Index

N.B. ‘f’ following a locator indicates a figure and ‘t’ indicates a table.

A

abdominal cysts, fetal 122

abdominal myomectomy 607

abdominal pain, in pregnancy

aetiology 320

clinical approach 320

diagnosis 320–1

epidemiology 320

fatty liver of pregnancy 321

inflammatory causes 321

management 321–2

pancreatitis 321

placental abruption 321

postpartum pseudo-obstruction 321

pre-eclampsia and HELLP syndrome 321

preterm labour 321

surgical management 321–2

urological causes 321

abdominal wall defects, fetal 118–20

abnormalities see fetal abnormalities

Access to Health Records Act (1990) 24

ACE inhibitors see angiotensin-converting-enzyme (ACE) inhibitors

achondroplasia 133

acne 198

acromegaly 284

acute fatty liver of pregnancy (AFLP) 275–6, 321

Addison’s disease 176

adenosine 232

adolescent problems see paediatric and adolescent problems

adrenal disorders, in pregnancy

Addison’s disease 176

congenital adrenal hyperplasia (CAH) 176

Conn’s syndrome 177

Cushing’s syndrome 177–8

phaeochromocytoma 176

adrenocortical steroids 210

adrenoreceptor blockers 346

Adults with Incapacity (Scotland) Act 2000 15, 16, 26

airtravel, during pregnancy 33

albendazole 209

alcohol consumption, in pregnancy 4, 33, 61

see also fetal alcohol syndrome (FAS)

ambiguous genitalia

5-a-reductase deficiency 465

aetiology 464–5

complete androgen insensitivity syndrome (CAIS) 464–5, 572

congenital adrenal hyperplasia (CAH) 464

diagnosis 465

gender of rearing 465–6, 483

incidence 464

management 465–7

normal sexual differentiation 464

pathophysiology of 464

surgery for 466–7

see also disorders of sex development (DSDs)

amenorrhoea 570

see also oligomenorrhoea and amenorrhoea

aminoglycosides 209

aminosalicylates 263

amiodarone 210–11, 232

amniocentesis 351

amniotic band syndrome 126–7

amniotic fluid embolism (AFE)

clinical approach 324

definition 324

diagnosis 324

epidemiology 324

investigations 324

management 324–5

pathophysiology 324

symptoms and signs 324

amniotomy 386–7

anaemia

causes 180

definition 180

diagnosis 180

fetal 92, 146, 148, 149–50, 378

iron-deficiency 180–1

megaloblastic anaemias 181

mother, effects on 180

pregnancy and fetus, effects on 180

prevalence 180

screening for 33, 68

anaesthesia, in obstetrics

anaesthesia-related mortality 367

Caesarean sections 365

epidural anaesthesia 365–6

general anaesthesia 366–7

rapid sequence induction (RSI) of anaesthesia 366–7

regional anaesthesia, complications of 366t

technique 366–7

analgesia, for labour

definition 364

epidemiology 364

epidural analgesia 364–5

pharmacological agents 364

regional techniques 364, 365

androgen insensitivity syndrome (AIS) 482

anencephaly 98–9

aneuploidy, fetal

antenatal screening versus prenatal diagnosis 168

Down’s syndrome screening 168

Edward’s syndrome 170

first trimester tests 169

markers 168

model predicted DR for 5% FPR 169

natural history 168

neural tube defects 170

prospective intervention studies 169

risk calculation 168–9

second trimester tests 169

sequential tests 169

strategies, possible future 169–70

twins 170

angiotensin-converting-enzyme (ACE) inhibitors 211, 232, 255, 292, 345

antenatal care

antenatal appointments 32, 35–7

antenatal information 32

booking appointment 32, 38–40

care, provision and organization of 32

clinical conditions, screening for 35

clinical examination, of pregnant women 33

documentation 32

first trimester 39f

gestational age assessment 32

haematological conditions, screening for 33–5

infections, screening for 34–5

lifestyle considerations 32

midwife- and GP-led models of care 32

minor ailments, in pregnancy 33

second trimester 35f

third trimester 36f

antepartum haemorrhage

causes 326

definition 326

examination 326

history 326

incidence 326

management 326

of indeterminate origin 326–7

prognosis 326

anthrax 260

anti-angina drugs 210

antiarrhythmics 210–11, 232–3

antibacterials 209

antibiotic administration 351

antibodies, screening for 68

anticoagulants 233

anticonvulsants 209–11, 287

antidepressants 212, 288, 339

antiemetics 77

antihypertensives 211, 232, 254–5, 345–6

antimuscarinic drugs 616, 619

antiphospholipid syndrome (APS) 193, 590

antiplatelet agents 233

antiprotozoal drugs 210

antipsychotics 211–12, 288

antipyretics 208

antiretroviral drugs 246–7

antisteroid therapy 607

antithrombotics 78, 211, 213, 432

antypsychotics 343

aortic dissection/aneurysm 227–8

Apert’s syndrome 112

arthrogryposis 113

asthma

acute attack, treatment of 296–8

definition 296

diagnosis 296

during pregnancy 296t

epidemiology 296

history 296

management 296t

medications 296–98

pathology 296

precipitants 296

preconception 296t

severity of 296t

signs 296

symptoms 296

atrial fibrillation and flutter 226

autoimmune disease

chronic active hepatitis 183

liver disorders 182

multiple sclerosis 182

myasthenia gravis 182

primary biliary cirrhosis 183

primary sclerosing cholangitis 183

azathioprine 210, 263

azithromycin 188

B

β-2 agonists 296

β-adrenergic antagonists 211

bacterial vaginosis 34

aetiology 184

clinical features 184

complications 184

definition 184

diagnosis 184

epidemiology 184

management 184–5

preterm delivery (PTD), prediction of 352

bacteriuria 34

bad news, breaking

baby, death of 13, 14

fertility 14

oncology 14–15

palliative care 670

Bakri tamponade balloon 431

balloon tamponade

advantages of 431

aetiology 430

application 431–2

clinical approach 431

definition 430

epidemiology 430

pathology 430

postoperative management 432

balloon valvuloplasty/valvotomy 154, 233

Bartholin’s gland carcinoma 679

Beckwith Wiedemann 111–12

benign and urogynaecology

endometrial polyps 600

female genital cutting 602–3

female urinary incontinence 614–6

fibroids 606–7

ovarian cysts 610–11

pelvic inflammatory disease (PID) 612–3

urinary frequency and urgency 618–19

urinary retention 620–1

urinary tract injury 622–4

urodynamic investigation 630

uterovaginal prolapse 626–8

vaginal discharge 632

vesicovaginal fistulae 634–5

vulval pain and pruritis 636–7

benign tumours see tumours

bereavement, and grieving process 13

beta-blockers 232

betamethazone 210

biophysical profile (BPP), fetal

biophysical profile score 84

clinical management protocol 84–5

definition 84

pathophysiology 84

biparietal diameter (BPD) 48

biscuspid aortic valve with/without coarctation of the aorta 228

bleeding, in early pregnancy 74

blood grouping

cell alloantibodies 33–4

screening for 68

blood tests, routine in pregnancy

anaemia 68

antibodies, screening for 68

blood grouping 68

Down’s syndrome, screening for 69–70

gestational diabetes (GDM), screening for 69

haemoglobin electrophoresis 68–69

haemoglobinopathies, and pregnancy 69

infections, in pregnancy 70–1

routine tests 68

special tests 68

body mass index (BMI) 615

Bolam principle 21

Bolitho qualification 21

booking appointment (visit) 32

aim of 38

booking clinic, management at 38

first trimester 39f

lifestyle advice 38

referrals, arrangement of 40

risk assessment 38

tests during 38–40

timing of 38

bradycardia 226

brain abnormalities 112

Braxton-Hicks contractions 51, 54–5

breast cancer screening 640–1

breastfeeding

antidepressants 339

baby-friendly hospital 44

breast abscess 45

breast, anatomy of 42

colostrum 43–4

contraindications to 45

drug abuse/medications 45–6

economic benefits 43

engorgement 44

galactocoeles/plugged ducts 44

HIV 45

hypertension 256

immunization 258

infant benefits 43

initiation and maintenance of 43

lactation, physiology of 42

latch-on 43–4

mastitis 45

maternal benefits 42

metabolism, inborn errors of 45

nipple-related problems 45

breech delivery

clinical approach 369

definition 368

epidemiology 368

management 369–70

medicolegal issues 22

pathophysiology 368–9

post ‘Term Breech Trial’ 370

predisposing factors 368

types of 368

brittle bone disease 132, 133

brow presentation

clinical approach 371

definition 371

epidemiology 371

management 371

mechanism of labour 371

C

Caesarean myomectomy 442

Caesarean section (CS)

