Index

Note: Page numbers in italics denote figures; those followed by a ‘t’ denote tables; those followed by a b denote boxes.

Abdomen

examination findings

during labor, 94

with premature rupture of membranes, 171

with uterine leiomyomata, 424

palpation of, in postpartum infection evaluation, 131

Abdominal distension in ectopic pregnancy, 180

Abdominal hysterectomy, 317

Abdominal pain

in ectopic pregnancy, 180

in spontaneous abortion, 186

Abdominal pregnancy, 185

Abdominal tenderness in ectopic pregnancy, 181

Abdominal wall

physiologic changes in, during pregnancy, 54

postpartum changes in, 131

Abdominopelvic examination for uterine leiomyomata, 424

Ablation therapy

for cervical intraepithelial neoplasia, 416–417

endometrial, 315

for abnormal uterine bleeding, 315

for endometriosis, 294

for vaginal intraepithelial neoplasia, 407

Abnormal labor, 105–110, 110

arrest disorders in, 107, 108t, 109

augmentation of, 108–109

breech presentation in, 111–112, 111, 112

vaginal deliveries and, 112

causes of, 105–107

cephalopelvic disproportion in, 107

description of, 105

evaluation of, 105–107, 107

“passage” in evaluation of, 106–107

“passenger” in evaluation of, 106, 107

patterns of, 107–110, 108t

“power” in evaluation of, 105–106

presentations in, 106, 107

protraction disorders in, 107, 108t, 109

risks of, 107

terminology for, 105

uterine atony risk with, 137, 137b

uterine rupture risk in, 142

ABO hemolytic disease, 222

Abortion

complete, 186, 188

criminal vs.

defined, 185

ectopic pregnancy related to, 180

elective, 187

incomplete, 186, 187

induced, 187–188

complications of, 187–188

inevitable, 186, 187

medical, 187, 316

missed, 186, 187

mortality rate for, 188

postabortal syndrome with, 188

recurrent, 186–187

septic, 188

spontaneous, 185–187

causes of, 185

chromosomal abnormalities associated with, 185

classification of, 186

differential diagnosis of, 186

ectopic pregnancy vs., 181

endocrine factors in, 185

environmental factors in, 185

immunologic factors in, 185

incidence of, 185

infectious factors in, 185

treatment of, 187

uterine factors in, 185

surgical, 187

threatened, 186, 188

tubal, 179

Abruptio placentae, 166–167

alpha-fetoprotein level, elevated, as risk for, 166

characteristics of, 166, 165t

complications of, 166–167

concealed hemorrhage in, 166

couvelaire uterus, 166

defined, 166

diagnosis of, 166

fetal signs and symptoms of, 165t, 166

management of, 166

maternal diabetes as cause of, 191

postpartum hemorrhage due to, 142

with pregnancy-related hypertension, 208

risk factors for, 166

types of, 166, 167

ultrasound detection of, 69

vaginal bleeding with, 166

Abscess(es)

breast, postpartum, 132

in gonorrhea, 269

in lymphogranuloma venereum, 275

in pelvic inflammatory disease, 267, 269–270, 271b

in salpingitis, 270b

Abuse

child, 333–334

partner (see Domestic violence)

physical, 334, 334t

psychological, 334

sexual (see Sexual abuse)

substance (see Alcohol use; Substance abuse; Tobacco use)

Acanthosis, coexistence of, with lichen sclerosus of the vulva, 401

Acanthosis nigricans, polycystic ovary syndrome and, 359

Acanthotic histologic pattern, 399, 400t, 402

Accelerated starvation during pregnancy, 54

Accelerations of fetal heart rate, 115t, 116

scalp stimulation and, 116, 118

ACE inhibitors (see Angiotensin-converting enzyme [ACE] inhibitors)

Acetaminophen, teratogenesis associated with, 76t

Acetic acid solution for VIN, usual type, lesions, 404

Achondroplasia, 84, 86

Acid-base balance

hematologic influence on, during pregnancy, 51

newborn, assessment of, 125, 125t

respiratory influence on, during pregnancy, 49

Acidemia, 125

Acne

in adrenal neoplasms, 361

in congenital adrenal hyperplasia, 360, 361b

as danazol adverse effect, 362

in hirsutism, 355, 356, 357

in polycystic ovary syndrome, 357, 359

in Sertoli–Leydig cell tumor, 360

ACOG (see American College of Obstetricians and Gynecologists [ACOG])

Acquaintance rape, 329–330

Acquired immune deficiency syndrome (AIDS)

in pregnancy, 227–228

incidence and prevalence of, 274

screening test for, 275

Actinomycin D

as antineoplastic drug, 388, 388t, 390t

for choriocarcinoma, 396–397

Active phase of labor, 96, 97t

arrest disorder in, 107, 108t

prolonged, 107

protraction disorder in, 107, 108t

Acyclovir

for herpes simplex infection, 225, 272

for sexual assault, 332t

for varicella infection, 230–231

Additive interactions in chemotherapy, 389

Adenoacanthoma of endometrium, 430

Adenocarcinoma

of cervix, 412, 418, 420

of endometrium, 427, 430–431, 431, 433, 434

of fallopian tubes, 444

of vagina, 407, 408

Adenocarcinoma in situ (AIS), Pap smear identification of, 411, 412

Adenomyosis as dysmenorrhea cause, 296, 297

Adenosis

in fibrocystic changes of the breast, 306t, 307

sclerosing, 306t, 307

Adenosquamous carcinoma

of cervix, 418

of endometrium, 430

of fallopian tubes, 444

Adjuvant chemotherapy, 389

Adnexa

bimanual examination of, 14, 15

mass tenderness of, with ectopic pregnancy, 181

uterine leiomyomata involvement of, 424, 425

Adnexal masses in pregnancy, 203

Adnexal space, 435

Adrenal androgen production, 355–366, 356t

Adrenal function during pregnancy, 54

Adrenal neoplasms, 361

Adrenal steroidogenesis, 356, 357

Adrenal tumors as precocious puberty cause, 345, 345b

Adrenarche, 343

Adrenocorticotropic hormone (ACTH), adrenal androgen regulation by, 356, 358

Adult respiratory distress syndrome, pyelonephritis associated with, 201

AFP (see Alpha-fetoprotein [AFP])

Age

as breast cancer risk factor, 307

maternal

advanced, as genetic disorder risk factor, 86, 86

intrauterine growth restriction associated with, 153

paternal, advanced, as genetic disorder risk factor, 86

pelvic relaxation related to, 277

Aid for Families with Dependent Children food program, 73

AIS (adenocarcinoma in situ), Pap smear identification of, 411, 412

Alanine transaminase (ALT) during pregnancy, 51t, 53

Albumin, serum, during pregnancy, 51t, 53

Albuterol for asthma, 213

Alcohol use

as antepartum risk factor, 63

breast cancer risk and, 308

intrauterine growth restriction associated with, 152

preconception abstinence from, 61, 62

spontaneous abortion related to, 185

as teratogen, 76, 77

Aldosterone levels during pregnancy, 52

Alendronate for osteoporosis, 367, 367t

Alkaline phosphatase, elevated, during pregnancy, 51t, 53

Alkylating agents

in chemotherapy, 388, 388t

application of, 390t

side effects of, 390t

teratogenesis associated with, 76t

Alkylating-like agents in chemotherapy, 388, 388t

application of, 390t

side effects of, 390t

Allergic contact dermatitis related to vulvar dermatitis, 400t, 402

clinical characteristics of, 402t

Alpha-fetoprotein (AFP)

elevated, as abruptio placenta risk, 166

endodermal sinus tumor production of, 444

germ cell tumor production of, 443

maternal, in genetic screening, 88t, 89

Alpha-thalassemia, 216–218, 217t

Aluminum acetate solution (5%) for vulvar dermatitis, 402

Ambulation

during labor, 97–99

postpartum, benefits of, 131

Amenorrhea, 349–352

causes of, 349–351, 350b, 351, 351b

defined, 349

with ectopic pregnancy, 180

genital outflow tract obstruction and, 350, 351

hypothalamic, 347

hypothalamic-pituitary, 350, 350b

incidence of, 349

infertility related to, 374

lactational, 134, 251

with missed abortion, 186

müllerian agenesis as cause of, 347

with oral contraceptive use, 240

ovarian dysfunction and, 350, 351b

in patients who desire pregnancy, 352

postpill, 241

pregnancy-related, 349–350

primary, 349

secondary, 349

treatment of, 351–352

American College of Obstetricians and Gynecologists (ACOG)

antepartum record and postpartum form, 473–486

Woman’s Health Record, 3, 447–460

American Diabetes Association, diabetes mellitus classifications, 189

American Foundation of Urological Disease, sexual dysfunctions defined by, 324–325

American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines for cell abnormalities, 20, 414, 414, 415, 416, 417

American Society for Reproductive Medicine revised classification of endometriosis, 291, 292–293

Amino acids (see also Protein[s])

construction of, 80

excretion of, during pregnancy, 52

placental metabolism of, 55

Amitriptyline for vulvodynia, localized, 403

Amniocentesis

for DNA analysis, 90

for fetal lung maturity assessment, 193

for intrauterine growth restriction, 154

for isoimmunization management, 177

for premature rupture of membranes, 171, 172

for preterm labor evaluation, 159–160

Amnioinfusion, 117

Amniotic fluid

assessment of, for isoimmunization management, 177

decreased or absent, effect of, 169

pH of, 170

production of, 169

protection provided by, 170

urine and vaginal secretions distinguished from, 170, 171

volume of

adequate, importance of, 70, 176

in intrauterine growth restriction, 154, 155

in polyhydramnios, 156

Amniotic fluid embolism, postpartum hemorrhage due to, 142

Amniotic fluid index, fetal well-being assessment and, 71, 176

Amniotic membranes, “stripping of,” for labor induction, 103

Amniotomy for prolonged latent labor, 108 (see also Rupture of membranes, artificial, risks of)

Amoxicillin for chlamydial infection, 229

Amphetamine as breastfeeding contraindication, 133

Ampicillin

for asymptomatic bacteriuria, 201

for pyelonephritis, 201

Amylase, serum, during pregnancy, 51t, 53

Anabolic steroids, teratogenesis associated with, 76t

Analgesia

for herpes simplex virus infection, 272

immediate postpartum indications for, 131

Anaphase as mitosis stage, 80, 81

Anastrozole as aromatase inhibitors, 359, 389

Anatomy of reproductive system, 37–45, 42

anomalies of, 44–45

bony pelvis, 37, 39, 40

fallopian tubes, 43, 44

ovaries, 44

perineum, 40, 40

uterus, 41, 43

vagina, 41, 44

vulva, 40, 40, 43

Androblastoma, 360

Androgen(s)

external genitalia development and, 37

exogenous, teratogenesis associated with, 76t

production and action of, 355–357, 356t, 357

adrenal, 356, 356t

extraglandular, 356, 356t

ovarian, 356, 356t

sexual response and, 323, 325b

Androgen excess disorders

adrenal, conditions caused by, 360–361, 361b

congenital adrenal hyperplasia, 360–361, 361b

Cushing syndrome, 361

neoplasms, 361

HAir-An syndrome, 359

hirsutism and virilization in, 355, 358

ovarian, conditions caused by, 360

hyperthecosis, 359–360

polycystic ovary syndrome, 355, 357–360, 359

Sertoli–Leydig cell tumors, 360

uncommon tumors, 360

Android pelvis, 40, 40

Androstenedione

in congenital adrenal hyperplasia, 360, 361

in hirsutism and virilization evaluation, 355, 356, 356t

in hyperthecosis, 359

in polycystic ovary syndrome, 357, 358

postmenopausal ranges for, 364t

postoophorectomy ranges for, 364t

premenopausal ranges for, 364t

in Sertoli–Leydig cell tumor, 360

Anemia(s)

physiologic, during pregnancy, 50

in pregnancy, 215–218

criteria for, 215

fetal consequences of, 215

folate deficiency, 216

hemoglobinopathies, 216–218, 217t

hereditary hemolytic, 216

iron-deficiency, 215–216, 216

maternal consequences of, 215

sickle cell, 216, 217–218, 217t

thalassemias, 216–218, 217t

Anesthetics in labor management, 99, 100

Aneuploidy

altered chromosome number in, 81

genetic screening for, 87, 88t, 89

Angiotensin during pregnancy, 52

Angiotensin-converting enzyme (ACE) inhibitors

avoidance of, in pregnancy, 209

teratogenesis associated with, 76t

Angiotensinogen during pregnancy, 52

Anomalies

aneuploid risk of, 88t

of breast, 301

congenital, 33, 301

maternal diabetes–related, 190, 190

developmental, 33, 350

of female reproductive system, 44–45, 44, 350

placenta previa associated with, 165

Anorectal canal, development of, 37

Antagonistic interactions in chemotherapy, 389

Anteflexion of uterus, 41, 43

Antepartum care, 62–78

common symptoms and, 77–78

fetal surveillance, 220, 221

maternal assessment, 63–68

diagnosis of pregnancy, 63–66

estimated date of delivery, 66

gestational age, 66

initial evaluation, 63, 64–65, 66

laboratory tests, 64–65

nutritional, 72–73

subsequent periodic evaluations, 66–68, 67t, 67

patient education, 71–74, 72b, 73t, 74b, 75t–76t, 76–77

purpose of, 63

risk assessment in, 63, 66

in women with hemoglobinopathies, 216–218, 217t

Antepartum record and postpartum form, ACOG, 473–486

Anteversion of uterus, 41, 43

Anthropoid pelvis, 40, 40

Antibiotics

abortion indications for, 188

for asymptomatic bacteriuria, 201

for chlamydial infection, 269

for postpartum mastitis, 132

for premature rupture of membranes, 171

to prolong latency period in premature rupture of membranes, 172

for urinary tract infections, 285

Antibodies

atypical, related to fetal hemolytic disease, 218t

in isoimmunization

anamnestic response to, 219

management of irregular, 222

prevention of, 221–222

titers in management of, 220

recurrent pregnancy loss related to, 186

Antibody screening for Rh isoimmunization, 219–220

Anticipation, genetic disorders and, 85

Anticonvulsants, intrauterine growth restriction associated with, 153

Antidepressants

postpartum indications for, 134t

sexual dysfunction associated with, 325

tricyclic, for urge incontinence, 306

Antigens

in isoimmunization

other irregular, 218t, 222

Rh, 218

paternal, significance of status of, 219

Antihypertensive therapy

for chronic hypertension, 209, 211t

for preeclampsia, 210

Anti–immunoglobulin D, postpartum indications for, 132

Antimetabolites in chemotherapy, 388, 388t

applications for, 390t

side effects of, 390t

Antimicrobial therapy for gonorrhea, 269

Antineoplastic drugs, actions of, within cell cycle, 388, 388 (see also Chemotherapy)

Antioxidant release in pregnancy-related hypertension, 207

Antiphospholipid antibodies, recurrent pregnancy loss related to, 186

Antipruritic therapy

for lichen simplex chronicus, 401

for vulvar dermatitis, 402

Antiretroviral therapy, 228

Antitumor antibiotics in chemotherapy, 388, 388t

applications for, 390t

side effects of, 390t

Antiviral therapy for herpes simplex infection, 272

Anus, imperforate, 124

Anxiety disorder, 135, 134t, 234–235

Aorta in fetal circulation, 56, 56–57

Apert syndrome, 86

Apgar score

components of, 123t

in fetal macrosomia, 155

resuscitation indications based on, 123

timing of evaluation of, 121, 123

Appendicitis

adnexal space and, 435

in pregnancy, 202–203

Apt test, 167

Areola, 9

physical examination of, 9, 11

physiologic changes in, during pregnancy, 55

Arias-Stella reaction in pregnancy diagnosis, 182

Aromatase inhibitors

for breast cancer, 309

in chemotherapy, 389

Arrest disorders in labor, 107, 108t, 108

Arrhenoblastoma, 360, 444 (see also Sertoli–Leydig cell tumors)

Arrhythmias, cardiac, maternal, 212

Arterial blood gases

during pregnancy, 50, 51t

from umbilical cord, 125, 125t

Arterial embolization for uterine leiomyomas, 426

Artery(ies)

of fallopian tubes, 43

of ovaries, 44

of uterus, 41, 43

of vagina, 41

Arzoxifene as antineoplastic drug, 389

ASC (atypical squamous cells) in Pap tests, 411, 412b, 413t, 415–416, 416, 417

ASC-H (atypical squamous cells–cannot exclude high-grade squamous intraepithelial lesions) in Pap smears, 411, 412b, 415, 417

ASC-US (atypical squamous cells of undetermined significance) in Pap smears, 411, 412b, 413t, 414, 414, 415

ASCCP (American Society for Colposcopy and Cervical Pathology) guidelines for cell abnormalities, 20, 414, 414, 415, 416, 417

Asherman syndrome, 141

amenorrhea related to, 351, 351

spontaneous abortion related to, 185, 186

Aspartate transaminase (AST) during pregnancy, 51t, 53

Asphyxia, 123

fetal, disorders associated with, 113, 125, 152

peripartum, 114

Aspiration by fetus

of amniotic fluid, 107

of meconium, 176

Aspirin, teratogenesis associated with, 76t

Assessment, periodic, 466–469

for ages 13–18 years, 466

for ages 19–39 years, 467

for ages 40–64 years, 468

for ages 65 years and older, 469

Assisted reproductive technologies (ARTs), 180, 379–380

counseling for, 380

for infertility, 378

gestational age assessment and, 66

Asthenospermia, infertility related to, 377t

Asthma in pregnancy, 212–213

management of, 213

severity classification of, 213t

Asynclitism, abnormal labor related to, 106, 107

Atopic dermatitis related to vulvar dermatitis, 402

clinical characteristics of, 402t

Atrial fibrillation/flutter in pregnancy, 212

Atrophic vaginitis, 263

Atypical glandular cells in Pap smears, 412b, 416, 417, 429

Atypical squamous cells (ASC) in Pap tests, 411, 412b, 413t, 414, 414, 415, 415, 417

Atypical squamous cells–cannot exclude high-grade squamous intraepithelial lesions (ASC-H) in

Pap smears, 411, 412b, 413t, 415, 417

Atypical squamous cells of undetermined significance (ASC-US) in Pap smears, 311, 412b, 413t, 414–415, 414

Augmentation of labor, 170

Auscultation of fetal heart tones, 63

intermittent, 114, 116t

Auspitz sign, 402

Autoimmune disorders, premature ovarian failure in, 368

Autonomy of patient, respect for, 26, 27

Autosomal dominant disorders

characteristics of, 84b

inheritance pattern in, 84–85

phenotypic expression in, 84

Autosomal recessive disorders

characteristics of, 84b

inheritance pattern in, 85

phenotypic expression in, 85

Axillary tail, physical examination of, 10, 11

Azithromycin

for chlamydial infection, 229, 269

for gonorrhoeae, 269

for sexual assault, 332t

Azoospermia, infertility related to, 377, 377t

Back pain during pregnancy, 78

Bacteremia, prolonged labor and, 107

Bacterial vaginosis (BV), 259, 260–261

causes of vaginitis, 259

diagnostic criteria for, 260t, 261

discharge characteristics in, 260, 260t, 261

infections associated with, 169, 226, 260

organisms that cause, 261

screening for, 261

sexual assault prophylaxis for, 332t

treatment of, 261

Bacteriuria

asymptomatic, 201

treatment of, 285

Bag and mask for newborn resuscitation, 125

Ballard scoring system and, 121, 122

Barium enema, double contrast, recommendations for, 21

Barrier contraceptives, 244–247

benefits of, 244–245

cervical cap, 246, 246

condoms, 245, 245

diaphragm, 245–246, 246

folklore-based, 251

pregnancy rates within first year, 244t

spermicides, 246–247

sponge, 246

Bartholin glands

anatomy of, 40, 40

carcinoma of, 407

infection of, in gonorrhea, 265

inspection and examination of, 12, 12

in sexual response, 323

Basal body temperature

as contraceptive method, 250

in infertility evaluation, 372–373, 373

reproductive cycle and, 342

Beckwith-Wiedemann syndrome, 155

Bell’s palsy during pregnancy, 234

Beneficence, ethics of, 26–27

Benign cystic teratoma of ovary, 438, 439

Benzathine penicillin G for syphilis, 274

Benzodiazepines, teratogenesis associated with, 76t

Beta blockers, teratogenesis associated with, 76t

11β-hydroxylase deficiency in congenital adrenal hyperplasia, 361

Betamethasone to enhance fetal lung maturity, 161

Betamethasone valerate

for lichen simplex chronicus, 401

for vulvar dermatitis, 402

for vulvar psoriasis, 402

β-thalassemia, 216, 217t

Bethesda 2001 classification of Pap smears, 411–412, 412b, 413t, 416

Bevacizumab as chemotherapeutic agent, 391

Bicarbonate levels during pregnancy, 49, 50

Bilirubin

during pregnancy, 53

release of, in isoimmunization, 218, 219

toxicity of, 124

Bimanual examination

of adnexa, 15, 14

hand placement for, 14–15

rectovaginal, 15, 15

of uterus, 14–15, 14

technique variations for, 15

Biometry measurements, fetal, in intrauterine growth restriction diagnosis, 154

Biophysical profile for fetal well-being assessment, 70–71, 71t, 177, 209

Biopsy

of breasts for cancer, 304

of cervix, 314

colposcopic, 413, 415, 418

core-needle, 304

endometrial, 314, 317, 429

fine-needle aspiration, 304

genital tract, 314, 314

luteal phase endometrial, for infertility, 373

of vagina, 314

of vulva, 314, 314, 408

Bipolar disorders, during pregnancy, 235

BI-RADS (Breast Imaging Reporting and Data System) classification of screening mammograms, 303, 304t

Birth asphyxia, 113

Apgar score and, 121

fetal heart rate in, 113, 123

Birth canal, inspection of, 102

Birth control (see Contraception)

Birth trauma with postterm pregnancy, 176

Black cohosh

antepartum use of, 74

for menopausal symptoms, 369

Bleeding, 164

implantation, 139

intermenstrual, 5

irregular, 5

menstrual (see Menstruation)

postcoital, 5

postmenopausal, with endometrial carcinoma, 431, 434

uterine (see Uterine bleeding)

vaginal (see Vaginal bleeding)

