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P1: Trim:8.375in×10.875in Top:0.498in Gutter:0.664in LWBK920-FM LWW-Berek-clinical October27,2011 12:32 Berek Novak’s & Gynecology i P1: Trim:8.375in×10.875in Top:0.498in Gutter:0.664in LWBK920-FM LWW-Berek-clinical October27,2011 12:32 ii P1: Trim:8.375in×10.875in Top:0.498in Gutter:0.664in LWBK920-FM LWW-Berek-clinical October27,2011 12:32 Berek Novak’s & Gynecology Fifteenth Edition Jonathan S. Berek , MD, MMS ProfessorandChair DepartmentofObstetricsandGynecology StanfordUniversitySchoolofMedicine Director,StanfordWomen’sCancerCenter StanfordCancerInstitute Stanford,California EditorialAssistant&Design Deborah L. Berek, MA Illustrationsby Timothy C. Hengst, CMI, FAMI George Barile iii P1: Trim:8.375in×10.875in Top:0.498in Gutter:0.664in LWBK920-IE-FM LWW-Berek-clinical October27,2011 12:32 AcquisitionsEditor:SonyaSeigafuse ProductManager:NicoleWalz VendorManager:AliciaJackson SeniorManufacturingManager:BenjaminRivera MarketingManager:KimberlySchonberger DesignCoordinator:HollyReidMcLaughlin ProductionService:Aptara,Inc. (cid:2)C 2012byLIPPINCOTTWILLIAMS&WILKINS,aWOLTERSKLUWERbusiness (cid:2)C 2007,2002,and1996byLippincottWilliams&Wilkins (cid:2)C 1988,1981,and1975byWilliams&Wilkins TwoCommerceSquare 2001MarketStreet Philadelphia,PA19103USA LWW.com Allrightsreserved.Thisbookisprotectedbycopyright.Nopartofthisbookmaybereproducedinanyformby anymeans,includingphotocopying,orutilizedbyanyinformationstorageandretrievalsystemwithoutwritten permissionfromthecopyrightowner,exceptforbriefquotationsembodiedincriticalarticlesandreviews. MaterialsappearinginthisbookpreparedbyindividualsaspartoftheirofficialdutiesasU.S.government employeesarenotcoveredbytheabove-mentionedcopyright. PrintedintheUnitedStatesofAmerica NotauthorisedforSaleinNorthAmericaortheCaribbean CIPdataavailableuponrequest ISBN-13:978-1-4511-7556-1 ISBN-10:1-4511-7556-6 Carehasbeentakentoconfirmtheaccuracyoftheinformationpresentedandtodescribegenerallyaccepted practices.However,theauthors,editors,andpublisherarenotresponsibleforerrorsoromissionsorforany consequencesfromapplicationoftheinformationinthisbookandmakenowarranty,expressedorimplied,with respecttothecurrency,completeness,oraccuracyofthecontentsofthepublication.Applicationofthe informationinaparticularsituationremainstheprofessionalresponsibilityofthepractitioner. Theauthors,editors,andpublisherhaveexertedeveryefforttoensurethatdrugselectionanddosagesetforthin thistextareinaccordancewithcurrentrecommendationsandpracticeatthetimeofpublication.However,in viewofongoingresearch,changesingovernmentregulations,andtheconstantflowofinformationrelatingto drugtherapyanddrugreactions,thereaderisurgedtocheckthepackageinsertforeachdrugforanychangein indicationsanddosageandforaddedwarningsandprecautions.Thisisparticularlyimportantwhenthe recommendedagentisaneworinfrequentlyemployeddrug. SomedrugsandmedicaldevicespresentedinthepublicationhaveFoodandDrugAdministration(FDA) clearanceforlimiteduseinrestrictedresearchsettings.Itistheresponsibilityofthehealthcareproviderto