CONTENTS

preface xiii

PART 1

GOVERNANCE and ADMINISTRATION 1

Governance 3

The Department of Obstetrics and Gynecology 3

Ambulatory Surgical Facilities 12

Offices 13

Evaluating Credentials and Granting Privileges 17

Medical Staff Appointments and Credentialing 17

Delineation of Privileges 22

Evaluation for Continuing Competence 30

Impairment and Disruptive Behavior 32

Revoking Privileges 35

Quality Improvement 39

Quality Improvement in the Inpatient Setting 40

Quality Improvement in the Office 57

Patient Safety 63

National Patient Safety Goals 63

Patient Safety Principles 63

Risk Management 79

Risk Reduction 79

Practice Coverage and Referrals 81

Billing 83

Adverse Events, Litigation Stress, and Physician Behavior 84

Compliance With Government Regulations 87

Occupational Exposure to Bloodborne Pathogens Standard 87

Clinical Laboratory Improvement Amendments 89

Emergency Medical Treatment and Labor Act 90

Health Insurance Portability and Accountability Act 91

Mammography Quality Standards Act and Program 91

Human Resources 95

Personnel 95

Professional Behavior 96

Ethical Issues 117

Ethical Foundations 118

Ethics in Practice 121

Patient Protection 126

Ethical Decision Making and Institutional Ethics Committees 129

PART 2

ORGANIZATION of SERVICES 135

Facilities and Equipment 137

General Requirements 137

Specific Physical and Supply Requirements 139

Office and Other Ambulatory Settings 142

Surgical Facilities 143

Inpatient Facilities 144

Infection Control 147

Hand Hygiene 147

Isolation and Standard Precautions 148

Postexposure Testing and Prophylaxis 150

Management of Infected Health Care Workers 151

Cleaning and Disinfecting Patient Care Equipment 152

Environmental Infection Control 153

Ancillary Services 157

Pharmacy Services 157

Laboratory and Pathology Services 159

Imaging Services 160

Anesthesia and Analgesia 162

Follow-up Services 163

Information Management 167

Medical Records 167

Electronic Health Records 170

Patient Communication and Follow-up 172

Informed Consent 179

Practice Management 185

Staffing 185

Billing 193

Care Coordination 195

Appointments, Scheduling, and Patient Flow 196

Practice Coverage 197

Control and Disposal of Drugs and Other Sensitive Materials 197

PART 3

WELL-WOMAN CARE 201

Access to Care 205

Increasing Access to High-Quality Care 206

Health Literacy 207

Health Care for the Uninsured 208

Health Care for Undocumented Immigrants 209

Health Care for Homeless Women 210

Health Care for Women in the Military and Women Veterans 212

Well-Woman Annual Health Assessment 217

Importance of the Annual Visit 218

Medical History 219

General Physical Examination 225

Clinical Breast Examination 226

Pelvic Examination 227

Immunizations 233

Integrating Immunizations Into Practice 234

Immunization Against Human Papillomavirus 238

Fitness 245

Weight ^^5

Nutrition 250

Exercise 258

Complementary and Alternative Medicine 265

Types of Therapy 265

Safety Concerns 267

Addressing Patient Use and Interest 268

Health Care Provider Education 269

Cardiovascular Disorders 273

Hypertension 275

Dyslipidemia 279

Thromboembolic Disease 280

Diabetes Mellitus 287

Prevention 287

Screening and Diagnosis 289

Management 290

Gestational Diabetes Mellitus 292

Osteoporosis 295

Prevention Counseling 297

Bone Mineral Density Screening 297

Fracture Risk Assessment Tool 299

Pharmacologic Interventions 3501

Genetic Risk Assessment 305

Family History 306

Assisted Reproductive Technology 307

Ethical Issues 307

Cancer Screening and Prevention 311

Breast Cancer 3512

Cervical Cancer 3519

Endometrial Cancer 321

Ovarian Cancer 322

Colon Cancer 323

Lung Cancer 324

Substance Use and Abuse 329

Smoking 35250

Alcohol and Other Drug Use and Abuse 35254

Family Planning 343

Initial Evaluation 343

Periodic Reassessment 349

Special Populations 350

Methods 351

Postpartum Contraception 3571

Contraceptive Failure 3574

Preconception and Interconception Care 381

Preconception Care 382

Interconception Care 392

Sexually Transmitted Infections 399

Prevention 399

Screening 403

Diagnosis and Management 406

Sexual Health Risks of Noncoital Sexual Activity 414

Pediatric Gynecology 421

The Pediatric Gynecologic Examination 421

Vulvovaginitis 423

Vulvar Disorders 425

Precocious Puberty 427

Sexual Abuse 430

Adolescents 435

