Essential Obstetrics and Gynaecology E-Book

 
 
Churchill Livingstone (Verlag)
  • 5. Auflage
  • |
  • erschienen am 23. Juli 2014
  • |
  • 448 Seiten
 
E-Book | ePUB mit Adobe DRM | Systemvoraussetzungen
E-Book | PDF mit Adobe DRM | Systemvoraussetzungen
978-0-7020-5475-4 (ISBN)
 

This is the fifth edition of a popular, highly readable primer in obstetrics and gynaecology. It has been thoroughly updated and reconfigured to key into the new undergraduate curriculum n O&G devised by the Royal College of Obstetrics and Gynaecology.

  • Highly illustrated throughout.
  • Essential information points at the end of chapters.
  • Case histories throughout.
  • Practical procedures boxes throughout.
  • Alert (warnings or advice) and tick (guidance or definitions) boxes throughout.
  • New editor: Professor Sabaratnam Arulkumaran.
  • Now a multi-authored text written by eminent experts from across the specialty.
  • Book entirely restructured to reflect the national undergraduate curriculum in obstetrics and gynaecology.
  • Two new appendices: Principles of Perioperative Care and Governance, Audit and Research.
  • Over 100 self-assessment MCQs at the end of the book.
  • Englisch
  • London
  • 47,30 MB
978-0-7020-5475-4 (9780702054754)
0702054755 (0702054755)
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  • Front cover
  • Half title page
  • Dedication
  • Essential Obstetrics and Gynaecology
  • Copyright page
  • Preface to fifth edition
  • Preface to fourth edition
  • Contributors
  • Table of Contents
  • 1 Essential reproductive science
  • 1 Anatomy of the female pelvis
  • The bony pelvis
  • The external genitalia
  • The internal genital organs
  • The vagina
  • The uterus
  • Supports and ligaments of the uterus
  • The Fallopian tubes
  • The ovaries
  • The blood supply to the pelvic organs
  • Internal iliac arteries
  • Anterior division
  • Posterior division
  • The ovarian vessels
  • The pelvic lymphatic system
  • Nerves of the pelvis
  • Somatic innervation
  • Autonomic innervation
  • The pelvic floor
  • The perineum
  • 2 Conception and nidation
  • Oogenesis
  • Meiosis
  • Follicular development in the ovary
  • Hormonal events associated with ovulation
  • The action of gonadotrophins
  • The endometrial cycle
  • Production of sperm
  • Spermatogenesis
  • Structure of the spermatozoon
  • Seminal plasma
  • Fertilization
  • Sperm transport
  • Capacitation
  • Fertilization and implantation
  • The physiology of coitus
  • 3 Physiological changes in pregnancy
  • Immunology of pregnancy
  • The uterus
  • The cervix
  • The isthmus
  • The corpus uteri
  • Uterine contractility
  • The development of myometrial activity
  • The vagina
  • The cardiovascular system
  • Cardiac position and size
  • Cardiac output
  • Total peripheral resistance
  • Arterial blood pressure
  • The blood
  • Erythrocytes
  • The white cells
  • Platelets
  • Clotting factors
  • Respiratory function
  • Renal function
  • Anatomy
  • Physiology
  • The alimentary system
  • Nutrients in blood
  • Maternal carbohydrate metabolism
  • Changes in plasma proteins
  • Amino acids
  • Lipids
  • Calcium
  • Maternal weight gain
  • Postpartum weight
  • The breasts
  • Breast development during pregnancy
  • The initiation of lactation
  • The skin
  • Endocrine changes
  • Placental hormones
  • The pituitary gland
  • Anatomy
  • Anterior pituitary
  • Posterior pituitary
  • Hypothalamus
  • The thyroid
  • The parathyroids
  • The renin-angiotensin system (RAS)
  • The adrenal gland
  • Conclusion
  • 4 Placental and fetal growth and development
  • Early placental development
  • Further placental development
  • The villus
  • Structure of the umbilical cord
  • Uteroplacental blood flow
  • Factors that regulate fetoplacental and uterine blood flow
  • Placental transfer
  • Simple diffusion
  • Facilitated diffusion
  • Active transport
  • Pinocytosis
  • Transport of intact cells
  • Water and electrolyte transfer
  • Sodium
  • Potassium
  • Calcium
  • Placental function
  • Gaseous exchange
  • Oxygen transfer
  • Carbon dioxide transfer
  • Acid-base balance
  • Fetal nutrition and removal of waste products
  • Carbohydrate metabolism
  • Fat metabolism
  • Protein metabolism
  • Urea and ammonia
  • Placental hormone production
  • Protein hormones
  • Chorionic gonadotrophin
  • Human placental lactogen
  • Steroid hormones
  • Progesterone
  • Oestrogens
  • Corticosteroids
  • Corticotrophin-releasing hormone
  • Fetal development
  • Growth
  • The cardiovascular system
  • The respiratory system
  • The gastrointestinal tract
  • The kidney
