Menstrual Bleeding
Non-hysterectomy Surgery (Endometrial Ablation)
Hysterectomy
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 65:
Uterine Leiomyomas
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Pelvic Examination
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Conservative Treatment
Medical Management
Prostaglandin Synthetase Inhibitors
Haemostatic Agents
Gonadotropin-releasing Hormone Agonists
Exogenous Progestins and Oral Contraceptive Agents
Levonorgestrel Intrauterine System
Antiprogestins and Progesterone Receptor Modulators
Selective Oestrogen Receptor Modulators
Danazol
Surgical Treatment
Uterine Artery Embolisation
Focussed Ultrasound for Treatment of Fibroids
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 66:
Dysmenorrhoea and Pelvic Pain
INTRODUCTION
AETIOLOGY
Primary Dysmenorrhoea
Secondary Dysmenorrhoea
Risk Factors
DIAGNOSIS
Clinical Presentation
Pelvic Examination
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Non-steroidal Anti-inflammatory Drugs
Combined Oral Contraceptive Pills
Other Hormonal Preparations
Alternative Therapies for Primary and Secondary Dysmenorrhoea
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 67:
Premenstrual Syndrome
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Lifestyle Changes
Complementary Therapies
Cognitive Behavioural Therapy
Selective Serotonin Reuptake Inhibitors and Selective Serotonin and Noradrenaline Reuptake Inhibitors
Dosing
Adverse Effects
Newer SSRI/SNRI Regimens
Ovulation Suppression Using Hormonal Regimens
Combined Oral Contraceptive Pill
Percutaneous Oestradiol Patch and Implant
Danazol
Gonadotropin-releasing Analogues
Surgical Approach
Role of Hormone Replacement Therapy
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 68:
Chronic Pelvic Pain and Endometriosis
INTRODUCTION
AETIOLOGY
Identifying the Cause of Pelvic Pain
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Pelvic Examination
Investigations
MANAGEMENT
Non-gynaecological Management
Gynaecological Management
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Per Speculum Examination
Bimanual Pelvic Examination
Rectal Examination
Investigations
MANAGEMENT
MANAGEMENT WHEN PAIN IS THE MAIN PRESENTING COMPLAINT
Analgesics for Treatment of Endometriosis-associated Pain
Use of Hormonal Therapies
Hormonal Contraceptives
Progestogens and Antiprogestogens
Levonorgestrel-releasing Intrauterine System
Gonadotropin-releasing Hormone Agonist
Androgenic Agents
Aromatase Inhibitors
Adjuvant Therapy
Surgery for Treatment of Endometriosis-associated Pain
Ablation versus Excision of Endometriosis
Laparoscopic Uterosacral Nerve Ablation versus Presacral Neurectomy
Hysterectomy for Endometriosis-associated Pain
Prevention of Adhesions following Endometriosis Surgery
TREATMENT OF ENDOMETRIOSIS-ASSOCIATED INFERTILITY
Hormonal Therapies for Treatment of Endometriosis-associated Infertility
Surgery for Treatment of Endometriosis-associated Infertility
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 69:
Adenomyosis
INTRODUCTION
Associated Pathology
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Pelvic Examination
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
MEDICAL THERAPY
SURGICAL MANAGEMENT
Hysterectomy
Conservative Surgery
Uterine Artery Embolisation
Endomyometrial Ablation
Magnetic Resonance-guided Focussed Ultrasound
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
SECTION 13: REPRODUCTIVE MEDICINE
CHAPTER 70:
Normal Conception
EMBRYOLOGY AND EARLY FOETAL DEVELOPMENT
Gametogenesis
Spermatogenesis
Oogenesis
OVULATION-FERTILISATION
CLEAVAGE DIVISION AND FORMATION OF MORULA
FORMATION OF BLASTOCYST
CHAPTER 71:
Primary and Secondary Amenorrhoea
INTRODUCTION
AETIOLOGY
Pathophysiology of Menstrual Bleeding
DIAGNOSIS
Clinical Presentation
Per Speculum Examination
Pelvic Examination
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Management of Primary Amenorrhoea
Secondary Sexual Characteristics Have Developed
Secondary Sexual Characteristics Have Not Developed
Hypogonadotropic Hypogonadism
Hypergonadotropic Hypogonadism
Management of Secondary Amenorrhoea
Chronic Anovulation
Specific Treatment
Disorders of Sexual Development
Turner's Syndrome
Hypothalamic Amenorrhoea
Polycystic Ovarian Syndrome
Thyroid Dysfunction
Hypopituitarism
Premature Ovarian Failure
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 72:
Male Infertility
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Sexual History
Medical History
Surgical History
Treatment History
Social History
Family History
Examination of Male Partner
Investigation
Semen Analysis
Determination of Serum Testosterone Levels
