Clinical Obstetrics and Gynaecology

Clinical Obstetrics and Gynaecology provides a thorough overview of the essential topics that healthcare practitioners in the field need to know, with a focus on clinical practice.

This highly regarded textbook provides comprehensive coverage of gynaecology, reproductive health, obstetrics and on-call for O&G. It has been thoroughly updated to incorporate significant developments in clinical care, including in prenatal diagnosis and screening, COVID-19 management, antenatal and postnatal care, and telemedicine abortion practices.

With full colour illustrations, self-assessment questions and additional online material to reinforce learning, this is a valuable resource for medical students, junior doctors, midwives, nurses and for healthcare practitioners from other specialties seeking a broad-based grounding in O&G.

Cover Image
Title Page
Copyright
Dedication
Preface
Contributors
Language Statement
Table of Contents
Section 1 Fundamentals
Chapter 1 Clinical Pelvic Anatomy
Chapter Outline
Introduction
Obstetric Anatomy
The Pelvic Organs During Pregnancy
Anatomical Points for Obstetric Analgesia
Gynaecological Anatomy
Anatomy of the Lower Urinary Tract
Chapter 2 History and Examination
Chapter Outline
Introduction
Gynaecological History
Gynaecological Examination
Obstetrical History
Obstetrical Examination
Section 2 Gynaecology
Chapter 3 Paediatric Gynaecology and Differences in Sex Development
Chapter Outline
Introduction
Normal Puberty
Variations of Normal Puberty
Precocious Puberty
Delayed Puberty
Pre-Pubertal Conditions
Post-Pubertal Conditions
Müllerian Duct Anomalies
Differences in Sex Development (DSD)
Summary
Chapter 4 Menstruation and Amenorrhoea
Chapter Outline
The Menstrual Cycle
Endocrine Control of the Menstrual Cycle
The Ovarian Cycle
The Uterine Cycle
Other Cyclical Changes
Amenorrhoea
Primary Amenorrhoea
Secondary Amenorrhoea
Care of Women with Secondary Amenorrhoea
Chapter 5 Subfertility
Chapter Outline
Introduction
Definitions
Age and Fertility
Causes of Subfertility
Diagnosis
History and Examination
Investigations and Their Interpretation
Care of Couples With Subfertility
Assisted Conception
The UK Human Fertilisation and Embryology Act
Chapter 6 Early Pregnancy Care
Chapter Outline
Introduction
Miscarriage
Pregnancy of Unknown Location
Ectopic Pregnancy
After Pregnancy Loss
Chapter 7 Heavy Menstrual Bleeding, Dysmenorrhoea and Pre-Menstrual Syndrome
Chapter Outline
Heavy Menstrual Bleeding
Dysmenorrhoea
Pre-Menstrual Syndrome
Aetiology
Clinical Presentation
Differential Diagnosis
Care of Women With Pre-Menstrual Syndrome
Chapter 8 Pelvic Pain and Endometriosis
Chapter Outline
Pelvic Pain
History
Examination
Acute Pelvic Pain
Chronic Pelvic Pain (CPP)
Endometriosis
Incidence
Aetiology
Clinical Presentation
Examination
Endometriosis and Fertility
Investigation
Care of Women With Endometriosis
Fertility Treatment
Complications, Prognosis and Long-Term Sequelae
Chapter 9 Menopause and Hormone Replacement Therapy
Chapter Outline
Introduction
Physiology
Signs and Symptoms
Long-Term Effects
Diagnosis
Hormone Replacement Therapy
Risks and Side Effects of HRT
Non-Hormonal Treatment
Chapter 10 Pelvic Organ Prolapse
Chapter Outline
Introduction
Aetiology
Types of Prolapse
Prolapse Staging
Symptoms
Signs
Care of Women With Pelvic Organ Prolapse
Chapter 11 Urinary Incontinence
Chapter Outline
Introduction
Types of Urinary Incontinence
The Mechanism of Urinary Continence
Aetiology of Incontinence
Clinical Presentation
Clinical Assessment
Care of Women With Urinary Incontinence
Conservative
Chapter 12 Ovarian Neoplasms
Chapter Outline
Introduction
Risk Factors
Natural History
Genetics
Pathology
Spread
Presentation
Investigation
Tumour Markers
FIGO Staging
Care of Women With Benign Tumours
Surgery for Early Ovarian Cancer
Surgery for Advanced Ovarian Cancer
Chemotherapy and Targeted Therapies
Recurrence
Survival
Chapter 13 Uterine Neoplasms
Chapter Outline
Introduction
Incidence
Aetiology
Clinical Features and Diagnosis
Pathology
Prognostic Factors
Care of Women With Endometrial Carcinoma
Recurrence
Summary
Chapter 14 Cervical Neoplasms
Chapter Outline
Introduction
The Transformation Zone
The Cervical Screening Programme (UK)
Cervical Cancer
Chapter 15 Gestational Trophoblastic Disease
Chapter Outline
Introduction