  • The special senses
  • Amniotic fluid
  • Formation
  • Volume
  • Clinical significance of amniotic fluid volume
  • Oligohydramnios
  • Polyhydramnios
  • Clinical value of tests on amniotic fluid
  • Amniocentesis
  • Indications for amniocentesis
  • Chromosomal abnormalities and sex-linked diseases
  • Metabolic disorders
  • Estimation of fetal lung maturity
  • 5 Perinatal and maternal mortality
  • Perinatal mortality
  • Introduction
  • Definitions
  • Mortality rates
  • Incidence
  • Sociodemographic factors and perinatal mortality
  • Maternal age
  • Deprivation
  • Ethnicity
  • Other maternal characteristics
  • Causes of stillbirths
  • Intrapartum stillbirth
  • Causes of neonatal deaths
  • Maternal mortality
  • Definition
  • Maternal mortality rates
  • Major causes of maternal death in the UK
  • 2 Essential obstetrics
  • 6 History taking and examination in obstetrics
  • Taking a relevant and comprehensive history
  • Obstetric history
  • History of present pregnancy
  • Symptoms of pregnancy
  • Pseudocyesis
  • Previous obstetric history
  • Previous medical history
  • Family history
  • Examination
  • General and systemic examination
  • Heart and lungs
  • Head and neck
  • Breasts
  • Abdomen
  • Limbs and skeletal changes
  • Pelvic examination
  • Assessment of the bony pelvis
  • The planes of the Pelvis
  • Plane of the pelvic inlet
  • Plane of greatest pelvic dimensions
  • Plane of least pelvic dimensions
  • Outlet of the pelvis
  • Obstetrical examination at subsequent routine visits
  • Abdominal palpation
  • Palpation of the uterine fundus
  • Measurement of symphysial-fundal height
  • Measurement of abdominal girth
  • Palpation of fetal parts
  • Lie
  • Presentation
  • Position
  • Station and engagement
  • Auscultation
  • 7 Normal pregnancy and antenatal care
  • Aims and patterns of routine antenatal care
  • Preconceptual care and vitamin supplementation
  • The risk of substance abuse in pregnancy
  • Smoking
  • Alcohol intake
  • Illicit drug use
  • Changing demographics of pregnancy
  • The booking visit
  • Consideration of past obstetric history, including mode of delivery
  • Recommended routine screening tests
  • Haematological investigations
  • Blood group and antibodies
  • The use of anti-D immunoglobulin
  • Infection screening
  • Rubella
  • Syphilis
  • Non-specific tests
  • Specific tests
  • Hepatitis (see Chapter 9)
  • Human immunodeficiency virus
  • Group B Streptococcus
  • Urinary tract infection
  • Gestational diabetes
  • Screening for fetal anomaly
  • Nuchal translucency and biochemical screening
  • Schedules of routine antenatal care
  • Subsequent visits
  • Antenatal education
  • Dietary advice
  • Energy intake
  • Protein
  • Fats
  • Carbohydrates
  • Minerals and vitamins
  • Exercise in pregnancy
  • Coitus in pregnancy
  • Breast care
  • Social and cultural awareness
  • Safe prescribing in pregnancy
  • 8 Obstetric disorders
  • Hypertensive disorders of pregnancy
  • Definitions
  • Classification
  • Pathogenesis and pathology of pre-eclampsia and eclampsia
  • The renal lesion
  • Placental pathology
  • Disseminated intravascular coagulation (DIC)
  • Other associations with pregnancy hypertension
  • The HELLP syndrome
  • Management of gestational hypertension and pre-eclampsia
  • Blood pressure measurement
  • Antihypertensive drug therapy
  • Maternal investigations
  • Laboratory investigations
  • Fetoplacental investigations
  • Prevention of pre-eclampsia
  • Symptoms of pre-eclampsia and eclampsia
  • Induction of labour
  • Complications
  • Eclampsia
  • Management of eclampsia
  • Control of fits
  • Control of blood pressure
  • Delivery of the infant
  • Management after delivery
  • Antepartum haemorrhage
  • Placenta praevia
  • Incidence
  • Aetiology
  • Classification
  • Symptoms and signs
  • Diagnosis
  • Clinical findings
  • Abdominal examination
  • Diagnostic procedures
  • Management
  • Abruptio placentae
  • Aetiology
  • Clinical types and presentation
  • Haemorrhage
  • Clinical assessment/differential diagnosis
  • Management
  • Complications
  • Afibrinogenaemia
  • Renal tubular or cortical necrosis
  • Other causes of antepartum haemorrhage
  • Vasa praevia
  • Unexplained antepartum haemorrhage
  • Vaginal infections
  • Cervical lesions
  • Multiple pregnancy
  • Prevalence
  • Types of twinning and determination of chorionicity
  • Monozygotic multiple pregnancy
  • Dizygotic twins
  • Complications of twin pregnancy
  • Complications unrelated to zygosity
  • Nausea and vomiting
  • Anaemia
  • Miscarriage
  • Antepartum haemorrhage
