Gynaecology for the Obstetrician

 

Description:

 

 

In this era of specialisation, obstetricians are becoming increasingly skilled at their jobs and deskilled in areas outside their expertise. In recent years, the education and training curricula for obstetrics and gynaecology has changed, with obstetricians expected to manage women with complex gynaecological problems encountered during pregnancy and the postnatal period competently, despite training and curricula not covering these problems in detail. Exploring common gynaecological problems such as ovarian cysts, management of vaginal prolapse and female genital mutilation, this practical book offers guidance for managing these conditions throughout the different stages of pregnancy and post-partum. Each chapter has a section on good governance, discussing salient points for clinical practice to improve patient safety and satisfaction, as well as reducing complaints and litigation. This hands-on book provides obstetricians around the globe with the evidence-based knowledge needed to deliver high quality care to pregnant women.

 

Table of Contents:

 

Chapter 1 Ovarian Cysts in Pregnancy

1.1 Introduction

1.2 Types of Cysts

1.3 Clinical Presentation and Complications

1.3.1 Torsion

1.3.2 Ovarian Cyst Rupture and Haemorrhage

1.3.3 Mass Effect: Obstruction of Labour

1.4 Diagnostic Evaluation

1.4.1 Imaging

1.4.2 Tumour Markers

1.5 Management

1.5.1 Expectant Management

1.5.2 Ultrasound-Guided Fine Needle Aspiration

1.5.3 Surgical Management

1.5.3.1 Elective versus Emergency Surgery

1.5.3.2 Cystectomy versus Oophorectomy

1.5.3.3 When to Operate?

1.5.3.4 Obstetrical Considerations and Fetal Monitoring

1.6 Post-Natal Follow-Up

1.7 Conclusion

References

Chapter 2 Fibroids in Pregnancy

2.1 Introduction

2.2 Types of Fibroids

2.3 The Effect of Pregnancy on Fibroids

2.4 The Effect of Fibroids on the Pregnancy

2.4.1 Multiple Large Fibroids in the Anterior Wall and Lower Segment

2.4.1.1 Maternal Complications

2.4.1.2 Fetal Complications

2.4.2 Large Cervical Fibroids

2.4.2.1 Cervical Fibroid Polyps in the Vagina

2.5 Antenatal Management of Women with Fibroids

2.6 Counselling about the Risks and Impact of Fibroids on Mode of Delivery

2.6.1 Vaginal Delivery

2.6.2 Caesarean Section

2.7 Delivery with History of Previous Myomectomy

2.8 Post-Natal Management of Women with Fibroids

References

Chapter 3 Cervical Abnormalities in Pregnancy

3.1 Introduction

3.1.1 LLETZ and Obstetric Outcomes

3.1.2 Loop Depth and the Risk of Preterm Labour

3.1.3 Cervical Length Screening

3.2 Abnormal Smears

3.2.1 Introduction

3.2.2 Abnormal Smears and Colposcopy during Pregnancy

3.3 Cervical Cancer in Pregnancy

3.3.1 Introduction

3.3.2 Staging of Cancer

3.3.3 Treatment

3.4 Benign Cervical Lesions in Pregnancy

References

Chapter 4 Vulval Disorders in Pregnancy

