Obstetrics and Gynecology at a Glance

170 Pages·2013·17.72 MB·English

by  Errol R. Norwitz

Obstetrics and
Gynecology
at a Glance

Obstetrics and
Gynecology
at a Glance
Errol R. Norwitz
MD, PhD(Oxon), FACOG
Louis E Phaneuf Professor of Obstetrics & Gynecology
Tufts University School of Medicine
Chairman, Department of Obstetrics & Gynecology
Tufts Medical Center
Boston, MA, USA
John O. Schorge
MD, FACOG, FACS
Associate Professor of Obstetrics, Gynecology and Reproductive Biology
Harvard Medical School
Chief, Gynecologic Oncology Service
Department of Obstetrics and Gynecology
Massachusetts General Hospital,
Boston, MA, USA
Fourth Edition
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Library of Congress Cataloging-in-Publication Data
Norwitz, Errol R., author.
Obstetrics and gynecology at a glance / Errol R. Norwitz, John O. Schorge. – Fourth edition.
p. ; cm. – (At a glance)
Includes bibliographical references and index.
ISBN 978-1-118-34173-5 (pbk. : alk. paper) – ISBN 978-1-118-34478-1 (Mobi) –
ISBN 978-1-118-34479-8 (ePub) – ISBN 978-1-118-34480-4 (ePdf) – ISBN 978-1-118-73234-2 –
ISBN 978-1-118-73241-0
I. Schorge, John O., author. II. Title. III. Series: At a glance series (Oxford, England)
[DNLM: 1. Genital Diseases, Female–Handbooks. 2. Pregnancy Complications–Handbooks.
WP 39]
RG110
618–dc23
2013017944
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may
not be available in electronic books.
Cover image: Two month old foetus, artwork Sciepro/Science Photo Library
Cover design by Meaden Creative
Set in 9/11.5 pt Times by Toppan Best-set Premedia Limited
1 2013
Contents
List of contributors 7 38 Maternal adaptations to pregnancy 84
Preface 8 39 Prenatal diagnosis 86
Acknowledgments 8 40 Obstetric ultrasound 88
About the companion website 9 41 Obstetrics in primary care 90
Part 1 Gynecology Antepartum complications
General 42 Infections in pregnancy: bacteria and protozoa 92
1 History taking and physical examination 10 43 Infections in pregnancy: viruses and spirochetes 94
2 Anatomy of the female reproductive tract 12 44 Hypertensive disorders of pregnancy 96
3 The menstrual cycle 14 45 Diabetes mellitus in pregnancy 98
4 Abnormal vaginal bleeding 16 46 Cardiovascular disease in pregnancy 100
5 Ectopic pregnancy 18 47 Thyroid disease in pregnancy 102
6 Pelvic pain 20 48 Other medical and surgical conditions in pregnancy 104
7 Lower genital tract infections 22 49 Drugs and medications during pregnancy 106
8 Pelvic inflammatory disease (PID) 24 50 Disorders of amniotic fluid volume 108
9 Benign disorders of the lower genital tract 26 51 Disorders of fetal growth 110
10 Benign disorders of the upper genital tract 28 52 Antepartum fetal surveillance 112
11 Endometriosis and adenomyosis 30 53 Hydrops fetalis 114
12 Contraception 32 54 Intrauterine fetal demise 116
13 Sterilization 34 55 Multiple pregnancy 118
14 Breast disease 36 56 Antepartum hemorrhage 120
15 Miscarriage 38 57 Premature labor 122
16 Termination of pregnancy 40 58 Cervical insufficiency and cervical cerclage 124
17 Gynecologic surgery 42 59 Premature rupture of the membranes 126
18 Ethical and medicolegal issues 44
Intrapartum management
Urogynecology 60 Normal labor and delivery I 128
19 Urinary incontinence 46 61 Normal labor and delivery II 130
20 Pelvic organ prolapse 48 62 Induction and augmentation of labor 132
63 Abnormal labor and delivery 134
Reproductive endocrinology and infertility 64 Pain relief in labor 136
21 Puberty and precocious puberty 50 65 Intrapartum fetal monitoring 138
22 Amenorrhea 52 66 Surgical vaginal delivery 140
23 Polycystic ovarian syndrome (PCOS) 54 67 Cesarean section delivery 142
24 Recurrent pregnancy loss 56
25 The infertile couple 58 Postpartum complications
26 Ovulation induction 60 68 Third stage of labor and postpartum hemorrhage 144
27 Assisted reproductive technology (ART) 62 69 The puerperium 146
28 Menopause and hormone replacement therapy 64 70 Circumcision 148
Gynecologic oncology Part 3 Self assessment
29 Cervical dysplasia and HPV vaccine 66 Case studies and questions 150
30 Cervical and vaginal cancer 68 Answers 152
31 Vulvar cancer 70 Further reading 162
32 Uterine cancer 72
33 Ovarian cancer 74 Index 163
34 Gestational trophoblastic disease (GTD) 76
Part 2 Obstetrics
General
35 Embryology and early fetal development 78
36 Fetal physiology 80
37 Endocrinology of pregnancy and parturition 82
Contents  5