  • Pre-eclampsia
  • Intra-uterine growth restriction (IUGR)
  • Preterm labour
  • Complications related to zygosity
  • Twin-to-twin transfusion syndrome (TTTS)
  • Monoamniotic and conjoined twinning
  • Prenatal diagnosis
  • Management of twin pregnancy
  • Management of labour and delivery
  • Presentation at delivery
  • Method of delivery
  • Caesarean section
  • Vaginal delivery
  • Complications of labour
  • Locked twins
  • Conjoined twins
  • Perinatal mortality
  • Prolonged pregnancy
  • Aetiology
  • Management
  • Labour management
  • Breech presentation
  • Types of breech presentation
  • Causation and hazards of breech presentation
  • Management
  • Antenatal management
  • External cephalic version (ECV)
  • Indication
  • Contraindications
  • Technique
  • Complications
  • Method of delivery
  • Vaginal breech delivery
  • Technique
  • Caesarean section
  • Unstable lie, transverse lie and shoulder presentation
  • Complications
  • Management
  • 9 Maternal medicine
  • Introduction
  • Minor complaints of pregnancy
  • Abdominal pain
  • Heartburn
  • Constipation
  • Backache
  • Syncope
  • Varicosities
  • Carpal tunnel syndrome
  • Pelvic girdle dysfunction (symphyseal pelvic dysfunction, SPD)
  • Medical problems arising in pregnancy
  • Anaemia
  • Aetiology
  • Risk factors
  • Clinical features and diagnosis
  • Implications on pregnancy
  • Management
  • Prophylaxis
  • Gestational diabetes
  • Aetiology
  • Risk factors
  • Clinical features and diagnosis
  • Implications on pregnancy
  • Management
  • Infections acquired in pregnancy
  • Risk factors
  • Implications on pregnancy and management
  • Chicken pox
  • Parvovirus B19
  • Influenza H1N1
  • Human Immunodeficiency Virus (HIV) Infection
  • Implications of pregnancy on the disease
  • Implications of the disease on pregnancy
  • Screening
  • Management
  • Acute viral hepatitis
  • Tuberculosis
  • Malaria
  • Acute pyelonephritis and urinary tract infections
  • Thromboembolic disease
  • Aetiology
  • Risk factors
  • Clinical features and diagnosis
  • Implications on pregnancy
  • Management
  • Liver disease
  • Obstetric cholestasis
  • Aetiology
  • Risk factors
  • Clinical features and diagnosis
  • Implications on pregnancy
  • Management
  • Acute fatty liver of pregnancy
  • Aetiology
  • Risk factors
  • Clinical features and diagnosis
  • Implications on pregnancy
  • Management
  • Pre-existing medical conditions and pregnancy
  • Renal disease in pregnancy
  • Implications of pregnancy on the disease
  • Implications of the disease on pregnancy
  • Management
  • Special circumstances
  • Renal calculi
  • Diabetes mellitus
  • Implications of pregnancy on the disease
  • Implications of the disease on pregnancy (Table 9.5)
  • Management
  • Thyroid disease in pregnancy
  • Hypothyroidism
  • Implications of pregnancy on the disease
  • Implications of the disease on pregnancy
  • Management
  • Hyperthyroidism
  • Implications of pregnancy on the disease
  • Implications of the disease on pregnancy
  • Management
  • Obesity
  • Implications of pregnancy on obesity
  • Implications of obesity on pregnancy (Table 9.6)
  • Management
  • Thrombophilia
  • Implications of pregnancy on the disease
  • Implications of the disease on pregnancy
  • Screening
  • Management
  • Epilepsy
  • Implications of pregnancy on the disease
  • Implications of disease on pregnancy
  • Medications
  • Management
  • Migraine
  • Cardiac disease
  • Implications of pregnancy on the disease
  • Implications of the disease on pregnancy
  • Management
  • Respiratory disorders
  • Asthma
  • Implications of pregnancy on the disease
  • Implications of the disease on pregnancy
  • Management
  • Cystic fibrosis
  • Implications of pregnancy on the disease
  • Implications of the disease on pregnancy
  • Management
  • Autoimmune disease
  • Systemic lupus erythematosis
  • Implications of pregnancy on the disease
  • Implications of the disease on pregnancy
  • Management
  • Haemoglobinopathies
  • Sickle cell syndromes
  • Implications of pregnancy on the disease
  • Implications of the disease on pregnancy
  • Management
  • The thalassaemias
  • Implications of pregnancy on the disease
  • Implications of the disease on pregnancy and management
  • Conclusions
  • 10 Congenital abnormalities and assessment of fetal wellbeing
  • Congenital abnormalities
  • Neural tube defects
  • Congenital cardiac defects
  • Defects of the abdominal wall
  • Chromosomal abnormalities
  • Down's syndrome
  • Assessing fetal normality
  • Screening
  • Clinical risk factors: early pregnancy