adverse outcomes, factors affecting 435–6

aetiology 436–7

anaesthesia 365, 438

bladder/omentum/bowel, repair of 442

breech delivery 370

brow presentation 371

cord prolapse 372–3

decision to delivery interval 438

definition 434

epidemiology 434

EXIT (ex utero intrapartum treatment) procedure 442

face presentation 377

fetal/neonatal benefits of 436–7

general approach 438

indications for 436

infection, prevention of 438

labour, managing delay 392

lower segment 22

maternal benefits of 436–7

maternal morbidity 434–5

maternal mortality 435

multifetal pregnancy 441

pathology 434–6

pelvic organs, inspection of 442

perinatal morbidity 435

placenta praevia 403

placenta, delivery of 441

placental abruption 406–7

postpartum management 442

predictors of 436

preparations 438–9

prognosis 437–8

shoulder dystocia 421

singleton pregnancy 440–1

skin incision 439–40

uterine compression sutures 453

uterine incision 440

uterus, repair of 441–2

cancer, in pregnancy

aetiology 328

chemotherapy/radiotherapy, effects on fetus 328

children, risks to 329

clinical approach 328–9

definition 328

epidemiology 328

major considerations 328

pathology 328

screening 640–2

see also tumours, in gynaecology

carbamazepine 209

cardiac arrest 227

cardiac arrhythmias 226–7

cardiac symptoms, classification of severity of 224

cardiopathies 226

cardiotocography (CTG) 86–8, 354, 355, 380–2

cardiovascular abnormalities, fetal

aetiology and associations 94

chromosomal defects 94

clinical approach 95

definition 94

delivery, place and timing of 96

environmental and maternal factors 94

epidemiology 94

family history 94

genetic syndromes 94

natural history, and antenatal prognosis 94–5

nuchal translucency 94

perinatal management 95–6

cardiovascular system, changes in

pregnancy 57

cardioverter defibrillators 232

Cat Cry syndrome 106

central nervous system abnormalities, fetal

cerebral lesions, destructive 102–3

corpus callosum, agenesis of 101–2

Dandy-Walker complex 101–2

microcephaly 102

neural tube defects 98–9

ventriculomegaly 99–100

cerebral lesions, fetal 102–3

cerebral palsy 398

cervical cancer

clinical presentation 644

clinical staging 644

incidence of 644

non-surgical management 646

pathological classification 644–5

radiological staging 645

rates of in pregnancy 349

recurrent, recognizing and managing 646

risk factors 644

screening 641

surgical management 645–6

treatment 646

cervical dysplasia

and human papillomavirus (HPV) 648, 649–50

cervical screening 648–9, 650

cervix, anatomy of 648

colposcopic features 649

cervical glandular intraepithelial neoplasia (CGIN) 349

cervical intraepithelial neoplasia (CIN) 349

cervical teratomas 129

Chadwick sign, of pregnancy 50

chicken pox

aetiology 186

clinical approach 186

congenital varicella syndrome 186

epidemiology 186

fetal outcome 187

first trimester exposure 186

postpartum exposure 186–7

second trimester exposure 186

third trimester exposure 186

varicella screening 187

varicella zoster virus 70, 186

chlamydia 34, 188–9

chloramphenicol 209

chloroquine 210

cholecystitis, acute 266–7

choledocal cyst 122t

chondrodysplasia punctata (CPD) 133

chorioamnionitis 400

choriocarcinoma 660

chorionic villus sampling (CVS) versus amniocentesis 152

chromosomal anomalies

balanced translocations 106–7

chromosome mosaicism 107

chromosome results, abnormal 106

confined placental mosaicism 107

definition 106

deletions and duplications 106

Down’s syndrome 106

Edward’s syndrome 106

epidemiology 106

fetal aneuploidy 106

marker chromosomes 107

Patau syndrome 106

sex chromosome aneuploidies 106

triploidy 69 106

ciprofloxacin 209

cirrhosis 277

clomiphine 504, 514

clonidine 548

clover leave 112

club foot 124

coagulation disorders

acquired defects 191

bleeding disorders 190

inherited defects 190–1

colon cancer screening 640

colostrum 43–4

communication skills 12

core clinical skill 12

doctors-children/young people 12

improving 16

information transfer 12

partnership-building 12

patient-gynaecologist 12

rapport-building 12

comparative genomic hybridization (CGH) 106

complementary therapies 32, 501, 546–7, 548, 582–3

complete androgen insensitivity syndrome (CAIS) 464–5, 572

condom hydrostatic tamponade 431

confidentiality 13, 24, 485, 597

congenital adrenal hyperplasia (CAH) 176, 464, 482

congenital cystic adenomatous malformation (CCAM) 136

congenital diaphragmatic hernia (CDH) 136–7

congenital heart disease 95

see also cardiovascular abnormalities, fetal

Conn’s syndrome 177

connective tissue disorder

antiphospholipid syndrome (APS) 193

neonatal lupus syndromes 192–3

rheumatoid arthritis, and pregnancy 192

scleroderma, and pregnancy 193

systemic lupus erythematosus (SLE) 192–3

consent

Caesarean sections, court-ordered 21

capacity 13, 15, 16

children and young people 16

decisions, reviewing 15

emergency obstetric procedures 21

express 13, 15

implied 15

informed 21, 22

maternal immunity 21

model for 15

oral versus written 15

continence procedures

abdominal procedures 702

artificial urinary sphincter 703

bulking agents, injection of 703

counselling 703

minimally invasive mid-urethral slings 702–3

minitapes 703

sling procedures 702

stress incontinence, treatment of 702

surgical treatment 702–3

tension-free vaginal tape 702

transobturator procedures 702–3

contraception

aetiology 478–9

antiprogesterones 498

barrier methods 478

combined emergency 498

contraindications 479

copper-bearing intrauterine device 498

counselling points 499

definition 478

efficacy 479, 498

epidemiology 478

Fraser guidelines 23–4

hormonal methods 478

impact 498

indications 498

mechanism of action 478–9, 498

non-contraceptive benefits of 478

non-hormonal 478

oral 478

pathology 478

prevalence, by method 479

progestogen-only emergency hormonal contraception (PEHC) 498

risks 478

safety 478, 498–9

selective oestrogen receptor modulator 498

sterilization procedure 479

ulipristal acetate 498

vaccines, research on 479

see also intrauterine devices

copper IUDs see intrauterine devices

cord prolapse

definition 372

diagnosis 372

epidemiology 372

management 372–3

pathophysiology 372

risk factors 372

cordocentesis 152

corpus callosum, agenesis of 101–2

corticosteroids 263, 351

craniosynostosis syndromes 112

Crohn’s disease see inflammatory bowel disease

crown-rump length (CRL) measurement 48, 49f

CS see Caesarean section (CS) Cuscoe’s speculum 9

Cushing’s syndrome 177–8, 284

cyclophosphamide 209

cyclosporin 210, 263

cystic fibrosis 120–1, 300

cystic hygroma 128

cytomegalovirus (CMV) 34, 60, 196

D

Dandy-Walker complex 101–2

dating, in pregnancy

clinical dating 48

expected date of delivery (EDD) 48–9

gestational age (GA) 48, 49f

deep vein thrombosis (DVT) 231, 310, 311, 346, 432

depression 287

see also postnatal depression

dermatology

coincidental conditions 198

dermatoses, pregnancy specific 198–9

physiological changes 198

pre-existing conditions 198

detrusor overactivity (DO) 614

diabetes, in pregnancy

acute emergencies, management of 205

aetiology and pathogenesis 200

delivery, management of 205–6

diabetes, types of 200

diabetic ketoacidosis 205

diagnostic criteria 200t, 201t

fetal surveillance 205

gestational diabetes (GDM) 200–1, 203

hypoglycaemia 205

management of 204–5

mortality rates 205t

pituitary disorders 283–4

pre-existing diabetes 203–4

prevalence 200

Type 1 DM 201

Type 2 DM 201

diagnosis, of pregnancy

Braxton-Hicks contractions 51

breast changes 50

breast discomfort 50

cervical mucus, changes in 50

cervix, changes in 50

differential diagnosis 51f

fatigue 50

fetal heart sounds 51

fetal movements 51

fetal parts, palpation of 51

first trimester 50

fundal height 51

home pregnancy test 51

hormonal tests 50

immunoassay 50–1

investigations 50–1

laboratory test kits 51

menstruation, cessation of 50

micturition, frequency of 50

morning sickness 50

objective signs 50, 51