Trophoblast Cells in Health and Disease
Premalignant Gestational Trophoblastic Disease
Malignant Gestational Trophoblastic Disease
Epithelioid Trophoblastic Tumour
Care of Women With Molar Pregnancies
Follow-Up After a Molar Pregnancy
Care of Women With Malignant Gestational Trophoblastic Disease
Chapter 16 Disorders of the Vulva
Chapter Outline
Introduction
Points to Note in the History
Examination of the Vulva
Simple Vulval Conditions
Infection
Dermatoses
Pruritus
Vulvodynia
Vulval Intraepithelial Neoplasia
Vulval Carcinoma
Female Genital Mutilation
Chapter 17 Gynaecological Surgery
Chapter Outline
Introduction
Preoperative Care
Safer Surgery Principles
Gynaecological Operations
Laparoscopic Hysterectomy
Postoperative Care
Section 3 Reproductive Health
Chapter 18 Sexually Transmitted Infections
Chapter Outline
Introduction
Principles of Sexually Transmitted Infection Management
Sexual History
Examination for Genital Infections
Taking Samples for Genital Infections
Syndromes Associated With Genital Infections
Infections of the Vagina
Infections of the Cervix
Systemic Presentations of Sexually Transmitted Infections
Chapter 19 Sexual Problems
Chapter Outline
Introduction
Normal Sexual Response
The Effect of Age
The Functions of Sex
History Taking
Female Sexual Dysfunction
Male Sexual Dysfunction
Care of People With Sexual Problems
Conclusion
Chapter 20 Abortion
Chapter Outline
Introduction
Worldwide Perspectives
United Kingdom (Uk) Legal and Ethical Issues
UK Perspectives
Personal Beliefs
Consultation and Counselling Before Abortion
Pre-abortion Investigations
Methods of abortion
Complications of Abortion
Abortion Aftercare
Conclusion
Chapter 21 Contraception
Chapter Outline
Introduction
Methods of Contraception
Hormonal Contraception
Non-Hormonal Contraception
Fertility-Awareness Methods
Emergency Contraception (EC)
Sterilization
Chapter 22 Ethical Issues
Chapter Outline
Introduction
Conception
Contraception
De-Conception Issues – Abortion
Assisted Conception
Pregnancy and Birth
Gender
Surgical Manipulation for Non-Medical Reasons
Conclusion
Section 4 Obstetrics
Chapter 23 Antenatal and Postnatal Care
Chapter Outline
The Aim of Antenatal Care
Models of Antenatal Care
The First Trimester
The Second Trimester (12–26 Weeks)
The Third Trimester (26 Weeks–Term)
Antenatal Summary
Postnatal Care
Models of Postnatal Care
Immediate Post-Birth Care
Postnatal Follow-Up in the First 10 Days
Late Postnatal Examination
Postnatal Problems
Chapter 24 Maternal Medicine
Chapter Outline
Introduction
Diabetes Mellitus
Venous Thromboembolic Disease
Cardiac Disease
Connective Tissue Disease
Epilepsy
Hepatic Disorders
Renal Disorders
Respiratory Disorders
Thrombocytopenia
Thyroid Disorders
Chapter 25 Fetal Medicine
Chapter Outline
Introduction
Principles of Screening
Assessing the Chance of Anomalies
Screening for Chromosomal Anomalies
Screening for Structural Anomalies
Diagnosis of Chromosomal and Genetic Anomalies
Chromosomal Abnormalities
Single-Gene Disorders
Structural Anomalies
Haemolytic Disease of the Fetus and Newborn (HDFN)
Advances in Fetal Therapy
Ethical Considerations and Parental Support
Termination of Pregnancy for Fetal Abnormality
Chapter 26 Obstetric Haemorrhage
Chapter Outline
Introduction
Definitions
Antepartum Haemorrhage
Intrapartum Haemorrhage
Postpartum Haemorrhage
Chapter 27 Fetal Growth and Surveillance
Chapter Outline
Introduction
Accuracy of Dating
Small for Gestational Age
Fetal Growth Restriction
Aetiology
Screening and Diagnosis
Management
Long-Term Implications of Fetal Growth Restriction
Chapter 28 Hypertension in Pregnancy
Chapter Outline
Definitions
Pathophysiology
Epidemiology of Hypertensive Disorders in Pregnancy
Chronic Hypertension
Gestational Hypertension and Pre-Eclampsia
Global Challenges
Long-Term Implications of Hypertension in Pregnancy
Chapter 29 Pre-Term Birth
Chapter Outline
Introduction
Definitions
Aetiology and Predisposing Factors
Identifying Women at Increased Risk of Pre-Term Birth
Prevention of Pre-Term Labour
Inhibition of Pre-Term Labour
Pre-Term Pre-Labour Rupture of the Membranes
Diagnosis and Management of Pre-Term Labour
Mode of Birth
Chapter 30 Multiple Pregnancy
Chapter Outline
Introduction
The Nature of Twinning and Chorionicity
Maternal Complications
Fetal Complications
Antenatal Problems Specific to Monochorionic Twin Pregnancies