  • Clinical risk factors: late pregnancy
  • Ultrasound
  • Biochemistry
  • Counselling in advance of US and biochemical testing
  • Management options with an 'abnormal' or 'positive' test
  • Further counselling
  • Further assessment
  • Options for pregnancy
  • Possible interventions
  • Surveillance in pregnancy
  • Delivery issues
  • Assessing the health of a normally formed fetus
  • Screening for fetal health
  • Surveillance of fetal health in at-risk pregnancies
  • Doppler recordings of blood flow in the umbilical artery (UA)
  • Fetal growth
  • Small fetuses
  • Big fetuses
  • Amniotic fluid volume (AFV)
  • Biophysical measurements
  • Interventions
  • Non-specific risk
  • Specific risk
  • Conclusions
  • 11 Management of labour
  • Stages of labour
  • Onset of labour
  • The initiation of labour
  • Uterine activity in labour: the powers
  • The passages
  • The mechanism of labour
  • The third stage of labour
  • Pain in labour
  • The management of normal labour
  • Examination at the commencement of labour
  • General principles of the management of the first stage of labour
  • Observation: the use of the partogram
  • Fetal condition
  • Progress in labour
  • Fluid and nutrition during labour
  • Pain relief in labour
  • Narcotic analgesia
  • Inhalational analgesia
  • Non-pharmacological methods
  • Regional analgesia
  • Other forms of regional anaesthesia
  • Posture in labour
  • Water births
  • Fetal monitoring
  • Intermittent auscultation
  • Fetal cardiotocography
  • Basal heart rate
  • Baseline variability
  • Transient changes in fetal heart rate (Tables 11.2 and 11.3)
  • Accelerations
  • Decelerations
  • Early decelerations
  • Late decelerations
  • Variable decelerations
  • The fetal electrocardiogram
  • Fetal acid-base balance
  • Preterm delivery
  • Spontaneous preterm labour
  • Aetiology
  • The role of genital tract infection
  • The preterm infant
  • Survival
  • Complications of preterm birth
  • The management of preterm labour
  • Prevention
  • Treatment
  • ß-Adrenergic agonists
  • Prostaglandin synthetase inhibitors
  • Calcium antagonists
  • Corticosteroids
  • Neuroprotection by magnesium sulphate
  • Method of delivery
  • Prelabour rupture of the membranes
  • Pathogenesis
  • Management
  • Induction of labour
  • Indications
  • Cervical assessment
  • Methods of induction
  • Forewater rupture
  • Hindwater rupture
  • Medical induction of labour following amniotomy
  • Medical induction of labour and cervical ripening
  • Syntocinon infusion
  • Prostaglandins
  • Mechanical cervical ripening
  • Precipitate labour
  • Uterine hyperstimulation
  • Delay in progress in labour
  • Inefficient uterine activity
  • Hypotonic uterine activity
  • Hypertonic uterine activity
  • Management
  • Cephalopelvic disproportion
  • Management
  • Cord presentation and cord prolapse
  • Predisposing factors
  • Management
  • 12 Management of delivery
  • Normal vaginal delivery
  • Repair of episiotomy or perineal injury
  • Third and fourth degree injuries
  • Repair and management of third and fourth degree tears
  • Malpresentations
  • Face presentation
  • Diagnosis
  • Management
  • Brow presentation
  • Diagnosis and management
  • Malposition of the fetal head
  • The occipitoposterior position
  • Diagnosis and management
  • Deep transverse arrest
  • Diagnosis and management
  • Instrumental delivery
  • Indications for instrumental delivery
  • Prerequisites for instrumental delivery
  • Method of instrumental delivery
  • Non-rotational instrumental delivery
  • Forceps
  • Vacuum delivery
  • Rotational instrumental delivery
  • Trial of instrumental delivery
  • Caesarean section
  • Indications for caesarean section
  • Complications
  • Shoulder dystocia
  • Abnormalities of the third stage of labour
  • Postpartum haemorrhage
  • Primary postpartum haemorrhage
  • Predisposing causes
  • Management
  • Controlling the haemorrhage
  • Secondary postpartum haemorrhage
  • Causes and predisposing factors
  • Management
  • Vaginal wall haematomas
  • Uterine inversion
  • Perineal wound breakdown
  • Amniotic fluid embolism
  • 13 Postpartum problems
  • The normal postpartum period
  • Physiological changes
  • Genital tract
  • Cardiovascular system
  • Endocrine changes
  • The importance of breastfeeding
  • Colostrum
  • Breastfeeding
  • Complications of the postpartum period
  • Puerperal infections
  • Endometritis
  • Urinary tract infections (UTIs)
  • Mastitis and breast abscess
  • Caesarean wound infections and perineal infections
  • Other infections
  • Thromboembolism