second trimester 51

skin changes 50

third trimester 51

ultrasound 51

uterus, changes in 50

vagina, discolouration of 50

digoxin 232

dinoprostone (PGE2) 386

disclosure 13

see also confidentiality

disorders of sex development (DSDs) 46XY 572

androgen insensitivity syndrome (AIS) 482

clitoral surgery 483

complete androgen insensitivity syndrome (CAIS) 464–5, 572

congenital adrenal hyperplasia (CAH) 482, 572

definition 482

diagnosis 483

disorders of testosterone biosynthesis 482

gender of rearing 465–6, 483

gonadectomy 483

medical management 483

Müllerian duct anomalies 572

ovotesticulary DSD 482

presentation of 483

Rokitansky syndrome 482–3

surgical management 483

Swyer’s syndrome 482, 572

Turner’s syndrome 482, 572

vagina creation 483

disseminated intravascular coagulation (DIC) 407

diuretics 231–2

donor insemination

child, welfare of 485

confidentiality 485

counselling 484

donor matching 485

donor recruitment 484

donor screening 484

female partner, assessment of 484

indications 484

intracytoplasmic sperm injection (ICSI) 484

law and regulation, UK 485

male factor infertility 484

rights, of parents/donor/child 485

semen storage 484

success rates 485

treatment cycle, management of 485

Doppler ultrasound 5

Doppler guidelines 93f

fetal venous Doppler 92

fetal vessels 90–1

hypoxic baby 93

middle cerebral artery (MCA) 91–2

physics of 90

thoracic aorta 92

types of 90

umbilical artery 90–1

waveforms, assessment of 90, 91t

Down’s syndrome

chromosomal anomalies 106

screening for 34, 69–70, 167, 168

drug use, recreational 4

drugs, in pregnancy

ACE inhibitors 211

adrenocortical steroids 210

anti-angina drugs 210

anti-arrhythmics 210–1

anti-filarials 209

anti-helminthic-intestinal drugs 209

anti-hypertensives 211

anti-schistosmals 209

anti-trematodes 209

antibacterials 209

anticonvulsants/antiepileptics 209

antiprotozoal drugs 210

antipyretics 208

antithrombotic drugs 211

antithyroid drugs 211

carbamazepine 209

drug metabolism, in pregnancy 208–9

fetus, effects of drugs on 208

immunosuppressive drugs 210

non-opioid analgesics 208

non-steroidal anti-inflammatory drugs (NSAIDs) 208

opioid analgesics 208–9

phenobarbitone 209

phenytoin 209

primidone 209

psychotherapeutic drugs 211–2

sodium valproate 209

US FDA pregnancy category definitions 208t duloxetine 616

duodenal atresia 120

dysmenorrhoea

aetiology 489

definition 489

epidemiology 489

examination 489

history 489

investigation 489

pathology 489

prognosis 489

treatment 489

E

eating disorders 287

echocardiography 95, 231

echogenic bowel

aetiology 120–1

cystic fibrosis 120–1

definition 120

diagnosis, ultrasound findings 121

epidemiology 120

history 121

investigation 121

management 121–2

eclampsia see pre-eclampsia, and eclampsia

ectopic pregnancy

aetiology 490

definition 490

epidemiology 490

examination 490

future pregnancies 492

history 490

investigations 490–1

management 491–2

ectrodactyly 124–5

eczema 198

Edward’s syndrome 106, 170

Ehlers-Danlos syndrome 227–8

electrocardiogram (ECG) 230–1

electroconvulsive therapy 288

Ellis-van Creveld syndrome 133

embryo freezing

advantages of 494

challenges 494

cryoprotectants, use of 494

definition 494

embryo development, stage of for freezing 494–5

epidemiology 494

frozen embryo replacement cycles 495

legal aspects and regulation 494

slow cooling, or vitrification 495

encephalocele 98–9

endocrine and metabolic changes, in pregnancy 58–9

adrenal glands 58

breast changes 59

pancreas 58

postural changes 59

thyroid 58

endometrial ablation

balloon thermal ablation 690

chemoablation 691

complications 691

cryoablation: Her option 691

endometrial preparation 691

first generation techniques 690

free fluid endometrial ablation (hydrothermablator HTA) 690

gynaelase endometrial laser intrauterine thermal therapy (ELITT) 691

impedance bipolar radiofrequency endometrial ablation 691

menstrual bleeding, heavy 486–7

microwave endometrial ablation 690

outpatient endometrial ablation 691

second generation techniques 690–1

endometrial polyp

human chorionic gonadotrophin (hCG) trigger 505–6

hysteroscopic polypectomy 505

hysteroscopy 505

semen collection 505

success rates 506

endometriosis

aetiology 500

assisted reproduction 501

cancers, associated 500

complementary therapies 501

definition 500

diagnosis 500

endometriosis-associated infertility 501

examination 500

investigations 500

pain, treatment of 500

patient support groups 501

quality of life, impact on 500

symptoms 500

treatment, empirical 500

endometrium, neoplastic conditions of

advanced disease, treatment of 656

aetiology 652

clinical approach 653–5

endometrial cancer 652, 653, 654, 655

endometrial hyperplasia 653–4

epidemiology 652

pathology 653

positive peritoneal cytology 654–5

radiotherapy 655–6

recurrent disease, treatment of 656

smooth muscle tumours 653

staging 653, 654t

epidural anaesthesia 365–6

epidural analgesia 364–5

epilepsy

AEDs, teratogenic effects of 214

classification of 214

contraception 215

genetic aspects 214

management 214–15

migraine 215

post partum management 215

preconception advice 214

pregnancy risks 214

seizure frequency 214

episiotomy

definition 374

incidence 374

indications for 374

perineal trauma, management and repair of 374–5

ergometrine 298

erythema multiform 198

erythema nodosum 198

examination

gynaecological patient 8–9

obstetric patient 4–5

exercise, in pregnancy 32–33

expected date of delivery (EDD) 4, 48–9

external cephalic version (ECV) 370

F

face presentation

clinical approach 376

definition 376

epidemiology 376

management 376–7

mechanism of labour 376

postpartum complications 377

facial abnormalities

facial clefts 116

micrognathia 116–7

fallopian tube cancer 641, 668

female genital mutilation (FGM) 4

causes 602

classification 602

consequences of 602–3

definition 602

eradication of 603

legal issues 602

prevalence 602

female infertility see infertility, female

female pelvis see pelvis, anatomy of female

female urinary incontinence see urinary incontinence, female

femur length (FL) 48

fertility, in survivors of childhood malignancy

cancer treatment effects 508

clinical approach 509–10

comorbidity 510

counselling 510

definition 508

epidemiology 508

Faddy-Gosden model, dose and age at treatment 508f

fertility preservation 509–10, 511

follow-up 511

male patients 511

management 509

pathology 508–9

post-treatment considerations 509

pre-treatment considerations 509

premature ovarian failure 508

prognosis 509

quick reference material 510

radiotherapy 508–9, 511

see also infertility, female

fetal abnormalities

cardiovascular 94–6

central nervous system 98–103

chromosomal anomalies 106–7

face 116–17

gastrointestinal system 117–23

genetic disorders 110–14

head and neck 128–9

hydrops 148–50

limbs 124–7

screening for 34

skeletal abnormalities/dysplasias 132–5

thorax 136–8

urinary system 140–2

fetal alcohol spectrum disorder (FASD) 61

fetal alcohol syndrome (FAS) 61, 304

fetal aneuploidy 106

fetal blood sampling (FBS) 152

fetal goitre 128–29

fetal hydrops 113

fetal movement charts 144–5

fetal stethoscope 5

fetal surveillance, in labour

cardiotocography (CTG) 380–2

definition 378

diagnostic tests 378

epidemiology 378

fetal blood sampling 382

pathology 378–9

prognosis 379

screening tests 378

surveillance approach 379–80

fetal vesico-amniotic shunt 153

fetral pleural effusion 137–8

fetus, care of

biophysical profile (BPP) 84–5

cardiotocography (CTG) 86–9

Doppler ultrasound 90–3

fetal movement charts 144–5

fetal nuchal translucency 146–7

intrauterine growth restriction (IUGR) 156–7

invasive procedures 152–4

multiple pregnancy 158–9

oligohydramnios 160–1

placental abnormalities 162

polyhydramnios 164–5

red blood cell isoimmunization 166–7

symphyseal fundal height (SFH) 172–4

umbilical cord abnormalities 162

FGM see female genital mutilation (FGM)