ascertaintheFDAstatusofeachdrugordeviceplannedforuseintheirclinicalpractice. Topurchaseadditionalcopiesofthisbook,callourcustomerservicedepartmentat(800)638-3030orfaxorders to(301)223-2320.Internationalcustomersshouldcall(301)223-2300. VisitLippincottWilliams&WilkinsontheInternet:atLWW.com.LippincottWilliams&Wilkinscustomer servicerepresentativesareavailablefrom8:30amto6pm,EST. 10 9 8 7 6 5 4 3 2 1 iv P1: Trim:8.375in×10.875in Top:0.498in Gutter:0.664in LWBK920-FM LWW-Berek-clinical October27,2011 12:32 ToDeborah—togetherinlifeandinprint. v P1: Trim:8.375in×10.875in Top:0.498in Gutter:0.664in LWBK920-FM LWW-Berek-clinical October27,2011 12:32 Contributors LisaN.Abaid,MD,MPH LieutenantColonelRichardO.Burney,MD,MSc GynecologicOncologyAssociates DepartmentofObstetricsandGynecology NewportBeach,California MadiganHealthcareSystem UnitedStatesArmyMedicalCommand JeanR.Anderson,MD Tacoma,Washington Professor DepartmentofGynecologyandObstetrics JoannaM.Cain,MD JohnsHopkinsUniversitySchoolofMedicine ProfessorandViceChair Baltimore,Maryland DepartmentofObstetricsandGynecology UniversityofMassachusettsMedicalSchool MiraAubuchon,MD Worcester,Massachusetts AssistantProfessor DepartmentofObstetrics,Gynecologyand DanielL.Clarke-Pearson,MD Women’sHealth RobertA.RossDistinguishedProfessorandChair UniversityofMissouriSchoolofMedicine DepartmentofObstetricsandGynecology Columbia,Missouri UniversityofNorthCarolina PhysicianandChief ValerieL.Baker,MD NorthCarolinaWomen’sHospital AssistantProfessor UniversityofNorthCarolinaHospitals DepartmentofObstetricsandGynecology ChapelHill,NorthCarolina StanfordUniversitySchoolofMedcine Stanford,California DanielW.Cramer,MD,ScD DavidA.Baram,MD Professor ClinicalAssistantProfessor DepartmentofEpidemiology DepartmentofObstetricsandGynecology HarvardMedicalSchool UniversityofMinnesotaSchoolofMedicine Boston,Massachusetts RegionsHospital St.Paul,Minnesota GeoffreyW.Cundiff,MD ProfessorandHead RosemaryBasson,MD DepartmentofObstetricsandGynecology ClinicalProfessor UniversityofBritishColumbia DepartmentsofPsychiatryandObstetrics&Gynecology VancouverCoastalHealth UniversityofBritishColumbia Vancouver,BritishColumbia UniversityofBritishColumbiaCentreforSexualMedicine Vancouver,Canada JessieDorais,MD RossS.Berkowitz,MD VisitingInstructor WilliamH.BakerProfessorofGynecology DepartmentofObstetricsandGynecology DepartmentofObstetricsandGynecology DivisionofReproductiveEndocrinology HarvardMedicalSchool UniversityofUtahHealthCare DirectorofGynecologyandGynecologicOncology UtahCenterforReproductiveMedicine BrighamandWomen’sHospital SaltLakeCity,Utah DanaFarberCancerInstitute Boston,Massachusetts ThomasM.D’Hooghe,MD,PhD Professor AndrewI.Brill,MD DepartmentofReproduction,Regeneration DirectorofMinimallyInvasiveGynecology andDevelopment DepartmentofObstetricsandGynecology LeuvenUniversity CaliforniaPacificMedicalCenter Director,LeuvenUniversityFertilityCenter SanFrancisco,California Leuven,Belgium vi P1: Trim:8.375in×10.875in Top:0.498in Gutter:0.664in LWBK920-FM LWW-Berek-clinical