  • Thrombophlebitis
  • Phlebothrombosis (see also Chapter 9)
  • Postnatal anticoagulation
  • Primary and secondary postpartum haemorrhage (PPH)
  • Anaemia
  • Maternal collapse
  • Contraception in the postnatal period
  • Neonatal problems
  • Conducting a routine postnatal clinical review
  • 14 Psychiatric disorders of childbirth
  • Introduction
  • The relevance of maternal mental health to obstetricians
  • Perinatal psychiatry
  • Antenatal psychiatric disorders
  • Mild to moderate psychiatric disorder
  • Management
  • Serious mental illness
  • Management
  • Psychiatric medication in pregnancy
  • Antidepressant medication
  • Monoamine oxidase inhibitors (MAOIs)
  • Tricyclic antidepressants (TCAs)
  • Current guidelines support the use of TCAs in pregnancy
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Current guidelines support the use of fluoxetine and sertraline in pregnancy
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Antipsychotic medication
  • Older 'typical' antipsychotics
  • Newer 'atypical' antipsychotics
  • Mood stabilizers
  • Anti-epileptic drugs
  • Antenatal screening
  • Screening for risk of postnatal depression (PND)
  • Postnatal psychiatric conditions
  • Normal emotional changes
  • The blues
  • Postnatal psychiatric disorders
  • Aetiology
  • Postpartum (puerperal) psychosis
  • Management
  • Prevention
  • Primary prevention
  • Secondary prevention
  • Postnatal depressive illness
  • Severe postnatal depression
  • Management
  • Mild to moderate postnatal depression
  • Management
  • Effects on the child
  • Prevention
  • Secondary prevention
  • Primary prevention
  • Hormones
  • Psychiatric medication in breastfeeding
  • Antidepressant medication
  • TCAs
  • SSRIs
  • Antipsychotic medication
  • Mood stabilizers
  • Anti-epileptic drugs
  • Benzodiazepines
  • UK confidential enquiries into maternal deaths
  • Maternal death due to suicide
  • Most suicides were seriously ill
  • They died violently
  • Previous history and the risk of recurrence
  • The women who died
  • Communication
  • The care received
  • Other causes of maternal death associated with psychiatric disorder
  • Substance misuse
  • Cause of death
  • Deaths from accidental overdose
  • Deaths from physical consequences of substance misuse
  • Avoidance of care
  • The women who died
  • Other maternal deaths from medical conditions associated with psychiatric disorder
  • Back to basics
  • Anxiety and distress in pregnancy and following delivery
  • Unexplained physical symptoms
  • Recommendations
  • Preconception counselling
  • Implications for psychiatric services
  • Maternity services
  • Communication and working with other services
  • Child safeguarding
  • Substance misusers
  • 3 Essential gynaecology
  • 15 Basic clinical skills in gynaecology
  • History
  • The presenting complaint
  • Menstrual history
  • Previous gynaecological history
  • Previous medical history
  • Family and social history
  • Examination
  • Breast examination
  • Examination of the abdomen
  • Pelvic examination
  • Bimanual examination
  • Special circumstances
  • Rectal examination
  • Presenting your findings
  • 16 Gynaecological disorders
  • Introduction
  • Benign conditions of the upper genital tract
  • The uterus
  • Symptoms and signs
  • Diagnosis and management
  • Surgical treatment
  • Endometrial polyps
  • Symptoms
  • Signs
  • Pathology
  • Treatment
  • Benign tumours of the myometrium
  • Histopathology
  • Pathological changes
  • Symptoms and signs
  • Management
  • Medical treatment
  • Uterine artery embolization (UAE)
  • Surgical treatment
  • Treatments in development
  • Adenomyosis
  • Symptoms and signs
  • Pathology
  • Treatment
  • Lesions of the ovary
  • Symptoms
  • Signs
  • Endometriosis
  • Pathophysiology
  • Diagnosis
  • Management
  • Abnormal uterine bleeding
  • Intermenstrual bleeding
  • Postcoital bleeding
  • Postmenopausal bleeding
  • Heavy menstrual bleeding
  • Causes
  • Structural
  • Non structural
  • History and examination
  • Investigations
  • Management
  • Medical treatment
  • Non-hormonal treatments
  • Hormonal treatments
  • Surgical treatment
  • Endometrial resection or ablation
  • Hysterectomy
  • Secondary amenorrhoea and oligomenorrhoea
  • Aetiology
  • Physiological
  • Pathological
  • Hypothalamic disorders
  • Pituitary disorders
  • Ovarian disorders
  • Ovarian failure
  • Polycystic ovary syndrome
  • Pathogenesis
  • Diagnosis
  • Uterine causes
  • Cryptomenorrhoea (literally 'hidden menstruation')
  • Investigations in women with amenorrhoea or oligomenorrhoea