fibroids

abdominal myomectomy 607

aetiology 330

antenatal care 330

Caesarean section 331

classification 606

clinical features 330

complications 606

definition 330

differential diagnosis 606

epidemiology 330

fibroid pain, management of 330–1

hormonal therapies 607

hysterectomy 607

in pregnancy 330–1

management 330–31, 606–7

miscarriage 330

myomectomy 331, 442, 553, 607

non-hormonal therapies 607

pathology 330

pathophysiology 606

pharmacological options 607

postpartum care 331

pregnancy 607

subfertility 330

surgical treatment, indications for 607

uterine artery embolization 607

fluoxetine 212

Foley catheter 431

forceps delivery

abdominal palpation 447

aetiology 446

clinical approach 447

definition 446

delivery, abandoning (’failed forceps’) 450

epidemiology 446

examination, prior to forceps application 447

forceps, application of 448–9

pathology 446

preparation 447

prerequisities 447

prognosis 447

successful delivery, procedures after 449–50

traction in cephalic presentation 449

vaginal examination 447

furosemide 231–2

G

galactocoeles 44

galactopoiesis 42

galactosaemia 45

gastrointestinal abnormalities, fetal

abdominal cysts 122

anterior abdominal wall defects 118–20

exomphalos 113

gastroschisis 113

genitalia, ambiguous 113

GI tract abnormalities 120–2

pregnancies, future 122

pregnancy, termination of 122

gastroschisis 113, 400

genetic disorders, fetal

gastrointestinal abnormalities 113

inheritance patterns 110

investigations 113–14

screening 111–13

genital tract

premalignant conditions of 349

uterine anomalies 533

vaginal anomalies 532–3

genitalia, ambiguous see ambiguous genitalia

German measles see rubella

gestational diabetes (GDM) 35, 69, 200–1, 203

gestational trophoblastic neoplasia

chemotherapy 660, 661

choriocarcinoma 660

complete hydatidiform mole 659–60

definition 658

diagnosis 658–9

epidemiology 658

high-risk patients 660

invasive mole 660

low-risk patients 660

management 659–60

partial hydatidiform mole 660

pathology 658

placental site trophopblastic tumour (PSTT) 661

radiation therapy 661

surgery in 661

Gilbert’s syndrome 266

Gillick competence 24

glycerine trinitrate (GTN) 351, 419

gonadectomy 467, 483

gonadotrophin-releasing hormone (GnRH) 506, 515, 525, 607

gonorrhoea

counselling 218

definition 218

diagnosis 218

epidemiology 218

examination 218

history 218

investigations 218

management 218–9

pathology 218

gynaecological cancers

incidence of 640

screening 641–2

gynaecological procedures/surgery

colposcopy 688

continence procedures 702–3

endometrial ablation techniques 690–1

hysterectomy 698–9

hysteroscopy 694–6

laparoscopy 706–9

pelvic floor surgery 710–11

pipelle biopsy 705

H

haematological changes, in pregnancy

coagulation and fibrinolysis, alterations in 58

erythrocyte, increase in 58

maternal plasma volume, increase in 58

peripheral white blood cell count, rise in 58

platelet count, fall in 58

haematological investigations, in pregnancy 38–9

haemoglobin electrophoresis 68–9

haemoglobinopathies

and pregnancy 69

clinical approach 222–3

counselling and management 223

definition 222

epidemiology 222

pathology 222

screening for 34, 39

haemolytic disease of the newborn (HDN) 68

haemophilias 190

head and neck abnormalities, fetal

cervical teratomas 129

cystic hygroma 128

fetal goitre 128–9

head circumference (HC) 48

heart disease

aetiology 228

antenatal care 230

arrhythmias 225

definition 224

epidemiology 224

fetal assessment 231

investigations 230–31

labour and delivery, management of 234–5

medical treatment 231–3

pathology 224–8

postnatal management and breastfeeding 235

pre-pregnancy/conception counseling 229–30

prognosis 228–9

pulmonary hypertension 225–6

surgical treatment 233–4

tetralogy of Fallot (TOF) 225

HELLP syndrome 344, 347

heparin 211, 233

hepatitis A 259, 260

hepatitis B 34, 60, 70, 259, 260

acute 238

antiviral drugs 240t

chronic 238–39

counselling 240

diagnosis 240

epidemiology 238

in pregnancy 240–1

management 240–1

prevention 239

hepatitis C 34

herpes simplex virus (HSV)

aetiology 242

counselling 243

definition 242

diagnosis 242

epidemiology 242

examination 242

history 242

infection, types of 242

investigations 242

management 243

maternal-fetal transmission 242

neonatal clinical manifestation 242

pathology 242

prognosis 242

risk factors 242

herpes zoster see chicken pox

HIV see human immunodeficiency virus (HIV)

holoprosencephaly 100

home birth

advantages of 384

antenatal preparation 384

complications, possible 384–5

definition 384

eligibility criteria 384

epidemiology 384

future challenges 385

maternal choice versus safety 385

hormone replacement therapy (HRT)

fibroids 607

menopause 545–47

human chorionic gonadotrophin (hCG) 52, 556–7

Human Fertilization and Embryology Act (1990) 26

human immunodeficiency virus (HIV) 34

AIDS presenting illnesses, common 244t

antiretroviral drugs 246–7

breastfeeding 45

counselling 247

definition 244

drug interactions 247

epidemiology 244

examination and investigation 246

gynaecology, HIV in 248–9

history 244–6

late presentation 247

management 246–7

natural history 244, 245f

prevalence 244, 245f

prognosis 247

screening, advantages of 71

human papillomavirus (HPV) 250–1

cervical carcinoma, precursors of 648

testing 649–50

vaccines 16, 650

Human Tissue Act 2005 26

hydralazine 255, 346

hydrocortizone 210

hydrops

aetiology 148–9

cardiac arrhythmias 150

chorioangiomas 150

counselling and management 149–50

definition 148

diagnosis 149

epidemiology 148

fetal anaemia 148, 149–50

fetal congenital infection 149

fetal syndromes 148–9

fetus/placenta, structural abnormalities of 148

multiple pregnancy 148

non-treatable causes of 150

prognosis 149

twin reversed arterial perfusion syndrome 149

twin-twin transfusion syndrome 149

hypercoagulability, in pregnancy 224

hyperemesis gravidarum

aetiology 76

complications 78

definition 76

diagnosis 50

epidemiology 76

minor symptoms, of pregnancy 52

prognosis 77

hyperprolactinaemia 282, 503

hypertension

aetiology 252

antihypertensives 254–55

blood pressure measurement 253

chronic 252

clinical assessment 253

conceptual understanding 253

counselling 253

definition 252

epidemiology 252

fetal assessment/monitoring 254

gestational 252

investigations 254

labour and delivery 255–6

pathology 252

postnatal management 256

prevention of 256

prognosis 252–53

hypertrophic cardiomyopathy 226

hypopituitarism 282–83

hypoproteinaemia, fetal 146

hypothalamic/pituitary dysfunction 502–3

hypoxaemia 378

hypoxia 378–9

hysterectomy 453

abdominal 698

approach, choice of 698

fibroids 607

laparoscopic 699

ovaries, removal of 699

preoperative care 698

subtotal 698

types of 698

vaginal 699

hystero contrast salpingography (HyCoSy) 512

hystero-salpingography (HSG) 512–3

hysteroscopic myomectomy 553, 607

hysteroscopy

complications 696

distension medium 694–5

energy, types of 695

hysteroscopes 694

indications 694

inpatient hysteroscopy 696

office hysteroscopy 695–6

procedures 694

procedures for operative 696

training in 696–97

types of 694

I

imaging, in reproductive medicine

hystero contrast salpingography (HyCoSy) 512

hystero salpingography (HSG) 512–13

magnetic resonance imaging 513

selective salpingography 513

ultrasound 512

immunization

active, during pregnancy 259–60

breastfeeding 258

clinical approach 258

definition 258

efficacy 258

passive, during pregnancy 260

safety 258

vaccination, timing of 258

vulnerable population 258

immunoassay 50–1

immunosuppressive drugs 210

in utero shunt insertion 153

in vitro fertilization (IVF)

adjuncts to 526

ART 525

blastocyst culture 506

complications 526

definition 524

down-regulation, using GnRH agonist 506

embryo transfer 506, 525–6

endometriosis 501

fertilization and embryo culture 506

GnRH agonists 525

hCG trigger 506

infertility, incidence of 524

intracytoplasmic sperm injection 506

oocyte collection 525

oocyte retrieval 506

ovarian hyperstimulation syndrome, prevention of 567–8

ovarian stimulation 506

pathology 524

prognosis 524–5

regulation 526–7

sperm collection 525

success rates 506

in vitro oocyte maturation (IVM)

definition 528

embryo transfer 530–1

embryology laboratory procedures 530

epidemiology 528

indications 528–9

IVM cycle, monitoring and management of 530

luteal-phase support 531

oocyte collection procedure 530

prognosis 529–30

technique 528

incontinence see urinary incontinence, female

induction of labour

clinical approach 387

definition 386

frequency 386

high risk inductions 388

indications 386

non-pharmacological methods 387

pharmacological methods 386–7

risks of 386

special indications 387

surgical methods 386–7

induction of ovulation

anovulation, investigation of 514

oestrogen-deficient patients, treatment of 515

oestrogen-replete patients, treatment of 514–15

infections

fetal 146–47, 378

in pregnancy 70–1

screening for 34–5

infertility, female

adhesions 504–5

definition 502

diagnosis 502

endometrial polyp 505–6

endometriosis 505

fibroids 505

in vitro fertilization (IVF) 506

obstructive and developmental disorders 504–6

ovulatory disorders 502–4

sexually transmitted infections 502

tubal occlusion 504

see also male subfertility

inflammatory bowel disease

causes 262

clinical features 262

complications 263–4

contraception 264

definition 262

effect of pregnancy of 262

epidemiology 262

flare in pregnancy, medical treatment of 263

investigations 262

management 263

pathology 262

pregnancy, effect on 262–3

rectovaginal fistulae 634

infliximab 263

influenza 259

International Federation of Gynaecologists and Obstetricians (FIGO) 20

International Planned Parenthood Federation 20

intestinal duplication cyst 122t

intracytoplasmic sperm injection (ICSI)

clinical approach 518–19

counselling 518

definition 518

epidemiology 518

follow-up 518–19

indications 518

management 518

success rates 518

intrauterine devices 498

bleeding patterns and pain 521

choice of 522

clinical approach 522

contraindications for 521

definition 520

duration of use 521

ectopic pregnancy, risk of 521

efficacy 521

epidemiology 520

expulsion 521

fertility, return to 521

hormonal side-effects 521

indications for 521

insertion 522

medicated devices 520

mode of action 520

non-contraceptive benefits 522

ovarian cysts 521

pathology 520

pelvic actinomyces, and IUD 523

pelvic inflammatory disease 521

post insertion instructions 523

prognosis 521

shape 520

types of 520f, 521

intrauterine growth restriction (IUGR)

aetiology 156

definition 156

diagnosis 156–7

epidemiology 156

management 157

prognosis 156

iron deficiency 52, 180–1

ischaemic heart disease 227

IVF see in vitro fertilization (IVF)

IVM see in vitro oocyte maturation (IVM)