October27,2011 12:32 Contributors OliverDorigo,MD,PhD ArmandoE.Giuliano,MD AssistantProfessor ClinicalProfessorofSurgery DivisionofGynecologicOncology DavidGeffenSchoolofMedicineatUCLA DepartmentofObstetricsandGynecology ExecutiveViceChair,Surgery DavidGeffenSchoolofMedicineatUCLA Cedars-SinaiMedicalCenter LosAngeles,California LosAngeles,California SeanC.Dowdy,MD, AssociateProfessor JonathanL.Gleason,MD DepartmentofObstetricsandGynecology Instructor Co-ProgramLeader,Women’sCancerProgram DepartmentofObstetricsandGynecology MayoClinic UniversityofAlabamaatBirmingham Rochester,Minnesota Birmingham,Alabama JohnC.Elkas,MD,JD AssociateProfessor ReneGenadry,MD DepartmentofObstetricsandGynecology AssociateProfessor VirginiaCommonwealthUniversity, DepartmentofGynecologyandObstetrics InovaFairfaxCampus JohnsHopkinsUniversitySchoolofMedicine InovaFairfaxHospital Baltimore,Maryland FallsChurch,Virginia TommasoFalcone,MD DonaldP.Goldstein,MD ProfessorandChair Professor DepartmentofObstetricsandGynecology DepartmentofObstetricsandGynecology ClevelandClinic HarvardMedicalSchool Cleveland,Ohio BrighamandWomen’sHospital CarrieE.Frederick,MD Boston,Massachusetts ClinicalInstructor DivisionofFamilyPlanning BaibaJ.Grube,MD DepartmentofObstetricsandGynecology DepartmentofOncology&GeneralSurgery StanfordUniversitySchoolofMedicine YaleSchoolofMedicine Sanford,California NewHaven,Connecticut MichaelL.Friedlander,MBCHB,PhD ConjointProfessor RobertE.Gutman,MD UniversityofNewSouthWales PrinceofWalesCancerCentre AssociateProfessor Sydney,Australia DepartmentofObstetricsandGynecologyand Urology JosephC.Gambone,DO,MPH GeorgetownUniversity ProfessorEmeritus FellowshipDirector,FemalePelvicMedicineand DepartmentofObstetricsandGynecology ReconstructiveSurgery DavidGeffenSchoolofMedicineatUCLA WashingtonHospitalCenter LosAngeles,California Washington,DC FranciscoGarcia,MD,MPH KennethD.Hatch,MD DistinguishedOutreachProfessor DepartmentsofPublic,Health,ObstetricsandGynecology, Professor ClinicalPharmacy,andNursing DepartmentofObstetricsandGynecology UniversityofArizona UniversityofArizonaSchoolofMedicine UniversityMedicalCenter Tucson,Arizona Tucson,Arizona TracyW.Gaudet,MD PaulaJ.AdamsHillard,MD Director Professor Veteran’sHealthAdministration DepartmentofObstetricsandGynecology OfficeofPatient-CenteredCareandCulturalTransformation StanfordUniversitySchoolofMedicine Washington,DC Stanford,California vii P1: Trim:8.375in×10.875in Top:0.498in Gutter:0.664in LWBK920-FM LWW-Berek-clinical October27,2011 12:32 Contributors ChristineH.Holschneider,MD AndreaMariani,MD AssociateProfessor AssociateProfessor DepartmentofObstetricsandGynecology DepartmentofObstetricsandGynecology DavidGeffenSchoolofMedicineatUCLA MayoClinic LosAngeles,California Rochester,Minnesota Chair,DepartmentofObstetricsandGynecology OliveView-UCLAMedicalCenter OtonielMart´ınez-Maza,PhD Sylmar,California Professor JohnP.Keats,MD DepartmentofObsteticsandGynecology DavidGeffenSchoolofMedicineatUCLA MedicalDirector,PerinatalSafety LosAngeles,California CatholicHealthcareWest