  • Management
  • Dysmenorrhoea
  • Investigations
  • Management
  • Pharmacological
  • Premenstrual syndrome
  • Symptoms and signs
  • Pathogenesis
  • Management
  • Pharmacological
  • Disorders of puberty
  • Puberty and menarche
  • Thelarche
  • Adrenarche
  • Menarche
  • Growth spurt
  • Precocious puberty
  • Evaluation
  • Investigations
  • Management
  • Variations on normal puberty
  • Premature adrenarche
  • Premature thelarche
  • Precocious menarche
  • Delayed puberty
  • Investigations
  • Management
  • Menopause
  • Menopause transition
  • Hormone changes after the menopause
  • Symptoms and signs of menopause
  • Physical symptoms
  • Vascular disturbances
  • Urogenital tract
  • Other physical symptoms
  • Psychological and emotional symptoms
  • Other symptoms
  • Headaches
  • Bone and joint pain
  • Consequences of menopause
  • Bone changes
  • Cardiovascular complications
  • Treatment of the menopause
  • Hormone replacement therapy
  • Oral therapy
  • Parenteral therapy
  • Topical therapy
  • Contraindications
  • Risks
  • Benefits
  • Alternatives to oestrogen-containing HRT
  • Benign conditions of the lower genital tract
  • Vulval pruritus
  • Vulval neoplasia
  • Vaginal discharge
  • Cervical polyps
  • Benign tumours of the vulva and vagina
  • Vaginal cysts
  • Congenital
  • Vaginal inclusion cysts
  • Endometriosis
  • Solid benign tumours
  • Neoplastic lesions of the vaginal epithelium
  • Vaginal intraepithelial neoplasia
  • Vaginal adenosis
  • Emergency gynaecology
  • Pelvic infection
  • Bartholin's abscess/cyst
  • Vulval and vaginal trauma
  • Acute abdominal pain of uncertain origin
  • Acute appendicitis
  • Acute and excessively heavy unscheduled vaginal bleeding
  • 17 Infertility
  • History and examination
  • Female infertility
  • Disorders of ovulation
  • Tubal factors
  • Uterine factors
  • Endometriosis
  • Cervical factors
  • Investigation of infertility
  • Investigation of the female partner
  • Detection of ovulation
  • Ultrasonography
  • Investigation of anovulation
  • Assessment of ovarian reserve
  • Investigation of tubal patency
  • Hysterosalpingography
  • Hysterosonocontrast sonography
  • Laparoscopy and dye insufflation
  • Investigation of cervical factor infertility
  • Investigation of the male partner
  • Analysis of sperm DNA
  • Endocrine assessment of the male
  • Cytogenetic studies
  • Testicular/epididymal biopsy
  • Retrograde ejaculation
  • Immunological tests for male infertility
  • Treatment of female subfertility
  • Anovulation
  • Tubal pathology
  • Intrauterine insemination
  • In vitro fertilization and embryo transfer
  • Ovarian hyperstimulation syndrome
  • Treatment
  • Treatment of male infertility
  • Donor insemination
  • 18 Early pregnancy care
  • Bleeding in early pregnancy
  • Miscarriage
  • The aetiology of miscarriage
  • Genetic abnormalities
  • Endocrine factors
  • Maternal illness and infection
  • Maternal lifestyle and drug history
  • Abnormalities of the uterus
  • Cervical incompetence
  • Autoimmune factors
  • Thrombophilic defects
  • Alloimmune factors
  • Clinical types of miscarriage
  • Threatened miscarriage
  • Inevitable/incomplete miscarriage
  • Complete miscarriage
  • Miscarriage with infection (sepsis)
  • Missed miscarriage (empty gestation sac, embryonic loss, early and late fetal loss)
  • Spontaneous second trimester loss
  • Recurrent miscarriage
  • Management
  • Surgical management
  • Medical management
  • Conservative Management
  • Sensitive disposal of fetal tissues
  • Recurrent miscarriage
  • Ectopic pregnancy
  • Predisposing factors (Table 18.1)
  • Clinical presentation
  • Acute presentation
  • Subacute presentation
  • Pathology
  • Diagnosis
  • Management
  • Surgical management
  • Medical management
  • Pregnancy of unknown location
  • Management of other forms of extrauterine pregnancy
  • Abdominal pregnancy
  • Cervical pregnancy
  • Trophoblastic disease
  • Incidence
  • Pathology
  • Clinical presentation
  • Management
  • Vomiting in early pregnancy
  • Aetiology
  • Diagnosis
  • Management
  • 19 Sexual and reproductive health
  • Contraception and termination of pregnancy
  • Barrier methods of contraception
  • Male condoms
  • Female condoms
  • Diaphragms and cervical caps
  • Spermicides and sponges
  • Intrauterine contraceptive devices
  • Types of devices
  • Inert devices
  • Pharmacologically active devices
  • Devices containing progestogen
  • Life span of devices
  • Insertion of devices
  • Complications
  • Pregnancy rates
  • Perforation of the uterus