J

jaundice acute and chronic viral hepatitis 266

acute cholecystitis 266–7

acute pancreatitis 267, 270

causes 266

definition 266

gall bladder disease 266

Gilbert’s syndrome 266

herpes simplex hepatitis 267

history 266

investigations 266

signs 266

L

labetolol 255

labour

anaesthesia, in obstetrics 365–7

analgesia 364–5

breech 368–70

brow presentation 371

cord prolapse 372–3

definitions 390

episiotomy 374–5

face presentation 376–7

first stage 390, 392

home birth 384–5

maternal collapse 394–7

meconium-stained liquor 398–400

newborn, resuscitation of 414–17

normal physiological progress 392–3

optimizing outcomes 393

physiology 393

placenta praevia 402–4

placental abruption 406–7

postpartum haemorrhage (PPH) 408–10

prelabour rupture of membranes at term (PROM) 412–13

progress, assessment of 390

retained placenta 418–19

schools of labour management 390

second stage 392

shoulder dystocia 420–2

shoulder presentation 424–5

third stage 392–3

uterine inversion 426–7

see also fetal surveillance, in labour; induction of labour

lactogenesis 42

laminaria tents 387

laparoscopy 321, 491

advantages of 708

assessment before 706

complications 708

indications 706

instruments for 706

procedure 706

techniques and sites of entry 706–8

theatre set up 707f

training in 708–9

umbilicus, anatomy of 708f

laparotomy 321–2

last menstrual period (LMP) 4

legal framework, for care in obstetrics and gynaecology

‘good medicine’ 20

capacity, patients lacking 25–6

children and young people 23–4

consent, in obstetrics 21–2

damage, prevention of 22

fertility treatments 26

human tissue, use of 26

medical ethics 20

medical litigation, principles of 20

medical negligence 20–1

miscellaneous legislation 25–6

sexual and reproductive rights, of women 20

specific obstetric conditions 22–3

standards of care 21

STIs 24–5

termination of pregnancy 23, 27

leucorrhoea, of pregnancy 55

leucotrien receptor agonists 297

lignocain 232

limb abnormalities, fetal

amniotic band syndrome 126–7

club foot 124

ectrodactyly 124–5

polydactyly 126

radial aplasia 125–26

limb reduction defects 112–13

Lipkin Model, for communication 16

listeriosis

aetiology 272

definition 272

diagnosis 272

epidemiology 272

examination 272

immunocompromised states 272

investigations 272

management 272–73

neonatal infection 272

pregnancy 272

prognosis 272

lithium 211–12, 288

liver disease 274–7

acute fatty liver of pregnancy (AFLP) 275–6

cirrhosis 277

HELLP syndrome 274t, 276

hepatitis 277

liver function tests, normal pregnancy values 275

liver transplants 277

obstetric cholestasis (OC) 274–5

primary biliary cirrhosis 276

sclerosing cholangitis 276

Wilson’s disease 277

long bones, short 112

lung cancer screening 640

lymhocytic cardiomyopathy 226

lymphatic drainage, failure of (fetal) 146

lymphocytic hypophysitis 282–3

M

macrocephaly 111

magnetic resonance imaging (MRI) 513

male subfertility

aetiology 536

chromosomal analysis 538

complications/side effects/sequelae 539

counselling 539

definition 536

diagnosis 536

DNA fragmentation 538

epidemiology 536

examination 538–9

genetic causes, of male infertility 538

history 536–7

hormone analysis 538

investigations 537–38

management 539, 540t

medications 537

prognosis 539

retrograde ejaculation 539

treatment options 539

Y chromosome gene defects 538

malignant melanoma 679–80

malignant tumours see tumours

mammogenesis 42

Marfan’s syndrome 227

mastitis 44, 45

maternal collapse, in labour

aetiology 394–5

definition 394

diagnosis 395

epidemiology 394

further management 396

prevention 394

primary survey 395

prognosis 395

resuscitation 395–96

maternal medicine and infections

adrenal disorders 176–8

anaemia 180–1

autoimmune disease 182–3

bacterial vaginosis 184–5

chicken pox/herpes zoster 186–7

chlamydia 188–9

coagulation disorders 190–1

connective tissue disorder 192–3

cytomegalovirus (CMV) 196

dermatology 198–9

diabetes, in pregnancy 200–206

drugs, in pregnancy 208–12

epilepsy, and other neurological conditions 214–15

gonorrhoea 218–19

haemoglobinopathies 222–3

heart disease 224–5

hepatitis B (HBV) 238–41

herpes simplex virus (HSV) 242–3

HIV infection 244–9

human papillomavirus 250–1

hypertension 252–6

immunization 258–60

inflammatory bowel disease 262–4

jaundice 266–70

listeriosis 272–7

liver disease 274–7

measles: rubeola 278–9

parvovirus B19 280

perinatal group B streptococcus (GBS) 220–1

physiological changes 282

pituitary disorders, in pregnancy 282–4

psychiatric disorders, in pregnancy 286–7

renal disease 290–4

respiratory disease 296–300

rubella (German measles) 302–3

substance abuse, in pregnancy 304–5

syphilis 306–7

thromboembolic disease 310–11

thyroid and parathyroid disease 312–14

toxoplasmosis, in pregnancy 316

vulvovaginal candidiasis 318

maturity-onset diabetes of the young (MODY) 200

mean sac diameter (MSD) 48

measles see rubeola

measles mumps and rubella (MMR) vaccine 302–3

mebendazole 209

meconium-stained liquor

aetiology 398

counselling 400

definition 398

depressed 400

diagnosis 398–99

epidemiology 398

fetal heart rate 399

gastroschisis, and other fetal bowel obstruction 400

good condition 400

heavy meconium 400

home birth 400

initial management 399

light meconium 400

neonatal resuscitation 400

postnatal neonatal observation by midwifery team 400

prematurity 399–400

prognosis 398

recurrence/future pregnancy planning 400

meningococcus 259

menopause

best practice 548–9

complementary therapies 546–7

consequences of 542–3

definitions 542

diagnosis of 543–4

epidemiology 542

hormonal changes 542

hormone replacement therapy (HRT) 545–4

hormone therapy regimes 544

lifestyle measures 544

mammography 543, 544

menstrual cycle 542

osteoporosis 543, 544

ovarian reserve, prediction of 543

pathophysiology 542–3

premature ovarian failure 542

prescribing advice, official 546

progestogens 545

testosterone preparations/regimens 546

vasomotor symptoms, management of 547–8

menorrhagia

blood tests 551

complications/side effects/sequelae 553

counselling 552

definition 550

diagnosis 550

endometrial carcinoma, risk factors 550t

epidemiology 550

examination 551

follow up 553

history 550–1

investigations 551

medical management 552

menstrual blood loss, quantification of 551

non-medical management 552

pathology 550

prognosis 550

surgical management 552–3

surgical/radiological management 552–3

uterus and endometrium, assessment of 551–2

menstrual bleeding, heavy

aetiology 486

definition 486

diagnosis 486

epidemiology 486

pathology 486

prognosis 486

treatment 486–7

menstrual cycle, physiology of

amenorrhoea 555

clinical approach: top tips 555

cycle length, variability 555

endocrinology 554

endometrial cycle 554

follicular development 554

LH dipsticks, and polycystic ovarian syndrome 555

menstrual cycle phases 554–5

progesterone, and body temperature 555

Mental Capacity Act (2005) 15, 16, 25–6

Mental Health Act (2007) 340

mesenteric/omental cyst 122t metformin 205

methimazole 211

methotrexate 263

methyldopa 232, 254, 345–6

metronidazole 210, 263

microcephaly 102, 111

micrognathia 116–17

mifepristone 386

miscarriage

definition 556

diagnosis 556–7

epidemiology 556

expert adviser 558

management 557–8

nomenclature, of early pregnancy loss 556

risk factors 556

see also recurrent miscarriage

misoprostol (PGE1) 386

mixed incontinence 614

morning sickness see hyperemesis gravidarum

multiple pregnancy

Caesarean section 441

chorionicity 158

complications 158

definition 158

delivery 158–59

dichorionic twins 158

epidemiology 158

fetal growth restriction 158

higher order 159

hydrops 148

intrapartum 159

intrauterine growth restriction (IUGR) 156

management 158

monochorionic twins 158–9

prenatal screening 158

presentation 158

twin-twin transformation syndrome 149, 153, 158

vanishing twin 158

multiple sclerosis 182

multiple thrombosis 216

mumps 259

myasthenia gravis 182

mycophenolate mofetil (MMF) 292

myocarditis 226

myomectomy 331, 442, 553, 607

N

neck abnormalites see head and neck abnormalities

neonatal chlamydia trachomatis 188

neonatal lupus syndromes 192–3

neonatal necrotizing enterocolitis (NEC) 43

neonatal services, optimal 351

neural tube defects, fetal 98–9

newborn, resuscitation of

congenital problems, known 415

equipment 414

incidence 414

meconium aspiration 415

newborn life support 416–17

physiology 414

preterm infants 415–16

priorities 414–15

resuscitation, stopping 416

nifedipine 255, 346

nitrofurantoin 209

nitroglycerin 210

non-opioid analgesics 208

non-steroidal anti-inflammatory drugs (NSAIDs) 208, 607

nuchal translucency

definition 146

diagnosis 146

epidemiology 146

increased, implications of 111, 147

management 147

pathophysiology 146–7

nutritional supplements, in pregnancy 32

O

obesity 173, 435

obstetric cholestasis (OC)

