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2015v1.0
Llewellyn-Jones
Fun d a m e n t a ls
of
Ob s t e t ric s
and
Gyn a e c o lo g y
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1 0
th
EDITION
Lle we llyn-Jone s
Fu n d a m e n t a ls
o f
Ob s t e t ric s
a nd
Gy n a e c o lo g y
Je re m y Oa t s
MBBS DM FRCOG FRANZCOG
Chair Victorian, Consultative Council on Obstetric and Paediatric Mortality and Morbidity, Australia;
Consultant Obstetrician and Gynaecologist, Royal Women’s Hospital, Melbourne, Australia;
Professorial Fellow, Melbourne School of Population and Global Health, University of Melbourne,
Australia
Su za n n e Ab ra h a m
MSc PhD (Med) MAPS
Associate Professor in Perinatal and Women’s Health, Faculty of Medicine, University of Sydney,
Sydney, Australia
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto
© 2017, Elsevier Limited. All rights reserved.
Sixth edition © Mosby Professional Ltd 1994
Seventh edition © Elsevier Limited 1999
Eighth edition © Elsevier Limited 2005
Ninth edition © Elsevier Limited 2010
The right of Jeremy Oats and Suzanne Abrahams to be identi ed as author of this work has been asserted by them in
accordance with the Copyright, Designs and Patents Act 1988.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical,
including photocopying, recording, or any information storage and retrieval system, without permission in writing from
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found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than
as may be noted herein).
Notices
Knowledge and best practice in this eld are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any
information, methods, compounds, or experiments described herein. In using such information or methods they should
be mindful of their own safety and the safety of others, including parties for whom they have a professional
responsibility.
With respect to any drug or pharmaceutical products identi ed, readers are advised to check the most current
information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify
the recommended dose or formula, the method and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to
determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for
any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any
use or operation of any methods, products, instructions, or ideas contained in the material herein.
ISBN: 978-0-7020-6065-6
International Edition ISBN: 978-0-7020-6064-9
Ebook ISBN: 978-0-7020-6066-3
Printed in China
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Content Strategist: Pauline Graham
Content Development Specialist: Fiona Conn
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Co n ten ts
Preface ..................................................................vi 21. Abnormal fetal presentations .................172
Acknowledgements ............................................vii 22. Abnormal labour (dystocia) ..................185
1. Gynaecological and obstetric 23. Disorders in the puerperium ..................198
history and examination ..............................1
24. Obstetric operations .................................203
2. Ovulation and the menstrual cycle ..........10
25. The epidemiology of obstetrics ..............215
3. Conception and placental
26. The newborn infant ..................................221
development ................................................19
27. The low-birthweight infant ......................231
4. Embryo and fetus .......................................30
28. Disorders of menstruation ......................235
5. Physiological and anatomical
29. Psychological and physical
changes in pregnancy .................................34
disorders of the menstrual cycle .............245
6. Antenatal care ............................................40
30. Human sexuality .......................................251
7. Physiological and anatomical
31. Conception control ...................................257
changes in childbirth ..................................57
32. Infertility ....................................................267
8. Course and management of
33. Infections of the genital tract..................272
childbirth ......................................................70
34. Atrophic and dystrophic conditions ......282
9. The puerperium ..........................................90
35. Endometriosis and adenomyosis ............286
10. Minor complications of pregnancy .........100
36. Benign tumours, cysts and
11. Miscarriage and abortion ........................105
malformations of the genital tract..........294
12. Extra-uterine pregnancy/ectopic
37. Premalignant and malignant
gestation .....................................................113
conditions of the female
13. Antepartum haemorrhage .......................119
genital tract ................................................305
14. Hypertensive diseases in pregnancy ......124
38. Uterovaginal displacements,
15. Cardiovascular, respiratory,
damage and prolapse ...............................318
haematological, neurological and
39. The urinary tract and its
gastrointestinal disorders in
relationship to gynaecology ....................325
pregnancy ...................................................131
40. The breast ..................................................332
16. Endocrine disorders in pregnancy .........141
41. Gynaecological problems in
17. Infections during pregnancy....................146
childhood and adolescence .....................336
18. Diseases of the placenta and
42. The menopause .........................................341
membranes ................................................152
43. Anatomy of the female
19. Variations in the duration of
genital tract ................................................348
pregnancy ...................................................158
20. The at-risk fetus ........................................163 Index...........................................................365
v
Pre ace
When Derek Llewellyn-Jones prepared the f rst edition o Fundamentals of Obstetrics and Gynaecology,
the pro essions’ perception o the priorities o women’s health was somewhat di erent to those 50
years on. Maternity and gynaecological care was primarily medical in ocus, and management was
based on the teachings, personal experience and belie s o senior clinicians.
Modern women’s health care is now ounded on collaboration between the multiple members o
the team – midwi e, nurse, obstetrician, gynaecologist, dietitian, physiotherapist, paediatrician,
specialist physician, ultrasonologist, oncologist, social worker – and the woman at the centre.
Decisions about management are, or should be, based on the best available quality evidence com-
municated to the woman and her amily in comprehensible language with total acceptance that the
f nal decision on what treatment is decided on is the woman’s. It is appropriate to recall that Derek
Llewellyn-Jones was a pioneer in writing accessible in ormation or women o all ages, explaining
how their bodies unctioned and the causes o many o the common conditions they might experi-
ence. The internet has now become the primary source o in ormation or many women, and the
challenge or the practitioner is to assist women in sorting through and being able to assess this vast
array o literature.
This tenth edition continues the legacy and philosophy o Derek Llewellyn-Jones, with the objec-
tive o providing the student o women’s health with the undamentals o this vital area, based on
the best available and proven in ormation that will enable them to practise high quality, empathetic
health care.
Jeremy Oats
Suzanne Abraham
vi
Ackn owled gem en ts
We particularly wish to thank Dr Ricardo Palma-Dias for reviewing and updating, where required,
the ultrasound images.
We remain indebted to Dr Neil Roy for his advice on the neonatal content, Dr Suzanne Garland
for the infectious diseases sections and Dr Helen Savoia for the haematological components.
In addition we acknowledge the assistance of the late Dr Aldo Vacca for his guidance on the
vacuum extractor and OmniCup photograph, Dr John Bell, John Gocking, Dr Jenny King, Gwen
Moody, Dr Diane Payton, Susan Hart and the Down Syndrome Association for their generous provi-
sion of pathology and clinical photographs and Dr Amanda Sampson for ultrasound images.
Our gratitude also to our colleagues and especially Dr Robert Lahoud, Professor Rod Baber and
Professor Amanda McBride for their advice and assistance in updating various sections of this
edition.
To the team at Elsevier – Fiona Conn, Anne Collett, Pauline Graham – our appreciation for their
persistence, patience and professionalism and to Susan and Glyn for their ongoing support.
vii
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