  • Pelvic inflammatory disease
  • Abnormal uterine bleeding
  • Pelvic pain
  • Vaginal discharge
  • Ectopic pregnancy
  • Hormonal contraception
  • Combined pill
  • Progestogen-only pill
  • Mode of action of the contraceptive pills
  • Contraindications
  • Other therapeutic uses
  • Major side effects
  • Beneficial effects
  • Interaction between drugs and contraceptive steroids
  • Failure rates
  • The pill and surgery
  • The pill and lactation
  • Injectable compounds
  • Newer methods of hormonal contraception
  • Emergency contraception
  • Non-medical methods of contraception
  • Sterilization
  • Counselling
  • Timing of sterilization
  • Techniques
  • Female sterilization
  • Laparoscopic sterilization
  • Tubal ligation (Fig. 19.7)
  • The Essure® procedure
  • Complications
  • Vasectomy
  • Psychological implications of sterilization
  • Termination of pregnancy
  • Methods
  • Surgical termination
  • Medical termination
  • Complications
  • Psychological sequelae of termination
  • Risk factors for adverse sequelae of first-trimester abortion
  • Later terminations of pregnancy
  • Contraception following termination
  • Criminal abortion
  • Genital tract infections
  • Lower genital tract infections
  • Symptoms
  • Signs
  • Common organisms causing lower genital tract infections
  • Vaginal candidiasis
  • Trichomoniasis
  • Genital herpes
  • Bacterial vaginosis
  • Gonococcal and chlamydial vulvovaginitis
  • Syphilis
  • Genital warts (condylomata acuminata)
  • Treatment of lower genital tract infections
  • Upper genital tract infections
  • Symptoms and signs
  • Common organisms
  • Chlamydia
  • Gonorrhoea
  • Differential diagnosis
  • Investigations
  • Management
  • Indications for surgical intervention
  • Chronic pelvic infection
  • Symptoms and signs
  • Management
  • Human immunodeficiency virus
  • Disorders of female sexual function
  • Dyspareunia
  • Superficial dyspareunia
  • Deep dyspareunia
  • Apareunia
  • Treatment
  • Vaginismus
  • Loss of libido
  • Treatment
  • Orgasmic dysfunction
  • Disorders of male sexual function
  • Erectile dysfunction
  • Treatment
  • Ejaculatory problems
  • Treatment
  • 20 Gynaecological oncology
  • Lesions of the vulva
  • Vulval intraepithelial neoplasia
  • Management
  • Cancers of the vulva
  • Symptoms
  • Mode of spread
  • Treatment
  • Prognosis
  • Neoplastic lesions of the vaginal epithelium
  • Vaginal intraepithelial neoplasia
  • Vaginal adenosis
  • Vaginal malignancy
  • Symptoms
  • Method of spread
  • Treatment
  • Prognosis
  • Lesions of the cervix
  • Screening for cervical cancer
  • Classification of cervical cytology
  • Colposcopy
  • Pathophysiology
  • Colposcopic appearances
  • Human papilloma virus
  • Cervical intraepithelial neoplasia
  • Treatment
  • Complications of cone biopsy
  • Follow-up
  • Cervical cancer
  • Pathology
  • The spread of tumour
  • Clinical features
  • Investigation
  • Treatment of invasive carcinoma
  • Surgery - radical hysterectomy and pelvic lymph node dissection
  • Radiotherapy/Chemoradiation
  • Prognosis
  • Malignant disease of the uterus
  • Endometrial carcinoma
  • Symptoms
  • Pathology
  • Investigations
  • Treatment
  • Prognosis
  • Malignant mesenchymal tumours of the uterus
  • Stromal sarcomas
  • Mixed müllerian tumours (carcinosarcomas)
  • Leiomyosarcoma
  • Treatment
  • Lesions of the ovary
  • Symptoms
  • Signs
  • Benign ovarian tumours
  • Functional cysts of the ovary
  • Follicular cysts
  • Management
  • Lutein cysts
  • Benign neoplastic cysts
  • Epithelial tumours
  • Serous cystadenomas
  • Mucinous cystadenomas
  • Brenner cell tumours
  • Sex cord stromal tumours
  • Granulosa cell tumours
  • Arrhenoblastomas or androblastomas
  • Germ cell tumours
  • Mature cystic teratoma (dermoid cyst)
  • Fibromas
  • Tumour-like conditions
  • Endometriotic cysts
  • Ovarian malignancy
  • Aetiology
  • Genetic
  • Parity and fertility
  • Pathology
  • Primary ovarian carcinoma
  • Epithelial type
  • Sex cord stromal tumours
  • Germ cell tumours
  • Secondary ovarian carcinomas
  • Staging of ovarian carcinoma
  • Diagnosis
  • Management
  • Chemotherapy
  • Borderline tumours
  • Germ cell tumours
  • Follow-up and treatment of recurrence
  • Prognosis
  • Screening for ovarian cancer
  • Principles of palliative care in gynaecological cancer
  • 21 Prolapse and disorders of the urinary tract
  • Uterovaginal prolapse
  • Definitions
  • Vaginal prolapse
  • Uterine prolapse
  • Symptoms and signs
  • Urethrocele and cystocele
  • Rectocele
  • Enterocele
  • Uterine prolapse
  • Staging/grading of prolapse