Zona-free Hamster Oocyte Penetration Test
Other Investigations
MANAGEMENT
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 73:
Female Infertility
INTRODUCTION
AETIOLOGY
FACTORS AFFECTING FERTILITY IN FEMALES
Cervical Factor Infertility
Uterine Factor Infertility
Congenital Defects
Acquired Causes
Ovarian Factor Infertility
Causes of Ovulatory Dysfunction
Tubal Factors
Causes of Tubal Obstruction
Peritoneal Factors
Peritoneal Defects
FACTORS AFFECTING FERTILITY IN BOTH SEXES
Environmental and Occupational Factors
Toxic Effects Related to Tobacco, Marijuana and Other Drugs
Exercise
Inadequate Diet Associated with Extreme Weight Loss or Gain
DIAGNOSIS
Clinical Presentation
History of Presenting Complaints
Sexual History
Patient's Lifestyle
Menstrual History
Obstetric History
Past History
Family History
General Physical Examination
Specific Systemic Examination
Abdominal Examination
Pelvic Examination
Investigations
Routine Investigations
Tests for Ovarian Factors
Checking the Ovarian Reserve
Tests for Uterine Factor
Ultrasonography
Hysteroscopy
Tests for Tubal and Peritoneal Factors
Hysterosalpingogram
Laparoscopy
Falloposcopy
Chlamydia Antibodies
Hysterosalpingo-contrast Sonography
Evaluation of Cervical Factor
MANAGEMENT
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 74:
Polycystic Ovarian Disease
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
MEDICAL MANAGEMENT
Menstrual Irregularities
Induction of Ovulation
Clomiphene Citrate
Human Menopausal Gonadotropins
Tamoxifen
Aromatase Inhibitors
Metformin
SURGICAL MANAGEMENT
Laparoscopic Ovarian Drilling
Advantages
Mechanism of Action of Laparoscopic Ovarian Drilling
COMPLICATIONS
Complications Related to Polycystic Ovarian Disease Per Se
Complications Related to Medical Management
Clomiphene Citrate
Gonadotropins
Complications Related to Surgical Management
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 75:
Hirsutism
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
General Physical Examination
Pelvic Examination
Investigations
MANAGEMENT
General Therapy
Systemic Therapy
Oral Contraceptive Agents
Antiandrogens
Insulin Sensitisers
Gonadotropin-releasing Hormone Agonists
Eflornithine
Surgical Therapy
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 76:
Assisted Reproductive Techniques
INTRODUCTION
OTHER ASSISTED REPRODUCTIVE TECHNIQUES
INDICATIONS
MANAGEMENT
PREPARATION PRIOR TO THE PROCEDURE
STEPS OF THE PROCEDURE
Ovarian Stimulation for In Vitro Fertilisation
Various Protocols
Long Protocols
Short Protocols
Poor Responders to Ovarian Stimulation
Follicular Aspiration
Oocyte Classification
Sperm Preparation and Oocyte Insemination
Embryo Culture
Embryo Transfer
Cryopreservation
Management of the Luteal Phase
POSTPROCEDURE CARE
COMPLICATIONS
Ovarian Hyperstimulation Syndrome
Ectopic Pregnancy
Iatrogenic Multiple Pregnancy
Strategies to Reduce the Risk of Multiple Pregnancies
Oncogenic Risk Related to Assisted Reproductive Technology
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 77:
Primary Ovarian Insufficiency
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
General Physical Examination
Investigations
MANAGEMENT
Preventing the Development of POI in Young Women Exposed to Gonadotoxic Chemotherapy
Treatment for Infertility
Use of Barrier Contraception in Women Who Wish to Avoid Pregnancy
Hormonal Replacement Therapy
Prevention of Bone Loss
Psychological Support
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 78:
Fertility Preservation
INTRODUCTION
INDICATIONS
Loss of Fertility due to Cancer Treatment
Decline in Fertility due to Ageing
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Fertility Preserving Options
Fertility-preserving Options for Men
Fertility-preserving Options for Women
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 79:
Unexplained Infertility
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
General Physical Examination
Investigations
MANAGEMENT
Expectant Management
Intrauterine Insemination
Controlled Ovarian Hyperstimulation
Clomiphene Citrate
Gonadotropin Injections
Assisted Reproductive Technologies and In Vitro Fertilisation
Last Options
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
SECTION 14: UROGYNAECOLOGICAL AND PELVIC FLOOR ABNORMALITIES
CHAPTER 80:
Urogenital Prolapse
INTRODUCTION
Evaluation of the Degree of Prolapse
Baden-Walker Halfway System
POP-Q System for Quantification of Pelvic Prolapse
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
SURGICAL MANAGEMENT
Principles of Surgery for Pelvic Organ Prolapse
Preoperative Preparation
Steps of Surgery
Anterior Colporrhaphy