SanFrancisco,Californina HowardD.McClamrock,MD EmilyKo,MD Chief ClinicalFellow DivisionofReproductiveEndocrinologyandInfertility DivisionofGynecologicOncology DepartmentsofObstetrics,GynecologyandReproductive UniversityofNorthCarolina Sciences ChapelHill,NorthCarolina UniversityofMaryland Baltimore,Maryland OumarKuzbari,MD ShadyGroveFertilityReproductiveSciencesCenter VisitingInstructor Rockville,MD DepartmentofObstetricsandGynecology DivisionofGeneralObstetricsandGynecology UniversityofUtahHealthCare ShawnA.Menefee,MD UtahCenterforReproductiveMedicine AssociateClinicalProfessor SaltLakeCity,Utah DepartmentofReproductiveMedicine UniversityofCalifornia,SanDiego RuthBunkerLathi,MD SanDiego,California AssistantProfessor DivisionofReproductiveEndocrinology CaelaR.MillerMD DepartmentofObstetricsandGynecology AssistantProfessor StanfordUniversitySchoolofMedicine DivisionofGynecologicOncology Stanford,California DepartmentofObstetricsandGynecology CameliaA.Lawrence,MD UniformedServicesUniversityoftheHealthSciences WalterReedNationalMilitaryMedicalCenter BreastSurgeon Bethesda,Maryland UnitedHealthServicesWilsonMedicalCenter JohnsonCity,NewYork MalcolmG.Munro,MD TeriA.Longacre,MD ClinicalProfessor Professor DepartmentofObstetrics&Gynecology DepartmentofPathology DavidGeffenSchoolofMedicineatUCLA StanfordUniversitySchoolofMedicine DirectorofGynecologicServices Stanford,California KaiserPermanente,LosAngelesMedicalCenter LosAngeles,California JohnR.Lurain,MD MarciaStennProfessorofGynecologicOncology LeenaNathan,MD DepartmentofObstetricsandGynecology DepartmentofObstetricsandGynecology NorthwesternUniversityFeinbergSchoolofMedicine DavidGeffenSchoolofMedicineatUCLA Chicago,Illinois LosAngeles,California JavierF.Magrina,MD Professor AntoniaF.Nicosia,MD DepartmentofGynecology ClinicalAssistantProfessor MayoClinicArizona DivisionofFamilyPlanning Director,GynecologicOncology DepartmentofObstetricsandGynecology MayoClinicHospital StanfordUniversitySchoolofMedicine Phoenix,Arizona Stanford,California viii P1: Trim:8.375in×10.875in Top:0.498in Gutter:0.664in LWBK920-FM LWW-Berek-clinical November3,2011 1:30 Contributors ThomasE.Nolan,MD,MBA MaureenG.Phipps,MD,MPH ProfessorandDepartmentHeadEmeritus AssociateProfessor DepartmentofObstetricsandGynecology DepartmentsofObstetricsandGynecologyand LouisianaStateUniversityHealthScience CommunityHealth Center-NewOrleans WarrenAlpertMedicalSchoolofBrownUniversity NewOrleans,Louisiana Women&InfantsHospitalofRhodeIsland Providence,RhodeIsland IngridNygaard,MD,MS Professor AndreaJ.Rapkin,MD DepartmentofObstetricsandGynecology Professor DivisionofUrogynecologyandPelvic DepartmentofObstetricsandGynecology ReconstructiveSurgery DavidGeffenSchoolofMedicineatUCLA UniversityofUtahSchoolofMedicine LosAngeles,California SaltLakeCity,Utah DavidL.Olive,MD RobertW.Rebar,MD AttendingPhysician ExecutiveDirector DepartmentofObstetricsandGynecology AmericanSocietyforReproductiveMedicine MeriterHospital Birmingham,Alabama WisconsinFertilityInstitute Middleton,Wisconsin HollyE.Richter,PhD,MD ProfessorandDivisionDirector