Bleomycin, 388

as antineoplastic drug, 388t, 390t

for ovarian carcinoma, 443

Blood gases

arterial (see Arterial blood gases)

from umbilical cord, 125, 125t

Blood glucose

fasting

diabetes mellitus and, 189

screening recommendations for, 23

during labor and delivery, 190

during pregnancy, 52

Blood group systems in isoimmunization, 218

Blood loss in postpartum hemorrhage, 137

Blood pressure

antepartum evaluation of, 66

decreased (see Hypotension)

elevated (see Hypertension)

measurement of, factors that influence, 209

during pregnancy, 48

Blood replacement therapy

components of, 139, 139t

for postpartum hemorrhage, 138–139, 138b, 139b

Blood supply (see Artery[ies]; Vein[s])

Blood transfusion, signed consent for, 318

Blood urea nitrogen during pregnancy, 51t, 52

Blue cohosh, antepartum use of, 74

B-Lynch suture for uterine atony, 140, 140

Body mass index, 23, 23b

pregnancy weight gain and, 133, 155

Bohr effect, maternal-fetal circulation and, 50

Bone demineralization with aging, 366 (see also Osteoporosis)

Bone density

during pregnancy, 54

screening recommendations for, 22b, 366b, 470t

Bony pelvis

abnormal labor related to, 107

anatomy of, 37, 39, 40

Boric acid capsules, intravaginal, for vulvovaginal candidiasis, 262

Bowel movement, postpartum, 132

Brachial plexus injury

avoiding, during delivery, 102, 102

in macrosomic infants, 176

with postterm pregnancy, 175, 176

shoulder dystocia and, 112

Brachytherapy, 390–391

for cervical cancer, 420

Bradycardia, fetal, 114

Braxton Hicks contractions, 93, 94

BRCA genes, cancers associated with, 92

BRCA1 gene

breast cancer associated with, 307–308

ovarian carcinoma associated with, 440, 442

BRCA2 gene

breast cancer associated with, 307–308

ovarian carcinoma associated with, 442

Breakthrough bleeding with oral contraceptives, 239, 240, 243

Breast(s)

abscess, postpartum, 132

blood supply of, 301

clinical anatomy of, 7, 9

congenital anomalies of, 301

discharges from, 9, 306

disorders of

benign, 305–307, 306t

diagnosis algorithm for, 305, 305

diagnostic testing for, 303–304, 303, 304, 304t

evaluation of, 302–305, 303, 304, 304t

malignant, 307–310 (see also Breast cancer)

patient interview and, 303

physical examination and, 303

presenting complaints related to, 302

duct system of, 301

engorgement, postpartum, 131, 131t

examination of, 7, 9, 11 (see also Breast examination)

glandular tissue distribution in, 301

hormonal changes effects on, 301

infection of, postpartum, 131, 131t

inframammary ridge of, 11

lobular anatomy of, 301, 302

lymphatic system of, 301, 302

physiologic changes in, during pregnancy, 129

postpartum care of, 131–132

reconstruction of, 309

reproductive cycle manifestations in, 342

Breast budding, during puberty, 343, 344

Breast cancer, 307–310

age-related probability of developing, 307

breast changes and, 308

chemotherapy for, 389, 391

common site for, 301

demographics of, 310

early detection of, 7, 9, 10, 11

follow-up care for, 302–303

genetics of, 307–308

histologic types of, 381, 308t

incidence of, 307

menstrual history and, 308

mortality rates for, 307

radiation exposure and, 308

radiation therapy for, 391

receptor status of, 309

reproductive history and, 308

risk assessment tool for, 308

risk factors for, 303b, 307–308

screening guidelines for, 20, 92, 310

staging, 308–309, 309t

treatment of, 309–310

Breast conservation therapy, 309, 309t

Breast examination, 7–11

anatomy-based descriptions for, 7, 9

expressing fluid in, 10, 11

inspection and, 7, 9, 10

palpation and, 10, 11

by patient, 20

screening recommendations for, 20, 306

self-awareness, 11

timing of, 303

Breastfeeding

benefits of, 73, 133

contraindications to, 73, 133

hormonal contraceptives and, 240

hyperbilirubinemia and, 124

immediate, of newborns, 123

lochia resolution and, 129–130

medication risk factor categories for, 75t

medications in, 133–134

ovulation suppression during, 130

perinatal HIV transmission and, 228

prolactin release, 133–134

uterine contractions associated with, 129

Breast imaging, 313, 313

Breast Imaging Reporting and Data System (BIRADS) classification of screening mammograms, 303–304, 304t

Breast mass

characteristics of, that suggest malignancy, 306

growth rate of, 306

nonproliferative, 307, 306t

proliferative with atypia, 307, 306t

proliferative without atypia, 307, 306t

Breast milk production, 133

Breast/ovarian familial cancer syndrome, 442

Breast reconstruction, 309

Breast self-examination, 11, 20

screening recommendations for, 310

Breech extraction, second maneuver, 149

Breech presentation

antepartum evaluation of, 68

conditions associated with, 111

external cephalic version for, 68, 111–112, 111

incidence of, 111

morbidity and mortality rates for, 111

of multifetal gestation, 149, 149

types of, 111, 111

vaginal deliveries

criteria for, 112

risks associated with, 112

Brenner cell tumor

benign, 438

malignant, 443

Broad ligament of uterus

anatomy of, 41, 42

embryology of, 36

ovary attachment to, 44

Bromocriptine (Parlodel)

for amenorrhea, 351

as breastfeeding contraindication, 133

for mastalgia, 306

Brow presentation in abnormal labor, 106

Budesonide for asthma, 213

Bulking agents for stress incontinence, 283, 284

Bupropion, sexual response and, 325

Burch procedure for stress incontinence, 284

Buspirone, sexual response and, 325

Butoconazole for vulvovaginal candidiasis, 262

BV (see Bacterial vaginosis [BV])

CA-125 assay

in benign conditions, 441

in endometrial carcinoma, 431–432

in endometriosis, 291

in ovarian carcinoma, 436, 441

Cabergoline (Dostinex) for amenorrhea, 351

CAH (see Congenital adrenal hyperplasia [CAH])

Calcitonin, 54

Calcium, serum, mobilization during pregnancy, 54

Calcium citrate for vulvodynia, localized, 403

Calcium supplementation for osteoporosis, 366–367, 367t

Caldwell-Moloy pelvic types, 40, 40

Calendar method, as fertility awareness method, 250

Caloric intake during pregnancy, 53, 191

Canal of Nuck, cyst of, 403

Canavan disease, carrier testing for, 90

Cancer (see also specific type)

genetic screening for predisposition to, 91–92

screening tests for, 18

Candida vaginitis (see Candidiasis, vulvovaginal)

Candidiasis, vulvovaginal, 261–262

classification of, 262b

clinical presentations of, 261

diagnosis of, 260t, 261–262

organisms that cause, 260

population at risk for, 261

preventing recurrence of, 261

secretion characteristics in, 260t, 260

treatment of, 262

Capillary refill, delayed, in postpartum hemorrhage, 137

Caput succedaneum, 101

Carbamazepine, teratogenesis associated with, 75t

Carbohydrate metabolism during pregnancy, 54

Carbon dioxide (PaCO₂)

fetal excretion of, through placenta, 55

during pregnancy, 50, 51t

Carboplatin

as antineoplastic drug, 388, 388t, 390t

for ovarian carcinoma, 446

Carboprost for postpartum hemorrhage, 102

Carcinoma in situ

ductal, 306t, 307, 308t

lobular, 306t, 307, 308t

of vulva, 404t, 405

Carcinosarcomas of ovary, 444

Cardiac defects

congenital, as multifactorial disorders, 85

prenatal screening for, 89

Cardiac disease

in early postpartum period, 130

in pregnancy, 211–212

classification of, 211, 212t

fetal risks associated with, 211

management of, 212

Cardiac output

during labor, 47–48

cardiac disease and, 211

postpartum, 48, 130

during pregnancy

in fetus, 56

maternal, 47

in pregnancy-related hypertension, 207

Cardinal ligament, 41

Cardinal movements of labor, 96–97, 98

Cardiomegaly in pregnancy, 48

Cardiomyopathy, peripartum, 212

Cardiopulmonary arrest, maternal resuscitation in, 203

Cardiovascular disorders, screening recommendations for, 22

Cardiovascular lipid changes in menopause, 367

Cardiovascular system

physiologic changes in, during pregnancy, 47–48, 48

postpartum changes in, 130

pregnancy-related hypertension effects on, 207

Care, ethic of, 27, 27b

Carpal tunnel syndrome, during pregnancy, 234

Carrier testing for genetic disorders, 90

Case-based reasoning, 26t, 28b

Catecholestrogens, 368

Cats, toxoplasmosis associated with, 230

CD4⁺ cells in HIV/AIDS syndrome, 227

Ceftriaxone

for gonorrhea, 269, 270

for sexual assault, 332t

Cell biology, 387–391

chemotherapy and, 387–388, 388t, 390t

endocrine therapy and, 388–389

gene therapy and, 391

molecularly targeted agents and, 391

principles of, 387

radiation therapy and, 389–391

tumor vaccines and, 391

Cell culture for herpes simplex virus infection, 224

Cell cycle

antineoplastic agent actions within, 388, 388

cancer therapy and, 387

generation time in, 387

growth fraction and, 387

phases of, 387

stages of, 80

Cell division, 80–81, 81

disjunction in, 80–81

Cellular hyperplasia, early-onset intrauterine growth restriction and, 152

Cellular hypertrophy, delayed-onset intrauterine growth restriction and, 152

Cephalexin for asymptomatic bacteriuria, 201

Cephalic (vertex) presentation

antepartum evaluation of, 67

in multifetal gestation, 149

positions in, 111–112, 111

Cephalosporins

for gonorrhea, 229

for pyelonephritis, 201

Cerebral artery, blood flow in

in intrauterine growth restriction, 154

isoimmunization and, 220, 220, 221b

Cerebral palsy

fetal blood supply interruption and, 114

intrapartum hypoxic events sufficient to cause, 114, 114b

Certificate of merit, legal action component, 29

Cervical cancer, 418–421

clinical evaluation of, 418

diagnosis of, 418, 420

etiology of, 418

FIGO staging of, 418, 419b

histologic types of, 418

human papillomas virus risk for, 272

incidence and prevalence of, 409, 418

management of, 418, 420

mortality from, 411, 418

precursor lesions of, 411, 418

prevention of, 421, 421b

screening recommendations for, 20

signs and symptoms of, 418

spread patterns of, 418, 420

survival rates for, 420t

Cervical cap, 246, 246

Cervical conization, 316, 316

for cervical cancer, 418, 420

for cervical intraepithelial neoplasia, 413, 418

Cervical dilation

during labor, 93, 96, 97t

abnormal, 107, 108t, 108

complete, 100

evaluation of, 93, 94

graphic representation of, 96, 97

Cervical dysplasia

cervical cancer risk and, 272

as human papillomavirus subtype, 273

immunization against, 273

Cervical effacement during labor, 93, 94

evaluation of, 93, 94

relative position vs., 96

Cervical insufficiency, preterm labor related to, 159, 286

Cervical intraepithelial neoplasia (CIN), 409–416

classification of, 411–413, 412b, 413t

colposcopy with directed biopsy for, 413–414

conization for, 418, 420

cytology screening for, 20

early diagnosis of, 20

endocervical curettage for, 413–414, 429, 430

etiology of, 409–411, 410

human papillomavirus DNA testing for, 20, 414

management guidelines for, 414–416

in atypical glandular cells, 416, 417

in atypical squamous cells–cannot exclude high-grade squamous intraepithelial lesions, 415, 417

in atypical squamous cells of undetermined significance, 414–415, 414

in high-grade squamous intraepithelial lesions, 415, 415, 416

in low-grade squamous intraepithelial lesions, 414–415, 414

Pap test for, 18, 409, 411, 413–418, 413t

evaluation of abnormal results of, 413–414, 413

risk factors for, 411, 411b

treatment of, 416–418

follow-up to, 418

Cervical mucus evaluation as fertility awareness method, 250

Cervical pregnancy, 184

Cervical ripening, 103, 103

Cervicitis

in chlamydial infection, 267, 269

in gonorrhea, 269

Cervix

anatomy of, 35, 37, 409, 410

bimanual examination and, 15

biopsy of, 314

ectropion of, 164, 267

external os of, 409, 410

histology of, 409, 410

incompetent, recurrent abortion related to, 187

internal os of, 409, 410

length of, as preterm labor predictor, 159

physiologic change in

with ectopic pregnancy, 181

during pregnancy, 63

position of, related to uterine position, 15

postpartum physiology of, 130

ripening/readiness of

agents for, 103

in postterm pregnancy, 103

in sexual response, 323

Cesarean delivery, 103–104

blood loss associated with, 137

for breech presentations, 104

for condyloma acuminata, 272

in fetal macrosomia, 156

for genital herpes, 272

for human papillomavirus, 228

incisions for, 104

indications for, 104

maternal request for, 104

mortality rates associated with, 104

in postterm pregnancy, 176

to reduce risk of perinatal HIV transmission, 228

for third-trimester bleeding, 165, 167

trial of labor after, 104, 104b

vaginal birth after, 104, 104b

Cetirizine for menopausal symptoms, 370

CGH (comparative genomic hybridization), 91

Chadwick sign, 63

Chancre, syphilitic, 273, 273

Chancroid, 275

diagnosis of, 266t

presentation of, 266t

prevalence of, 266t

Chemotherapy

additive interactions in, 389

adjuvant, 389

for breast cancer, 309, 309t

alkylating, premature ovarian failure related to, 368

antagonistic interactions in, 389

as breastfeeding contraindication, 133

cell-cycle actions of, 387

classes of, 388, 388t

combination strategies, 389

for choriocarinoma, 396

for ovarian carcinoma, 444

consolidation, 389

for cervical cancer, 420

for choriocarinoma, 396

for endometrial carcinoma, 432

induction, 389

maintenance, 389

neoadjuvant, 389

for sarcoma botryoides, 408

synergistic interactions in, 389

toxicity of, 389, 390t

for vulvar cancer, 406

Chest radiographs during pregnancy

changes in, 48, 50

precautions for, 202

Chicken pox in pregnancy, 230

Chief complaint in history taking, 4

Child sexual assault, 333–334

assessment of, 333–334

management of, 334

perpetrator identity in, 333–334

signs of, 333, 333b

Chlamydial infection, 267–269

antepartum screening for, 229

complications of, 21, 267

diagnosis of, 267, 269, 269

ectopic pregnancy related to, 179–180

evaluation of, 268t

incidence and prevalence of, 21, 267, 268t

laboratory testing for, 267

newborn conjunctivitis caused by, 229

in pregnancy, 229

presentation of, 268t

screening recommendations for, 21, 224t

sexual assault prophylaxis for, 332t

signs and symptoms of, 267

special considerations for, 268t

spontaneous abortion related to, 185

treatment of, 269

Chlamydia trachomatis, 267, 269 (see also Chlamydial infection)

Chloasma during pregnancy, 55

Cholecystitis in pregnancy, 197

Cholelithiasis in pregnancy, 197, 202

Cholesterol, elevated

during pregnancy, 54

risk factors for, 23

Chorioamnionitis

in premature rupture of membranes, 170, 171

preterm labor associated with, 159–160

prolonged labor and, 107

Choriocarcinoma, 396

chemotherapy for, 396

incidence of, 396

prognostic categories for, 396, 396t

radiation therapy for, 396

Chorionicity in multifetal gestation, 145, 146, 148

Chorionic villi sampling (CVS)

for DNA analysis, 90

for genetic disorder testing, 87

Chromatin, 80

Chromosomal abnormalities

advanced maternal age as risk factor for, 86, 86t

advanced paternal age as risk factor for, 86

detection of, by ultrasound examination, 68

early pregnancy loss as risk factor for, 86

ethnicity as risk factor for, 86–87

intrauterine growth restriction associated with, 153

in number, 81, 83, 83t

pregnancy complications as risk factor for, 86

spontaneous abortion associated with, 185

in structure, 81–82, 84, 84t

Chromosomes, 80–84

deoxyribonucleic acid and, 79

independent assortment of, 81

replication of, 80

Chromotubation for infertility evaluation, 376

Chronic pelvic pain, 297–299

assessment of, 297–298

conditions that increase risk of, 298–299

conditions that may cause or exacerbate

gynecologic, 298b

nongynecologic, 299t

defined, 297

follow-up care for, 300

incidence and prevalence of, 297

therapy for, 300

Chronic renal failure, pregnancy risk with, 202

CIN (see Cervical intraepithelial neoplasia [CIN])

Ciprofloxacin

for urinary tract infections, 285

Circumcision, male, of newborn, 126–127

benefits, 126

definition, 126

dorsal block local anesthesia, 126, 127

instruments used, 126, 126

Cisplatin

as antineoplastic drug, 388, 388t, 390t

for endometrial carcinoma, 433

for ovarian carcinoma, 446

for vulvar cancer, 406

CKC (see Cold knife conization)

“Clean-catch midstream” urine sample, 285

Clear cell carcinoma

of endometrium, 430, 432t

of ovary, 443

Cleft lip/palate, 85

Climacteric, 363

Clindamycin for bacterial vaginosis, 261

Clitoris

anatomy of, 40, 40

embryology of, 37, 38

in sexual response, 323

Cloaca, 34, 37

Cloacal membrane, 37

Clobetasol for lichen sclerosus of the vulva, 401

Clomiphene

for amenorrhea, 351

for ovulation induction, 378

for polycystic ovary syndrome, 359

Clotrimazole for vulvovaginal candidiasis, 262

Clotting factors, elevated, during pregnancy, 50, 51t

CMV (see Cytomegalovirus [CMV] infection)

Coagulopathy

in abruptio placentae, 165t, 166

postpartum hemorrhage due to, 142

Coal tar preparations for vulvar psoriasis, 402

Cocaine as breastfeeding contraindication, 133

Coccyx in pelvic anatomy, 37, 39

Cochrane Data Base Review

of selective serotonin reuptake inhibitors for premenstrual dysphoric disorder, 385

Codons, genetic code translation into, 80

Coelomic metaplasia as endometriosis theory, 287–288

Cognitive dysfunction in rape trauma syndrome, 333

Coincident pregnancy, 184–185

Coitus (see Sexual intercourse)

Cold knife conization (CKC), 316, 316

of cervix, 417, 418

Cold stress, prematurity and, 123

Colon cancer, screening recommendations for, 20–21, 92, 470t

Colonoscopy, recommendations for, 21

Color blindness, 85

Colorectal cancer, screening recommendations for, 21, 92, 470t

Colostrum, 55, 133

Colpocleisis, 281

Colposcope, 413

Colposcopy, 314

with directed biopsy for evaluating abnormal Pap test results, 413, 414–415

for vulvar diseases, 399

Coma in postpartum hemorrhage, 142

Combined pregnancy, 184

Communitarian ethics, 26t

Comparative genomic hybridization (CGH), 91

Complete abortion, 186

Compound presentations in abnormal labor, 106, 107

Computed axial tomography (CT, CAT), 312

in adrenal neoplasms, 361

in endometriosis, 291

in hirsutism evaluation, 356

in ovarian dermoid cyst, 439

of uterine leiomyomata, 425

Conception, events required for, 371, 372

Conception rates for fertile couples, 371, 372

Concurrent blockade in combination chemotherapy, 389

Condoms, 245

female, 245, 245

pregnancy rates within first year, 244t

Condyloma acuminata

diagnosis of, 273

as human papillomavirus subtype, 272, 409

lesions associated with, 272, 272

vs.

management of, 272

during pregnancy, 228

vulvar intraepithelial neoplasia associated with, 404

Condyloma lata, 228, 273–274, 274

Conflicts of interest, avoiding, 27

Congenital adrenal hyperplasia (CAH), 33, 360–361

11-beta-hydroxylase deficiency in, 361

21-hydroxylase deficiency in, 360–361, 361b

in precocious puberty, 345, 345b

treatment of, 361

Congenital anomalies, 33, 301

maternal diabetes–related, 190, 190

Congenital rubella syndrome, 225

Congenital syphilis, 228–229, 229

Conization (see Cervical conization)

Conjoined twins, 145

Conjunctivitis, inclusion, chlamydial infection as cause of, 267

Consolidation chemotherapy, 389

Constipation during pregnancy, 53, 78

Constitutional delay of puberty, 346

Constitutional hirsutism, 361–362

Contraception, 237–251 (see also specific method)

barrier, 244–247, 245, 246

choice of

decision tree for, 238, 239

factors affecting, 238

ectopic pregnancy related to, 179

emergency, for sexual assault, 251, 332t

failure of

factors affecting, 238, 239, 241

pregnancy rates within first year, 244t

fertility awareness methods, 250–251

folklore-based techniques of, 234

hormonal, 239–244, 241–242b

benefits of, 240, 244

combination oral, 239–240

effects of, 240–241

evaluation for, 241, 243

implantable, 244, 245

injectable, 243–244, 244b

medication interactions with, 243

patch, 243, 243

progestin-only oral, 240, 242b

vaginal ring, 243, 243

in immediate postpartum period, 131

ineffective methods, 251

intrauterine, 247–250, 247, 248–249b

maternal diabetes and, 193

mechanisms of action of, 239–240

natural family planning in, 238t

permanent (see Sterilization)

Contraceptive history, 5

Contraceptive sponge, 246

Contraction stress test (CST) for fetal well-being assessment, 69, 70

Cord compression (see Umbilical cord)

