Obstetrics and Gynecology Board Review

672 Pages·2014·145.26 MB·English

by  Stephen G. Somkuti

Obstetrics
and Gynecology
Board review
Fourth edition
Stephen G. Somkuti, MD, PhD
Associate Professor
Department of Obstetrics and Gynecology and Reproductive Sciences
Temple University School of Medicine School
Philadelphia, Pennsylvania
Director, The Toll Center for Reproductive Sciences
Division of Reproductive Endocrinology
Department of Obstetrics and Gynecology
Abington Memorial Hospital
Abington Reproductive Medicine
Abington, Pennsylvania
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COntents
Contributors ..................................................................vi
Introduction ...................................................................xi
1. Anatomy of the Pelvis and Reproductive Tract .....................................1
2. Embryology of the Genital Tract .............................................. 15
3. Physiology of Normal Pregnancy ..............................................23
4. Antepartum Management and Fetal Surveillance ..................................41
5. Labor and Delivery .........................................................53
6. Operative Obstetrics Pearls ...................................................61
7. Multiple Gestations ........................................................ 77
8. Breech ..................................................................83
9. Postdates Pregnancy and Fetal Demise ..........................................91
10. Labor Abnormalities ........................................................97
11. The Puerperium ..........................................................103
12. Obstetric Complications ...................................................111
13. Hypertension and Pregnancy ................................................ 117
14. Management of Medical and Surgical Conditions in Pregnancy ...................... 131
15. Gastrointestinal Disorders in Pregnancy ........................................ 159
16. First Trimester Ultrasound ..................................................169
17. Obstetrical Ultrasound and Fetal Abnormalities .................................. 179
18. Amniotic Fluid ...........................................................185
19. The Placenta and Umbilical Cord ............................................193
iii
iv Contents • • •
20. Rh Alloimmunization ......................................................205
21. Genetics for the Obstetrician ................................................215
22. Lactation ............................................................... 223
23. Primary and Preventative Care ................................ ............... 231
24. Functional and Dysfunctional Uterine Bleeding ..................................239
25. Adenomyosis and Endometriosis ............................................. 249
26. Benign Disorders of the Upper Genital Tract ....................................257
27. Dysmenorrhea and Premenstrual Syndrome .....................................269
28. Vulvodynia .............................................................. 275
29. Ectopic Pregnancy ........................................................ 277
30. Genital Tract Infections and PID .............................................289
31. Benign Vulvar and Vaginal Lesions ................................ ............ 297
32. Hysterectomy ........................................... .................303
33. Menopause ............................................................. 315
34. Preoperative Evaluation and Preparation of Gynecologic Surgery ........ ............. 339
35. Postoperative Care of the Gynecologic Patient ................................... 349
36. Robotic Systems and Infertility Surgery ........................................361
37. Lower Urinary Tract Injuries During Gynecologic Surgery ..........................369
38. Pelvic Organ Prolapse ......................................................375
39. Urinary Incontinence and Urodynamics ........................................385
40. Pediatric and Adolescent Gynecology ..........................................391
41. Breast Disorders ..........................................................403
42. Ethics, Psychosocial, and Psychiatric Pearls ......................................419
43. Cervical Lesions and Cancer ................................................. 431
• • • Contents v
44. Endometrial Hyperplasia and Carcinoma .......................................441
45. Uterine Sarcomas .........................................................451
46. Epithelial and Nonepithelial Ovarian Tumors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457
47. Fallopian Tube Neoplasms ..................................................463