aetiology 332

definition 332

diagnosis 332

endocrine factors 332

environmental factors 332

epidemiology 332

examination 332

fetal complications, aetiology of 332

genetic factors 332

history 332

investigations 333

liver disease 274–5

management 333

prognosis 332

obstetric conditions

abdominal pain, in pregnancy 320–2

amniotic fluid embolism (AFE) 324–5

antepartum haemorrhage 326–7

cancer, in pregnancy 328–9

fibroids, in pregnancy 330–1

genital tract, premalignant conditions of in pregnancy 349

obstetric cholestasis (OC) 332–3

ovarian cysts 336–7

postnatal depression 338–40

pre-eclampsia, and eclampsia 344–4

preterm labour (preterm delivery (PTD)) 350–2

preterm prelabour rupture of membranes (pPROM) 354–6

prolonged pregnancy 358–9

puerperal psychosis 342–3

puerperal sepsis 360–1

obstetric techniques/procedures/surgery

balloon tamponade 430–2

Caesarean section 434–2

forceps delivery 446–50

uterine compression sutures 452–4

ventouse delivery 456–9

oesophageal atresia 120

oestrogen 52

Ogilvie syndrome 321

oligohydramnios

amnio-infusion 160–1

amniotic fluid volume, assessment of 160

anhydramnios 160

differential diagnosis 160

epidemiology 160

fetal surveillance, in labour 379

management 160–1

pathology/aetiology 160

vesico-amniotic shunts 161

oligomenorrhoea and amenorrhoea

aetiology 562

anatomical causes 563

causes, categories of 563

clinical approach 562–4

definition 562

epidemiology 562

history 562

hypergonadotrophic hypogonadism 564

hyperprolactinaemia 563

hypogonadotrophic hypogonadism 564

investigations 562–3

management 563

normogonadotrophic hypogonadism 564

physical examination 562

oocyte donation

donor assessment 560

donor management 560

donor recruitment 560

embryo transfer 561

indications 560

laboratory aspects 560–61

law and regulation 561

recipient management 560

success rates 561

opioid analgesics 208–9

oral glucose tolerance test (OGTT) 200–201

Osiander’s sign, of pregnancy 50

osteogenesis imperfecta 132, 133

ovarian cancer

adjuvant therapies 667

aetiology 664

borderline malignant epithelial ovarian tumours 667

chemotherapy 667

clinical approach 665–8

diagnosis 665–6

germ cell tumours 667

in young women 666–7

incidence of 664

management 666–8

pathology 664

prognosis 665

sarcoma of the ovary 668

screening 641–2, 664–5

sex cord stromal tumours of the ovary 668

small cell carcinoma of the ovary 668

staging 665

surgery 666

tumour markers 666

ovarian cysts 122t

acute abdominal pain 336

aetiology 336, 610

clinical features 336, 610

definition 336

differential diagnosis 610

epidemiology 336

in pregnancy 611

investigations 610

laparoscopy 611

monitoring 336

ovarian cyst accidents 610

pathology 336

pathophysiology 610

risk of malignancy index scoring system 610–11

surgery, place of 611

suspected ovarian torsion 611

suspicious cysts, and diagnostic difficulty 337

transvaginal cyst aspiration 611

ovarian hyperstimulation syndrome

classification 566

complications 568

description of 566

diagnosis 568

management 568

mechanisms 566

pathophysiology 566

prediction, and risk factors 566–7

prevalence 566

prevention 567–8

surveillance 568

ovulation, induction of see induction of

ovulation oxytocin 386, 392, 408, 418–19

P

paediatric and adolescent problems

‘no vagina’ 571

adolescence, definition of 570

amenorrhoea 570

clinical approach 570

delayed puberty 571

dysmenorrohea/pelvic pain 571

epidemiology 570

hypoandrogenism 571

labial adhesions 570

menstrual dysfunction 571

oligomenorrhoea 571

ovarian cysts/masses 571

polycystic ovarian syndrome (PCOS) 571

precocious puberty 571

premature ovarian failure 571

thelarche/pubarche/menarche 570

vulvovaginitis 570

see also disorders of sex development (DSDs)

pain

abdominal, in pregnancy 320–2

cancer 670–1

endometriosis-associated 500

fibroids 330–1

in early pregnancy 74

ovarian cysts 336

pelvic 476–7

vulval 626

palliative care

bad news, breaking 670

breathlessness 673

constipation 672

definition 670

emergencies 674–5

epidemiology 670

history and examination 670

investigation 670

malignant fistulae 673–4

management 670

nausea and vomiting, control of 671–2

pain control, in cancer 670–1

recurrent malignant ascites 672–3

syringe driver, drugs in 672, 674, 675t

tumour fungation 674

pancreatitis 267, 270, 321

parathyroid disease see thyroid and parathyroid disease

partogram 390, 391

parvovirus B19 60, 280

Patau syndrome 106

Pederson’s hypothesis, modified 202

pelvic floor surgery

anterior vaginal prolapse 710

posterior vaginal wall prolapse 710

vaginal apical prolapse 710–11

pelvic inflammatory disease (PID)

aetiology 612

clinical diagnosis 612

consequences 612

counselling 613

description of 612

differential diagnosis 612

follow up 613

investigations 612

management 612–13

risk factors 612

pelvic pain, chronic

condition-specific treatment 477

contributory factors 476

definition 476

empirical treatment 477

epidemiology 476

examination 476

initial consultation 476

initial history 476

investigations 476–7

risk factors 476

treatment options 477

pelvis, anatomy of female

blood supply, in pelvis 469

bony pelvis 468

external genitalia 470–1

internal genitalia 471–4

lymphatic drainage 470

muscles 468

nerve supply 470

pelvic floor 468, 469f

pelvic planes, diameter of 468t

perineal body (central perineal tendon) 468–9

soft tissues 468–9

urogenital diaphragm 468

veins 470

pemphigoid gestationis 198

percutaneous umbilical blood sampling (PUBS) 152

perinatal group B streptococcus (GBS)

background 220

intrapartum antibiotic prophylaxis 220

late-onset neonatal disease 220–1

preterm birth/low birthweight 221

prevention of 220

resistant organisms, emergence of 220

perineal trauma, management and repair of

episiotomy 374, 375f

postoperative care 374–5

peripartum cardiomyopathy 226

peripheral nerve compression syndromes 215

Pfeiffer syndrome 112

phaeochromocytoma 176

phenobarbitone 209

phenytoin 209

physiological changes, in pregnancy

alimentary tract 56

cardiovascular system 57–5

endocrine and metabolic changes 58–9

haematological changes 58

hyperprolactinaemia 282

respiratory tract system 56

urinary and renal system 56–7

phytoestrogens 548

pipelle biopsy 705

pituitary disorders, in pregnancy

acromegaly 284

Cushing’s syndrome 284

diabetes insipidus 283–4

hyperprolactinaemia 282

hypopituitarism 282–3

placenta accreta 403–4

placenta praevia 35

aetiology 402

clinical presentation 402

counselling 403

definition 402

future pregnancies 403

incidence 402

management 403

placenta accreta 403–4

risk factors 402

screening for 402

vasa praevia 404

placenta, retained see retained placenta

placental abnormalities

chorioangioma 162

circumvallate placenta 162

placental morphology, normal variation in 162

placental abruption

baby, care of 407

Caesarean delivery 406–7

clinical presentation 406

complications 406, 407

counselling 407

definition 406

disseminated intravascular coagulation (DIC) 407

incidence 406

management 406–7

pathology 406

postpartum haemorrhage 407

renal failure 407

risk factors for 406

subsequent pregnancies, advice for 407

vaginal delivery 406–7

placental site trophopblastic tumour (PSTT) 661

pleuro-amniotic shunt 153–4

pneumococcus 259

pneumonia 298

poliomyelitis 259

polycystic ovary syndrome (PCOS)

acne and hirsuitism 575

aetiology 574

alopecia 575

assisted reproduction 504

clomiphine, and ovulation induction 504

definition 574

diagnosis 574

eflornithine cream 575

epidemiology 574

examination 574–75

finasteride 575

follow-up, long term 576

history 574

investigations 575

laparoscopic ovarian drilling (LOD) 504

long-term consequences 574

menstrual disturbance 575–6

pathology 574

weight loss 575

polydactyly 126

polyhydramnios

aetiological treatment 165

aetiology 164

counselling 164

definition of 164

diagnosis 164

epidemiology 164

prognosis 164

symptomatic treatment 165

polymorphic eruption, of pregnancy 198

postnatal depression

and baby blues, differences between 338–9

antidepressants 339

clinical features 338

counselling 339

detection/screening/prevention 338

electroconvulsive therapy (ECT) 339

examination 339

history 339

incidence of 338

Mother and Baby unit, admission to 339–40

special investigations 339

treatment 339–40

postpartum pseudo-obstruction 321

pre-eclampsia, and eclampsia 35

abdominal pain 321

aetiology 344

BP, monitoring 345

counselling 345

definitions 344

delivery 345, 346

diagnosis 344–5

epidemiology 344

fetal monitoring 346

future pregnancy, planning 348

HELLP syndrome 347

investigations 345

magnesium sulphate 346

management 345–7

pathology 344

postpartum 347–8

pre-eclamptic toxaemia (PET) 346–4

prognosis 344

treatment 345–6

prednisolone 210, 297

pregnancy of unknown location (PUL)

aetiology 80

definition 80

diagnosis 80–81

ectopic pregnancy 80

epidemiology 80

failing PUL 80

intrauterine pregnancy 80

management 81

persistent PUL 80

pregnancy, diagnosis of see diagnosis, of

pregnancy preimplantation genetic diagnosis

clinical approach 578

definition 578

estimate of use 579

indications 578

procedure 578

process 578

variations 578–9

prelabour rupture of membranes at term (PROM)