Cordocentesis for DNA sampling, 90–91

Core-needle biopsy for breast mass evaluation, 304

Cornu, 41

Cornual pregnancy, 184

Corpus, uterine

anatomy of, 41, 139

cancer of, 427–434 (see also Endometrial carcinoma)

wall layers of, 35, 41

Corpus albicans, 339, 340

Corpus hemorrhagicum, 339, 437

Corpus luteum, reproductive maturation of, 338, 339, 339, 340

Corpus luteum cyst

hemorrhagic, 437

persistent, 436–437

Cortical cords, 34, 35

Corticosteroids

for fetal lung maturity enhancement, 213

for lichen sclerosus of the vulva, 401

for maternal asthma, 213

in premature rupture of membranes, 171

for preterm labor, 161

for vulvar dermatitis, 402

for vulvar intraepithelial neoplasia, 404

for vulvar psoriasis, 402

Corticotropin levels during pregnancy, 54

Cortisol

in congenital adrenal hyperplasia, 361

in hirsutism and virilization, 356, 357, 358

during pregnancy, 51t, 54

Counseling

ART and, 380

breast self-awareness, 11

genetic, 91

as legal action component, 29

preconception, 6, 61–62, 202, 234

presterilization, 258

for sexual assault, 330t, 330, 332, 335

for sexual dysfunction, 321

Couvelaire uterus, 166

Cranberry juice for urinary tract infections, 285

Craniopharyngioma as delayed puberty cause, 347

Creatinine, serum, during pregnancy, 51t, 52

Criminal sexual assault, 329

aggravated, 330

Crotamiton for vulvar dermatitis, 402

Crowning of fetal head, 101, 101

Cryoprecipitate for blood replacement, 139t

Cryotherapy, 314

for cervical intraepithelial neoplasia, 409, 416–417

for condyloma acuminata, 273

CST (contraction stress test) for fetal well-being assessment, 69, 70

Cul-de-sac (pouch of Douglas), 41

Culdocentesis for ectopic pregnancy diagnosis, 182–183, 182

Cultures

for dysmenorrhea, 296–297, 298

for ectopic pregnancy, 179

for herpes simplex virus infection, 271

for sexually transmitted diseases, 224, 224b, 266t, 268t, 269, 271–272, 275

for urinary incontinence, 281–282

urine

for Neisseria gonorrhoeae, 172

for urinary tract infections, 285b, 285

Curettage

endocervical, for neoplasia, 413

uterine

dilation and (see Dilation and curettage [D&C])

suction (see Suction curettage)

Cushing syndrome, 361

CVS (see Chorionic villi sampling)

Cyclophosphamide as antineoplastic drug, 397, 388t, 390t

Cyproterone acetate for constitutional hirsutism, 361

Cyst(s)

of canal of Nuck, 403

corpus luteum, 436

hemorrhagic, 437

luteal-phase, 437

persistent, 437

dermoid, 438, 439

of fallopian tubes, 444

follicular, 436

Gartner duct, 35, 45, 45, 407

hydatid, of Morgagni, 444

inclusion, of vulva, 407

Nabothian, 410, 411

ovarian, 436–437, 436

paraovarian, 444

sebaceous, of vulva, 403

theca lutein, 437

Cystadenocarcinoma of ovary

mucinous, 441

serous, 441

Cystadenomas of ovary

mucinous, 438, 438b, 439

serous, 437, 438, 438b

Cystectomy for benign ovarian neoplasm, 438

Cystic fibrosis

as autorecessive disorder, 85

carrier testing for, 90

ethnicity as risk factor for, 62

Cystitis, 285b

acute, in pregnancy, 201

interstitial

chronic pelvic pain associated with, 300, 299t

interstitial, therapy for, 300

Cystocele, 278, 279

Cystourethroscopy, 283

Cytokinesis, 80

Cytology, peritoneal, for ovarian carcinoma, 445–446

Cytomegalovirus (CMV) infection, 229–230

intrauterine growth restriction associated with, 230

in pregnancy, 230

transmission of, 230

Cytoreductive surgery for ovarian carcinoma, 445

Dactinomycin, as antineoplastic drug, 388t, 390t

Daily Record of Severity of Problems as premenstrual syndrome diagnostic tool, 383, 384

Danazol

for endometriosis, 291, 294

iatrogenic androgen excess from, 362

for mastalgia, 306

for premenstrual syndrome, 385–386

teratogenesis associated with, 76t

for uterine leiomyomata, 425

Dark-field examination for syphilis, 266t

Date rape, 329–330

Dating (see Estimated date of delivery)

D&C (see Dilation and curettage [D&C])

DCIS (ductal carcinoma in situ), 306t, 307, 308t

Death/death rate (see Mortality)

Debulking surgery for tumors, 387

Decelerations of fetal heart rate, 117, 118

Decidua, postpartum changes in, 129

Degeneration, red (carneous), during pregnancy, 426

Dehiscence

of episiotomy, 132

of uterus, 142, 167

Dehydroepiandrosterone sulfate (DHEA-S)

in adrenal neoplasms, 361

in congenital adrenal hyperplasia, 361

in hirsutism and virilization evaluation, 355, 356t, 357

increased production of, during adrenarche, 355

during pregnancy, 54

Delayed puberty, 345–346

anatomic causes of, 345, 346b

constitutional, 346

defined, 345

hypergonadotropic hypogonadism as cause of, 346, 346, 346b

hypogonadotropic hypogonadism as cause of, 346, 346b

Deletion(s), 80

as chromosome structure abnormality, 81, 84t

as deoxyribonucleic acid replication errors, 80

Delivery

breech presentation and, 111–112

cesarean (see Cesarean delivery)

crowning of fetal head, 101, 101

dorsal lithotomy position for, 98

engagement and, 97, 98

episiotomy in, 101, 101

by forceps, 110–111, 110

of infant shoulders, 97, 102

infectious disease considerations, 224

of multifetal gestation, 148–149, 148t, 149

operative, 110–111, 110

pain control during, 99, 100

of placenta, 102, 102

preeclampsia indications for, 142

Ritgen maneuver in, 101, 101

stages of labor and, 96

by vacuum extraction, 111, 111

vaginal (see Vaginal delivery)

vaginal examination and, 94–95

Delivery maneuvers, 149, 149

Delivery room assessment of newborn, 121, 122, 123, 123t

Dematitis, vulvar (see Vulvar dermatitis)

Demographics of women in the U.S., changes in, 2, 2

Dental caries during pregnancy, 53

Deoxycorticosterone levels during pregnancy, 54

Deoxyribonucleic acid (DNA), 79

errors in replication of, 80

sequences of, determining length of, 90

transcription of, to ribonucleic acid, 79

Depo-medroxyprogesterone acetate (see Medroxyprogesterone acetate)

Depression

mood disorder in pregnancy, 234–235

postpartum, 134, 134t, 135, 235

sexual dysfunction related to, 325

Dermal homogenization/sclerosus, histologic pattern in, 400t

Dermoid, 438–439, 439

Descent, fetal, during labor, 97, 98

maternal pushing and, 100

overestimation of, 101

D&E (see Dilation and evacuation [D&E])

Desipramine for vulvodynia, localized, 403

Desogestrel in oral contraceptive preparations, 239, 240

Desquamative inflammatory vaginitis, 263

Detrusor overactivity, 281, 299t (see also Urinary incontinence)

Dexamethasone to enhance fetal lung maturity, 161

DHEA-S (see Dehydroepiandrosterone sulfate [DHEA-S])

Diabetes mellitus, 189–193

classification of, 189

fetal morbidity and mortality in, 190–191, 190

gestational, 189, 191–193

antepartal fetal monitoring with, 192

incidence of, 191–192

infection in, 193

labor and delivery of patient with, 193

laboratory screening for, 192

management of, 192–193

physiology of, 190

prevalence of, 191

pregestational, 189, 191

antepartum fetal monitoring with, 191

complications of, 191

management of, 191

risk factors for, 191

screening recommendations for, 23

type I, 189

spontaneous abortion related to, 185

type II, 189, 191, 193

Diabetic ketoacidosis (DKA), 189

in pregnancy, 190, 191, 199b

Diabetic nephropathy in pregnancy, 191

Diabetic retinopathy in pregnancy, 191

Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, sexual dysfunctions recognized by, 324t, 381

Diagonal conjugate of pelvis, 37, 39, 40

Diamniotic/dichorionic gestation, 145, 146

Diamnionic/monochorionic gestation, 145, 146

Diaphragm, contraceptive, 237, 239

pregnancy rates within first year, 244t

Diastasis recti, postpartum changes in, 130

Dietary cravings during pregnancy, 53

Diethylstilbestrol (DES) in utero exposure

cervical incompetence related to, 20

spontaneous abortion related to, 185

Digital examination for labor evaluation, 159

Dihydrotestosterone, conversion of testosterone to, 356

Dilation and curettage (D&C), 315

for endometrial hyperplasia/carcinoma, 429, 430

Dilation and evacuation (D&E), 315

for hydatidiform mole, 395

Dimethyl sulfoxide (DMSO) for interstitial cystitis, 300

Dinoprostone for postpartum hemorrhage, 138b, 140

Diphenhydramine hydrochloride (Benadryl) for lichen simplex chronicus, 401

“Dipstick” urine tests, 285

Direct fluorescent antibody tests for syphilis, 266t

Disjunction in cell division, 81

Disseminated intravascular coagulopathy

as abruptio placentae complication, 165t, 167

postpartum hemorrhage due to, 142

with pregnancy-related hypertenson, 207, 207

Diuretics

during pregnancy, 209

teratogenesis associated with, 76t

Diverticular disease, sigmoid, adnexal space and, 435

Dizygotic (fraternal) twins, 145

DMSO for interstitial cystitis, 300

DNA (see Deoxyribonucleic acid)

DNA testing

for human papillomavirus, 413, 414, 415, 416, 418

for isoimmunization diagnosis, 221, 221b

Docusate, 78

Domestic violence, 334–336

counseling for, 335, 335b

cyclic and repetitive nature of, 334

defined, 334

exit plan to leave, 335b

RADAR model of approach to, 334, 335b

risk factors for, 334, 335b

types of abuse in, 334, 334t

victim of, identifying, 334, 335b

Doppler ultrasound device, fetal heart rate evaluation by, 67, 68, 71

Doppler ultrasound of umbilical artery, 71

Doppler velocimetry for intrauterine growth restriction, 154, 154

Down syndrome (trisomy 21)

advanced maternal age as risk factor for, 86, 87

altered chromosome number in, 81, 83t

characteristics of, 83t

fetal assessment for, 68

genetic screening for, 87, 88t, 89

live birth incidence of, 83t

Doxorubicin (Adriamycin)

for ovarian cancer, 390t, 446

Doxycycline

for chlamydial infection, 269

for sexual assault, 332t

Drospirenone in oral contraceptive preparations, 239, 240

Drospirenone/ethinyl estradiol for premenstrual dysphoric disorder, 385

Dual-energy x-ray absorptiometry (DXA), 22

Ductal carcinoma in situ (DCIS), 306t, 307, 308t

Ductal ectasia, nipple discharge in, 306

Ductus arteriosus in fetal circulation, 56, 56, 57, 57

Ductus deferens, development of, 35, 36

Ductus venosus in fetal circulation, 55, 56, 57

DXA (dual-energy x-ray absorptiometry), 22

Dysautonomia, familial, 90

Dysfunctional uterine bleeding (see Uterine bleeding, abnormal)

Dysgerminomas of ovary, 443, 443

Dysmaturity syndrome in infants, postterm pregnancy related to, 176

Dysmenorrhea, 295–297

assessment of, 296–297

defined, 295

diagnosis of, 296–297

in endometriosis, 289

etiology of, 295–296, 296b

follow-up care for, 300

history of, 296

incidence and prevalence of, 295

primary

causes of, 295

pain in, 295, 296t

symptoms of, 295, 296t

secondary

causes of, 295, 296b

symptoms of, 296

therapy for, 297

with uterine leiomyomata, 424

Dyspareunia, 324t

in endometriosis, 289

insertional, in vulvodynia, localized, 403

Dyspnea of pregnancy, 49

Dystocia (see Abnormal labor)

Eccrine sweating during pregnancy, 55

Echinacea, antepartum use of, 74

Echocardiography for antepartum fetal monitoring, 191

Eclampsia

defined, 206

management of, 210–211

seizures with, 206, 210

Ectopic pregnancy, 179–185

abdominal, 185

cervical, 184

combined, 184–185

cornual, 184

diagnostic procedures for, 181–184, 181, 182

differential diagnosis of, 181

heterotopic, 184–185

incidence of types of, by location, 179, 180

interstitial, 184

management of

medical, 183, 183b

surgical, 183–184, 184

nontubal, 184

ovarian, 184

post-tubal ligation, 257–258

sexually transmitted diseases and, 267, 269

symptoms of, 180

tubal

clinical findings in, 180–181

clinical scenarios resulting in, 179

pathophysiology and risk factors for, 179–180

symptoms of, 180

unruptured, 180

ECV (see External cephalic version [ECV])

Eczema, vulvar dermatitis and, 402

EDD (see Estimated date of delivery [EDD])

Edema

during pregnancy, 50, 77

peripheral, with pregnancy-related hypertension, 208

in premenstrual syndrome, 383, 383b

Edwards syndrome (trisomy 18)

altered chromosome number in, 81, 83t

characteristics of, 83t

live birth incidence of, 83t

Effacement of cervix (see Cervical effacement)

Eflornithine hydrochloride for constitutional hirsutism, 361

Eisenmenger syndrome as pregnancy contraindication, 211

Ejaculatory ducts, development of, 35, 36

Elective abortion, 187

Electrocardiograms, changes in, during pregnancy, 48

Electrocautery-based methods for female sterilization, 254–255

Electronic fetal monitoring (EFM), 99, 114, 115t

definitions, 113–114, 115t, 114b

external, 114

internal, 114

intrapartum, guidelines for, 116t

perioperative, during maternal surgery, 202

in premature rupture of membranes, 172

for preterm labor, 159

ELISA (see Enzyme-linked immunosorbent assays [ELISA])

EMACO combination chemotherapy for choriocarcinoma, 397

Embolism, amniotic fluid, postpartum hemorrhage due to, 142

Embolization, uterine arterial, for uterine leiomyomas, 426

Embryology, 33–37

developmental anomalies associated with, 33, 44–45

of external genitalia, 37, 38

genetic sex determination and, 33

of genital ducts, 36, 37

indifferent (undifferentiated) stage of, 33

of ovaries, 34, 34

of urogenital system, 34, 34, 36

of uterus, 33, 36

of vagina, 33, 36

Embryonal cell carcinomas, 443

Embryonal rhabdomyosarcoma, 408

Emergency contraception, 251

pregnancy rates within first year, 244t

Emotional support for spontaneous abortion, 187

Employment during pregnancy, 72

Endocervical canal, 409

Endocervical curettage for cervical intraepithelial neoplasia, 413–414, 415–416

Endocervix, reproductive cycle manifestations in, 341–342

Endocrine system, physiologic changes in, during pregnancy, 51t, 53–54, 53

Endodermal sinus tumors, 443–444

Endometrial ablation, 315

for abnormal uterine bleeding, 353

Endometrial biopsy, 314, 314

for granulosa cell tumor, 444

for hyperplasia/carcinoma, 429

luteal phase, for infertility, 373

for uterine leiomyomata, 425

Endometrial carcinoma, 427, 430–433

biopsy for, 434

chemotherapy for, 389, 390t

diagnosis of, 431–432

estrogen-dependent, 433

estrogen-independent, 433

FIGO surgical staging system for, 432, 433t

granulosa cell tumor associated with, 444

hormone therapy after treatment for, 433

incidence and prevalence of, 427, 430

mortality and survival rates for, 427, 430

pathogenesis of, 431

prognostic factors of, 432, 433b

recurrent, 433

risk factors for, 431, 429t

screening recommendations for, 91

treatment of, 432–433

types of, 431, 431

histologic, 431, 432t

Endometrial hyperplasia, 427–430

benign polyps as, 430

biopsy for, 429, 430

complex, 427, 428t, 428

with cytological atypia, 427–428, 428

as endometrioid adenocarcinoma precursor, 427

evaluation of, 429, 429

granulosa cell tumor associated with, 444

management of, 429–430

pathophysiology of, 428

patient history and, 428

risk factors for, 428, 429t

simple, 427, 428t

from unopposed estrogen, 368

WHO classification of, 427, 428t

Endometrial polyps, 430

Endometrial sampling (see Endometrial biopsy)

Endometrioid adenocarcinoma, endometrial hyperplasia as precursor to, 433

Endometrioid endometrial carcinoma, 432t

Endometrioid tumors

benign, 438

malignant, 443

Endometriomas, 438

Endometriosis, 287–294

classification system for, 291, 292–293

defined, 287

diagnosis of, 289, 291, 292–293

criteria for, 291

differential diagnosis of, 289

as dysmenorrhea cause, 295, 296

genetic component associated with, 287

Halban’s theory of, 287

incidence and prevalence of, 287

Meyer’s theory of, 287–288

pathogenesis of, 287–288

pathology of, 288, 288

Sampson’s theory of, 287

signs and symptoms of, 288–289, 290

sites of, 288, 289t

treatment of, 291, 294

expectant, 291

medical, 291, 294

surgical, 294

Endometritis, postpartum, group B streptococcus as cause of, 224

Endometrium

menstrual cycle phases and, 339

reproductive cycle manifestations in, 340–341

of uterine wall, 41, 42

postpartum changes in, 129–130

Endothelium, changes in, with pregnancy-related hypertension, 207

Endotracheal intubation for newborn resuscitation, 124, 125

Engagement

fetal

evaluation of, 95–96, 96

during labor, 97, 98

fundal height measurement in, 67, 67

Enterocele, 278, 279, 281

Enzyme-linked immunosorbent assays (ELISA), 21

for acquired immunodeficiency syndrome, 275

for human immunodeficiency virus screening, 227

Epididymis, development of, 35, 36

Epidural block

abnormal, 109

in labor management, 99

Epilepsy, during pregnancy, 234

Episiotomy

hematomas with, 141

infection of, 132

in vaginal delivery, 101, 101

Episodic therapy for herpes simplex virus infection, 272

Epithelial cell neoplasms, ovarian

benign, 437–440, 438b

Brenner cell tumor, 438

endometrioid tumor, 438

mucinous cystadenoma, 438, 439

serous cystadenoma, 437–438, 438

histologic classification of, 437b

malignant, 440–444

breast/ovarian familial cancer syndrome, 442

Brenner tumors, 443

clear cell carcinoma, 443

endometrioid tumors, 443

hereditary nonpolyposis colorectal cancer and, 442–443

incidence of, 440

mucinous cystadenocarcinoma, 441

serous cystadenocarcinoma, 441

spread mechanisms of, 440

Epithelial hyperplasia of the breast, 306t, 307

Epithelium

of cervix, 41, 409, 410, 411

in lichen sclerosus of the vulva, 400, 400

of vagina, 41

Epulis gravidarum, 53

Erb-Duchenne palsy, fetal, postterm pregnancy related to, 176

Erythrocytes in iron-deficiency anemia, 215–216, 216

Erythromycin for chlamydial infection, 269

Escitalopram, sexual dysfunction associated with, 325

Estimated date of delivery (EDD)

initial assessment of, 66

inaccurate, in postterm pregnancy, 175

ultrasound determination of, 177

Estradiol

for menopause, 334

menstruation control by, 338, 338

phase I physiology, 340

phase II physiology, 340

phase III physiology, 340, 341

two-cell theory of, 338, 339

postmenopausal ranges for, 364t

postoophorectomy ranges for, 364t

premenopausal ranges for, 364t

Estriol, unconjugated, in genetic screening, 89

Estrogen(s)

breast changes and, 308

for delayed puberty, 346

effects of, 240

endometrial hyperplasia/carcinoma risk related to, 428

after treatment, 433

excess unopposed, endometrial proliferation and, 428, 428b

extragonadal, 364

glucose metabolism and, 190

menstruation control by, 338

postpartum physiology of, 130, 133

during pregnancy

insulin resistance with, 54

physiologic changes with, 53, 54

sexual response and, 325, 325b

side effects of, 240–241

sources of, 428

two-cell theory of production of, 338, 339

uterine leiomyomata growth induced by, 423

pharmacologic inhibition of, 425

for vaginal intraepithelial neoplasia, 407

Estrogen-dependent endometrial carcinoma, 431, 433

Estrogen-independent endometrial carcinoma, 431

Estrogen-progestin combinations

breastfeeding and, 132

in contraceptive vaginal ring, 243

in oral contraceptives, 132

in transdermal contraceptive patch, 243

Estrogen replacement therapy for menopause

administration routes for, 368

alternatives to, 369–370

cautions in, 369

preparations, 368

principal regimens for, 368

Estrone

postmenopausal ranges for, 364t

postoophorectomy level of, 364t

premenopausal ranges for, 364t

Ethics

autonomy principle of, 26, 26t

beneficence principle of, 26–27, 26t

of care, 26t, 27b

case-based, 246t

clinical management, 27–28

communitarian, 26t

decision-making process, 26t, 28

feminist, 26, 26t

framework for, 25

justice principle of, 26t, 27

nonmaleficence princple of, 26t, 27

principle-based, 26–28, 26t, 27–28b

virtue-based, 26t, 27b

Ethinyl estradiol in oral contraceptive preparations, 239

Ethnicity

as genetic disorder risk factor, 86–87

carrier testing for, 90

puberty onset and, 343, 344t

Ethynodiol diacetate in oral contraceptive preparations, 239

Etoposide

as antineoplastic drug, 397, 388t, 390t

for ovarian carcinoma, 443, 446

Euploidy, altered chromosome number in, 81

Excision

of Bartholin gland carcinoma, 407

of cervical intraepithelial neoplasia, 417

of condyloma acuminata, 273

of Paget’s disease of vulva, 405

of vaginal intraepithelial neoplasia, 404, 405

of vulvar melanoma, 403

Exercise during pregnancy, 72, 72b

Exocervix, 409, 410

Expedited partner therapy for sexually transmitted diseases, 267

Expert witnesses, legal action component, 29

External beam radiation for cervical cancer, 420

External cephalic version (ECV)

for breech presentation, 68, 111, 112

contraindications for, 68

of multifetal gestation, 149, 149

External genitalia

embryology of, 37, 38

inspection and examination of, 12, 12

External irradiation, 390

External os, anatomy of, 41, 42, 94, 409, 410, 411

External rotation, fetal, during labor, 97, 98

Extrauterine pregnancy (see Ectopic pregnancy)