48. Vulvar and Vaginal Carcinoma ...............................................467
49. Radiation Therapy, Chemotherapy, Immunotherapy, and Tumor Markers .............477
50. Gestational Trophoblastic Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493
51. Gynecologic Pathology .....................................................501
52. Hypothalamic-Pituitary-Ovarian-Uterine Axis ................................... 519
53. Amenorrhea .............................................................527
54. Infertility ...............................................................539
55. Assisted Reproductive Technology ............................................553
56. GnRH and GnRH Analogs ................................................. 559
57. Laparoscopy and Infertility Surgery ........................................... 567
58. Hyperandrogenism ........................................................575
59. Disorders of Prolactin Secretion .............................................. 589
60. Miscarriage, Recurrent Miscarriage, and Pregnancy Termination .....................601
61. Family Planning and Sterilization .............................................607
62. Lesbian, Gay, Bisexual, and Transgender Health ..................................621
63. Reproductive Toxicology ...................................................627
64. Basic Epidemiology and Clinical Biostatistics ....................................639
65. ACOG Screening Guidelines Since 2007 .......................................651
COntributOrs
Lauren Abern, MD Cari Brown, MD
Department of Obstetrics and Gynecology Resident Physician
Abington Memorial Hospital Department of Obstetrics and Gynecology
Abington, Pennsylvania Abington Memorial Hospital
Breast Disorders Abington, Pennsylvania
Lesbian, Gay, Bisexual, and Transgender Health Primary and Preventative Care
Vulvar and Vaginal Carcinoma The Puerperium
Aroti Achari, MD
Justin Chura, MD, MBA
Advocare Magness & Stafford OBGYN
Director, Robotic Surgery and Gynecologic
Associates
Oncology
Department of Obstetrics and Gynecology
Cancer Treatment Centers of America
Virtua Voorhees Hospital
Eastern Regional Medical Center
Voorhees, New Jersey
Philadelphia, Pennsylvania
Hysterectomy
Anatomy of the Pelvis and Reproductive Tract
U terine Sarcomas
Larry I. Barmat, MD
Assistant Professor
Frank J. Craparo, MD
Department of Obstetrics and Gynecology
Associate Professor
Temple University
Drexel University College of Medicine
Abington Reproductive Medicine
Philadelphia, Pennsylvania
Abington Memorial Hospital
Chief, Division of Maternal Fetal Medicine
Abington, Pennsylvania
Director, Fetal Diagnostic Center
Robotic Systems and Infertility Surgery
Department of Obstetrics and Gynecology
Abington Memorial Hospital
Katherine Bohnert, DO
Abington, Pennsylvania
Department of Obstetrics and Gynecology
Breech
Einstein Hospital Medical Center
Labor and Delivery
Philadelphia, Pennsylvania
First Trimester Ultrasound
Lindsay Curtis, MD
Erica L. Borman, DO Abington Memorial Hospital
Psychiatry Resident Abington, Pennsylvania
Rowan University School of Osteopathic Medicine Ectopic Pregnancy
Stratford, New Jersey Postoperative Care of the Gynecologic Patient
Amenorrhea Preoperative Evaluation and Preparation of
Hyperandrogenism Gynecologic Surgery
vi
• • • Contributors vii
Glen de Guzman, MD Emily R. Goldenthal, DO
Department of Obstetrics and Gynecology Department of Obstetrics and Gynecology
Abington Memorial Hospital Albert Einstein Medical Center
Abington, Pennsylvania Philadelphia, Pennsylvania
Gastrointestinal Disorders in Pregnancy Anatomy of the Pelvis and Reproductive Tract
Jennifer Deirmengian, MD
Remington Horesh, OMSII
Obstetrics Faculty Teaching Group
Osteopathic Medical Student
Abington Memorial Hospital
Class of 2015
Abington, Pennsylvania
Lake Erie College of Medicine
Lactation Bradenton, Florida
Rh Alloimmunization
Physiology of Normal Pregnancy
Mitchell I. Edelson, MD
Lisa Jambusaria, MD
Associate Professor
Resident, Department of Obstetrics and
Department of Obstetrics, Gynecolgy, and
Gynecology
Reproductive Sciences
Abington Memorial Hospital
Temple University School of Medicine
Abington, Pennsylvania
Hanjani Institute for Gynecologic Oncology
Benign Vulvar and Vaginal Lesions
Abington Memorial Hospital
Genital Tract Infections and PID
Abington, Pennsylvania
Pelvic Organ Prolapse
Epithelial and Nonepithelial Ovarian Tumors
Urinary Incontinence and Urodynamics
Fallopian Tube Neoplasms
Vulvodynia
Gestational Trophoblastic Disease
Gynecologic Pathology
Jacqueline Kohl, MD, MPH
Radiation Therapy, Chemotherapy,
Resident, Department of Obstetrics and
Immunotherapy, and Tumor Markers
Gynecology
Vulvar and Vaginal Carcinoma
Abington Memorial Hospital
Abington, Pennsylvania
Stephanie J. Estes, MD, FACOG