aetiology 412

clinical questions 412

definition 412

diagnosis and initial assessment 412

epidemiology 412

feto-maternal infectious morbidity, risk of 412

intrapartum antibiotic prophylaxis, advice against 412

management 412–13

neonatal infection, risk of 412

premalignant tumours see tumours

premature ovarian failure (POF)

aetiology 581

clinical presentation 581

definition 580

diagnosis 580

future objectives 581

hormone replacement therapy 502

initial evaluation 580

multidisciplinary care 581

treatment 580–81

premenstrual syndrome (PMS)

aetiology 582

clinical manifestations and diagnosis 582

complementary therapies 582–3

definition 582

epidemiology 582

herbal preparations 582

lifestyle changes 582

ovulation suppression 583

pathophysiology 582

treatment 582

preparation, for pregnancy

contraception, stopping 61

folic acid 61

foods to avoid 61

healthy eating 61

infectious disease screening 60

lifestyle issues 61

medicines and drugs 60

patient information/contacts 61

preconception care and counselling 60

sexual health 60–1

social assessment 60

work environment 61

X-rays 61

preterm delivery (PTD)

adverse sequelae, rates of 352

clinical assessment 350–51

definition 350

epidemiology and importance 350

management 351

prediction of 351–3

preterm labour, as symptom 352

preterm prelabour rupture of membranes (pPROM)

aetiology 354

amniocentesis, role of 355–6

clinical importance 354

corticosteroid therapy 355

definition 354

diagnosis 354

initial assessment 354

management 354–5

pathophysiology 354

prediction of 351–2

tocolysis 355

primary biliary cirrhosis 183

primary postpartum haemorrhage (PPH) 430

primary pulmonary hypertension 228

primary sclerosing cholangitis 183

primidone 209

probe amplification (MPLA) 106

procainamide 232

progestogens 545, 607

prolonged pregnancy

confirmation of 358

definition 358

incidence of 358

induction of labour, methods of 359

labour abnormalities 358

management 359

monitoring 358–9

perinatal morbidity 358

perinatal mortality 358

post-dated pregnancy, assessment of 358

practice points 359

recurrence, risk of 359

risk factors for 358

risks of 358

propylthiouracil 211

prostaglandin 298

prurigo of pregnancy 199

pruritic folliculitis of pregnancy 199

pruritis see vulval pain and pruritis psychiatric disorders, in pregnancy

anxiety disorders 286–7

bipolar affective disorder 287

clinical assessment 286

depression 287

eating disorders 287

psychiatric hospital, pregnant woman in 288

schizophrenia 287

screening for 286

subsyndromal emotional disturbances, prevalance of 286

treatment principles 287

treatments, specific 287–8

psychosexual problems

common presentations of 584

doctor-patient relationships 585–6

erectile dysfunction 586

female sexual function disorders, classification of 584

investigations 585

life events 586–7

male and female sexuality, impact of conditions and treatments on 586t

management strategies 586t

partners 586

psychosexual medicine 585–6

recognition of 587

sexual dysfunction, quantifying 584

sexual history 584–5

psychotherapeutic drugs 211–12

puberty, delayed 571

puerperal psychosis

aetiology 342

clinical approach 342–3

examination 342

history 342

presentation 342

prognosis 343

special investigations 342–3

treatment 343

puerperal sepsis

aetiology 360

breast abscess 360

definition 360

endometriosis 360

mastitis 360

septic pelvic thrombophlebitis 360

urinary tract infection 360

wounds and episiotomy infections 360–1

puerperium

definition of 64

management of 65

mother, general care of 65–6

normal changes of 64

pulmonary embolism (PE) 310, 311

pulmonary oedema 299

pulmonary vascular disease 228

Q

quinidine 210, 232

R

rabies 259, 260

radial aplasia 125–6

ranitidine 78

recurrent miscarriage (RM)

aetiology 590

anatomical factors 590

clinical approach 591

complications/side-effects/sequelae 592

counselling and adjuvant therapy 591

definition 590

epidemiology 590

immunological factors 590

infectious causes 590

investigations 591

management 591–92

medical management 591–92

pathology 590

prognosis 592

risk factors, recently identified 590–1

surgical management 592

red blood cell isoimmunization

definition 166

epidemiology 166

fetal blood transfusions 167

prognosis 167

red cell isoimmunized pregnancies 166–7

Rh-negative women 166

renal disease

acute pyelonephritis 290

acute renal failure (ARF) 290–1

asymptomatic bacteriuria 290

chronic renal disease 291–3

dialysis 293

effect of pregnancy on 292

fetal 113

haemolytic uraemic syndrome 291

management 292–3

pregnancy, effect on 292

renal transplant recipient 293–4

thrombotic thrombocytopenic purpura (TTP) 291

urinary tract infection 290

reproduction

ambiguous genitalia 464–7

chronic pelvic pain 476–7

contraception 478–9, 498–9

disorders of sex development (DSDs) 482–3

donor insemination 484–6

dysmenorrhoea 489–90

ectopic pregnancy 490–2

embryo freezing 494–5

endometriosis 500–501

female infertility 502–7

female pelvis, anatomy of 468–74

fertility, in survivors of childhood malignancy 508–11

genital tract, malformation of 532–3

imaging, in reproductive medicine 512–13

in vitro fertilization 524–7

in vitro oocyte maturation (IVM) 528–31

induction of ovulation 514–15

intracytoplasmic sperm injection (ICSI) 518–19

intrauterine devices 520–3

male subfertility 536–40

menopause, and hormone replacement therapy 543–9

menorrhagia 550–3

menstrual bleeding, heavy 486–7

menstrual cycle: physiology 554–5

miscarriage, early 556–8

oligomenorrhoea and amenorrhoea 562–4

oocyte donation 560–1

ovarian hyperstimulation syndrome 566–8

paediatric and adolescent problems 570–3

polycystic ovary syndrome (PCOS) 574–6

preimplantation genetic diagnosis 578–9

premenstrual syndrome (PMS) 582–3

psychosexual problems 584–7

recurrent miscarriage (RM) 590–2

termination of pregnancy (TOP) 594–7

reproductive tract, anatomy of female

anal canal 473–4

clitoris 471

external genitalia 470–1

fallopian tubes 472

hymen 471

internal genitalia 471–4

labia majora 470

labia minora 471

mons pubis 470

ovaries 472–3

perineum 470

urethra 471, 473

urinary bladder 473

urogenital triangle 470

uterus 471–2

vagina 471

vestibule 471

vulva 470

respiratory disease

asthma 296–8

cystic fibrosis 300

pneumonia 298

pulmonary oedema 299

restrictive lung disease 300

sarcoidosis 299

tuberculosis 298–9

respiratory tract system, in pregnancy 56

restrictive lung disease 300

resuscitation

maternal 395–6, 522–3

newborn 400, 414–17

retained placenta

aetiology 418

definition 418

diagnosis 418

epidemiology 418

general management 418

medical management 418

pathology 418

prognosis 418

surgical management 419

reversible posterior leucoencephalopathy 215

rheumatoid arthritis, and pregnancy 192

rights 20, 485

ritonavir 247

Rokitansky syndrome 482–3, 532–3

rubella (German measles) 34, 60, 70, 259

aetiology 302

congenital rubella syndrome (CRS) 302

definition 302

diagnosis 302

epidemiology 302

measles mumps and rubella (MMR) vaccine 302–3

pathology 302

prognosis 302

treatment 302–3

vaccination 302–3

rubeola (measles)

aetiology 278

clinical features 278

definition 278

diagnosis 278

differential diagnosis 278

epidemiology 278

management 278–79

post-exposure prophylaxis 279

pre-exposure prophylaxis 279

prevention 279

public health initiatives 279

Rüsch urological hydrostatic balloon 431

S

Saethre Chotzen 112

salpingectomy 491

salpingography 504, 513

salpingotomy 491

sarcoidosis 299

scleroderma, and pregnancy 193

sclerosing cholangitis 276

Sengstaken-Blakemore tube/oesophageal catheter 431

serum biochemistry, abnormal first trimester 111

sexual intercourse, in pregnancy 33

Sexual Offences Act 2003 23, 24

sexually transmitted infections (STIs) 4

confidentiality 24

disclosure 24–5

genitourinary medicine (GUM) services 24–5

gonorrhoea 218–19

infertility, female 502

medical colleagues with 25

pregnant women, with HIV 25

syphilis 35, 71, 306–7

see also human immunodeficiency virus (HIV)

shoulder dystocia

complications 420

definition 420

epidemiology 420

fetal asphyxia, prevention of 421

first-line manoeuvres 421

HELPERR algorithm 422t

management 421–22

pathophysiology 420

prediction and prevention 420–1

second-line manoeuvres 421–2

third-line manoeuvres 422

training 422

shoulder presentation

clinical approach 424–5

definition 424

epidemiology 424

management 425

natural history 424

predisposing factors 424

sickle cell disease 69

see also haemoglobinopathies

Sim’s speculum examination 9

Simpson Golabi Behmel Syndrome 111

sinus venous thrombosis 215–16

skeletal abnormalities/dysplasias, fetal

achondrogenesis types I and II 132

achondroplasia 133

aetiology 132

campomelic dysplasia 133

chondrodysplasia punctata (CPD) 133

clinical approach 134

counselling 134–5

definition 132

Ellis-van Creveld syndrome 133

epidemiology 132

examination 134

investigations 134

Jeunes asphyxiating thoracic dystrophy 133

lethal skeletal dysplasias 132–3

management 135

molecular analysis 134

non-lethal skeletal dysplasias 133

osteogenesis imperfecta 132, 133

pathology 132

perinatal/infantile hypophosphatasia 133

prognosis/recurrence risks 133–4

short rib polydactyly 132–3

spondyloepiphyseal dysplasia congenita (SEDC) 133

thanatophoric dysplasia 132

ultrasound findings 132

skeletal problems 112

skull shape, abnormal 112

smoking, in pregnancy 4, 33, 61, 615

sodium valproate 209

sotalol 232

Soto’s syndrome 112

spina bifida 98–9

spondyloepiphyseal dysplasia congenita (SEDC) 133

substance abuse, in pregnancy

aetiology 304

clinical approach 304–5

definition 304

epidemiology 304

fetal alcohol syndrome 61, 304

injecting drug use 304

prognosis 304

sulphasalazine 209

Swyer’s syndrome 482

symphyseal fundal height (SFH)