JunkoOzao-Choy,MD DepartmentofObstetricsandGynecology JohnWayneCancerInstitute UniversityofAlabamaatBirmingham Santa,Monica,California Birmingham,Alabama StevenF.Palter,MD DanielleM.Roncari,MD,MPH MedicalDirector AssistantProfessor GoldCoastIVF DepartmentofObstetricsandGynecology Syosset,NewYork TuftsNewEnglandMedicalCenter Boston,Massachusetts WilliamH.Parker,MD ClinicalProfessor IsaacSchiff,MD DepartmentofObstetricsandGynecology DavidGeffenSchoolofMedicineatUCLA JoeVincentMeigsProfessorofGynecology LosAngeles,California HarvardMedicalSchool AdjunctFaculty Chief,ObstetricsandGynecologyService JohnWayneCancerInstitute MassachusettsGeneralHospital SantaMonica,California Boston,Massachusetts ArasenA.V.Paupoo,MD,MA WendyJ.Schillings,MD AssistantProfessorandDirector DepartmentofObstetricsandGynecology DivisionofReproductiveEndocrinologyandInfertlity DivisionofReproductiveEndocrinology& DepartmentofObstetricsandGynecology Infertility/Gynecology CreightonUniversitySchoolofMedicine LehighValleyHealthNetwork Omaha,Nebraska Allentown,Pennsylvania C.MatthewPeterson,MD KevinM.Schuler,MD JohnA.DixonPresidentialProfessorandChair Fellow DepartmentofObstetricsandGynecology DivisionofGynecologicOncology UniversityofUtahSchoolofMedicine DepartmentofObstetricsandGynecology UniversityHospital UniversityofNorthCarolinaatChapelHill SaltLakeCity,Utah ChapelHill,NorthCarolina SharonT.Phelan,MD DannyJ.Schust,MD Professor DepartmentofObstetricsandGynecology AssociateProfessor HealthScienceCenterSchoolofMedicine DepartmentofObstetrics,GynecologyandWomen’sHealth UniversityofNewMexico UniversityofMissouri Albuquerque,NewMexico Columbia,Missouri ix P1: Trim:8.375in×10.875in Top:0.498in Gutter:0.664in LWBK920-FM LWW-Berek-clinical October27,2011 12:32 Contributors JanL.Shifren,MD PhillipStubblefield,MD AssociateProfessor EmeritusProfessor DepartmentofObstetrics,Gynecologyand DepartmentofObstetricsand ReproductiveBiology Gynecology HarvardMedicalSchool BostonUniversitySchoolofMedicine Director,VincentMenopauseProgram BostonMedicalCenter MassachusettsGeneralHospital Boston,Massachusetts Boston,Massachusetts R.EdwardVarner,MD EricR.Sokol,MD Professor AssistantProfessorofObstetricsandGynecology,and DepartmentofObstetricsandGynecology Urology(Courtesy) UniversityofAlabamaatBirmingham Co-Chief,DivisionofUrogynecologyandPelvic Birmingham,Alabama ReconstructiveSurgery StanfordUniversitySchoolofMedicine Stanford,California AmyJ.Voedisch,MD,MS ClinicalInstructor DavidE.Soper,MD DivisionofFamilyPlanning ProfessorandViceChair DepartmentofObstetricsandGynecology DepartmentofObstetricsandGynecology StanfordUniversitySchoolofMedicine MedicalUniversityofSouthCarolina Stanford,California Charleston,SouthCarolina MyleneW.M.Yao,MD NadaLoganStotland,MD,MPH ChiefExecutiveOfficer Professor UNIVFY DepartmentofPsychiatry PaloAlto,California RushMedicalCollege Chicago,Illinois ThomasG.Stovall,MD ClinicalProfessor DepartmentofObstetricsandGynecology UniversityofTennessee,Memphis Memphis,Tennessee x

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