Face presentation in abnormal labor, 106, 107

Factor V Leiden defect, recurrent pregnancy loss related to, 186

Fallopian tube(s)

anatomy of, 43

benign disease of, 444

bimanual examination and, 15

blood supply to, 43

carcinoma of, 444–446

metastatic, 445

primary, 444

rare, 445

surgical management of, 445–446

surgical staging of, 445, 445t

embryology of, 33, 34

infertility associated with, 374–376

ligation of (see Tubal ligation)

Falope ring for female sterilization, 254, 255, 255, 258

False labor, 93

False pelvis (greater pelvis), 37, 39

Famciclovir

for herpes simplex virus infection, 272

for sexual assault, 332t

Family history in health evaluation, 6

Family planning

natural (see Natural family planning)

prescribed (see Contraception)

FAS (see Fetal alcohol syndrome [FAS])

Fasting glucose testing, high-risk factor for, 470t

Fatigue during pregnancy, 78

Fatty liver, acute, of pregnancy, 199, 201

Fecal immunochemical testing, recommendations for, 21

Fecal occult blood testing, recommendations for, 21

Fecundability, 371

Fecundity, 371

Female orgasmic disorder (FOD), 324t

Female sexual arousal disorder (FSAD), 324t

Female sexual response cycle, physiology of, 322–323, 322b, 325

Feminist ethics, 26t

Fern test for distinguishing amniotic fluid from other fluids, 170, 171

Ferriman-Gallwey scale for assessing extent and distribution of hirsutism, 356

Ferrous sulfate during pregnancy, 50

Fertility

awareness methods, 250–251

conception rates based on, 371, 372

conditions that affect, 371 (see also Infertility)

reproductive age and, 371

FES (fetal scalp electrode) for fetal heart rate monitoring, 106

Fetal alcohol syndrome (FAS)

findings in, 76–77

intrauterine growth restriction associated with, 153

risk of maternal alcohol use in, 77

Fetal biometry measurement in intrauterine growth restriction diagnosis, 154

Fetal death

maternal hypertension associated wth, 208

in multifetal gestation, 147

parvovirus infection as cause of, 231

syphilis as cause of, 228

Fetal diagnostic procedures, 90–91

Fetal fibronectin levels in preterm labor, 148, 158–159

Fetal growth

assessment of, 69

blood flow as measurement of, 57

maternal diabetes impact on, 190

with multifetal gestation, 148, 148t

Fetal head

asynclitic, 106, 107

crowning of, 101, 101

molding of, 101, 101

Fetal heart rate (FHR)

accelerations of, 115t, 116

antepartum evaluation of, 67

baseline normal, 114, 115t

bradycardia, 114

contraction stress test measurement of, 70

decelerations, 115t, 117, 117

interpretation system for, 116b

intrapartum monitoring of, 114–117, 115b, 115t, 116t

guidelines for, 114

monitoring during labor, 100

nonreassuring, 114, 117

diagnosis and management of, 118

nonstress test measurement of, 70, 70

patterns of, 114, 115t, 118

periodic changes in, 116

physiology of, 56

pregnancy-related hypertension and, 210

in premature rupture of membranes, 170

scalp stimulation and, 118, 118

tachycardia, 114, 115t

variability of, 114, 115t, 117

vibroacoustic stimulation and, 116, 118

Fetal heart tones

hydatidiform mole and, 394, 395

in labor evaluation, 94

monitoring, perioperatively during maternal surgery, 202

in pregnancy diagnosis, 63

spontaneous membrane rupture and, 100

Fetal lung maturity

assessment of, by amniocentesis, 154, 165, 171, 177

corticosteroids to enhance, 165, 193

Fetal macrosomia, 155, 176

maternal diabetes associated with, 190, 192

shoulder dystocia and, 112

Fetal-maternal conflicts, 25

Fetal maturity, assessment of, 66, 71, 71b

with diabetes mellitus, 193

Fetal monitoring

antepartum

with gestational diabetes, 192

with pregestational diabetes, 191

for intrauterine growth restriction, 154

in materal cardiac disease, 212

perioperative, during maternal surgery, 202

Fetal movement

in antepartum evaluation, 66

monitoring of, in premature rupture of membranes, 191

in postterm pregnancy, 177

Fetal physiology, 55–59

circulation, 55–57, 56–57

gonadal differentiation, 58

hemoglobin, 58, 58

hepatic, 58

immunologic, 58–59

oxygenation, 58

placental, 55

renal, 58

thyroid gland, 58

Fetal scalp electrode (FES) for fetal heart rate monitoring, 106, 114

Fetal scalp sampling

for blood pH/lactate determination, 118, 118

as stimulation technique, 118, 118

Fetal scalp stimulation, heart rate acceleration and, 116, 118

Fetal station

during labor, 97

in labor evaluation, 95–96, 96

Fetal status, nonreassuring

heart rate in, 113, 118

pulse oximetry and, 118

Fetal stimulation, techniques for, 118

Fetal surveillance

asphyxia-related disorders, 114

intrapartum monitoring, 113

in abnormal labor, 114–117

ancillary tests for, 118–118, 118

electronic, 104, 114, 115t

risk factors for, 99

postterm pregnancy and, 177

Fetal testing, indications for, 69b

Fetal weight, estimation of, 69, 106, 112, 148, 154, 155

in postterm pregnancy, 177–178

Fetal well-being

assessment of, 148, 171, 172, 177, 218

intrapartum, 99, 114, 115t

antepartum, 69–71, 69b, 70

blood flow as measurement of, 57

Fetal-maternal hemorrhage

in abruptio placentae, 166

in maternal trauma, 203

Rh status determination in, 203

in third-trimester bleeding, 221–222

Fetoscope for fetal heart tones, 63

Fetus, antibody development effects on, 219 (see also Fetal entries)

Fever, maternal

antipyretic indications for, 201

with ruptured ectopic pregnancy, 250

Fibrinogen during pregnancy, 50, 51t

Fibroadenomas of breasts, 306t, 307

Fibrocystic changes of the breast, 307, 306t

adenosis in, 307, 306t

nipple discharge in, 306

Fibroids (see Leiomyomata, uterine)

Fibromas

of ovary, 440, 444

of vulva, 403

Fibromyomas of vulva, 403

Fibrosarcoma of ovary, 444

FIGO (see International Federation of Gynecology and Obstetrics [FIGO])

Filshie clip for female sterilization, 255, 255, 258

Finasteride for constitutional hirsutism, 361

Fine-needle aspiration biopsy for breast mass evaluation, 304

Fish, mercury levels in, 74

FISH (fluorescence in situ hybridization), 81–82, 91

Fitz-Hugh-Curtis syndrome, 270, 270

FHR (see Fetal heart rate [FHR])

Flexible sigmoidoscopy, recommendations for, 21

Flexion of fetal head during labor, 97, 98

Fluconazole for vulvovaginal candidiasis, 262

Fluid intake in labor management, 99

Fluorescence in situ hybridization (FISH), 81–82, 91

Fluorescent treponemal antibody absorbed (FTA-ABS)

test for syphilis, 229, 274b

Fluoride supplementation, high-risk factor for, 470t

5-Fluorouracil

as antineoplastic drug, 388t

for vaginal intraepithelial neoplasia, 407

for vulvar cancer, 406

for vulvar intraepithelial neoplasia, 404

Fluoxetine

for menopausal symptoms, 370

for premenstrual dysphoric disorder, 385

for localized vulvodynia, 403

Flutamide for constitutional hirsutism, 361

Focused ultrasound surgery, MRI-guided, for uterine leiomyomata, 426

FOD (female orgasmic disorder), 324t

Folate

demands during pregnancy, 62, 216

dietary sources of, 216

Folate deficiency anemia in pregnancy, 216

Folic acid antagonists, intrauterine growth restriction associated with, 153

Folic acid for neural tube defect prevention, 62, 89, 216

Folklore-based contraception, 251

Follicles, primordial

development of, 34, 35

maturation of, 34

reproductive maturation of, 338, 339

Follicle-stimulating hormone (FSH)

in abnormal pubertal development, 344

dysfunctional secretion of, amenorrhea related to, 350

in endometriosis management, 291–292

in infertility, 378

menopausal alterations in, 364

menstruation control by, 338, 338, 339

relative changes in, during life stages, 363, 364

Follicular cyst, ovarian, 436

Foramen ovale in fetal circulation, 55–56, 56, 57

Forceps delivery, 110, 110

indications for, 110

risks of, 110

Forensic examination/specimens for sexual assault, 329, 330–331, 331b

Fornix, regional anatomy of, 41

Fragile X syndrome, 85

Fraternal (dizygotic) twins, 145

Free radicals in pregnancy-related hypertension, 207

Free thyroxine index in pregnancy, 194

Free T4 levels during pregnancy, 53, 194, 194

Frenulum, anatomy of, 40, 40

Fresh frozen plasma for blood replacement, 139t

Friedman curve, 96, 107

FSAD (female sexual arousal disorder), 324t

FSH (see Follicle-stimulating hormone [FSH])

FTA-ABS (fluorescent treponemal antibody absorbed) test for syphilis, 229, 274b

Functional ovarian cysts, 436–437

Fundus (see Uterine fundus)

Gabapentin for menopausal symptoms, 370

Gail Model breast cancer risk assessment tool, 308

Galactocele, postpartum, 127, 131t

Galactorrhea, 9

amenorrhea associated with, 351

Gallbladder, physiologic changes in, during pregnancy, 52–53

Gallstones in pregnancy, 202

Gametes

chromosomes in, 80

development of, 34

Gamma-glutamyl transferase during pregnancy, 53

Garlic, antepartum use of, 74

Gartner duct cysts, 45, 45, 407

Gastric cancer, screening recommendations for, 92

Gastroesophageal reflux during pregnancy, 52–53

Gastrointestinal conditions associated with chronic pelvic pain, 299–300, 299t

Gastrointestinal disorders, 197–198

Gastrointestinal system, physiologic changes in, during pregnancy, 51t, 52–53

Gatifloxacin for urinary tract infections, 285

Gaucher disease, 87

GBS (see Group B streptococcus)

Gemcitabine for ovarian carcinoma, 390t, 446

Gender

androgen role in, 33

genetic determination of, 33

General anesthesia in labor management, 99

Generation time in cell cycle, 387

Genes

definition of, 79–80

function of, 79–80

Gene therapy for cancer, 391

Genetic code, 79

translation of, into codons, 80

Genetic counseling, 91

high-risk factor for, 470t

Genetic disorders, 79–92

autosomal dominant, 84b, 84–85

autosomal recessive, 84b, 85

inheritance patterns and, 84–85

Mendelian, 84

mitochondrial inheritance, 85

multifactorial inheritance, 85

prenatal diagnosis of, 90–91

prenatal screening for, 87, 87, 88t, 89

risk factors for, 85–87, 86t

single-gene, 84

X-linked, 85, 85b

Genetics

of breast cancer, 307–308

endometriosis predisposition and, 287

in hydatidiform mole, 393, 394t

intrauterine growth restriction associated with, 153

of ovarian carcinoma, 440, 441

in recurrent pregnancy loss, 186

of sex determination, 33

spontaneous abortion related to, 185

Genital ducts, embryology of, 36, 37

Genital herpes, 271–272

diagnosis of, 266t, 271, 271

epidemiology of, 271

herpes simplex virus as cause of, 271

incidence and prevalence of, 266t, 271

laboratory testing for, 271–272

presentation of, 266t

signs and symptoms of, 272

treatment of, 272

Genitalia, external

embryology of, 37, 40

examination of, 12

Genital outflow tract obstruction, amenorrhea related to, 350

Genital ridges, embryology of, 34, 34

Genital tract

atrophy of, in menopause, 365–366

lower, lacertions of, postpartum hemorrhage due to, 141, 141

upper, anomalies of, 347

Genital tract biopsy, 314, 314

Genital tubercle, embryology of, 37, 38

Genital ulcers, diseases characterized by, 266t (see also specific diseases)

Genital warts (see Condyloma acuminata)

Genotyping for Rh isoimmunization diagnosis, 222

Gentamicin for pyelonephritis, 201

Gentian violet for vulvovaginal candidiasis, 262

Germ cell neoplasms, ovarian

benign, 438–440, 439

malignant, 440–444, 443

Germ cells

chromosomes in, 80

primordial, 34, 34

Germ cell tumors, chemotherapy for, 390t

Gestational age

assessment of

assisted reproductive technologies and, 66

by pelvic examination, 66

retroverted uterus and, 66

by ultrasound examination, 66

fetal assessment of, 69

first-trimester ultrasound for dating, 176–177

initial assessment of, 66

in intrauterine growth restriction, 151, 152, 153–154

in postterm pregnancy, 175

importance of, 175

in premature rupture of membranes, 170, 171–173

preterm, 171–173

term, 171

in preterm labor evaluation, 159

placenta previa management based on, 166

Gestational diabetes mellitus (see Diabetes mellitus)

Gestational hypertension, 206 (see also Hypertension)

Gestational trophoblastic neoplasia (GTN), 393–397

chemotherapy for, 390t

classification of, 394b

clinical presentation of, 393–396, 394, 394t, 395

description of, 393

FIGO scoring system, revised, for, 396–397, 397t

hydatidiform mole, 393–396 (see also Hydatidiform mole)

malignant, 396–397

classification of, 396t

nonmetastatic persistent, 396–397, 396t

placental, 397

recurrent benign, 395–396

GFR (see Glomerular filtration rate [GFR])

Gingival disease during pregnancy, 53

Ginkgo, antepartum use of, 74

Ginseng, antepartum use of, 74

Glomerular filtration rate (GFR)

postpartum physiology of, 130

during pregnancy, 52

pregnancy-related hypertension effects on, 208

Glucocorticoids for congenital adrenal hyperplasia, 361

Glucose

excretion of, during pregnancy, 52

placental metabolism dependence on, 55

serum (see Blood glucose)

urine, during pregnancy, 54

Glucose challenge test, 69

Glucose infusion during labor for maternal diabetes control, 193

Glucose intolerance (see also Diabetes mellitus)

fetal macrosomia associated with, 155

in pregnancy

classification of, 189

laboratory diagnosis of, 192

laboratory screening for, 192

Glucose metabolism in pregnancy, physiology of, 190

Glucose monitoring during pregnancy, 192, 193

hemoglogin A1_c, 191

Glucose-6-phosphate dehydrogenase deficiency, 216

Glucose tolerance testing

in antepartum evaluation, 69

postpartum, 193

during pregnancy, 192

Glucosuria of pregnancy, normal, 190 (see also Diabetes mellitus)

Glyburide for diabetes mellitus, 192

GnRH (see Gonadotropin-releasing hormone [GnRH])

GnRH agonists (see Gonadotropin-releasing hormone [GnRH] agonists)

Gonadal differentiation in fetus, 58

Gonadal dysgenesis

in delayed puberty, 346, 346, 346b

dysgerminomas associated with, 443

Gonadal ridges, embryology of, 34

Gonadoblastoma, 443

Gonadotropin-releasing hormone (GnRH)

for chronic pelvic pain, 300

dysfunctional secretion of, amenorrhea related to, 350

for mastalgia, 306

menstruation control by, 338, 338

Gonadotropin-releasing hormone (GnRH) agonists

for endometriosis, 300

for pelvic congestion syndrome, 300

for precocious puberty, 345

for premenstrual syndrome, 385

for uterine leiomyomata, 425

Gonadotropins for infertility, 378

Gonads, development of, 33, 34, 35, 36

Gonococcal ophthalmia neonatorum, prophylaxis for, 123, 229

Gonorrhea, 269

abscess in, 269

antepartum screening for, 229

chlamydial infection and, 267

diagnosis of, 269

evaluation of, 268t

incidence and prevalence of, 268t, 269

laboratory testing for, 269

neonatal, 229

in pregnancy, 229

presentation of, 268t

screening recommendations for, 21, 224t

sexual assault prophylaxis for, 332t

special considerations for, 268t

treatment of, 269

Goserelin as antineoplastic drug, 389

Granuloma inguinale

diagnosis of, 266t

presentation of, 266t

prevalence of, 266t

sexual transmission of, 275

Granulosa cells, reproductive maturation of, 338, 339

Granulosa cell tumor

chemotherapy for, 390t

of ovary, 444

Granulosa theca cell tumors, 440 (see also Sertoli–Leydig cell tumors)

Graves disease, 193, 194

Graves speculum, 12, 13

Gravida, 6b

Gravidity, classifying, 6

Greater pelvis (false pelvis), 37, 39

Group B streptococcus

in newborn, 223

postpartum endometritis caused by, 224

in pregnancy, 223–224

prophylaxis against, 223–224

screening for, 69, 224t

spontaneous abortion related to, 158

Growth fraction in cell cycle, 387

Growth hormone for delayed puberty, 346

Gubernaculum, 34, 36

Gummas, 274

Gynandroblastoma, 360

Gynecoid pelvis, 40, 40

Gynecologic history in health evaluation, 5–6

Gynecologic procedures, 311–319 (see also specific procedure)

complications of, 319

intraoperative considerations for, 318

postoperative considerations for, 318–319

preoperative considerations for, 318

Gynecology

as division of surgery, 1

evolution of, as specialty care, 1

Hair, menopausal changes in, 366

HAIR-AN syndrome, polycystic ovary syndrome and, 359

Hair follicles in vulva anatomy, 40

Hair growth

in congenital adrenal hyperplasia, 361, 361b

during pregnancy, 55

terminal, in hirsutism, 355

testosterone secretion and, 356–357, 359, 361

Hair loss, postpartum, 55

Halban’s theory of endometriosis, 287

Hands-off/sign-out, health care team communication, 30

hCG (see Human chorionic gonadotropin [hCG])

Headaches

during pregnancy, 77

migraine, 233–234

tension, 233

Health evaluation

follow-up and continuity of care component, 15–16

patient history component of, 3–6, 5b

physical examination component of, 6–7, 8b, 9, 11

Heart, physiologic changes in, during pregnancy, 47–48, 48

Heartburn during pregnancy, 78

Heart failure in pregnancy, 146, 155, 194, 208

Heart murmurs during pregnancy, 48

Heart rate in postpartum hemorrhage, 137

Heart sounds during pregnancy, 48

Heat therapy for dysmenorrhea, 297

Hegar sign, 63

HELLP syndrome

defined, 207

diagnostic criteria for, 207

management of, 211

Hematocrit in anemia, 215

Hematologic diseases in pregnancy, 215–218

Hematologic system

changes in, during pregnancy, 50, 51t

pregnancy-related hypertension effects on, 208

Hematoma

perineal, postpartum, 132

postpartum hemorrhage due to, 141–142

Hematopoietic system, postpartum changes in, 130

Hematosalpinx, 183

Hemoglobin

antepartum evaluation of, 69

assessment of level of, high-risk factor for, 470t

fetal, 50, 58

during pregnancy, 46t, 58

Hemoglobin A1_c in glucose control monitoring, 191

Hemoglobin Barts disease, 216

Hemoglobinopathies, 216–218, 217t

antenatal assessment in, 218

genetics related to, 216–218, 217t

hemoglobin production in, 216–217, 217t

incidence of, 216

risk groups for, 216–217, 217t

sickle cell disorders, 216, 217–218, 217t

thalassemias, 216–218, 217t

transfusions for, 217–218

Hemoglobin sAg1, newborn immunization with, 132

Hemolysis in isoimmunization, 218, 219–220

Hemolytic disease, ABO, 222

Hemolytic disease of the newborn, 218

Hemoperitoneum with ectopic pregnancy, 182

Hemophilia, 85

carrier testing for, 90

Hemorrhagic disease of the newborn, vitamin K1 for prevention of, 123

Hemorrhoids

postpartum, 132

during pregnancy, 53, 78

Hemostatic changes with pregnancy-related hypertension, 207

Heparin, teratogenesis associated with, 75t

Hepatic disorders, 198–201

Hepatitis, viral, in pregnancy, 225–227(see also specific types)

Hepatitis A virus (HAV) in pregnancy, 226

Hepatitis A virus vaccination, high-risk factor for, 470t

Hepatitis B virus (HBV) infection

in pregnancy, 226

screening recommendations for, 224t

sexual assault prophylaxis for, 332t

Hepatitis B immune globulin (HBIG), 226

Hepatitis B surface antigen (HBsAg), 226

Hepatitis B vaccination

high-risk factor for, 470t

postexposure, for sexual assault, 331

Hepatitis C virus infection

in pregnancy, 226

risk factors for routine screening for, 226b

screening recommendations for, 224t, 470t

Hepatitis D virus infection in pregnancy, 227

Hepatitis E virus infection in pregnancy, 227

Herbal remedies, antepartum use of, 74

Hereditary hemolytic anemias in pregnancy, 216

Hereditary nonpolyposis colorectal cancer (HNPCC)

ovarian carcinoma associated with, 440, 442–443

type A/B (HNPCC type A/B), 92

Hereditary spherocytosis, 216

Heroin as breastfeeding contraindication, 133

Herpes genitalis (see Genital herpes)

Herpes simplex virus (HSV) infection

categories of, 224

diagnosis of, 224, 225

genital, 224, 271–273 (see also Genital herpes)

in pregnancy, 224–225, 225

screening recommendations for, 224t

sexual assault prophylaxis for, 331

type 1, 166, 224

type 2, 166, 224

Heteroploidy, altered chromosome number in, 81

Heterotopic pregnancy, 184–185

Hidradenoma of vulva, 403

High-grade squamous intraepithelial lesions (HSIL)

in Pap smears, 411, 412b, 415, 416

High-risk factors, 470t–471t

High-risk patients, periodic antenatal visits for, 66

Hilar cell tumors, 360

Hirsutism

androgen production and, 355–357, 356t, 357

androstenedione role in, 355, 356, 356t

causes of, 355

congenital adrenal hyperplasia and, 360–361

constitutional, 361–362

defined, 355

dehydroepiandrosterone sulfate role in, 355, 356t

evaluating extent and distribution of, 356, 356

familial, 355, 357

idiopathic, 355, 357

polycystic ovary syndrome and, 351, 357–360, 358

testosterone role in, 355, 359–360, 356t

History of present illness (HPI), 4

HIV (see Human immunodeficiency virus [HIV] infection)