Adolescent Development 435

Confidentiality and Consent in Adolescent Health Care 438

The Physical Examination and Screening 441

Counseling 447

Sexuality 452

Adolescents With Disabilities 459

Menopause 469

Counseling 470

Hormone Therapy 471

Nonhormonal Therapy 475

Women 65 Years and Older 479

Communication Issues 479

Functional Assessment 480

Common Medical Conditions 484

Common Psychosocial Concerns 486

Medication Use 487

Female Genital Cutting 493

Lesbians and Bisexual Women 499

Barriers to Health Care 499

Routine Health Visits 500

Psychosocial Concerns 500

Legal Considerations 501

Creating a Welcoming Patient Care Environment 501

Transgender Individuals 505

Barriers to Health Care 505

Caring for Transgender Individuals 507

Creating a Welcoming Patient Care Environment 508

Women With Disabilities 511

End-of-Life Considerations 517

Legal Rights 519

Terminal Care 5211

Posthumous Reproduction 523

Psychosocial Issues 527

Stress 527

Feeding and Eating Disorders 528

Nonsuicidal Self-Injury Behavior and Related Disorders 534

Abuse 537

Intimate Partner Violence and Domestic Violence 537

Elder Abuse 543

Child Abuse, Child Sexual Abuse, and the Adult

Manifestations of Childhood Sexual Abuse 545

Reproductive and Sexual Coercion 548

Sexual Assault or Rape 549

Depression 555

Symptoms 556

Differential Diagnosis 559

Management 560

PART 4

GYNECOLOGIC CARE 565

Amenorrhea 567

Normal Menstrual Cycles 567

Etiology 567

Evaluation 568

Management 570

Abnormal Genital Bleeding 573

Evaluation, Diagnosis, and Management 573

Abnormal Uterine Bleeding 575

Endometriosis 583

Symptoms 586

Evaluation and Diagnosis 586

Management 587

Endometriosis in Adolescents 589

Leiomyomas 593

Diagnosis 593

Management 593

Acute and Chronic Pain Management 599

Pain Management Guidelines and Quality Indicators 599

Approaches to Pain Management 601

Pain Management Legislation and Regulations 603

Premenstrual Syndrome 607

Evaluation and Diagnosis 607

Management 609

Premenstrual Dysphoric Disorder 610

Vaginitis 615

Bacterial Vaginosis 616

Vulvovaginal Candidiasis 617

Trichomoniasis 619

Other Causes of Vaginal Symptoms 619

Chronic Gynecologic Pain 623

Vulvodynia and Vaginismus 623

Evaluation and Diagnosis 624

Management 625

Chronic Pelvic Pain 627

Vulvar Skin Disorders 629

Evaluation 629

Diagnosis and Management 631

Abnormal Cervical Cytology 635

Test Result Reporting 635

Evaluation and Management of Screening Results 639

Cancer Diagnosis and Management 643

Breast Cancer 643

Cervical and Vaginal Cancer 649

Endometrial Cancer 651

Ovarian Cancer 654

Vulvar Cancer 656

Gestational Trophoblastic Disease 658

Fertility Preservation 660

Polycystic Ovary Syndrome 665

Definition and Diagnostic Criteria 665

Management 669

Sexual Function and Dysfunction 673

Sexual Function 673

Sexual Dysfunction 675

Pelvic Organ Prolapse 683

Risk Factors 683

Evaluation and Diagnosis 684

Management 684

Urinary Incontinence 689

Etiology 689

Evaluation and Diagnosis 689

Management 692

Urinary Tract Infections 697

Evaluation and Diagnosis 697

Management 699

Infertility 703

Early Pregnancy Complications 707

Early Pregnancy Loss 707

Ectopic Pregnancy 709

Molar Pregnancy 711

Recurrent Pregnancy Loss 713

Induced Abortion 717

Access to Care 717

Legal Issues 717

Timing 718

Methods 718

Complications 719

Patient Counseling 719

Evaluation and Management 720

Ambulatory Gynecologic Surgery 725

Regulations 725

Facilities 728

Selection and Management of Anesthesia 730

Preoperative Care 735

Intraoperative Care 740

Postoperative Care 7411

Adverse Reactions 742

Recovery and Discharge 743

Cosmetic Surgery 744

Appendixes

A. Code of Professional Ethics of the American College of

Obstetricians and Gynecologists 749

B.

C.

D. Occupational Safety and Health Administration Regulations on

Occupational Exposure to Bloodborne Pathogens 773

E. Clinical Laboratory Improvement Amendments of 1988 787

F. Emergency Medical Treatment and Labor Act 793

G. Americans with Disabilities Act 799

H. Title VI of the Civil Rights Act 805

I. Health Insurance Portability and Accountability Act 807

J. Statement on Scope of Practice of Obstetrics and

Gynecology 813

K. Principles of Evidence-Based Medicine 8115

L. U.S. Organizations Concerned With Gynecology and Women's

Health Care 841

Index 851