background 172

clinical management 173

customized measurements 173

definition 172

ethnic populations, variations in 173

future assessment of 173–4

measurement of 172–3

obese women, measurement in 173

pathology 172

symptoms, of pregnancy

aches and pains 53

backache 53

Braxton-Hicks contractions 54–5

breathlessness 54

carpal tunnel syndrome 53

constipation and haemorrhoids 52

heartburn 52

insomnia 54

nausea/vomiting 52

palpitations 54

pica, and ptyalism 52

skin changes 54

tiredness 55

urinary problems 52–3

vaginal discharge 55

varicosities 53–4

syphilis 35, 71

complications 307

definition 306

epidemiology 306

management 307

risk factors 306

screening and diagnosis 306–7

stages of 306

systemic lupus erythematosus (SLE) 192–3

T

tachycardia 226–7

termination of pregnancy (TOP)

abdominal wall defects, fetal 119–20

anti-D prophylaxis 596–7

cervical trauma 596

complications 596

consent 595

contraceptive advice following 595

counselling 594, 595

early medical 595–6

failure to abort 596

gastrointestinal abnormalities, fetal 122

haemorrhage 596

incidence of 594

induced abortion, as healthcare need 594

infection 596

investigations 595

late medical 596

long-term sequelae 596

management 595

medical procedure 595

medicolegal issues 23, 27

patient confidentiality 597

referral procedure 594–5

retained products 596

statutory grounds for 594

surgical procedure 595

uterine perforation 596

tetanus 260

tetracycline 209

thalassaemias 69

see also haemoglobinopathies

thanatophoric dysplasia 132

theophyline 297

thorax abnormalities, fetal

congenital cystic adenomatous malformation (CCAM) 136

congenital diaphragmatic hernia (CDH) 136–7

fetal pleural effusion 137–8

thromboembolic disease

definition 310

diagnosis 310

epidemiology 310

examination 310

laboratory investigations 311–12

pathophysiology 310

thrombophilia 190–1

thrombotic thrombocytopenic purpura (TTP) 291

thyroid and parathyroid disease 76

drugs 211

hyperparathyroidism 314

hyperthyroidism 312–13

hypoparathyroidism 314

hypothyroidism 312

postpartum thyroiditis 313

thyroid cancer 314

thyroid function tests, normal pregnancy ranges 312t

thyroid nodules 314

tocolysis 351

toxoplasmosis, in pregnancy 35, 60, 316

transcervical balloon catheter 387

transcutaneous electrical nerve stimulation (TENS) 364

tricyclic antidepressants 212

trimethoprim 209

triploidy 69 106

tuberculosis 298–9

tumours, in gynaecology

cancer screening 640–2

cervical cancer 644–6

cervical dysplasia and human papillomavirus 648–50

fallopian tube cancer 668

gestational trophoblastic neoplasia 658–61

gynaecological cancers 640–1

non-gynaecological cancers 640–1

ovarian cancer 664–8

palliative care 670–5

screening programme, characteristics of successful 640

vulval cancer 676–80

vulval intraepithelial neoplasia (VIN) 682–4

Turner’s mosaic 106

Turner’s syndrome 106, 482

twin reversed arterial perfusion syndrome 149

twin-twin transfusion syndrome (TTTS) 149, 153, 158

twins see multiple pregnancy typhoid 260

U

ulcerative colitis see inflammatory bowel disease

ultrasound 512

see also Doppler ultrasound

umbilical artery 90–1

umbilical cord abnormalities

abnormal length 162

coiling 162

marginal insertion 162

two-vessel cord 162

umbilical cord masses 162

velamentous cord insertion 162

urinary and renal system, changes in pregnancy

anatomic changes 56

physiological changes 57

urinary frequency and urgency

aetiology 618

alternative therapy 619

antimuscarinic therapy 619

behavioural management 619

definition 618

epidemiology 618

examination 618

history 618

investigations 618–19

lifestyle changes 619

management 618

surgery 619

treatment 619

urinary incontinence, female

antimuscarinic drugs 616

behavioural interventions 616

bladder re-education 616

catheterization 616

conservative 616

definition of 614

duloxetine 616

examination 615

history 615

investigation 615

lifestyle changes 616

non-urethral conditions 614

pelvic floor muscle restraining 616

prevalence of 614

risk factors 614–15

scheduled toileting 616

treatment 616

types of 614

urethral conditions 614

urinary retention

aetiology 620

definitions/classification 620

detrusor myopathy 620

endocrine causes 620

foreign bodies and calculi 620

inflammatory causes 620

investigations 621

micturition, governing factors for 620

obstructive causes 620

overdistension 620

pharmacological causes 620

presentation 621

psychogenic causes 620

treatment 621

urethral sphincter hypertrophy 620

with overflow 614

urinary system abnormalities, fetal

aetiology 141

definition 140

diagnosis 142

epidemiology 140

management 142

pathology 140

prognosis 141–2

ultrasound findings 140–1

urinary tract infections 614

screening for 39–40

urinary tract injury 622–4

aetiology 622

bladder injury 623

definition 622

diagnosis 622

epidemiology 622

postoperative care 624

prevention 622

prognosis 624

ureteric injury 622–3

urethral injury 622, 623

urodynamic investigation 630

urodynamic stress incontinence (USI) 614

urogynaecology see benign and urogynaecology

ursodeoxycholic acid (UDCA) 333

uterine cancer screening 641

uterine compression sutures

aetiology 452

B-Lynch suture 453

Caesarean delivery 453

clinical approach 452–4

efficacy, testing for 453

epidemiology 452

pathology 452

postoperative management 454

postpartum haemorrhage 452

prognosis 452

square suture 453

suture material 453

transverse suture 454

U-suture 454

vaginal delivery 453

vertical suture 453

uterine inversion

aetiology 426

clinical presentation 426

definition 426

epidemiology 426

management 426–7

prevention 427

uterovaginal prolapse

aetiology 626

classification 626–37

definition 626

diagnosis 627

endopelvic fascia support 626, 626f

epidemiology 626

management 627–8

pelvic diaphragm, anatomy of 626, 626f

prevention 628

prognosis 627

V

vaginal breech delivery 369

vaginal cancer screening 641

vaginal discharge

evaluation of patient with 632

investigations 632

non sexually transmitted 632

non-infective 632

sexually transmitted 632

treatments 632

typical features 632

vaginal nitric oxide donors 386

valvular diseases

aortic valve 225

mitral valve 224–5

prosthetic valves 225

pulmonary valve 225

tricuspid valve 225

vancomycin 209

varicella zoster see chicken pox

vasodilators 232

venous congestion, fetal head and neck 146

ventouse delivery

clinical approach 457

contraindications for 457

cup application, examination prior to 458

definition 456

epidemiology 456

failed 459

fetal injuries 456

indications for 456–7

low-risk procedure 456

maternal injuries 456

moderate-risk procedure 456

prerequisites for 458

prognosis 457

successful delivery, procedure after 459

traction, for cephalic presentation 458–9

training in 459

trial of 459

vacuum pressure, building up 458

ventouse cup, choice of 458

ventouse devices 456, 457

ventriculomegaly 99–100

verapamil 232

vesicovaginal fistulae

aetiology 634

definition 634

investigations 634

malignancy 634

management 634

miscellaneous 634

obstetric 634

presentation 634

prevalence 634

radiation 634

surgical management 634–5

vitamin K 333

voiding difficulty see urinary retention

von Willebrand’s disease (vWD) 190

vulval cancer

aetiology 676

clinical approach 677–9

diagnosis 677

incidence of 676

management 678–9

pathology 676

prognostic factors 676–7

screening 641

staging 676, 677t

treatment complications/side effects 679–80

vulval intraepithelial neoplasia (VIN)

‘squamous cell carcinoma in situ’ concept 682

clinical evaluation 683–4

definition 682

differential diagnosis 683

epidemiology and pathogenesis 682–3

management 684

treatment options 684

VIN-d (differentiated type) 682–3

VIN-u (usual type) 682, 683

vulval pain and pruritis

history and examination 636

special investigations 636

treatment 636–7

vulval itching 637

vulvovaginal candidiasis

clinical features 318

definition 318

diagnosis 318

epidemiology 318

risk factors 318

treatment 318

vulvovaginitis 570

W

warfarin 211, 233

Wernicke’s encephalopathy 77

Williams vaginoplasty 532–3

Wilson’s disease 277

Wolff Hirchorn syndrome 106

Y

yellow fever 259