Posterior Colporrhaphy and Colpoperineorrhaphy
Manchester Repair
Abdominal Sling Surgery
Abdominal Cervicopexy
Uterine Suspension
Postoperative Care
COMPLICATIONS
Complications due to Uterine Prolapse
Intraoperative Complications of Anterior Colporrhaphy
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
Innovations in Surgery for Uterine Prolapse
CHAPTER 81:
Urinary Incontinence
INTRODUCTION
Stress Incontinence
Urge Incontinence
AETIOLOGY
DIAGNOSIS
Clinical Presentation
General Physical Examination
Pelvic Examination
Investigations
MANAGEMENT
General Management
PHARMACOLOGICAL THERAPY
Stress Incontinence
Urge Incontinence
SURGICAL MANAGEMENT
Stress Incontinence
Indications for Surgery
Preoperative Preparation
Intraoperative Details
Suburethral Sling
Bladder Neck Sling
Mid-urethral Sling
Pubovaginal Sling Surgery
Minimally Invasive Slings
Retropubic Bladder Neck Colposuspension
Injection of Urethral Bulking Agents
Use of Artificial Urinary Sphincter
Postoperative Care
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 82:
Urinary Tract Infection
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
PREVENTION
TREATMENT
Complicated Urinary Tract Infections
Uncomplicated Urinary Tract Infections
Treatment of Urinary Tract Infections in Pregnancy
Treatment of Recurrent Urinary Tract Infection
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
SECTION 15: GYNAECOLOGICAL ONCOLOGY
CHAPTER 83:
Endometrial Cancer
INTRODUCTION
AETIOLOGY
Role of Tamoxifen in the Pathogenesis of Breast Cancer
DIAGNOSIS
Clinical Presentation
General Physical Examination
Per Speculum Examination
Pelvic Examination
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Cancer Staging
COMPLICATIONS
Complications Associated with Endometrial Cancer
Complications Associated with Therapy
Complications due to Radiotherapy
Side Effects due to Chemotherapy
Complications due to Surgery
Complications Related to Radical Vulvectomy and Bilateral Inguinal Lymphadenectomy
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 84:
Ovarian Neoplasia (Benign and Malignant)
INTRODUCTION
Serous Tumours
Mucinous Tumours
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Management Based on Risk of Malignancy Index-I
Low-risk Patients
Intermediate-risk Patients
High-risk Patients
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Abdominal Examination
Pelvic Examination
Breast and Chest Examination
Investigations
Tests for Assessing the Likelihood of Malignancy and Planning the Extent of Surgery
Tests for Assessing the Anaesthetic Fitness
MANAGEMENT
Prevention
Screening for Ovarian Cancer
Definitive Therapy
Stage IA (Grade I Disease)
Stage IA and IB (Grade II and III) and Stage IC
Stage II, III and IV
Cytoreductive Surgery
Optimal Cytoreduction
Radiation Therapy
Primary Surgery versus Interval Debulking Surgery following Neoadjuvant Chemotherapy in Advanced Stage Disease
Chemotherapy
Types of Chemotherapy
Treatment of Recurrent Disease
Follow-Up after Treatment for Ovarian Cancer
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 85:
Cervical Intraepithelial Neoplasia
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Per Speculum Examination
Investigations
Cytologic Screening Test
National Health Service Cancer Screening Programme
Human Papilloma Virus Triage and Test of Cure
Colposcopy
Procedure
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
STRATEGIES FOR PREVENTION
Prevention of Human Papillomavirus Infection
Use of Condoms
Nutritional Advice
HUMAN PAPILLOMAVIRUS VACCINATION PROGRAMME
TREATMENT OF DYSPLASTIC CHANGES
Locally Destructive Methods
Cryosurgery
Electrocoagulation
Laser Ablation
Excision of the Abnormal Tissue
Cone Biopsy
Cold-knife Conisation
Laser Excision
Large Loop Excision of the Transformation Zone
Loop Electrosurgical Excision Procedure
Surgical Options
Therapeutic Conisation
Hysterectomy
Follow-up after Therapy
Cervical Glandular Intraepithelial Neoplasia
COMPLICATIONS
Progression to Invasive Cancer
Procedural Complications
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 86:
Invasive Cervical Cancer
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
General Physical Examination
Per Speculum Examination
Rectal Examination
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Definitive Treatment for Invasive Cancer
Stage IA Tumours
Stage IB and IIA Tumours
Stage IIB, III and IV Tumours
Various Available Treatment Options
Surgery
Surgery versus Radiotherapy
Chemoradiation
Radiation Therapy
Chemotherapy
Pelvic Exenteration
COMPLICATIONS
Complications due to Surgery
Complications due to Radiotherapy and Chemotherapy
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 87:
Rare Cancers of the Female Genital Organs
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Per Speculum Examination
Pelvic Examination
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Early-stage Cancer
Advanced Cases
Follow-up
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Pelvic Examination
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 88:
Vulvar Cancer and Vulval Pain Syndromes
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Staging of Vulvar Cancer
SURGICAL TREATMENT OF VULVAR CANCER
Microinvasive or Superficially Invasive Vulvar Cancer
Stage IA
Stage IB to Stage II
Lateral Vulval Tumours
Inguinofemoral Lymphadenectomy
Stage III Vulvar Cancer
Stage IVA Vulvar Cancer
Treatment of Positive or Narrow Margins
Involved Groin Nodes on Examination
Radiation Therapy
Adjuvant Radiation Therapy
Primary Chemoradiation
Post-treatment Surveillance
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
Localised Provoked Vulvodynia
Unprovoked Vulvodynia
DIAGNOSIS
Clinical Presentation
Localised Provoked Vulvodynia
Unprovoked Vulvodynia
Investigations
MANAGEMENT
Localised Provoked Vulvodynia
Unprovoked Vulvodynia
Follow-up
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
SECTION 16: GYNAECOLOGICAL INFECTIONS
CHAPTER 89:
Sexually Transmitted Infections
INTRODUCTION
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Prevention
Medical Treatment
COMPLICATIONS
CLINICAL PEARLS
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Management of Genital Herpes during Pregnancy
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
Uncomplicated Anogenital Infection in Adults
Pregnant or Breastfeeding Mothers
Follow-up
COMPLICATIONS
CLINICAL PEARLS
INTRODUCTION
DIAGNOSIS
Clinical Presentation
Investigations
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
CHAPTER 90:
Vaginal Discharge
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Investigations
Pregnancy Test
Microscopic Examination
KOH Whiff Test
Nitrazine pH Paper
Alternative Options to Microscopic Examination
Vaginal Culture
Cervical Culture
MANAGEMENT
Bacterial Vaginosis
Candidal Infection
Vaginal Trichomoniasis
COMPLICATIONS
General Complications
Complications Specific to Bacterial Vaginosis
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 91:
Pelvic Inflammatory Disease
INTRODUCTION
AETIOLOGY
DIAGNOSIS
Clinical Presentation
Physical Examination
Abdominal Examination
Pelvic Examination
Investigations
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
General Management
Medical Management
Surgical Management
Pelvic Inflammatory Disease in Pregnant or Breastfeeding Patients
Treatment of Sexual Partners
Women with Concomitant Human Immunodeficiency Virus Infection
Pelvic Inflammatory Disease with Intrauterine Device In Situ
Follow-up
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
SECTION 17: PREGNANCY PREVENTION
CHAPTER 92:
Contraception (Temporary and Permanent)
INTRODUCTION
INDICATIONS
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
INTRODUCTION
Oral Contraceptive Pills
Evra® Patch
NuvaRing®
AETIOLOGY
MANAGEMENT
Prescription
Yasmin®
Zoely®
Qlaira®
Evra® Patch
NuvaRing®
Follow-up
Extended and Continuous Regimens of Combined Oral Contraceptive Pills
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
MANAGEMENT
Prescription
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
MANAGEMENT
Prescription
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
MANAGEMENT
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
AETIOLOGY
MANAGEMENT
Prior to Insertion
Insertion
Postinsertion
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INTRODUCTION
Male Condom
Female Condom
Diaphragm
Cervical Cap
Spermicides
Vaginal Contraceptive Sponge
COMPLICATIONS
CLINICAL PEARLS
INTRODUCTION
INDICATIONS
MANAGEMENT
Prerequisites
Method of Administration
Drug Interaction and their Consequences on the Efficacy of Emergency Contraception
Repeated Use of Emergency Contraceptive Pills
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
TUBAL STERILISATION
INTRODUCTION
SURGICAL MANAGEMENT
Preoperative Preparation
Steps of Surgery
Postoperative Care
COMPLICATIONS
CLINICAL PEARLS
INTRODUCTION
SURGICAL MANAGEMENT
Preoperative Preparation
Postoperative Care
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
CHAPTER 93:
Medical Termination of Pregnancy
INTRODUCTION
Overview of Surgery
INDICATIONS
MANAGEMENT
Preoperative Preparation
Actual Procedure
Surgery
Vacuum Aspiration
Dilatation and Evacuation
Medical Abortion
Postoperative Care
COMPLICATIONS
CLINICAL PEARLS
EVIDENCE-BASED MEDICINE
INDEX
TOC
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