List of contributors
Laura Baecher-Lind, MD, MPH Trevin C. Lau, MD
Assistant Professor of Obstetrics and Gynecology Instructor of Obstetrics, Gynecology and Reproductive Biology
Tufts University School of Medicine Massachusetts General Hospital, Harvard Medical School
Boston, MA, USA Boston, MA, USA
Lori R. Berkowitz, MD Samantha J. Pulliam, MD
Assistant Professor of Obstetrics, Gynecology and Reproductive Assistant Professor of Obstetrics, Gynecology and Reproductive
Biology Biology
Massachusetts General Hospital, Harvard Medical School Division of Urogynecology and Pelvic Reconstructive Surgery
Boston, MA, USA Massachusetts General Hospital, Harvard Medical School
Boston, MA, USA
Brian K. Bond, PharmD, MD
Assistant Professor of Obstetrics and Gynecology Aaron K. Styer, MD
Associate Director, Obstetrics and Gynecology Residency Program Assistant Professor of Obstetrics, Gynecology, and Reproductive
Tufts University School of Medicine Biology
Boston, MA, USA Vincent Reproductive Medicine and IVF
Vincent Center for Reproductive Biology
Kelley E. Conroy, MD Massachusetts General Hospital, Harvard Medical School,
Clinical Fellow in Maternal-Fetal Medicine Boston, MA, USA
Tufts University School of Medicine
Boston, MA, USA Hong-Thao N. Thieu, MD
Assistant Professor of Obstetrics and Gynecology
Alissa R. Dangel, MD Director, Obstetrics and Gynecology Residency Program
Assistant Professor of Obstetrics and Gynecology Tufts University School of Medicine
Tufts University School of Medicine Boston, MA, USA
Boston, MA USA
Carey M. York-Best, MD
Kristen P. Eckler, MD Assistant Professor of Obstetrics, Gynecology and Reproductive
Assistant Professor of Obstetrics, Gynecology and Reproductive Biology
Biology Chief, Division of General Obstetrics and Gynecology
Massachusetts General Hospital, Harvard Medical School Massachusetts General Hospital, Harvard Medical School
Boston, MA, USA Boston, MA, USA
List of contributors 7
Preface
The medical and scientific problems of this world cannot be solved continue to debate such questions as: How is the LH surge regulated?
by skeptics whose horizons are limited by practical realities. We need What causes endometriosis? Why is there still no effective screening
women and men who dream of things that cannot be and ask why not. test for ovarian cancer? What triggers labor?
Professor Egon Diczfalusy, Karolinska Institute,
This text is written primarily for medical students starting their
Stockholm, Sweden, 1992
clinical rotations. It is designed to give the reader a succinct yet com-
prehensive review of obstetrics and gynecology. Each chapter consists
Medicine continues to attract the brightest and most dedicated students
of two pages: a page of text and an accompanying set of images or
to its ranks. The opportunity to nurture the talented young minds that
algorithms that serve to complement the text. It is the sincere hope of
will one day rise up to lead the medical community remains the single
the authors that the readers will find this book interesting, easy to read,
greatest privilege for the academic clinician. Nowhere is this privilege
and informative. Not all questions can be answered in a formal text
– and challenge – more apparent than in obstetrics and gynecology, a
format. Students should be encouraged to question and challenge their
discipline that remains more art than science. Although clinicians in
clinical teachers. Only then can the field move forward. Remember:
all disciplines aspire to practice rational evidence-based medicine,
“We need women and men who dream of things that cannot be and
many basic questions in the field of obstetrics and gynecology remain
ask why not.”
unanswered. While cardiologists measure changes in calcium flux
within a single myocardial cell and nephrologists estimate changes in
Errol R. Norwitz, MD, DPhil, FACOG
osmotic gradient along a single nephron, obstetrician–gynecologists
John O. Schorge, MD, FACOG, FACS
Acknowledgments
To my wife, Ann; my parents, Rollo and Marionne; and my children, addition, I would like to express my deep appreciation for the mentors
Nicholas, Gabriella, and Sam. who inspired me during my obstetrics and gynecology training – most
E.R.N. notably Isaac Schiff, Fred Frigoletto, John Repke, Ross Berkowitz,
and Sam Mok.
I would like to thank my wife, Sharon; and my children, Dante, Lena,
and Rocco for their support during the completion of this book. In J.O.S
8  Preface