Oxford handbook of obstretics and gynaecology

791 Pages·2008·34.29 MB·English

by  Sally Collins

Common drugs: safety and usage in pregnancy and breastfeeding
Drug Risk* Conclude Alternatives Breastfeeding
Antibiotics
Metronidazole possible increased risk of preterm labour Caution clindamycin safe
Penicillins nil known Use if indicated N/A safe
Erythromycin nil known Use if indicated N/A safe
Cephalosporins nil known Use if indicated N/A safe
Co-amoxiclav possible increased neonatal risk if preterm birth Caution penicillins safe
Tetracyclines discolour teeth if 2nd trimester Avoid erythromycin safe
Trimethoprim folic acid antagonsist Avoid cephalosporins safe
Fundamentals: bacterial infection in pregnancy requires treatment
Analgesics
Non-steroidals closure of fetal ductus arteriosus Caution paracetomol safe
(normal dose) fetal oliguria (avoid for analgesia)
possible cerebral haemorrhage Monitor fetus with ultrasound
Aspirin nil known Use if high risk of preeclampsia N/A safe
(low dose)
Paracetamol nil known Safe N/A safe
Opiates maternal/ fetal dependency Only if severe pain or drug (methadone if beware accumulation
dependency opiate addict)
Fundamentals: best use paracetamol, plus codeine if more severe
Anticoagulants
Warfarin teratogenic Only if artificial heart LMWH safe
Fetal haemorrhage valves (seek advice)
LMWH maternal bleeding in OD If indicated N/A safe
safe for fetus
Fundamentals: anticoagulation is probably under-used in pregnancy, warfarin only used in exceptional circumstances
Antihypertensives
ACE inhibitors fetal renal failure Avoid methyldopa captopril safe
teratogenic (3% risk) nifedipine
Methyldopa nil known Best 1st line N/A safe
B-Blockers possible IUGR if early Caution, 3rd line methyldopa safe
Ca antagonists nil known Best 2nd line {eg nifedipine) N/A safe
Thiazide diuretics maternal hypovolaemia Avoid methyldopa safe
Fetal thrombocytopenia
Fundamentals: Severe hypertension in pregnancy is common and life threatening and requires treatment. Avoid ACE inhibitors prenatally
Endocrine/ Hormone treatments
Thyroid hormone (replacement therapy) Use if indicated N/A safe
Propylthiouracil fetal hypothyroidism (rare) Use, minimum dose N/A monitor thyroid
Carbimazole fetal hypothyroidism (rare), aplasia cutis Use, minimum dose Propylthiouracil monitor thyroid
Insulin (replacement therapy) Use with usual precautions N/A safe
maternal hypoglycaemia
Metformin probably safe, little data Caution Insulin safe
Fundamentals: Treatment of underlying disease greatly reduces maternal and fetal risks.
Immunosuppresants
Ciclosporin nil known Continue, monitor levels N/A probably safe
Azothioprine minimal Continue if indicated N/A safe
Prednisolone no fetal effects Use minimum dose N/A safe
maternal gestational diabetes, hypertension
Fundamentals: Treatment of underlying disease (eg transplant) imperative and reduces maternal and therefore fetal risks.
OXFORD MEDICAL PUBLICATIONS
Oxford Handbook of
Obstetrics and
Gynaecology
Published and forthcoming Oxford Handbooks
Oxford Handbook of Clinical Medicine 7/e (also available for PDAs)
Oxford Handbook of Clinical Specialties 7/e
Oxford Handbook of Acute Medicine 2/e
Oxford Handbook of Anaesthesia 2/e
Oxford Handbook of Applied Dental Sciences
Oxford Handbook of Cardiology
Oxford Handbook of Clinical Density 4/e
Oxford Handbook of Clinical and Laboratory Investigation 2/e
Oxford Handbook of Clinical Diagnosis
Oxford Handbook of Clinical Haematology 2/e
Oxford Handbook of Clinical Immunology and Allergy 2/e
Oxford Handbook of Clinical Pharmacy
Oxford Handbook of Clinical Surgery 3/e
Oxford Handbook of Critical Care 2/e
Oxford Handbook of Dental Patient Care 2/e
Oxford Handbook of Dialysis 2/e
Oxford Handbook of Emergency Medicine 3/e
Oxford Handbook of Endocrinology and Diabetes
Oxford Handbook of ENT and Head and Neck Surgery
Oxford Handbook for the Foundation Programme, 2/e
Oxford Handbook of Gastroenterology and Hepatology
Oxford Handbook of General Practice 2/e
Oxford Handbook of Genitourinary Medicine, HIV and AIDS
Oxford Handbook of Geriatric Medicine
Oxford Handbook of Medical Sciences
Oxford Handbook of Nephrology and Hypertension
Oxford Handbook of Nutrition and Dietetics
Oxford Handbook of Neurology
Oxford Handbook of Occupational Health
Oxford Handbook of Obstetrics and Gynaecology, 2/e
Oxford Handbook of Oncology 2/e
Oxford Handbook of Ophthalmology
Oxford Handbook of Palliative Care
Oxford Handbook of Practical Drug Theraphy
Oxford Handbook of Pre-Hospital Care
Oxford Handbook of Psychiatry
Oxford Handbook of Public Health Practice 2/1
Oxford Handbook of Rehabilitation Medicine
Oxford Handbook of Respiratory Medicine
Oxford Handbook of Rheumatology 2/e
Oxford Handbook of Sport and Exercise Medicine
Oxford Handbook of Tropical Medicine 2/e
Oxford Handbook of Urology
Oxford Handbook of
Obstetrics and
Gynaecology
SECOND EDITION
Sally Collins
Specialist Registrar in Obstetrics and Gynaecology,
The John Raddiffe Hospital,
Oxford, UK
Sabaratnam Arulkumeran
Professor of Obstetrics and Gynaecology,
St George's Hospital Medical School,
University of London, UK
Kevin Hayes
Senior Lecturer/Honorary Consultant in Obstetrics
and Gynaecology, and Medical Education,
St George's Hospital and Medical School,
University of London, UK
Simon Jackson
Consultant Gynaecologist,
The John Radcliffe Hospital,
Oxford, UK
Lawrence Impey
Consultant in Obstetrics and Fetal Medicine,
The John Radcliffe Hospital,
Oxford, UK
OXJORD
UNIVERSITY PRESS
OXFORD
"UNIVERSITY PRESS
Great Clarendon Street, Oxford ox2 6Dp