HNPCC (see Hereditary nonpolyposis colorectal cancer [HNPCC])

Hormonal contraceptives, 239–244 (see also specific type)

benefits of, 239, 240

effects of, 240–241

implantable, 244, 245

injectable, 243–244, 244b

medication interactions with, 243

oral, 239–240

patch, 243, 243

in postpartum period, 132

pregnancy rates within first year, 244t

as protection against sexually transmitted diseases, 239

vaginal ring, 243, 243

Hormones

changes in, during pregnancy, 53, 54, 55, 58

postpartum physiology of, 133

Hormone therapy

after endometrial carcinoma treatment, 433

mastalgia and, 306

for menopause, 364, 369–370, 369b

Hospitalization

for gynecologic procedures, 318

for herpes simplex virus infection, 272

for molar twin gestations, 395

for pelvic inflammatory disease, 271, 271b

for postpartum care, 130–131

for preeclampsia, 209

for urinary tract infections, 285

Hot flushes in menopause, 364–365

Hot tub use during pregnancy, 72

hPL (see Human placental lactogen [hPL])

HPV (see Human papillovirus [HPV])

HSDD (hypoactive sexual desire disorder), 324t

HSV (see Herpes simplex virus [HSV] infection)

Hulka clip for female sterilization, 255, 258

Human chorionic gonadotropin (hCG)

during pregnancy, 53, 53

elevated, in hydatidiform mole, 394

embryonal cell carcinoma production of, 443–444

germ cell tumor production of, 443

in diagnosis

of ectopic pregnancy and, 179, 181

of pregnancy, 87, 197, 198

in genetic screening, 87, 88t

Human immunodeficiency virus (HIV) infection

as breastfeeding contraindication, 133

CD4 cells, depletion of, in, 274

drug therapy for, 275

incidence of, 274

methods of contracting, 275

perinatal transmission of, 228

in pregnancy, 227–228

management of, 228

pathophysiology of, 227

screening and testing during, 227–228

prevention of, 275

reduction of, in pregnancy, 274–275

screening recommendations for, 21, 224t, 227, 470t

sexual assault prophylaxis for, 332

spontaneous abortion related to, 185

types of, 274

untreated, latency period from, to acquired immune deficiency syndrome, 227

Human menopausal gonadotropins

for amenorrhea, 351

for infertility, 378

Human papillomavirus (HPV), 272–273

cervical cancer associated with, 409

cervical cancer risk with, 272

cervical dysplasia and, 273

cervical intraepithelial neoplasia associated with, 18, 409, 411

condyloma acuminata and, 228, 272–273, 273

diagnosis of, 273

management of, 273

DNA of, 411

testing for, 414, 415, 416, 418

genital wart lesions in, 228

immunization against, 267

incidence and prevalence of, 272

perinatal transmission of, 228

in pregnancy, 228

sexual assault prophylaxis for, 332t

subtypes of, 272

transmission of, 272

vulvar intraepithelial neoplasia associated with, 404

Human papillomavirus vaccine, 421

administration guidelines for, 421, 421b

for prevention of cervical neoplasia, 18

recommendations for, 19b

Human placental lactogen (hPL)

glucose metabolism and, 190

insulin requirements and, 193

insulin resistance and, 54

Human sexual response cycle

intimacy-based model of, 322, 322

traditional model of, 322, 322

Huntington disease, 80, 84–85

Hydatid cysts of Morgagni, 444

Hydatidiform mole, 393–396, 394t (see also Gestational trophoblastic neoplasia [GTN]

clinical presentation of, 393–395, 394, 395

complete vs.

description of, 393

fetal heart tones in, 394, 395

genetics of, 81, 393, 394t

incidence and prevalence of, 393

human chorionic gonadotropin in, 394–395

postevacuation, 395–396

hypertension related to, 395

invasive, 396

malignant transformation of, 396

methotrexate for, 390t

placental tissue replacement in, 393, 394t

postevacuation management of, 395–396

preoperative evaluation of, 395b

recurrence rate of, 393

treatment of, 395

twin pregnancies and, 395

ultrasound confirmation of, 393, 394, 394

Hydralazine (Apresoline) for pregnancy-related hypertension, 210, 211t

Hydramnios

maternal diabetes associated with, 190

as postpartum hemorrhage risk factor, 137, 137b

Hydrocele, 403

Hydrocephalus, 85

abnormal labor related to, 106, 107

Hydrocortisone cream (1%/2%) for vulvar diseases, 401

Hydronephrosis

with pelvic support defects, 278

with uterine leiomyomata, 424

Hydropic placental villi in hydatidiform mole, 393, 395

Hydrops fetalis

isoimmunization associated with, 219, 220

parvovirus infection as cause of, 231

Hydrotubae profluens, 445

Hydroureter

with pelvic support defects, 278

with uterine leiomyomata, 424

21-Hydroxylase deficiency in congenital adrenal hyperplasia, 360–361, 361b

Hydroxyzine hydrochloride (Atarax) for lichen simplex chronicus, 401

Hymen, anatomy of, 37, 38, 41, 347

Hyperbilirubinemia in newborns, 124

Hyperemesis gravidarum, 53

in pregnancy, 198

as hyperthyroidism cause, 194–195

Hypergonadotropic hypogonadism in delayed puberty, 346, 346b

Hyperkeratosis in vulvar diseases, 400t, 401, 404, 407

Hyperpigmentation during pregnancy, 54–55

Hyperplasia

adrenal gland (see Congenital adrenal hyperplasia)

endometrial, 427–430(see also Endometrial hyperplasia)

Hyperprolactinemia

amenorrhea associated with, 351

galactorrhea associated with, 351

Hyperreflexia

hydatidiform mole and, 395

in pregnancy-related hypertension, 208

Hypertension

chronic, 205

management of, 209

preeclampsia superimposed on, 205–206

defined, 23

gestational, 66, 206

preclampsia or eclampsia superimposed on, 207

hydatidiform mole associated with, 395

incidence of, 23

in pregnancy, 205–211

blood pressure dynamics in, 208, 208

classification of, 205–207, 206b

eclamptic seizures with, 206, 210–211

evaluation of, 208–209

HELLP syndrome, 207, 211

incidence of, 205

increased incidence of, in maternal diabetes, 191–192

laboratory assessment of, 209, 209t

management of, 209–211, 211t

multifetal gestation risk of, 206

pathophysiology of, 207–208

preeclampsia with, 206, 206b, 207, 209–210

screening recommendations for, 23

Hyperthecosis, 359–360

Hyperthyroidism, 194

treatment of, 194

Hyperviscosity syndrome in intrauterine growth restriction, 154–155

Hypoactive sexual desire disorder (HSDD), 324t

Hypoglycemia

during pregnancy, 54

effects on fetus, 176

neonatal, maternal diabetes as cause of, 191, 192

Hypogonadotropic hypogonadism in delayed puberty, 346–347, 346b

Hypomenorrhea, 349

Hypophosphatemia, 85

Hypothalamic-pituitary amenorrhea, 350, 350b

Hypothalamic-pituitary-gonadal axis

in abnormal pubertal development, 343–344

in normal pubertal development, 343

in precocious puberty, 344

Hypothalamic-pituitary-ovarian axis

menstruation control by, 337–338

suppression of, in uterine leiomyomata, 425

Hypothalamic thermoregulation, reproductive cycle and, 342

Hypothyroidism, 193

amenorrhea associated with, 351

neonatal, 194

treatment of, 194

Hypoxia, fetal heart rate changes with, 113, 114b

Hypoxic-ischemic encephalopathy, 113, 114b

Hysterectomy

abdominal, 317

for abnormal uterine bleeding, 353

for benign ovarian neoplasm, 438

for cervical cancer, 420

for chronic pelvic pain, 300

for endometrial hyperplasia/carcinoma, 429, 432–433

for endometriosis, 294

for hydatidiform mole, 294

indications for, 317

for interstitial (cornual) pregnancy, 184

laparoscopic, 318

for ovarian carcinoma, 443, 444

for pelvic support defects, 281

premature ovarian failure related to, 368

for retained placenta, 141

subtotal, 317

supracervical, 317

total, 317

total laparoscopic, 318

for uterine rupture, 142

for uterine sarcoma, 434

vaginal, 317

laparoscopic-assisted, 317–318

for vaginal cancer, 407

Hysterosalpingography (HSG), 313, 313

for infertility evaluation, 373t, 373, 374, 375b, 425

to prove efficacy of sterilization device, 256

Hysteroscopy, 315, 315

for endometrial hyperplasia, 425, 429, 429

for infertility evaluation, 375, 375b, 376

for sterilization, 256–257, 257

for uterine leiomyomata, 423

Ibandronate for osteoporosis, 333, 367t

Ibuprofen for dysmenorrhea, 297

Identical (monozygotic) twins, 145

Ifosfamide

as antineoplastic drug, 388t, 390t, 446

for ovarian carcinoma, 446

Imaging studies (see specific modality)

Imidazoles for vulvovaginal candidiasis, 262

Imidazo-quinolones for vulvar intraepithelial neoplasia, 404

Imiquimod

for human papillomavirus, 228

for vulvar intraepithelial neoplasia, 404

Immature teratoma, 443

Immune system, recurrent pregnancy loss related to, 186–187

Immunity, passive, 59

Immunizations

for hepatitis A virus infection, 226

for hepatitis B virus infection, 226

in immediate postpartum period, 132

recommended, 18, 19b

for varicella infection, 230–231

Immunoglobulins (Ig)

IgD, fetal production of, 59

IgE, fetal production of, 59

IgG

fetal production of, 59

in isoimmunization, 222

placental transfer of, 59

IgM

fetal production of, 59

in isoimmunization, 222

Immunology of pregnancy, 58–59

Immunosuppression, as cervical intraepithelial neoplasia risk factor, 411

Imperforate anus, 124

Imperforate hymen, 347

Implantable contraceptive rods, 244, 245

pregnancy rates within first year, 244t

Implantation bleeding, 186

Inclusion cysts

of vagina, 407

of vulva, 403

Incomplete abortion, 186, 188

Incontinence (see Urinary incontinence)

Indomethacin for preterm labor, 76t

Induced abortion, 187–188

complications of, 187–188

medical vs.

Induced labor for postterm pregnancy, 177–178

Induction chemotherapy, 389

Inevitable abortion, 186

Infection(s) (see also specific infection)

of breast tissue, 131, 131t

cytomegalovirus, 229–230

of episiotomy, 132

intrauterine, in premature rupture of membranes, 171, 172

maternal diabetes and, 193

parvovirus, 231

in pregnancy, 223–231

chlamydia, 229

gonorrhea, 229

group B streptococcus, 223–224

hepatitis, 225–227, 226b

herpes, 224–225, 225

HIV/AIDS syndrome, 227–228

human papillomavirus, 228

preterm labor associated with, 159–160

rubella, 225

syphilis, 228–229, 229

postabortal, 188

with prolonged labor, 107

sexually transmitted (see Sexually transmitted diseases [STDs])

spontaneous abortion related to, 185

toxoplasmosis, 230

varicella, 230–231, 231

Infertility, 371–380

abnormal spermatogenesis, 376–377, 377t

anatomic factors, 374–376, 400

anovulation, 371, 372, 357

assisted reproductive technologies for, 378, 379

causes of, 372–376

pelvic inflammatory disease, 261, 269–270

sexually transmitted diseases, 267

conception rates and, 371, 372

counseling for, 380

diagnostic procedures for, 373t

basal body temperature, 373, 373

chromotubation, 376

genetic testing, 377

hysterosalpingography, 374–375, 375, 375b, 376

hysteroscopy, 375b, 375–376

laparoscopy, 375b, 375–376

luteal-phase endometrial biopsy, 373

microsurgical epididymal sperm aspiration, 377

ovulatory dysfunction, 374

percutaneous epididymal sperm aspiration, 377

postcoital test, 376

saline-infusion sonography, 375b

semen analysis, 376, 376t

serum progesterone levels, 373

transvaginal ultrasonography, 375b

urine LH kits, 373, 378

ectopic pregnancy related to, 180

emotional issues in, 371

with endometriosis, 289

etiology of, 371, 372

evaluation scheme for, 372–376, 373t

hydatidiform mole associated with, 393

incidence of, 371

intrauterine insemination for, 378–379, 379

obstetric history and, 6

ovarian stimulation for, 378

reproductive age in, 371

treatment of, 378–380

unexplained, 377–378

uterine leiomyomata and, 426

Inflammatory bowel disease, adnexal space and, 435

Influenza, 213

Informed consent

patient autonomy and, 29

for surgical procedures, 313

Inframammary ridge, 11

Infundibulopelvic ligament, 41

Inheritance patterns, 84–85, 84b

autosomal dominant disorders and, 84–85, 84b

autosomal recessive disorders and, 85, 84b

mitochondrial, 85

multifactorial disorders, 85

X-linked disorders and, 85, 85b

Insertion(s)

as chromosome structure abnormality, 81, 84t

as deoxyribonucleic acid replication errors, 80

intrauterine devices, 247, 250, 251

Insulinase, glucose metabolism and, 190

Insulin resistance during pregnancy, 54

Insulin therapy for diabetes mellitus

during labor, 191

postpartum, 193

during pregnancy, 190

Interferon injections, intralesional, for condyloma acuminata, 273

Intermenstrual bleeding, 5

Internal rotation, fetal, during labor, 97, 98

International Federation of Gynecology and Obstetrics (FIGO)

cervical cancer staging, 418, 419b

endometrial carcinoma staging, 432, 433b

fallopian tube carcinoma staging, 445, 445t

metastatic gestational trophoblastic disease staging, 396, 397t

ovarian carcinoma staging, 441, 442t

vaginal cancer staging, 407, 408t

vulvar cancer staging, 406, 406t

International Society for the Study of Vulvar Disease (ISSVD)

classification of vulvar dermatosis, 399, 402t

grading system for vulvar intraepithelial neoplasia, 404, 404t

Interspinous diameter of pelvis, 39, 40

Interstitial implants for radiation therapy, 391

Interstitial pregnancy, 184

Intestines, displacement of, during pregnancy, 52

Intimacy-based model of human sexual response cycle, 322, 322

Intracavitary devices for radiation therapy, 391

Intracytoplasmic sperm injection, 377, 379

Intrahepatic cholestasis of pregnancy, 198–199

Intramural leiomyomata, 423, 423, 424(see also Leiomyomata, uterine)

Intrapartum care

fetal surveillance, 113

ancillary tests for, 118, 118

cerebral palsy, 114

fetal heart rate monitoring, 114, 116–117, 115t, 116b, 116t, 117

neonatal encephalopathy, 113–114

maternal labor, 93–104

changes before onset of, 93, 94

evaluation for, 93–96, 95, 96

first stage of, 96, 97, 97t, 100

fluid management for, 99

fourth stage of, 96, 102–103

induction of, 103, 103

management of, 100–103

mechanism of, 96–97, 98

oral intake during, 99

pain control during, 99

positions for, 97–99

second stage of, 96, 97, 97t, 100–102, 101, 102

stages of, 96, 97, 97t

third stage of, 96, 102, 102, 103t

Intrauterine compression for postpartum hemorrhage, 138b, 140, 140

Intrauterine contraception, 237–238, 247–250, 247

Intrauterine devices (IUDs), 247–250, 247

contraindications for, 248–249b

ectopic pregnancy related to, 180, 250

for emergency contraception, 248

expulsion of, 248

indications for, 248–249b

infection related to insertion of, 247

insertion techniques for, 247

lifespan of, 248

pregnancy rates within first year, 238t

removal of, 250

risk factors, 250

sexually transmitted infections and, 247

side effects of, 248

timing of insertion of, 247

types of, 247–248, 247

Intrauterine fetal demise, maternal diabetes as risk factor for, 190

Intrauterine growth restriction (IUGR), 151–156

defined, 151, 151t

diagnosis of, 153–154, 153, 154

etiology of, 152–153

fetal factors in, 153

management of, 154–155

with maternal chronic renal disease, 202

with maternal diabetes, 191

maternal factors in, 153

with maternal hypertension, 208, 210

morbidity and mortality associated with, 152

neonatal management of, 154–155

pathophysiology of, 152

placental factors in, 153

risk factors associated with, 152b

significance of, 152

Intrauterine pressure catheter (IUPC) for uterine contraction evaluation, 105–106, 106

Intrauterine pressure monitoring during labor, 105–106, 106

Intrauterine synechiae, spontaneous abortion related to, 185

Intravenous pyelography of renal system, 77t

Introitus, inspection of, 12

Inversion as chromosome structure abnormality, 81–82

paracentric, 81–82

pericentric, 82

In vitro fertilization (IVF), 376

incidence of, 379

indications for, 379

process of, 379, 379

Ionizing radiation, principles of, 74, 389

Iron-deficiency anemia

in pregnancy, 215–216, 216

uterine leiomyomata associated with, 424

Iron supplementation

for iron-deficiency anemia, 215–216

pregnancy recommendations for, 50, 73

red cell mass and, 50

Irritable bowel syndrome

chronic pelvic pain associated with, 298–299

gonadotropin-releasing hormone agonists for, 299–300

Rome III criteria for, 299–300

Irritant dermatitis

clinical characteristics of, 402t

vulvar dermatitis associated with, 400t, 401

Ischial spine in labor evaluation, 95–96, 96, 97

Isoflavones for menopause, 369

Isoimmunization, 218–222

assessment of, 220–221, 220

description of, 218

diagnosis of, 219–220

irregular antibody management in, 222

management of, 221

natural history of, 218–219, 218t

prevention of, 221–222

Isotretinoin, teratogenesis associated with, 76t

ISSVD (see International Society for the Study of Vulvar Disease [ISSVD])

IUDs (see Intrauterine devices [IUDs])

IUPC (intrauterine pressure catheter) for uterine contraction evaluation, 105, 106

IVF (see In vitro fertilization [IVF])

Jarisch-Herxheimer reaction, 229

Jaundice in newborns, 124

Justice, ethics of, 26t, 27

Kallmann syndrome, 346–347

Kaplan, human sexual response cycle and, 322, 322

Karyotype/karyotyping, 80, 81–82, 91

of hydatidiform mole, 393, 394t

for intrauterine growth restriction, 154

recurrent pregnancy loss indication for, 186

Kegel exercises, 130, 283, 298, 366

Kell antigen in isoimmunization, 218t, 222

Kernicterus, 124, 219

Kick counts, 69, 148 (see also Fetal movement)

Kidneys

fetal, 56, 57, 58

physiologic changes in, during pregnancy, 49

ptotic, in adnexal space, 435

Kleihauer-Betke test, 203, 221

for fetal-maternal hemorrhage, 166, 221

Klumpke paralysis, fetal, postterm pregnancy related, 176

Krukenberg tumor, 444

Labetalol for pregnancy-related hypertension, 210, 211t

Labia majora

anatomy of, 40, 40

embryology of, 37, 38

inspection and examination of, 12

Labia minora

anatomy of, 40, 40

embryology of, 37, 38

inspection and examination of, 12

in sexual response, 323

Labioscrotal swellings, 37, 38

Labor, 93–102

abnormal, 105–110, 110

active phase of, 96, 97t

ambulation during, 97–99

cardiac patient and, 211

cardinal movements of, 96–97, 98

changes before onset of, 93

continuous support during, 109

benefits of, 109

evaluation for, 93–96, 95, 96

factors that contribute to, 105–107

false, 93

first stage of, 96, 97, 97t, 100

fluid management for, 99

fourth stage of, 96, 102–103

induction of, 103, 103

oxytocin administration for, 103, 108

latent phase of, 96, 97t

management of, 100–103

mechanism of, 96–97, 98

oral intake during, 99

pain control during, 99

positions for, 97–99

preeclampsia management during, 210

prolonged, complications associated with, 107

second stage of, 96, 97, 97t, 100–102, 101, 102

spontaneous, in premature rupture of membranes, 171

stages of, 96, 97, 97t

third stage of, 96, 102, 102, 103t

true, 93

Laboratory testing

in antepartum evaluation, 62, 63, 64t–65t, 68

in labor management, 131

in pregnancy-related hypertension, 209, 210

in sexual assault, 331, 332, 332t

Lacerations

of lower genital tract, postpartum hemorrhage due to, 141

obstetric

classification of, 103t

during vaginal delivery, 101, 102

vaginal, fetal macrosomia risk for, 273

Lactation (see Breastfeeding)

Lactational amenorrhea, 134, 251

Laminaria for cervical ripening, 103, 103

Lanugo, 118

Laparoscopic hysterectomy, 318

Laparoscopy, 316, 317, 317

complications of, 316

for ectopic pregnancy diagnosis, 183

for infertility evaluation, 375–376, 375b, 378

sterilization by, 254–255, 255

Large for gestational age, 155 (see also Macrosomia)

risk factors for, 155b

implications of, 69

Large loop excision of the transformation zone (LLETZ) of cervix, 316, 316, 417

Laser surgery for condyloma acuminata, 273

Laser therapy (see also Ablation therapy)

for endometriosis, 294

vaporization, 315

Latent phase of labor, 96, 97t

prolonged, 108

protraction disorder in, 108, 108t

Latex agglutination tests for vulvovaginal candidiasis, 261–262

Lecithin/sphingomyelin (L/S) ratio, fetal lung maturity based on, 71, 71b

LEEP (loop electrosurgical excision procedures) of cervix, 315, 316, 316, 409, 415, 417–418

Leg cramps during pregnancy, 78

Leiomyomata, uterine, 423–426

common types of, 423, 424

conservative surgery for, 423

diagnosis of, 424–425

dysmenorrhea associated with, 296, 296b, 424

enlargement estimation of, 424

hysterectomy for, 425–426

incidence and prevalence of, 423

multiple, 424

origins of, 423

pathology of, 423

pregnancy with, 426

symptoms of, 424

treatment of, 425–426

Leiomyomata uteri

as dysmenorrhea cause, 296

submucous, spontaneous abortion related to, 186

Leiomyosarcoma, 423

Leopold maneuvers

for breech presentation diagnosis, 68, 111

to determine fetal position, 111

in fetal macrosomia diagnosis, 155–156

in labor evaluation, 94

Lesser pelvis (true pelvis), 37, 39

Leukocyte count (see White blood cell count)