4.1 Assessment of the Patient

4.1.1 History Taking

4.1.2 Vulval Examination

4.1.3 Investigations

4.1.3.1 Diagnostic Vulval Biopsy

4.1.3.2 Vaginal and Vulval Swabs

4.1.3.3 The Vulval Clinic

4.1.4 Specific Vulval Skin Diseases

4.2 Management of Vulval Skin Conditions

4.2.1 General Principles

4.2.2 Correct Barrier Function

4.2.3 Using Topical Steroids on the Vulva

4.3 Lichen Sclerosus

4.4 Contact Dermatitis

4.5 Candidiasis

4.6 Bartholin Gland Cysts

4.7 Vulvodynia

4.8 Conclusions

Further Resources

References

Chapter 5 Congenital Uterine Malformations and Vaginal Anomalies

5.1 Introduction

5.1.1 Classification of Congenital Female Genital Tract Malformations

5.2 Septate Uterus

5.3 Bicornuate, Didelphys and Unicornuate Uteri

5.4 Vaginal Septum and Repair

5.5 Counselling and Reproductive Outcomes

5.6 Conclusion

References

Chapter 6 Vaginal Prolapse and Previous Prolapse Surgery

6.1 Introduction

6.2 Antenatal

6.2.1 Women with Pre-existing Prolapse or First Presentation in Pregnancy

6.2.2 Women with Previous Prolapse Surgery

6.3 Intrapartum

6.3.1 Women with Pre-existing Prolapse or First Presentation in Pregnancy

6.3.2 Women with Previous Prolapse Surgery

6.4 Post-Partum

6.5 Clinical Dilemmas

6.6 Conclusion

References

Chapter 7 Urinary Tract Problems in Pregnancy

7.1 Urinary Incontinence

7.1.1 Previous Surgery for Stress Urinary Incontinence

7.2 Urinary Retention during Pregnancy and Post-Partum (URPP)

7.2.1 Pathophysiology

7.2.2 Assessment and Management of URPP: Antenatal, Perinatal and Post-Partum

7.2.3 Antenatal Urinary Retention

7.2.4 Peripartum Urinary Retention

7.2.5 Post-Partum Urinary Retention (PPUR)

7.3 Urinary Diversions and Mitrofanoffs during Pregnancy

7.4 Renal Transplant

7.4.1 Effects of Transplant on Pregnancy

7.4.2 Labour and Delivery

7.4.3 Immunosuppressive Agents During the Perinatal Period

7.5 Congenital Anomalies of the Urinary Tract

7.5.1 Exstrophy-Epispadias Complex

7.5.2 Persistent Cloaca

7.5.3 Spinal Dysraphism

7.5.4 Congenital Vesicoureteric Reflux (CVUR)

7.6 Conclusion

References

Chapter 8 Previous Third and Fourth Degree Tears

8.1 Background

8.1.1 Antenatal

8.1.2 Intrapartum

8.1.3 Post-Partum

8.2 Clinical Dilemmas

8.3 Conclusion

References

Chapter 9 Management of Post-Partum Retained Placental Remnants

9.1 Introduction

9.2 Diagnosis

9.2.1 Ultrasonography

9.2.2 Other Diagnostic Investigations

9.3 Causative Factors

9.4 Treatment of Post-Partum Placental Remnants

9.4.1 Expectant Management

9.4.2 Medical Management

9.4.3 Surgical Intervention

9.4.3.1 Hysteroscopic Techniques

9.4.3.2 Timing of Surgical Intervention

9.4.3.3 Effectiveness (complete removal rate)

9.4.3.4 Short-Term Complications

9.4.3.5 Longer-Term Outcomes

9.5 Counselling

9.6 Summary

References

Chapter 10 Gestational Trophoblastic Disease (GTD)