Oxford University Press is a department of the University of Oxford.
It furthers the University's objective of excellence in research, scholarship,
and education by publishing worldwide in
Oxford New York
Auckland Cape Town Dares Salaam Hong Kong Karachi
Kuala Lumpur Madrid Melbourne Mexico City Nairobi
New Delhi Shanghai Taipei Toronto
With offices in
Argentina Austria Brazil Chile Czech Republic France Greece
Guatemala Hungary Italy Japan Poland Portugal Singapore
South Korea Switzerland Thailand Turkey Ukraine Vietnam
Oxford is a registered trade mark of Oxford University Press
in the UK and in certain other countries
Published in the United States
by Oxford University Press Inc., New York
© Oxford University Press, 2008
The moral rights of the author have been asserted
Database right Oxford University Press (maker)
First published 2008
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
without the prior permission in writing of Oxford University Press,
or as expressly permitted by law, or under terms agreed with the appropriate
reprographics rights organization. Enquiries concerning reproduction
outside the scope of the above should be sent to the Rights Department,
Oxford University Press, at the address above
You must not circulate this book in any other binding or cover
and you must impose this same condition on any acquirer
British Library Cataloguing in Publication Data
Data available
Library of Congress Cataloguing in Publication Data
Data available
Typeset by Cepha Imaging Private Ltd., Bangalore, India
Printed in China
on acid-free through
Asia Pacific Offset
ISBN 978-0-19-922724-2
10 9 8 7 6 5 4 3 21
Contents
Preface vii
List of abbreviations ix
Contributors xiv
Obstetrics
1 Normal pregnancy 1
2 Pregnancy complications 47
3 Fetal medicine 105
4 Infectious diseases in pregnancy 151
5 Medical disorders in pregnancy 177
6 Labour and delivery 261
7 Obstetric anaesthesia 323
8 Neonatal resuscitation 335
9 Postnatal care 347
10 Obstetric emergencies 369
11 Miscellaneous obstetric issues 397
12 Substance abuse and psychiatric disorders 421
Gynaecology
13 Gynaecological anatomy and development 445
14 Normal menstruation and its disorders 483
15 Early pregnancy problems 501
16 Genital tract infections, and pelvic pain 519
17 Subfertility and reproductive medicine 543
18 Sexual assault 587
19 Contraception 595
20 Menopause 609
21 Urogynaecology 625
22 Benign and malignant gynaecological conditions 657
23 Miscellaneous gynaecology 743
Index 761
This page intentionally left blank
VII
Preface
Welcome to the completely re-written, second edition of this Oxford Hand-
book. In Obstetrics and Gynaecology, as in all fields of medicine, the available
evidence, technology and guidelines move forward at a rapid pace and can
often prove difficult to keep up with. As the majority of junior doctors are
well aware, the gaps in our knowledge often become apparent at the most
inopportune moments; this book seeks to fill those gaps rapidly and ef-
fectively. It uses the well-known Oxford Handbook format to facilitate easy
navigation around concise, clinically relevant, evidence-based information. It
can be quickly dipped into for specific answers between seeing patients in
clinic or on delivery suite, as well as providing a solid, general grounding for
those just beginning in the specialty. It also has sufficient depth and detail to
provide a good starting point in the preparation for postgraduate exams.
To ensure the most up-to-date information is always available, emphasis has
been placed on providing relevant web addresses, especially for guidelines
and useful organisations. Text boxes have also been employed to help high-
light some of the more important pieces of information.
Although this handbook is most likely to be used by trainees within the
specialty, we envisage it will be useful for all those involved in women's
health, including GPs, midwives and medical students. We hope you find it
a helpful resource and that it proves to be a valuable companion and guide
in your everyday practice of obstetrics and gynaecology.
Acknowledgements
It is always difficult to try to improve on a popular textbook and we owe
a huge debt of gratitude to the editors and authors of the first edition.
We would also like to thank all our second edition authors, especially the
trainees at the John Radcliffe and St George's hospitals. Additionally, we
are very grateful to the doctors of all grades who anonymously reviewed the
text for us and provided valuable feedback further fine-tuning the finished
manuscript. To conform to the Oxford Handbook style and to avoid over-
lap and repetition, some contributions have been considerably edited and
we thank all our authors for their understanding. We are most grateful to
Mr Basky Thilaganathan for providing many of the ultrasound images. Thank
you also to Sue Cunningham at St George's and Tracey Shepherd at the
John Radcliffe, for the invaluable secretarial support which they have so
generously provided. We cannot fail to mention the marvellous team at OUP
including Kate Wilson and Susan Crowhurst, but especially Mark Knowles,
whose endless patience, expert guidance and great sense of humour have
kept this book on track. Last, but definitely not least, we would like to thank
our partners and families who have remained so patient and supportive
throughout this project, especially Berni O'Connor and David Reynard.
Sally Collins, Sabaratnam Arulkumaran, Kevin Hayes, Simon
Jackson and Lawrence Impey.
London and Oxford, January 2008