Leukocytosis in postpartum period, 130

Leukorrhea of pregnancy, 55

Levofloxacin

for chlamydial infection, 269

for urinary tract infections, 285

Levonorgestrel

in emergency contraceptives, 251

in intrauterine device, 247, 247, 248–249b

in oral contraceptives, 240

Levothyroxine, 194

Lichenoid histologic pattern, 400, 400t

Lichen planus of the vulva, 401

characteristics of, 400, 401

clinical characteristics of, 402t

diagnosis of, 401

histologic pattern in, 400t, 401

treatment of, 401

Lichen sclerosus of the vulva, 399–401

acanthosis coexistence with, 401

anatomic changes in, 400

cancer risk with, 401

clinical characteristics of, 402t

common sites for, 400

epithelium in, 400, 400

etiology of, 400–401

histologic pattern in, 400, 400t

hyperkeratosis in, 401

treatment of, 401

Lichen simplex chronicus of the vulva, 401

causative factors in, 401

clinical characteristics of, 402t

clinical findings in, 400, 401

description of, 401

histologic pattern in, 400t

prognosis for, 401

treatment of, 401

Licorice, real, antepartum use of, 74

Lidocaine for herpes simplex virus infection, 272

Lie, fetal, in labor evaluation, 94

Ligaments in uterine anatomy, 41, 42

Lightening, 93

Linea alba, 55

Linea nigra, 55

Linear salpingostomy for ectopic pregnancy, 184, 184

Lipase, serum, during pregnancy, 53

Lipid disorders, screening recommendations for, 23

Lipid (lipoid) cell tumors, 360

Lipid metabolism during pregnancy, 54

Lipid peroxides in pregnancy-related hypertension, 207

Lipid profile assessment, high-risk factor for, 471t

Lipomas of vulva, 403

Listeria monocytogenes, spontaneous abortion related to, 185

Lisuride maleate for mastalgia, 306

Lithium

as breastfeeding contraindication, 133

teratogenesis associated with, 76t

Lithotomy position, 12, 12

for vaginal delivery, 98

Liver, fetal, 58

Liver function during pregnancy, hypertension effects on, 201

LLETZ (large loop excision of the transformation zone) of cervix, 316, 316, 417, 417

Lobular carcinoma in situ (LCIS), 306t, 307, 308t

Local block in labor management, 99, 100

Local irradiation, 390

Localized vulvodynia, 403

Lochia, postpartum discharge of, 129–130

Loop electrosurgical excision procedures (LEEP) of cervix, 315, 316, 316, 409, 417–418

Low-grade squamous intraepithelial lesions (LSIL) in Pap smears, 412, 412b, 413t, 414, 415

Low operative vaginal delivery, 110

L/S (lecithin/sphingomyelin) ratio, fetal lung maturity based on, 71, 71b

Lumbar lordosis during pregnancy, 54

Lumpectomy, 309, 309t

Luteal-phase cyst, 437

Luteal phase defect, abnormal uterine bleeding and, 352

Luteal phase endometrial biopsy, 373

Luteal phase of reproductive cycle, regular changes associated with, 372, 373 (see also Premenstrual syndrome [PMS])

Luteinization, 340

Luteinizing hormone (LH)

in abnormal pubertal development, 344, 346, 346b

dysfunctional secretion of, amenorrhea related to, 350

in endometriosis management, 291

in infertility evaluation, 373, 373

menstruation control by, 337–338, 338

estradiol feedback role in, 338, 338

phase II physiology, 340

phase III physiology, 340

urine, in infertility evaluation, 373

Lymphadenectomy, pelvic

for vaginal cancer, 407

for vulvar cancer, 406, 407

Lymph node dissection

for cervical cancer, 420

for vulvar cancer, 406

Lymph nodes

common iliac, endometrial carcinoma involvement of, 433

fallopian tube carcinoma spread to, 445

ovarian carcinoma spread to, 443, 445

vulvar cancer involvement of, 406

Lymphogranuloma venereum (LGV)

abscess in, 275

diagnosis of, 266t

presentation of, 266t

prevalence of, 266t

sexual transmission of, 275

Lymphoma of ovary, 444

Lynch I/II syndrome, 92

Lynch syndrome, ovarian carcinoma associated with, 440

Macrosomia, fetal, 155–156

defined, 155

diagnosis of, 155–156

differential diagnosis of, 156

fetal factors associated with, 155

gender prevalence in, 155

management of, 156

maternal diabetes associated with, 190, 192

maternal factors associated with, 155

neonatal risks in, 155

with postterm pregnancy, 176

significance of, 155

Magnesium sulfate

for eclamptic seizures, 210

for preeclampsia, 210, 210t

for preterm labor, 160t, 161

contraindications to, 160t, 161

toxicity, calcium gluconate for, 210

Magnetic resonance imaging (MRI), 313

for breast cancer, 304

breast cancer screening and, 20

for endometriosis, 291

of uterine leiomyomata, 425

Maintenance chemotherapy, 389

Mammography, 313, 313

diagnostic, 303, 303

high-risk factor for, 471t

screening

BI-RADS classification of, 303–304, 304t

limitations of, 303

mass detection rates for, 303, 303

recommendations for, 20, 310

Marfan syndrome, 84, 86

maternal, as pregnancy contraindication, 211

Marijuana as breastfeeding contraindication, 133

Marital rape, 329

“Mask of pregnancy,” 55

Mastalgia, 305–306

cyclic, 305

extramammary pain in, 306

noncyclic, 305

treatment of, 306

Mastectomy, 309, 309t

Masters and Johnson, human sexual response cycle and, 322, 322

Mastitis, postpartum, 131t, 132

Mastodynia in premenstrual syndrome, 381

Maternal age, advanced, as genetic disorder risk factor, 86, 86t

Maternal-fetal conflicts, 28

Maternal-fetal physiology, 47–59

Maternal-infant bonding, immediate postpartum, 131

Mayer-Rokitansky-Kuster-Hauser syndrome, 347

McCune-Albright syndrome, 345, 345b

McRoberts maneuver for shoulder dystocia, 112, 113

Meconium, 100, 118–119

passage of, 76, 178

Meconium aspiration syndrome, 118–119

with postterm pregnancy, 176, 178

Medical conditions

intrauterine growth restriction associated with, 153

sexual dysfunction related to, 325, 376, 470b

Medical history

ACOG Woman’s Health Record, 3, 447–464

chief complaint and, 4

family history and, 4

follow-up and, 16

gynecologic history and, 5–6

history of present illness, 4

medical record and, 3

obstetric history and, 6

past history and, 5

review of systems and, 6, 7b

social history and, 6

Medical liability, 28–29

certificate of merit, 29

counseling, 29

expert witnesses, 29

informed consent, 29

maloccurrence vs. malpractice, 29

plaintiff(s), 29

Medical record

ACOG Women’s Health Record and, 3, 447–464

medical history and, 3

Medications

intrauterine growth restriction associated with, 153

oral contraceptive interactions with, 243

risk factor categories for use during pregnancy and breastfeeding, 74

sexual dysfunction related to, 325, 325b

teratogenicity of, 74, 74b, 75t–76t

Medroxyprogesterone acetate

for abnormal uterine bleeding, 353

benefits of, 244

concerns about, 244

for contraception, 243, 244b

contraindications for, 244, 244b

efficacy of, 244, 244t

for endometriosis treatment, 291

indications for, 244b

as postpartum contraceptive, 132

pregnancy rates within first year, 244t

Mefenamic acid for dysmenorrhea, 297

Megestrol as antineoplastic drug, 389

Meigs syndrome, 440

Meiosis, 80–81

first division in, 80–81, 82, 83

second division in, 81, 82, 83

Melanocyte-stimulating hormone, hyperpigmentation and, 54–55

Melanoma of vulva, 406–407

Melasma during pregnancy, 55

Melphalan as antineoplastic drug, 388t

Membrane manipulation, for labor induction, 103

Menarche

menstrual history and, 5

normal onset of, 343

Mendelian disorders, 84, 84b

Meningitis, group B streptococcus as cause of, 223

Meningococcal vaccination, high-risk factor for, 471t

Menopause, 363–370

average vs.

cardiovascular lipid changes in, 367

defined, 5, 363

effects of, 365

female life expectancy and, 2, 363, 364

genital tract atrophy in, 365–366

hormone therapy for, 369

alternatives to, 369–370

cautions in, 369

contraindications to, 369, 369b

hot flushes in, 364–365

lifestyle changes for, 369–370

management of, 368–369

memory changes in, 366

menstrual cycle alterations in, 364

menstruation and, 363–364, 364t

mood changes in, 366

osteoporosis in, 366–367, 366b, 367, 367t

premature, 363

premature ovarian failure in, 367–368

signs and symptoms of, 364–367, 364t, 365, 366b, 367

skin, hair, and nail changes in, 366

sleep disturbances in, 365

systemic effects of, 364, 365

vaginal dryness in, 365–366

vasomotor instability in, 364–365

Menorrhagia, with uterine leiomyomata, 350b, 424

Menses (see Menstruation)

Menstrual cycle, menopausal alterations in, 364

Menstrual history

in gestational age assessment, 62, 66

in health evaluation, 5

Menstruation

absence of (see Amenorrhea)

in diagnosis of pregnancy, 63

feedback and control of, 337, 338

in health evaluation, 5

menopause and, 363–364, 364t

painful (see Dysmenorrhea)

phase, in reproductive cycle, 339

retrograde, as endometriosis theory, 287–288

Mentum anterior presentation in abnormal labor, 106

Mercury levels in fish, 74

Mesoderm, embryonic intermediate, 33

Mesodermal sarcomas, malignant ovarian, 444

Mesonephric ducts

development of, 35, 36, 36

remnants of, 44–45, 45

Mesosalpinx, benign disease of, 444

Mesovarium, 35, 44

Messenger RNA (mRNA), 80

Metabolic changes during pregnancy, 55

Metabolic disorders, screening recommendations for, 22–24

Metabolic syndrome, polycystic ovary syndrome and, 358–359

Metaphase as mitosis stage, 80, 81

Metastatic carcinoma

to fallopian tube, 444–445

to ovary, 445

Metformin, 192

for polycystic ovary syndrome, 359

Methimazole, 194

Methotrexate

as antineoplastic drug, 396, 388t, 390t

as breastfeeding contraindication, 133

for choriocarcinoma, 397

for ectopic pregnancy, 183

for medical abortion, 187

teratogenesis associated with, 76t

Methyldopa for pregnancy-related hypertension, 209, 211t

Methylergonovine maleate (Methergine)

for postpartum hemorrhage, 102

for spontaneous abortions, 187

for uterine atony, 138b, 140

Metronidazole

for bacterial vaginosis, 261

for sexual assault, 332t

teratogenesis associated with, 75t

for trichomonas infections, 262

Meyer’s theory of endometriosis, 287

Miconazole for vulvovaginal candidiasis, 262

Microhematuria, 202

Microsurgical epididymal sperm aspiration (MESA) for infertility, 377

Midpelvis operative vaginal delivery, 110

Mifepristone (RU-486) for medical abortion, 187

Migraine headaches, 233–234

Mineral supplements for pregnancy, 73

Minilaparotomy

postpartum, 132

for tubal ligation, 255–256

Pomeroy technique for, 255–256, 256

“Minipill,” 240

pregnancy rates within first year, 244t

Mirtazapine, sexual response and, 325

Miscarriage (see Spontaneous abortion)

Misoprostol

for labor induction, 103

for medical abortion, 187

for postpartum hemorrhage, 102, 138b, 140, 177

Missed abortion, 186

Missense mutations as deoxyribonucleic acid replication errors, 80

Mitochondrial inheritance, genetic disorders and, 85

Mitomycin for vulvar cancer, 406

Mitosis, stages of, 80, 81

Mitral stenosis in pregnancy, 211, 212

“Mittelschmerz,” 340, 372

Mixed urinary incontinence, 282 (see also Urinary incontinence)

MMR vaccination, high-risk factor for, 471t

Modified biophysical profile for fetal well-being assessment, 177

Molar pregnancy, 394–395 (see also Hydatidiform mole)

chemotherapy for, 390t

Molding of fetal head, 101, 101

Molluscum contagiosum, 275

Monoamnionic/monochorionic gestation, 145, 146

Monoamniotic twins, 147

Monozygotic (identical) twins, 145

Mons pubis

anatomy of, 40, 40

inspection and examination of, 12

Montevideo units, 106

Montgomery glands, enlargement of, during pregnancy, 55

Mood changes in menopause, 366

Mood disorders, postpartum, 134, 134t

“Morning sickness,” 53, 78

Mortality, sources of leading causes of, 467

Mosaicism, 81

MRI (see Magnetic resonance imaging [MRI])

MRI-guided focused ultrasound surgery for uterine leiomyomata, 426

mRNA, 80

Mucinous cystadenocarcinoma of ovary, 441

Mucinous cystadenoma of ovary, 438, 438b, 439

Mucinous endometrial carcinoma, 432t

Müllerian agenesis, 44, 44, 347

Müllerian ducts

anomalies of, 44

development of, 36, 37

Multifactorial inheritance, genetic disorders and, 85

Multifetal gestation, 145–149

antenatal management of, 148, 148t

diagnosis of, 147–148

incidence of, 145

intrapartum management of, 148–149, 149

morbidity and mortality in, 145–146, 147t

natural history of, 145, 146

preterm labor risk with, 157, 158b

risks of, 145–147, 147t

Multigravida, 6b

Multipara, 6b

Multiple sclerosis (MS), during pregnancy, 234

Muscles of vulva, 40, 40

Musculoskeletal system, physiologic changes in, during pregnancy, 54

Mutation, deoxyribonucleic acid replication errors and, 80

Mycoplasma hominis, spontaneous abortion related to, 185

Myolysis for uterine leiomyomata, 426

Myomas (see Leiomyomata, uterine)

Myomectomy for uterine leiomyomata, 425–426

during pregnancy, 426

vaginal birth after, 426

Myometrial invasion, depth of, as prognostic factor for endometrial carcinoma, 432

Myometrium of uterine wall, 41, 42

NAATs (nucleic acid amplification tests), 21, 267

Nabothian cysts, 410, 411, 377

Naegele’s rule, 66

Nails, menopausal changes in, 366

Naloxone, contraindication of, in newborn resuscitation, 125

Naproxen for dysmenorrhea, 297

Natural family planning, 238t

pregnancy rates within first year, 244t

Nausea of pregnancy, 53, 197–198, 198, 199b, 200

antepartum care for, 78

Nefazodone, sexual response and, 325

Neisseria gonorrhoeae, 269–270 (see also Gonorrhea)

Neoadjuvant chemotherapy, 389

Neonatal death with preterm labor, 157–158

Neonatal encephalopathy, 113, 114b

Neonatal herpes infection, 224

Neonatal intensive care management, 158

Neonatal resuscitation, 124–125

airway management in, 125

algorithm for, 124

Neoplasia

adnexal, 425

adrenal, 360

ovarian, 360, 437–444

uterine leiomyomata and, 423–426

Nephrolithiasis, 202

Neural tube defects

folic acid for prevention of, 61, 89, 216

incidence of, 89

as multifactorial disorders, 85

prenatal screening for, 89

Neurofibromatosis, 84, 86

Neurologic disorders, during pregnancy, 233–234

Neurologic system, pregnancy-related hypertension effects on, 208

Neurotransmitters in female sexual response, 322–323

Nevi

skin, during pregnancy, 55

vulvar, 403–404

Newborn(s) (see also Neonatal entries)

antibody development effects on, 219

characteristics of, who do not require resuscitation, 121

conjunctivitis, chlamydia infection as cause of, 229

group B streptococcus infection in, 223

ill, initial care of, 124–126, 124, 125

jaundice, 124

resuscitation of, 124–125, 124, 125

routine care of, 123, 125

transitional care of, 123–124

umbilical cord blood banking and, 125–126

immediate care of, 121–127

immunization, 132

prophylaxis for gonococcal ophthalmia neonatorum, 123, 229

stool, 123–124

voiding pattern observation, 123–124

screening for, 127

syphilis in, 228–229, 229

umbilical cord blood gases and, 125, 125t

well, initial care of, 121, 123

Apgar scoring system and, 121, 123, 123t

Ballard scoring system, 212, 123

delivery room assessment of, 121, 122, 123t, 123

gestational age estimation of, 121, 122

male circumcision, 126–127, 127

New York Heart Association heart disease classification, 211, 212t

Niemann-Pick disease, 87

Nifedipine

for pregnancy-related hypertension, 209, 211t

for preterm labor, 161

contraindications to, 160t

Night sweats, 365

Nipple(s)

care of, during breastfeeding, 134

physiologic changes in, during pregnancy, 55

Nipple discharge, benign vs.

Nitrazine test, 170

false results in, causes of, 170t

Nitrofurantoin

for asymptomatic bacteriuria, 201

for pyelonephritis, 201

teratogenesis associated with, 75t

for urinary tract infections, 285

Noncoital sexual pain disorder (NSPD), 324t

Nondisjunction in cell division, 81, 83

Nonmaleficence, ethics of, 26t, 27

Nonnucleoside reverse transcriptase inhibitors (NNRTIs) for HIV/AIDS syndrome, 275

Nonsense mutations as deoxyribonucleic acid replication errors, 80

Nonsteroidal anti-inflammatory drugs (NSAIDs)

for dysmenorrhea, 289

for endometriosis, 287

for menstrual pain, 5

for premenstrual syndrome, 385

teratogenesis associated with, 76t

Nonstress test (NST) for fetal well-being assessment, 69, 70, 70, 71t, 177, 209

Nontreponemal screening tests for syphilis, 22, 229, 274, 274b

Norethindrone

in oral contraceptive preparations, 239

for menopause, 368–369

Norethynodrel in oral contraceptive preparations, 239

Norfloxacin for urinary tract infections, 285

Norgestimate in oral contraceptive preparations, 239, 240

Norgestrel in oral contraceptive preparations, 239

19-Nortestosterones in oral contraceptive preparations, 239

NSAIDs (see Nonsteroidal anti-inflammatory drugs [NSAIDs])

NSPD (noncoital sexual pain disorder), 324t

NST (nonstress test) for fetal well-being assessment, 69, 70, 70, 71t, 177, 209

Nuchal transparency

in genetic screening, 87, 87, 88t

ultrasound measurement of, 68

Nucleic acid amplification tests (NAATs), 21

for chlamydial infection diagnosis, 267

Nucleoside reverse transcriptase inhibitors (NRTIs)

for HIV/AIDS syndrome, 275

Nulligravida, 6b

Nullipara, 6b

Nutrition during pregnancy

diabetes mellitus and, 193

for multifetal gestation, 148, 148t

recommendations for, 72–73

NVP (see Nausea of pregnancy; Vomiting of pregnancy)

Obesity

as breast cancer risk factor, 308

periodic assessment for, 23–24, 23b

polycystic ovary syndrome associated with, 357–358, 359

Oblique presentation, antepartum evaluation of, 68

Obstetrical conjugate of pelvis, 37, 39

measurement of, 39

Obstetric history in health evaluation, 6

Obstetrics

as branch of medicine, 2

evolution as specialty care, 2

Obstructive sleep apnea (OSA), 24

Occipitoposterior fetal position in abnormal labor, 106

rotation of fetus in, 109, 109

OCT (oxytocin challenge test) for fetal well-being assessment, 69

Ofloxacin for chlamydial infection, 269

Oligohydramnios

heart rate changes associated with, 117

with materal hypertension, 208, 209

postterm pregnancy complications and, 176

Oligomenorrhea, 349

Oligospermia, 377, 377t

Oliguria in postpartum hemorrhage, 138, 206

Omentectomy for ovarian carcinoma, 446

Oocyte(s)

decrease in number of, 363

development of, 34

genetic sex determination and, 33

selection process for, 363

Oogonia, development of, 34

Oophorectomy

for benign ovarian neoplasm, 438

for ovarian carcinoma, 441, 443

for premenstrual dysphoric disorder, 386

Operative delivery, 110–111, 110, 111

classification of, 110

contraindications for, 110

incidence of, 110

indications for, 110

techniques for, 110–111, 110, 111

uterine rupture risk in, 142

Ophthalmia neonatorum, gonococcal, prophylaxis for, 123, 229

Ophthalmic changes during pregnancy, 55

Oral contraceptives, 239–244

for abnormal uterine bleeding, 353

benefits of, 239, 240

combination

contraindications for, 241, 241b

patient evaluation for, 239–240

complications related to, 240

for constitutional hirsutism, 361

for dysmenorrhea, 297

effects of, 240–241

emergency, 248

for endometriosis treatment, 291

iatrogenic androgen excess from, 362

incidence and prevalence of use of, 239

management of new symptoms with, 241b

for mastalgia, 306

mechanisms of action of, 239–240

for ovarian carcinoma prevention, 440

for polycystic ovary syndrome, 359

in postevacuation hydatidiform mole management, 396

pregnancy rates within first year, 244t

for premenstrual syndrome, 385

progestin-only, 240

Oral hypoglycemic agents, 192–193

Oral intake in labor management, 99

Organization of Teratology Information Services, 74

Orthostatic changes in postpartum hemorrhage, 137

OSOM Trichomonas Rapid Test, 262

Osteopenia, incidence of, 22

Osteoporosis

incidence of, 22

in menopause, 366–367

nonhormonal therapy for, 366–367, 367t

preventive measures for, 22

risk factors for, 23, 367, 367b

for fractures in, 22b

screening recommendations for, 22

structural bone changes with, 367, 367

Outlet operative vaginal delivery, 101, 110

Ovarian carcinoma, 441–44

adjunctive therapies for, 445

borderline, 441

chemotherapy for, 390t, 445

diagnosis of, 440–441

delayed, 440

early warning signs of, 441, 441b

epidemiologic factors associated with, 440

epithelial cell, 441

spread mechanisms of, 441

follow-up of, 444

functioning, 444

gene therapy for, 391

genetics of, 443, 444

germ cell, 443, 443

gonadal stromal cell, 444

histologic classification of, 437b, 441

incidence and prevalence of, 440

metastatic, 444

mortality and survival rates for, 440

other, 444

pathogenesis of, 440

prevention of, ovulation suppression for, 440

radiation therapy for, 446

risk factors for, 440

screening recommendations for, 91–92

staging of, 441, 442t

surgical management of, 445

symptoms of, 440

tumor vaccines for, 391

Ovarian cysts, functional, 436–437

corpus luteum, 436–437

follicular, 436

theca lutein cyst, 437

Ovarian dysgenesis, 44

Ovarian endometriomas, 289, 290

Ovarian failure, 350

causes of, 351b

Ovarian hyperstimulation, controlled, for infertility, 378

Ovarian hyperstimulation syndrome, 378

Ovarian ligament, embryology of, 34, 35, 36

Ovarian masses in pregnancy, 203

Ovarian neoplasms, 360, 437–445

benign, 437–440

categories of, 437, 437b

epithelial cell, 437–438, 438b, 438, 439

functional cystic, 437

germ cell, 438–440, 437b, 439

incidence and prevalence of, 437

key points regarding, 440

stromal cell, 437b, 440

histologic classification of, 437, 437b

life cycle related to, 327

malignant, 440–444 (see also Ovarian carcinoma)