  • Baden-Walker halfway system (Fig. 21.8 and Table 21.2)
  • Pathogenesis
  • Management
  • Prevention
  • Conservative treatment
  • Pelvic floor physiotherapy
  • Surgical treatment
  • Fascial repairs
  • Graft repairs
  • Complications
  • Urinary tract disorders
  • Structure and physiology of the urinary tract
  • Common disorders of bladder function
  • Incontinence of urine
  • Urinary frequency
  • Dysuria
  • Urinary retention
  • Nocturnal enuresis or bed-wetting
  • Diagnosis
  • Management
  • Urinary tract fistula
  • Stress incontinence
  • The unstable bladder: overactive bladder syndrome (OAB)
  • Detrusor instability of unknown aetiology
  • Drug treatment
  • Pelvic floor physiotherapy: pelvic floor muscle training
  • Electrical stimulation (interferential therapy)
  • Biofeedback therapy
  • Dietary modifications
  • Timed voiding
  • Vaginal oestrogen
  • Bladder outlet obstruction
  • The neuropathic bladder
  • Presentation
  • Aetiology
  • Diagnosis
  • Management
  • Appendices
  • Appendix A Principles of perioperative care
  • Preoperative care
  • Patient counselling and consent (see also Appendix C)
  • Preoperative assessment
  • Clinical history and examination
  • Investigations
  • Medications
  • Preoperative preparation
  • Management of anaemia
  • Antibiotic prophylaxis
  • Management of diabetes
  • Intraoperative complications
  • Regional and general anaesthesia
  • Local anaesthesia
  • Complications secondary to patient positioning
  • Acute compartment syndrome
  • Neurological injury
  • Haemorrhage
  • Ureteric and bladder injury
  • Gastrointestinal injury
  • Postoperative care
  • Analgesia
  • Fluid and electrolyte balance
  • Cardiovascular stability
  • Bladder care
  • Oral intake
  • Postoperative complications
  • Postoperative haemorrhage
  • Pyrexia
  • Surgical site infections
  • Treatment
  • Cardiovascular and respiratory complications
  • Venous thromboembolism
  • Discharge from hospital
  • Appendix B Governance, audit and research
  • Data collection in the national health service
  • Sources of data collection and computing systems
  • GP consultations and registrations
  • Registration of births and deaths
  • Hospital episode statistics (HES)
  • Mortality rates statistics
  • Morbidity rates statistics
  • Research and data linkage
  • Data Protection Act
  • Caldicott principles
  • Evidence-based healthcare
  • Clinical audit
  • Four steps of clinical audit
  • Defining best practice
  • Preparing to monitor
  • Monitoring your achievement
  • Planning for improvement
  • National clinical audits
  • Clinical guidelines
  • Research
  • Type of research studies
  • Descriptive studies
  • Analytical studies
  • Clinical trials
  • Clinical governance
  • Risk management
  • Clinical incident reporting
  • Conclusion
  • Appendix C Medicolegal aspects of obstetrics and gynaecology
  • Principles and legal issues around informed consent
  • Litigation in obstetrics and gynaecology
  • Patient confidentiality (including data protection)
  • The rules regarding abortion
  • The use of assisted reproduction in infertility care
  • The relevant legal status of the fetus, the pregnant woman, the child and the pubertal girl
  • The role of the doctor in child protection
  • Self-assessment: Questions
  • Chapter 1
  • Chapter 2
  • Chapter 3
  • Chapter 4
  • Chapter 5
  • Chapter 6
  • Chapter 7
  • Chapter 8
  • Chapter 9
  • Chapter 10
  • Chapter 11
  • Chapter 12
  • Chapter 13
  • Chapter 14
  • Chapter 15
  • Chapter 16
  • Chapter 17
  • Chapter 18
  • Chapter 19
  • Chapter 20
  • Chapter 21
  • Appendix A
  • Appendix B
  • Appendix C
  • Self-assessment: Answers
  • Chapter 1
  • Chapter 2
  • Chapter 3
  • Chapter 4
  • Chapter 5
  • Chapter 6
  • Chapter 7
  • Chapter 8
  • Chapter 9
  • Chapter 10
  • Chapter 11
  • Chapter 12
  • Chapter 13
  • Chapter 14
  • Chapter 15
  • Chapter 16
  • Chapter 17
  • Chapter 18
  • Chapter 19
  • Chapter 20
  • Chapter 21
  • Appendix A
  • Appendix B
  • Appendix C
  • Further reading
  • Chapter 2
  • Chapter 3
  • Chapter 4
  • Chapter 5
  • Chapter 6
  • Chapter 7
  • Chapter 8
  • Chapter 9
  • Chapter 10
  • Chapter 11
  • Chapter 12
  • Chapter 13
  • Chapter 14
  • Chapter 15
  • Chapter 16
  • Chapter 17
  • Chapter 18
  • Chapter 19
  • Chapter 20
  • Chapter 21
  • Appendix A
  • Appendix B
  • Appendix C
  • Further websites
  • Index
  • A
  • B
  • C
  • D
  • E
  • F
  • G
  • H
  • I
  • J
  • K
  • L
  • M
  • N
  • O
  • P
  • Q
  • R
  • S
  • T
  • U
  • V
  • W
  • Y
  • Z

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