Dysmenorrhea and Premenstrual Syndrome
Associate Professor
Laparoscopy and Infertility Surgery
Division of Reproductive Endocrinology and
Infertility
Kuhali Kundu, DO
Department of Obstetrics and Gynecology
Obstetrics and Gynecology Resident
Penn State Hershey Medical Center
Albert Einstein Medical Center
Hershey, Pennsylvania
Philadelphia, Pennsylvania
Disorders of Prolactin Secretion
Postdates Pregnancy and Fetal Demise
GnRH and GnRH Analogs
Karen T. Feisullin, MD Richard A. Latta, MD
Department of Obstetrics and Gynecology Maternal-Fetal Medicine
Abington Memorial Hospital Abington Memorial Hospital
Abington, Pennsylvania Abington, Pennsylvania
Family Planning and Sterilization Operative Obstetrics Pearls
viii Contributors • • •
Vincent Lucente, MD, MBA Amelia McLennan, MD
Clinical Professor Resident, Department of Obstetrics and
Department of Obstetrics and Gynecology Gynecology
Temple University Abington Memorial Hospital
Chief of Gynecology Abington, Pennsylvania
St. Luke’s University Health Network Genetics for the Obstetrician
Allentown, Pennsylvania Obstetrical Ultrasound and
Lower Urinary Tract Injuries During Gynecologic Fetal Abnormalities
Surgery
Urinary Incontinence and Urodynamics Marlesa R. Moore, DO
Resident Physician
Rahil Malik, MD Department of Obstetrics and Gynecology
Senior Resident Abington Memorial Hospital
Department of Obstetrics and Gynecology Abington, Pennsylvania
Jackson Memorial Hospital Pediatric and Adolescent Gynecology
University of Miami
Miami, Florida
Erin M. Murphy, MD
Adenomyosis and Endometriosis
Center for Reproductive Medicine
and Infertility
Brielle A. Marks, BA Weill Cornell Medical College
Student, Abington Reproductive Medicine New York, New York
Holland, Pennsylvania Assisted Reproductive Technology
Robotic Systems and Infertility Surgery Embryology of the Genital Tract
Laura E. Martin, DO Victoria Myers, MD
Resident, Department of Obstetrics and Faculty Tech Group
Gynecology Abington Memorial Hospital
Albert Einstein Medical Center Abington, Pennsylvania
Philadelphia, Pennsylvania Miscarriage, Recurrent Miscarriage, and
ACOG Screening Guidelines Since 2007 Pregnancy Termination
Jennifer McClarren, MS, CGC Mary C. Naglak, PhD, RD
Genetic Counselor, Integrated Genetics Academic Research Specialist
Philadelphia, Pennsylvania Department of Medicine
Genetics for the Obstetrician Abington Memorial Hospital
Abington, Pennsylvania
Alison B. McGrorty, MD Basic Epidemiology and Clinical Biostatistics
Pediatric Resident
Nemours-AI duPont Hospital for Ashwinee Natu
Children Medical Student, Class of 2014
Thomas Jefferson University Hospital Drexel University College of Medicine
Philadelphia, Pennsylvania Philadelphia, PA
Ethics, Psychosocial, and Psychiatric Pearls Hypertension and Pregnancy
• • • Contributors ix
Neely N. Nelson, MD Stephen J. Smith, MD
Resident, Department of Obstetrics and Vice Chair and Associate Program Director
Gynecology Associate Professor
Abington Memorial Hospital Department of Obstetrics and Gynecology
Abington, Pennsylvania Abington Memorial Hospital and
Infertility Temple University School of Medicine
Abington, Pennsylvania
Labor Abnormalities
Jordana I. Reina-Fernandez, MD
Postdates Pregnancy and Fetal Demise
Resident, Department of Obstetrics
and Gynecology
Stephen G. Somkuti, MD, PhD
Albert Einstein Medical Center
Associate Professor
Philadelphia, Pennsylvania
Department of Obstetrics and Gynecology and
Antepartum Management and Fetal
Reproductive Sciences
Surveillance
Temple University School of Medicine School
Philadelphia, Pennsylvania
Amanda M. Rhodes, MD Director, The Toll Center for Reproductive
Resident, Department of Obstetrics and Sciences
Gynecology Division of Reproductive Endocrinology
Abington Memorial Hospital Department of Obstetrics and Gynecology
Abington, Pennsylvania Abington Memorial Hospital
Labor Abnormalities Abington Reproductive Medicine
Abington, Pennsylvania
Cristina M. Saiz, MD, FACOG Hyperandrogenism
Female Pelvic Medicine and Reconstructive Pediatric and Adolescent Gynecology
Surgery Physician
Maria A. Suescum, MD
The Institute for Female Pelvic Medicine and
Chief Resident, Department of Obstetrics and
Reconstructive Surgery
Gynecology
Allentown, Pennsylvania
Albert Einstein Medical Center
Lower Urinary Tract Injuries During Gynecologic
Philadelphia, Pennsylvania
Surgery
Uterine Sarcomas
Meike Schuster, DO Janos L. Tanyi, MD, PhD
Obstetrics and Gynecology Resident Assistant Professor
Abington Memorial Hospital Division of Gynecologic Oncology
Abington, Pennsylvania Department of Obstetrics and Gynecology
Maternal Fetal Medicine Fellow University of Pennsylvania Health System
Geisinger Medical Center Philadelphia, Pennsylvania
Danville, Pennsylvania Cervical Lesions and Cancer
Obstetric Complications Endometrial Hyperplasia and Carcinoma