Sertoli–Leydig cell tumors, 360

surgical management of, 445–446

virilizing, 360

Ovarian pregnancy, 184

Ovary(ies)

absence of, 44

anatomy of, 44

androgen production by, 355–356, 356t

bimanual examination and, 15

blood supply to, 44

development of, 34, 35, 36

disease of, 435–444

differential diagnosis of, 435

evaluation of, 435–436

functional cysts, 436–437, 436

neoplasms, 437–444 (see also Ovarian neoplasms)

embryology of, 58

pelvic examination of, 435–437

stimulation of, as infertility treatment, 364

Ovary-determining gene, 22

Overflow urinary incontinence, 282, 282t (see also Urinary incontinence)

Oviducts (see Fallopian tubes)

Ovulation

induction of, 359

in infertility evaluation, 374–376, 374

phase, in reproductive cycle, 340

postpartum physiology of, 130–131

suppression of

breastfeeding and, 130

for ovarian carcinoma prevention, 440

for premenstrual syndrome, 385

Oxygenation

of fetus, 55, 58

during labor rest periods, 106

intrapartum surveillance of, 113

in maternal asthma, 213

physiology of, 55, 56–57

in pregnancy-related hypertension, 208

during pregnancy, 55, 58

fetal uptake from placenta, 58

hemoglobin factor, 58

Oxytocin

for induction and augmentation of labor

latent phase considerations, 96, 97t, 108t

in postterm pregnancy, 103

for postpartum hemorrhage, 102, 138, 138b, 139–140

suckling stimulation of, 133

Oxytocin challenge test (OCT) for fetal well-being assessment, 69

Paclitaxel (Taxol)

as antineoplastic drug, 388, 388t, 390t

for ovarian carcinoma, 446

Paget’s disease of vulva, 405, 405

Pain

abdominal, with ectopic pregnancy, 180

back, with pregnancy, 78

chronic pelvic, 297–300

in dysmenorrhea, 295, 296t

menstrual, 5

referred, with ectopic pregnancy, 316

round ligament, in pregnancy, 78

sexual dysfunction related to, 324t

in threatened abortion, 186

with uterine leiomyomata, 424

Pain management during labor, 99, 100

Palmar erythema during pregnancy, 54

Palpable postmenopausal ovary (PPO) syndrome, 436

Palpation of uterus during pregnancy, 68

Pancreatic cancer, screening recommendations for, 92

Papanicolaou (Pap) smear

for cervical cancer, 18, 20, 418, 420

for cervical intraepithelial neoplasia, 409, 417–418

Bethesda Classification and, 411, 412b

descriptive conventions for, 412, 413t

evaluation of, 417–418

for endometrial hyperplasia/carcinoma, 429, 431

human papillomavirus identification by, 228

specimen collection for, 13, 14

postpartum timing of, 135

for vaginal intraepithelial neoplasia, 407

Papilloma, intraductal, of breasts, 306, 306t

Paramesonephric ducts, development of, 35, 36, 36, 37

incomplete anomalies of, 44, 44

Parametrium of uterus, 41

Paraovarian cysts, 444

Parathyroid levels during pregnancy, 54

Paraurethral glands (see Skene glands)

Parity, classifying, 6b

Paroxetine

for menopausal symptoms, 370

for premenstrual dysphoric disorder, 385

sexual dysfunction associated with, 325

Paroxysmal atrial tachycardia in pregnancy, 212

Parvovirus infection in pregnancy, 231

Past history in health evaluation, 5

Patau syndrome (trisomy 13)

altered chromosome number in, 81, 83t

characteristics of, 83t

live birth incidence of, 83t

Patch, transdermal contraceptive, 243, 243

pregnancy rates within first year, 244t

Paternal age, advanced, as genetic disorder risk factor, 86

Paternalism, 26

Patient autonomy

protection of, by informed consent, 26

respect for, 26

Patient education

antepartum, 71–77

for diabetes management, 192

in postpartum care, 133

Patient history

in breast disorders, 303

chief complaint, 4

contraceptive, 5

in endometrial hyperplasia, 428

family, 6

gynecologic, 5–6

in health evaluation, 3

history present illness, 4

in labor evaluation, 94–95

medical, 4–6

menstrual, 5

obstetric, 6

past, 5

in sexual assault, recalling, 331, 331b

social, 6

Patient-physician relationship, ethics and, 3

Patient safety, 29–31

definitions, 29–30

Agency for Healthcare Research and Quality and theNational Quality Forum, 30

Institute of Medicine, 30

National Patient Safety Foundation, 30

and error reduction, 30–31

PCOS (see Polycystic ovary syndrome [PCOS])

Peau d’orange, 9

Pederson speculum, 13

Pediculosis pubis, 275

Pedunculated leiomyoma, 423, 424 (see also Leiomyomata, uterine)

Pelvic adhesions, infertility related to, 375

Pelvic congestion syndrome, gonadotropin-releasing hormone agonists for, 300

Pelvic examination, 11–15

bimanual, 14–15, 14

communication with patient during, 11

for dysmenorrhea, 296

for endometrial carcinoma surveillance, 433

in endometriosis, 289

examiner position for, 11–12

of external genitalia, 12

for gestational age assessment, 63

in hydatidiform mole, 395

infertility related to, 374

during labor, 94–95

series of, 100

for ovarian disease, 435

patient position for, 11–12, 11

for pregnancy diagnosis, 63

preparation for, 11

rectovaginal, 15, 15

relaxation techniques for, 11

specimen collection for Pap test during, 13, 14

speculum examination in, 12–14, 12, 13

Pelvic exenteration

for cervical cancer, 420

for vaginal cancer, 407–408

Pelvic inflammatory disease (PID)

abscess in, 270, 271b

chlamydial infection as cause of, 267–269

chronic pelvic pain associated with, 299

contraceptives, role of, in, 270

criteria for hospitalization for, 271b

diagnosis of, 270, 270

as dysmenorrhea cause, 295

organisms that cause, 269–270

peritoneal involvement in, 270, 270

risk factors for, 270

scope of, 272

signs and symptoms of, 270

timing of, in relation to menstrual cycle, 270

treatment of, 270

Pelvic inlet, fetal station and, 96–97, 96

Pelvic mass, sensation of, in uterine leiomyomata, 424

Pelvic muscle training, 283

Pelvic organ prolapse, 278 (see also Pelvic support defects)

Pelvic outlet, fetal station and, 96, 96

Pelvic pain, chronic, 297–299 (see also Chronic pelvic pain)

Pelvic relaxation (see Pelvic support defects)

Pelvic support defects, 277–281

causes of, 277–278

differential diagnosis for, 280–281

evaluation of, 278, 280

prevalence of, 277

risk factors for, 277

signs and symptoms of, 277

stages of, 278, 280

treatment of, 281

types of, 278, 279

urinary incontinence in, 278

Pelvimetry, clinical, 37, 39, 107

Pelvis

android, 40, 40

anthropoid, 40, 40

bony

abnormal labor related to, 107

anatomy of, 37, 39, 40

cul-de-sac of, 41

diameters of, 37, 39

false, 37, 39

greater, 37, 39

gynecoid, 40, 40

lesser, 30, 37, 39

platypelloid, 40, 40

true, 34, 37, 39

Penetrance, genetic disorders and, 84

Penicillin for syphilis, 229

Pennyroyal, antepartum use of, 74

Pentosan polysulfate for interstitial cystitis, 300

Percutaneous epididymal sperm aspiration (PESA)

for infertility, 377

Percutaneous umbilical blood sampling (PUBS)

for DNA analysis, 90–91

for intrauterine growth restriction, 154

for isoimmunization management, 221

Perianal area, inspection and examination of, 12

Perihepatitis, 270, 270

Perimenopause, 363, 364t

cardiovascular lipid changes in, 367

defined, 5

hot flushes in, 365

ovary characteristics in, 435

signs and symptoms of, 5

Perimenstrual symptoms in menstrual history, 5

Perineum

anatomy of, 40, 40

inspection and examination of, 12

postpartum care of, 132

Peripartum cardiomyopathy, 212

Peritoneal seeding of ovarian carcinoma, 445

Peritoneum, infertility associated with, 374–375

Pessaries, 281

PG (phosphatidylgylcerol), fetal lung maturity based on, 71

PGI₂ (prostacyclin) in pregnancy-related hypertension, 207, 207

pH

of amniotic fluid, 170

arterial, during pregnancy, 49, 50, 51t, 125

of discharge

in bacterial vaginosis, 260, 261

in trichomonas vulvovaginitis, 262

in vulvovaginal candidiasis, 261

of fetal blood, 118

nitrazine test and, 170

of urine, 170, 201

of vagina, 259, 260t

in atrophic vaginitis, 263

of vaginal secretions, 170

Phencyclidine as breastfeeding contraindication, 133

Phenylketonuria, 85

Phenytoin, teratogenesis associated with, 75t

Phosphatidylglycerol (PG), fetal lung maturity based on, 41

Physical abuse, indicators of, 334, 334t

Physical examination (see also ACOG Women’s Health Record), 3, 6–7, 8b

of breasts, 6–7, 9, 10, 11, 303

anatomy-based descriptions for, 6–7, 9

how to do, 6–7, 10, 11

for chronic pelvic pain, 298

for health evaluation, 3–15

and history, 163–164

in hydatidiform mole, 395

for hypertension, 208–209

for intrauterine growth restriction, 153–154

for labor evaluation, 94

of pelvis, 44–15 (see also Pelvic examination)

purpose of, 11

for sexual assault

of adult, 331

of child, 331

of uterus for leiomyomata, 425

vital signs, 7, 9t

for vulvodynia, localized, 403

Physician-patient partnership, 3, 4t

communication, 11–12

cooperative model for, 2

establishing, 3

ethics and, 25–28

management plan, 16

Pica

in iron-deficiency anemia, 216

during pregnancy, 53, 72

PID (see Pelvic inflammatory disease [PID])

Placenta

accessory lobe of, 141

delivery of, 102, 102

expulsion of, 141

hormonal increases originating in, 55

immune protection role of, 58–59

in intrauterine growth restriction, 153, 154

blood flow assessment, 154

key functions of, 55

physiology of, 55

retained, postpartum hemorrhage due to, 138b, 141

predisposing factors for, 139–140

Placenta accreta, 141, 165

ultrasound detection of, 69

uterine rupture risk in, 167

Placenta increta, 141, 166

Placental abruption (see Abruptio placentae)

Placental hormones, postpartum levels of, 133

Placental site tumors, 397

Placenta percreta, 141, 166

Placenta previa, 164–166

blood loss in, 165

cesarean delivery in, 165

characteristics of, 165, 165t

classification of, 164, 164

complications of, 165–166

defined, 164

diagnosis, 165, 165

etiology, 165, 165

fetal anomalies associated with, 165

incidence of, 164–166

management of, 165

risk factors for, 165, 165

sexual activity and, 73

ultrasound diagnosis of, 69, 166

Plaintiff(s), legal action component, 29

Plan B and Next Choice, 251

Plant (vinca) alkaloids in chemotherapy, 388, 388t

applications for, 390t

side effects of, 390t

Plasma volume

with anemia in pregnancy, 215

postpartum, 130

postpartum physiology of, 130

during pregnancy, 50

pregnancy-related hypertension effects on, 208

Platelet count during pregnancy, 50, 51t

Platelets for blood replacement, 139t

Platypelloid pelvis, 40, 40

PMDD (see Premenstrual dysphoric disorder [PMDD])

PMS (see Premenstrual syndrome [PMS])

Pneumococcal vaccination, high-risk factor for, 471t

Podofilox for human papillomavirus, 273

Podophyllin resin in benzoin for human papillomavirus, 273

Polycystic ovary syndrome (PCOS), 357–360

acanthosis nigricans associated with, 359

amenorrhea associated with, 357

characteristics of, 357, 359

diagnostic criteria for, 357

estrogen excess with, long-term, 357–358

HAIR-AN syndrome and, 359

hirsutism with, 357, 358

hormonal studies in, 358

hyperthecosis form of, 359–360

infertility related to, 357

metabolic syndrome associated with, 358–359

obesity as common factor in, 357, 359

Rotterdam criteria on, 357

symptoms of, 357

treatment of, 359

Polyhydramnios, maternal diabetes associated with, 190–191

Polymastia, 301

Polymerase chain reaction (PCR) testing

for gonorrhea diagnosis, 229

for herpes simplex virus infection, 224, 271

for hepatitis C virus infection, 226

Polyostotic fibrous dysplasia, 345, 345b

Polyps

endometrial, 430

of vagina, embryonal, 408

Polythelia, 301

Pomeroy tubal ligation, 255–256, 256

Portal vein during pregnancy, 52

Position/positioning

fetal, in labor evaluation, 94, 95

maternal

for cardiac patient, 212

during labor, 97–99

for prolonged labor, 109

Postabortal syndrome, 188

Postcoital bleeding, 5

Postdates pregnancy (see Postterm pregnancy)

Postmenopausal patient

osteoporosis screening recommendations for, 22

ovary characteristics in, 436

risk factors for osteoporotic fractures in, 22

Postpartum blues, 134, 134t

Postpartum care, 129–135

anxiety and, 134–135, 134t

depression and, 134–135, 134t

glucose tolerance testing, 192

immediate, 130–134

ambulation, 131

analgesia, 131

bowel movements, 132

breast care, 131–132, 131t

breastfeeding, 133–134

complications of, 131

contraception, 132

hospital stay and, 130–131

immunizations, 132

lactation, 133–134

maternal-infant bonding, 131

nipple care, 134

patient education, 133

perineum care, 132

sexual activity, 133

urination, 132

weight loss, 133, 130

psychosis and, 134, 134t

puerperium physiology in, 129–130

time period for, 130

visits

care to include in first, 135

schedule for, 129

Postpartum depression, 134, 134t

Postpartum form, antepartum record and, ACOG, 473–486

Postpartum hemorrhage (PPH), 137–143

blood loss criteria for, 137

causes of, 137, 138, 139–142

amniotic fluid embolism, 142

coagulation defects, 138b, 142

hematomas, 141–142, 138b

lower genital tract lacerations, 141

retained placenta, 138b, 141

uterine atony, 102, 131, 139–141, 138b, 143

uterine inversion, 142, 142

uterine rupture, 142

delayed, 131

early detection of, 137–138

fetal macrosomia risk for, 155

future childbearing desires and, 140, 142

general management of, 138–139, 138b, 139t, 139b

immediate care of, 131

incidence of, 133

intravascular depletion, signs of, in, 137

morbidity and mortality associated with, 138

occurrence of, 102–103

prevalence of, 137

prevention of, 142–143

primary/secondary, 137

risk factors for, 137, 137b

sequelae associated with, 137

Postpartum psychosis, 134, 134t, 236

Postpartum thyroiditis, 193, 195

Postterm pregnancy, 175–178

cause of, 175–176

cesarean delivery in, 175

defined, 175

diagnosis of, 176–177

effects of, 176

factors associated with, 175t

incidence of, 175

management of, 177–178

morbidity and mortality associated with, 175

recurrence of, 175–176

risk factors for, 175

Posttraumatic stress disorder, sexual assault and, 333

Pouch of Douglas (cul-de-sac), 41

PPH (see Postpartum hemorrhage)

PPO (palpable postmenopausal ovary) syndrome, 436

Precocious pseudopuberty, 344–345, 345b

Precocious puberty, 344–345

adrenal causes of, 345, 345b

GnRH-dependent, 344, 345b

GnRH-independent, 344–345, 345b

treatment of, 345

Preconception counseling and care, 61–62

Prednisone for congenital adrenal hyperplasia, 361

Preeclampsia

antihypertensive therapy for, 210–211, 211t

defined, 191

diagnostic criteria for, 206

increased incidence of, in maternal diabetes, 191–192

magnesium sulfate for, 210, 211t

management of, 209–210

multisystem involvement with, 206

pathophysiology of, 207, 207

postpartum hemorrhage due to, 142

proteinuria in, 206, 208

risk factors for, 206b

Pregnancy

abdominal, 185

adnexal masses in, 203

alcohol use during, 76–77

amenorrhea related to, 349–350

antepartum care for, 63–68 (see also Antepartum care)

appendicitis in, 202–203

cervical, 184

coincident, 184–185

combined, 184–185

complications of, as chromosome abnormality risk factor, 81, 83t

cornual, 184

diagnosis of, 63

domestic violence risk in, 334

early loss of, as chromosome abnormality risk factor, 86

ectopic, 179–185 (see also Ectopic pregnancy)

employment during, 72

exercise during, 72, 72b

genetic screening in, 87–89, 87, 88t

hematologic diseases in, 215–222

heterotopic, 184–185

as hypercoagulable state, 50

immunology of, 58–59

infectious diseases in, 223–231 (see also Infection[s])

interstitial, 184

medications in

risk factor categories for, 75t

teratogenicity associated with, 74, 75b, 75t–76t

ovarian, 184

physiologic changes in, 47–55

breasts, 55

cardiovascular, 47–48, 48

endocrinologic, 51t, 53–54, 53

gastrointestinal, 51t, 52–53

hematologic, 50, 51t

metabolic, 54

musculoskeletal, 54

ophthalmic, 55

renal, 51–52, 51t

reproductive tract, 55

respiratory, 48–80, 49, 51t

skin, 54–55

postterm, 175–178 (see also Postterm pregnancy)

sexual intercourse during, 73

substance abuse during, 77

surgical conditions in, 202–203

termination of, 315–316 (see also Abortion)

tobacco use during, 77

trauma in, 203

travel during, 73

with uterine leiomyomata, 426

weight gain recommendations for, 66–67, 72–73

Pregnancy-associated plasma protein A in genetic screening, 68, 87

Pregnancy loss, recurrent, 186

Pregnancy tests, 63

ectopic pregnancy and, 181

Premature ovarian failure

causes of, 367–368

menopause vs., 363

Premature rupture of membranes (PROM), 169–217

bacterial vaginosis associated with, 169

cause of, 169

chorioamnionitis with, 170

defined, 169

diagnosis of, 170–171, 171, 172t

false test factors, 171, 172t

differential diagnosis of, 170

evaluation of, 170

group B streptococcus prophylaxis in, 169

incidence of, 169

latency period and, 171

management of, 171–173, 172t

neonatal consequences of, 169

preterm, 169, 171–173

preterm labor risks related to, 157, 158b, 158

risk factors for, 170

sexual activity and, 73

term, 171

Prematurity, cold stress and, 123

Premenstrual dysphoric disorder (PMDD)

cultural considerations and, 381

defined, 381

diagnosis of, 383, 385

diagnostic criteria for, 382, 382b

incidence of, 381

menstrual diary as diagnostic tool for, 383

premenstrual syndrome vs., 381

serotoninergic dysregulation as basis for, 382

treatment of, 385–386

Premenstrual syndrome (PMS)

defined, 381

diagnosis of, 383, 385

diagnostic criteria for, 382, 382b

differential diagnosis of, 383, 383b

etiology of, 382–383

incidence of, 381

menstrual diary as diagnostic tool for, 383

premenstrual dysphoric disorder vs., 381

serotoninergic dysregulation basis for, 382

symptoms of, 381

treatment of, 385–386

alternative therapies for, 385

diet recommendations for, 385

lifestyle interventions for, 385

nonpharmacologic, 385

pharmacologic, 385–386

surgical approach to, 386

symptom calendar to monitor, 385

vitamin therapy for, 385

Presacral neurectomy for dysmenorrhea, 297

Presentation(s), fetal (see also specific type)

antepartum evaluation of, 68

in labor evaluation, 109, 109

Preterm birth

causes of, 157

defined, 157

neonatal consequences of, 158

corticosteroids impact on, 161

prevalence of, 157

spontaneous vs. indicated, 157

Preterm labor, 157–161

causes of, 157, 158, 158b

complications of, 157

corticosteroids, 161

defined, 157

evaluation of suspected, 159–160

factors associated with, 157, 158b

factors improving outcomes, 157–158

group B streptococcus prophylaxis in, 223–225

management of, 160–161

maternal diabetes as cause of, 193

with multifetal gestation, 148, 148t

pathway for pathogenic processes in, 157, 158

prediction of, 158–159

prevention of, 159

signs and symptoms of, 159b

tocolytic therapy for, 158, 160–161, 160t

contraindications to, 161

Preventive care, 17–18

Primary prevention, 17

Primary/preventive care, 465–469

for ages 13–18 years, 466

for ages 19–39 years, 467

for ages 40–64 years, 468

for ages 65 years and older, 469

Primary sex cords, 34, 34, 35

Primigravida, 6b

Primipara, 6b

Primordial follicles

development of, 34, 35

maturation of, 34

Primordial germ cells, 34, 34

Principle-based ethics, 26–28, 26b

Procidentia, 278

Progestational agents in chemotherapy, 389

Progesterone

breast changes and, 309

in diagnosis of ectopic pregnancy, 182

for endometrial hyperplasia, 430

for endometriosis treatment, 291

glucose metabolism and, 190

for infertility, 372

insulin resistance during pregnancy and, 55

for menopausal symptoms, 368–369

menstruation

corpus luteum role, 338, 339, 339, 340

phase I physiology, 339–340

phase II physiology, 340

phase III physiology, 340, 341

as postpartum contraceptive, 132

for preterm labor, 159

serum levels of, and infertility, 373

thermogenic effects of, 342

Progesterone “challenge test” for amenorrhea, 351

Progestin(s)

for abnormal uterine bleeding, 353

effects of, 248

for endometrial hyperplasia/carcinoma, 430, 431, 433, 434

for menopause management, 368–369

in oral contraceptive preparations, 240, 362

“minipill,” 240, 241–242b

pregnancy rates within first year, 238t

as postpartum contraceptive, 132

for uterine leiomyomata, 425

Prolactin

in infertility evaluation, 377

postpartum physiology of, 130, 133

Prometaphase as mitosis stage, 80, 81

PROM (see Premature rupture of membranes [PROM])