Care of Women With Multiple Pregnancy
Management of Twin Birth
Triplets and Higher-Order Multiples
Chapter 31 Labour and Analgesia
Chapter Outline
Introduction
Evolution and Human Labour
Primigravid Compared With Multigravid Labour
The Uterus During Pregnancy
The Initiation of Labour
Pro-Pregnancy Factors
Pro-Labour Factors
The Mechanism of Normal Labour and Birth (See Also Chapter 1)
Clinical Progress in Labour
Episiotomies and Perineal Tears
Analgesia in Labour
Methods of Pain Relief
Chapter 32 Monitoring of the Fetus in Labour
Chapter Outline
Introduction
Fetal Physiology
Risk Assessment
Fetal Heart Rate Recording
Fetal Blood Sampling
Fetal Monitoring Scenarios
Long-Term Prognosis Following Delivery
Chapter 33 Induction of Labour
Chapter Outline
Introduction
Indications
Contraindications
Methods
Unfavourable Cervix
Favourable Cervix
Other Methods of Induction of Labour
Complications
Unsuccessful Induction
Chapter 34 Malpresentation and Slow Labour
Chapter Outline
Introduction
Precipitate Labour
Slow Labour
Malpresentation
Chapter 35 Obstetric Emergencies
Chapter Outline
Introduction
General Principles
Shoulder Dystocia
Cord Prolapse
Impacted Fetal Head at Caesarean Section
Maternal collapse
Maternal cardiac arrest
Amniotic Fluid Embolism
Sepsis
Uterine Inversion
Uterine Rupture
Chapter 36 Operative Birth
Chapter Outline
Introduction
Instrumental Vaginal Delivery
Caesarean Section
Chapter 37 Stillbirth and Neonatal Mortality
Chapter Outline
Introduction
Definitions
Stillbirth
Neonatal Death
Global Perspective
Chapter 38 Neonatal Resuscitation
Chapter Outline
Physiology
Practical Aspects of Neonatal Resuscitation
Discontinuation of Resuscitation
Debrief and Parental Communication
Chapter 39 Global Maternal and Neonatal Health
Chapter Outline
Estimates of Global Maternal and Neonatal Mortality
Obstetric Causes of Maternal Mortality
Medical Conditions Contributing to Maternal Mortality and Morbidity
Strategies to Improve Global Maternal and Newborn Health
Availability and Quality of Care
Epidemics and Pandemics
Section 5 Online-Only Chapters
Chapter 40 Human Embryology
Chapter Outline
Introduction
Nomenclature
Fertilization to Implantation (0–6 GD)
Implantation and Formation of the Germ Layers (7–18 GD)
Organogenesis (19–56+ GD)
Chapter 41 Imaging in Obstetrics and Gynaecology
Chapter Outline
Introduction
Obstetrics
Gynaecology
Chapter 42 The Physiology of Pregnancy
Chapter Outline
Introduction
Respiratory System
Cardiovascular System
Blood, Plasma and Extracellular Fluid Volume
Blood Constituents and Anaemia
Haemostasis in Pregnancy
Renal System
Endocrine System
Gastrointestinal System
Liver and Bile Ducts
Skin and Appendages
Metabolic Changes
Calcium Homeostasis
Placental Transfer
Immunology
Summary
Chapter 43 Neonatal Care
Chapter Outline
Introduction
The Transition at Birth
Routine Care at Birth
Perinatal Asphyxia
Neonatal Examination
Feeding
Signs of Illness
Infection
Jaundice
Low Birth Weight (LBW) Babies
Family Centred Care
Organ Donation
Chapter 44 Practical Obstetrics and Gynaecology
Chapter Outline
General Advice
Common Pitfalls
Acute Lower Abdominal Pain for the Gynaecologist
Bleeding in early pregnancy
Nausea and vomiting in pregnancy (NVP) and hyperemesis gravidarum (HG)
Termination of Pregnancy (TOP)
General principles when caring for antenatal women
Sepsis in pregnancy
Shortness of breath in pregnancy
Antepartum haemorrhage
Induction of labour
Labour ward: general principles
Chapter 45 UK Medicolegal Issues
Chapter Outline
Introduction
UK Legal Framework
Dissatisfaction, Complaints and Litigation
What Is Medical Negligence?
Consent
Shared Decision-Making
The Process and Consequences of Litigation
Avoiding Litigation
Section 6 Self-Assessment
Single Best Answer (SBA) Questions – Part One
Single Best Answer (SBA) Questions – Part Two
Objective Structured Clinical Examination (OSCE) Practice Cases
Answers to Single Best Answer (SBA) questions – part one
Answers to Single Best Answer (SBA) questions – part two
Index

Life Sciences

Physical Sciences & Engineering

Social Sciences & Humanities

Health

Clinical Obstetrics and Gynaecology

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Elizabeth A. Layden

Andrew Thomson

Philip Owen

Mayank Madhra

Brian A. Magowan

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