10.1 Background

10.2 Antenatal

10.2.1 Prior History of GTD or GTN

10.2.2 Early Pregnancy in GTD or GTN

10.2.2.1 Termination of pregnancy

10.2.2.2 Miscarriage

10.2.2.3 Fetal anomalies and stillbirth

10.2.2.4 Live birth rates

10.2.2.5 Relapse

10.2.2.6 Risk of second molar pregnancy

10.2.3 Twin Pregnancy with a Hydatidiform Mole and Viable Coexistent Fetus

10.2.3.1 Misdiagnosis

10.2.3.2 Complications

10.2.3.3 Termination of Pregnancy

10.2.3.4 Live Birth Rates

10.2.3.5 Risk of Developing GTN

10.3 Intrapartum

10.3.1 Prior History of GTD/GTN and Early Pregnant GTD Patients

10.3.2 Early Pregnant GTN Patients

10.3.3 Twin Pregnancy with a Hydatidiform Mole and Viable Coexistent Fetus

10.4 Post-Partum

10.4.1 Prior History of GTD and Early Pregnant GTD Patients

10.4.2 Prior History of GTN and Early Pregnant GTN Patient

10.4.3 Twin Pregnancy with CHM

10.4.4 Contraception

10.4.5 Rare Presentations of GTN

10.5 Conclusions

References

Chapter 11 Female Genital Mutilation

11.1 Introduction

11.1.1 Definition

11.1.2 History

11.1.3 Why Is FGM Practised?

11.1.4 Incidence

11.2 Classification of FGM Types

11.2.1 Classification Challenges

11.2.1.1 Difficulties Associated with Classification of FGM

11.2.1.2 Differential Diagnosis

11.2.2 Some Useful Definitions

11.3 Health Complications of FGM

11.3.1 FGM and Psychological Consequences

11.4 Clinical Presentations

11.4.1 FGM Types 1 and 2

11.4.2 FGM Type 3

11.4.3 Deinfibulation

11.4.4 FGM Type 4

11.5 Management of Pregnant Women Presenting to a Maternity Setting

11.5.1 Obstetric and Neonatal Risks Associated with FGM

11.5.2 A Holistic Best Practice Consultation Should Include:

11.6 Management of Pregnant Women with Type 3 FGM

11.6.1 Antenatal Deinfibulation

11.6.2 Intrapartum Deinfibulation

11.7 Safeguarding and Law

11.8 Conclusion

References

Chapter 12 Ovarian and Cervical Malignancy in Pregnancy

12.1 Background

12.2 General Principles of Managing Cancer in Pregnancy

12.3 Cervical Cancer

12.3.1 Pre-Malignant Cervical Conditions

12.3.2 Previous History of Cervical Malignancy

12.3.2.1 Antepartum Management

Women with a history of simple excisional treatment such as LLETZ

Women with a history of trachelectomy

12.3.2.2 Intrapartum Management

Women with a history of simple excisional treatment such as LLETZ

Women with a history of trachelectomy

12.3.2.3 Post-Partum Management

12.3.3 Cervical Cancer in Pregnancy

12.3.3.1 Symptoms and Diagnosis

12.3.3.2 Staging of Cervical Cancer in Pregnancy

12.3.3.3 Principles of Management of Cervical Cancer in Pregnancy

12.3.3.4 Definitive Treatment

12.4 Ovarian Cancer

12.4.1 Previous History of Ovarian Malignancy

12.4.2 Adnexal Mass Presenting in Pregnancy

12.4.3 Suspected Borderline Ovarian Tumours in Pregnancy

12.4.4 Suspected Ovarian Malignancy in Pregnancy

References

Chapter 13 Post-Partum Contraception

13.1 Background

13.2 Antenatal Planning for Post-Partum Contraception

13.2.1 When to Have the Discussion

13.2.2 How to Have the Discussion

13.2.3 What to Offer

13.3 Methods of Contraception

13.4 UK Medical Eligibility Criteria (UKMEC)

13.5 Overview of Contraceptive Method Use in the Post-Partum Period

13.5.1 Intra-Uterine Contraception (IUC)

13.5.2 Subdermal Implants (SDI)

13.5.3 Progesterone Only Injectables – Depo-Medroxyprogesterone Acetate (DMPA)

13.5.4 Combined Hormonal Contraception Including Oral, Vaginal and Transdermal Preparations

13.5.5 Progestogen Only Pills (POP)

13.5.6 Lactational Amenorrhoea Method (LAM)

13.5.7 Barrier Methods

13.5.8 Fertility Awareness Methods (FAM)

13.6 Breastfeeding and Contraception

13.7 Initiating Post-Partum Contraception

13.7.1 How Soon Can Contraception be Initiated Post-Partum?

13.7.2 Additional UKMEC Conditions

13.8 Emergency Contraception in the Post-Partum Period

13.9 Service Considerations

References

Further Sources of Information on Individual Contraceptive Methods

Chapter 14 Pregnancy Associated Breast Cancer

14.1 Epidemiology of Pregnancy Associated Breast Cancer

14.1.1 Stage at Diagnosis

14.1.2 Disease Biology

14.1.3 Prognosis

14.1.4 Risk Factors

14.2 Diagnosis

14.2.1 Pregnancy Termination

14.2.2 Obstetric Management

14.3 Treatment

14.3.1 Surgery

14.3.2 Systemic Chemotherapy and Radiotherapy

14.3.3 Endocrine Therapy

14.3.4 Radiotherapy

14.3.5 Future Fertility

14.4 Pregnancy in the Presence of Metastatic Breast Cancer

14.5 Conclusions

References

Index

 

An aparitie	31 July 2023
Autor	Swati Jha, Priya Madhuvrata
Dimensiuni	157 x 234 x 9 mm
Editura	Cambridge University Press
Format	Paperback
ISBN	9781009208826
Limba	Engleza
Nr pag	180