Prophase as mitosis stage, 80, 81

Propranolol for pregnancy-related hypertension, 211t

Propylthiouracil (PTU), 194

Prostacyclin (PGI₂) in pregnancy-related hypertension, 207, 207

Prostaglandin(s)

excess of, in dysmenorrhea, 295

for induced abortions, 184

for labor induction, 103

contraindications for, 103

for postpartum hemorrhage, 102, 140, 138b

Prostaglandin synthetase inhibitors

for dysmenorrhea, 295

for preterm labor, 160t

for uterine leiomyomata, 424

Protease inhibitors for HIV/AIDS syndrome, 275

Protein metabolism during pregnancy, 54

Protein(s), loss of, during pregnancy, 52

Proteinuria

preeclampsia and, 206

in pregnancy, 191

in pregnancy-related hypertension, 206

Prothrombin gene mutation, recurrent pregnancy loss related to, 186

Protraction disorders in labor, 107, 108t, 109

Pruritus during pregnancy, 53

Psammoma bodies, 441

Pseudoephedrine, teratogenesis associated with, 76t

Pseudogestational sac, 182, 182

Pseudomyxomatous peritonei, 441

Psoriasis of the vulva, 401–402

clinical characteristics of, 402t

diagnosis of, 402

histologic pattern in, 400t, 402

incidence and prevalence of, 401

lesions in, 401–402

treatment of, 402

Psychiatric disorders, during pregnancy, 234–236

Psychologic factors, sexual dysfunction related to, 325, 326b

Psychotherapy referrals for sexual dysfunction, 297, 300

Psyllium hydrophilic mucilloid, 78

Ptyalism during pregnancy, 53

Pubarche, 343

Puberty, 343–347

abnormalities of, 343–347

anatomic causes of, 347

delayed, 345–347, 346b

hypergonadotropic hypogonadism, 346, 346

hypogonadotropic hypogonadism, 346–347

precocious puberty, 344–345, 345b

defined, 343

ethnicity and onset of, 343, 344t

hypothalamic-pituitary-gonadal axis and, 337–338

normal development during, 343, 344

secondary sexual maturation in

normal sequence of, 343

Tanner’s classification of, 343, 344

Pubic lice, 275

PUBS (see Percutaneous umbilical blood sampling [PUBS])

Pudendal block in labor management, 99, 100

Puerperal fever, fetal macrosomia associated with, 155

Puerperium

description of, 129

physiology of, 129–130

abdominal wall changes, 130

cardiovascular system changes, 130

cervical changes, 130

hematopoietic system changes, 130

lochia, 129–130

ovarian function return, 130

renal system changes, 130

uterus involution, 129

vaginal changes, 130

Pulmonary function

during pregnancy, 49, 49

with asthma, 213

pregnancy-related hypertension effects on, 208

Pulmonary hypertension as pregnancy contraindication, 211

Pulmonary hypoplasia in infants, premature rupture of membranes and, 169, 172

Pulse oximetry, nonreaassuring fetal status and, 118

Pulse pressure, narrowed, in postpartum hemorrhage, 137

Pulse rate, postpartum, 130

Punch biopsy for vulvar lesions, 399

Pushing, maternal, fetal descent and, 100

Pyelography, intravenous, of renal system, 52

Pyelonephritis

acute, 285b

treatment of, 285

maternal diabetes and, 193

in pregnancy, 52, 201

Pyrimethamine for toxoplasmosis, 230

Pyruvate kinase deficiency, 216

Q-tip test for urethral hypermobility, 278

Quickening, 63

Quinolones, teratogenesis associated with, 75t

RADAR model of physician’s approach to domestic violence, 335b

Radiation, ionizing

antepartum exposure to, 74, 77t

breast cancer risk with, 308

Radiation therapy

for breast cancer, 309, 309t

cell-cycle actions of, 389–390

for cervical cancer, 418–421

chemotherapy with, 420

complications of, 420

for choriocarcinoma, 396

complications associated with, 391

for endometrial carcinoma, 433

external (teletherapy), 390

fractionated dosage of, basis of, 389–390

interstitial implants for, 391

intracavitary devices for, 391

intraoperative strategy for, 391

ionizing, 389

local (brachytherapy), 390

rad in, 390

for ovarian carcinoma, 443

spontaneous abortion related to, 185

for vulvar cancer, 406

Radioactive substances as breastfeeding contraindication, 133

Radiobiology, “four Rs” of, 389–390

Raloxifene

in breast cancer, 308

in chemotherapy, 389

for osteoporosis, 367, 367t

in sexual dysfunction, 325

Rape, 329 (see also Sexual assault)

Rape trauma syndrome, 333

Rapid HIV testing, 227

Rapid plasma reagin (RPR) test, 22

for syphilis, 229

RDS (see Respiratory distress syndrome [RDS])

Recombinant human follicle-stimulating hormone for infertility, 378

Recommended daily allowances (RDAs) for pregnancy, 73

Rectal canal, palpation of, 15

Rectal sphincter, palpation of, 15

Rectocele, 278, 279, 281

Rectosigmoid carcinoma, adnexal space and, 435

Rectovaginal examination, 15, 15

for endometrial carcinoma surveillance, 433

Recurrent pregnancy loss, 186

Red blood cells

autotransfusion of, postpartum, 130

packed, as replacement component, 139t

volume of, during pregnancy, 50

Red-cell indices with iron-deficiency anemia, 215–216

Renal calculi in adnexal space, 435

Renal cancer, screening recommendations for, 92

Renal colic in pregnancy, 202

Renal disease in pregnancy, 202

Renal function

postpartum changes in, 130

during pregnancy, 202

pregnancy-related hypertension effects on, 191, 208

Renal plasma flow during pregnancy, 52

Renal system

physiologic changes in, during pregnancy, 51–52, 51t

postpartum changes in, 130

Renin, effect of pregnancy on, 52

Renin-angiotensin-aldosterone system during pregnancy, 52

Renin substrate during pregnancy, 52

Reproductive age, infertility and, 371

Reproductive age group, ovary characteristics in, 435

Reproductive cycle, female, 337–342

breast changes during, 342

clinical manifestations of hormonal changes during, 340–342, 341

duration of, 337

endocervical changes during, 341–342

endometrial changes during, 340–341

feedback and control of, 337, 338

follicle-stimulating hormone in, 337, 338

follicular phase of, 337, 339–340

gonadotropin-releasing hormone in, 337, 338

hypothalamic-pituitary-ovarian axis control of, 337–338, 338

hypothalamic thermoregulation and, 342

interruption of, 337

luteal phase of, 337, 338–339

luteinizing hormone in, 337, 338

ovarian steroid hormone secretion in, 338, 339

corpus luteum role, 338, 339, 339

two-cell theory of, 338, 339

ovulation and, 337, 340

phase I (menstruation and follicular) of, 339–340, 341

phase II (ovulation) of, 340, 341

phase III (luteal) of, 340, 341

vaginal changes during, 342

Reproductive system

anomalies of, 44–45, 44

physiologic changes in, during pregnancy, 55

Resin triiodothyronine uptake (TR3U) in pregnancy, 194

Respiratory disorders, during pregnancy, 212–213

Respiratory distress syndrome (RDS)

fetal lung maturity and, 71

maternal diabetes as cause of, 191

neonatal, physiology of, 71

Respiratory system, physiologic changes in, during pregnancy, 48–50, 49, 51t

Restitution, 97, 98

Restless legs syndrome (RLS), 24

Restriction fragment-length polymorphisms, determining length of, 90

Resuscitation, neonatal, 124–125, 124, 125

Rete testis, development of, 34, 35

Retinoblastoma, 84–85

Retroflexion of uterus, 41, 43

Retropubic colposuspension for stress incontinence, 283, 283

Retroversion of uterus, 41, 43

Review of systems, 4, 6, 7b

Rhabdomyosarcoma, embryonal, 408

Rh (CDE) system

antigens in, 218

in isoimmunization, 218

Rheumatic heart disease in pregnancy, 212

Rh immune globulin (RhoGam)

for isoimmunization prevention, 218–219, 221–222

for Rh negative women

with ectopic pregnancy, 184

for fetal-maternal hemorrhage, 203

with spontaneous abortion, 187

in third-trimester bleeding, 164

Rh isoimmunization, 218

Ribonucleic acid, transcription of deoxyribonucleic acid to, 79–80

Risedronate for osteoporosis, 367, 367t

Risk assessment in antenatal evaluation, 63, 66

Ritgen maneuver, modified, for vaginal delivery, 101, 101

Robertsonian translocation, 82, 84t

Roe v. Wade, 187

Rotterdam consensus on polycystic ovary syndrome, 357

Round ligament pain during pregnancy, 78

Round ligament of uterus, embryology of, 34, 35, 36

RPR (rapid plasma reagin) test, 22

for syphilis, 229

Rubella

congenital, 225

immunization for

in postpartum period, 132

pregnancy timing with, 225

prenatal, 225

intrauterine growth restriction associated with, 153

in pregnancy, 225

as spontaneous abortion cause, 225

titer assessment of, high-risk factor for, 471t

RU-486 for medical abortion, 187

Rupture of membranes (ROM)

artificial

in first stage of labor, 100

for labor induction, 103

risks of, 100

spontaneous

determination of, 93

risks of, 100

Sacral agenesis, maternal diabetes as cause of, 190, 190

Sacroiliac joint in pelvic anatomy, 37, 39

Sacrospinous ligament, 41

fixation of, for pelvic support defects, 281

Sacrum, anatomy of, 37, 39

Saline-infusion sonography for infertility evaluation, 312, 375b

Salpingectomy for ectopic pregnancy, 184

Salpingitis

abscess in, 270b

in chlamydial infection, 267

diagnostic criteria for, 270b

ectopic pregnancy related to, 179

ectopic pregnancy risk with, 270

infertility associated with, 270

Salpingo-oophorectomy

for endometriosis, 291

for ovarian carcinoma, 443

Sampson’s theory of endometriosis, 287

Sarcoma

of fallopian tubes, 444–445

of uterus, 427, 433–434, 434

Sarcoma botryoides, 408

Sauna use during pregnancy, 72

Savage syndrome, premature ovarian failure in, 351

Scabies, 275

Schizophrenia during pregnancy, 236

Sclerosing adenosis of the breast, 306t, 307

Screening tests

for antepartum period, 68–69

for breast cancer, 20, 310

for cancer, 18, 19–21

for genetic predisposition to, 91–92

for cervical cancer, 20

characteristics of, 18

for chlamydial infection, 21

criteria for, 18, 20b

for diabetes mellitus, 23

for domestic violence, 334, 335b

for ectopic pregnancy, 182

for gonorrhea infection, 21–22

for hemoglobinopathy carriers, 216–218, 217t

hepatitis C, 226b

for human immunodeficiency virus, 21, 227–228

for hypertension, 23

for iron-deficiency anemia, 215, 216

for lipid disorders, 23

for metabolic and cardiovascular disorders, 22–24

for maternal diabetes, 192

for newborns, 127

for obesity, 23

for osteoporosis, 22

prenatal genetic, 87–89, 87, 88t

integrated, 89

for rubella, 225

for sexual dysfunction, 326

for sexually transmitted diseases, 21, 265–267, 266t, 267b

sleep disorders, 24

for syphilis, 22, 228–229

for thyroid disease, 23

for toxoplasmosis, 230

Scrotal folds, 37, 38

Sebaceous cysts of the vulva, 403

Sebaceous glands, cysts of, 403

Seborrheic dermatitis of the vulva, 402

clinical characteristics of, 402t

Sebum production during pregnancy, 55

Secondary prevention, 18

Secretory endometrial carcinoma, 432t

Segmental resection with tubal reanastomosis for ectopic pregnancy, 184, 184

Seizures

eclamptic

management of, 210–211

prevention of, 210

with pregnancy-related hypertension, 206

Selective estrogen receptor modulators (SERMs)

in chemotherapy, 389

for osteoporosis, 367, 367t

for ovulation induction, 378

Selective serotonin reuptake inhibitors (SSRIs)

for menopausal symptoms, 370

for premenstrual dysphoric disorder, 385

for premenstrual syndrome, 385

for psychiatric disorders, 235, 236

sexual dysfunction associated with, 325

side effects of, 385

teratogenesis associated with, 75t

Semen analysis for infertility evaluation, 373t, 376

abnormal counts and volume causes, 377t

reference values for, 376t

Seminiferous (testis) cords, development of, 34, 35

Seminiferous tubules, development of, 34, 35

Sensitivity of test, 18

Sepsis

group B streptococcus as cause of, 223, 224

postpartum hemorrhage due to, 141

pyelonephritis associated with, 201

Septic abortion, 188

Sequential blockade in combination chemotherapy, 389

SERMs (see Selective estrogen receptive modulators [SERMs])

Serologic testing

for hepatitis B virus infection, 332t

for hepatitis C virus infection, 226

for hepatitis E virus infection, 227

for herpes simplex virus infection, 224

for HIV, 227, 332t

for parvovirus infection, 231

for rubella, 225

for syphilis, 22, 229, 273, 274b, 332t

for varicella infection, 230

Serous cystadenocarcinoma of ovary, 441

Serous cystadenoma of ovary, 437–438, 438, 438b

Sertoli–Leydig cell tumors, 360

benign, 440

malignant (arrhenoblastoma), 444

Sertraline

mastalgia associated with, 305

for premenstrual dysphoric disorder, 385

sexual dysfunction associated with, 325

Serum pregnancy tests, 63

Sex chromosome abnormalities, 81

Sex-determining region on Y chromosome, 33

Sex hormone-binding globulin (SHBG), 356

Sexual abuse in domestic violence, 334

Sexual assault, 329–333

acquaintance rape as, 329–330

adult victim of, management of, 330–333

initial, 331, 332t

posttraumatic stress disorder, 333

rape trauma syndrome, 333

subsequent, 331–332

aggravated criminal, 330

antibiotic prophylaxis for, 331, 332t

child victim of, 333–334

assessment of, 333–334

management of, 334

perpetrator identity, 334

signs of, 333, 333b

date rape as, 329–330

defined, 329

forensic specimens/tests for, 329

history taking for, 330, 330b

incidence of, 329

laboratory tests in, 331

marital rape as, 329

multidisciplinary team approach to, 329

physical examination for, 331

posttreatment evaluation in, 331

reporting requirements for, 330

statutory rape statutes and, 329

underreporting of, 329

Sexual dysfunction (see Sexuality)

Sexual history

in health evaluation, 5–6

in sexual dysfunction assessment, 326

Sexual identity, development of, 321

Sexual intercourse

during pregnancy, 73

postpartum, 133

Sexuality, 321–328

determinants of, 321

developmental aspects of, 321

dysfunctional, 324

categories of, 324, 324t

clinical depression related to, 325

establishing diagnosis for, 327, 327

management of, 326–327

medical conditions related to, 325, 325b

medical interview for, 326

medications related to, 325, 325b

psychologic factors related to, 325, 326b

referrals for, 328

risk factors for, 326–327, 327b

screening for, 326

treatment of, 328, 328b

human sexual response, 321–323

feedback loops in, 322, 322

intimacy-based model, 322, 322

physiology of female, 322–323, 322b, 323

traditional model, 322, 322

interpersonal factors of, 321

intrapersonal factors of, 321

Sexually transmitted diseases (STDs), 265–275 (see also specific organism or disease)

expedited partner therapy for, 267

hormonal contraceptives as protection against, 269

multiplicity of, 265

patient notification of, 267

physical examination for, 265

premature rupture of membranes and, 227

prevention of, 267

risk factors for, 21b

scope of, 265

screening recommendations for, 21–22, 265–267, 267b

in pregnancy, 224t

sexual history in, 265

transmission of, 265

Sexual pain disorder, noncoital, 324t

Sexual response cycle, female, physiology of, 322–323, 322b, 323

Shock in postpartum hemorrhage, 137

Shoulder dystocia

antepartum conditions associated with, 112

brachial plexus injury risk in, 112

diagnosis of, 112

fetal macrosomia associated with, 112, 190

interventions for, 112, 113

with postterm pregnancy, 176

Shoulder pain with ectopic pregnancy, 180

Sickle cell anemia, 217, 218

Sickle cell/beta-thalassemia, 216, 217, 217t

Sickle cell disease

as autosomal recessive disorder, 85

carrier testing for, 90, 217

ethnicity as risk factor for, 86–87

Sickle cell disorders

in pregnancy, 216, 217–218, 217t

variation among patients with, 217

vaso-occlusive crisis in, 217

Sickle cell trait, 217, 218

Sigmoidoscopy, flexible, recommendations for, 21

Single-gene disorders, 84, 84b, 85b

Skeletal malformations, premature rupture of membranes and, 172

Skene glands

anatomy of, 40

inspection and examination of, 12, 12

Skin

menopausal changes in, 366

physiologic changes in, during pregnancy, 54–55

SKY (spectral karyotyping), 91

Sleep disorders

in menopause, 365

screening recommendations for, 24

Sling procedures for stress incontinence, 283, 283

Small bowel, transit time in, 52

Small for gestational age, 151 (see also Intrauterine growth restriction [IUGR])

implications of, 69

Smoking (see Tobacco use)

Social history in health evaluation, 6

Sodium, serum, during pregnancy, 51t, 52

Soft tissue, abnormal labor effects on, 106, 107

Somatic cells, 80

division of, 80

Sonohysterography (SHG), saline infusion, 312, 312

Soy-based remedies for menopause, 369

Spastic quadriplegia, 114

Specificity of test, 18

Spectral karyotyping (SKY), 91

Specula, vaginal, types of, 12–13, 13

Speculum examination, 12–14

specimen collection during, 13, 14

speculum insertion for, 13, 13

speculum withdrawal after, 13

vaginal

in premature rupture of membranes, 171

for preterm labor evaluation, 159

Spermatogenesis, abnormal, infertility related to, 376–377

Spermicides, 246–247

pregnancy rates within first year, 238t

Spherocytosis, hereditary, 216

Spider angiomata during pregnancy, 54

Spinal anesthesia in labor management, 99

Spinal-epidural anesthesia combination in labor management, 99

Spiramycin for toxoplasmosis, 230

Spironolactone

for constitutional hirsutism, 361

for premenstrual syndrome, 385

Sponge, contraceptive, 238t, 239, 246

Spongiotic histologic pattern, 400t, 402

Spontaneous abortion, 185–187

causes of, 185

chromosomal abnormalities associated with, 185

classification of, 186–187

differential diagnosis of, 186–187

ectopic pregnancy vs., 181

endocrine factors in, 185

environmental factors in, 185

hydatidiform mole associated with, 394

immunologic factors in, 185

incidence of, 185

infectious factors in, 185

maternal diabetes as risk factor for, 190

maternal systemic disease in, 185

parvovirus infection as cause of, 231

syphilis as cause of, 228

treatment of, 187

uterine factors in, 185

Squamocolumnar junction in cervical intraepithelial neoplasia, 411

Squamous cell carcinoma

of cervix, 418, 420

of endometrium, 432t

Pap smear identification of, 411, 412b, 413–414

of vagina, 407, 408

of vulva, 401, 404

Squamous cell hyperplasia (see Acanthotic histologic pattern)

SRY (sex-determining region on Y chromosome), 33

SSRIs (see Selective serotonin reuptake inhibitors [SSRIs])

St. John’s wort for menopausal depression, 369

Starvation, accelerated, during pregnancy, 54

Statutory rape statutes, 330

STDs (see Sexually transmitted diseases [STDs])

Stein-Leventhal syndrome, 357 (see also Polycystic ovary syndrome (PCOS))

Sterilization, 253–258

counseling for, 253

decision for, 258

risk indicators for regret about, 258b

ectopic pregnancy risk and, 180

failure rates for, 254t

fatality rate for, 257

incidence of, as contraceptive method, 253

of men, 253–254, 254

operative techniques for, changes in, 253

postpartum, 132

reversal of, 254, 258

by tubal ligation, 254–255, 255 (see also Tubal ligation)

complications of, 254t, 257–258

noncontraceptive benefits of, 258

side effects of, 257–258

of women, 254–258

by hysteroscopy, 256–257

by laparoscopy, 254–255, 255

by minilaparotomy, 255–256, 256

Stillbirth

maternal diabetes as risk factor for, 190

with postterm pregnancy, 176

syphilis as cause of, 228

Stomach

displacement of, during pregnancy, 52

transit time in, 52

Stool softeners for immediate postpartum period, 132

Stress urinary incontinence, 281–282, 282t (see also Urinary incontinence)

incidence of, during pregnancy, 52

postpartum, 130

“Stretch marks,” 54

Striae gravidarum

during pregnancy, 54

postpartum changes in, 130

Stromal cell neoplasms, ovarian

benign, 437b, 440

malignant, 444

Submucosal leiomyomata, 423, 424, 424, 425 (see also Leiomyomata, uterine)

Subserosal leiomyomata, 423, 424 (see also Leiomyomata, uterine)

Substance abuse

as breastfeeding contraindication, 133

intrauterine growth restriction associated with, 153

during pregnancy, 77

Suction curettage

for induced abortions, 187, 188

for retained placenta, 141

for spontaneous abortions, 186, 187, 188

Sulfadiazine for toxoplasmosis, 230

Sulfonamides, teratogenesis associated with, 75t

Supine hypotensive syndrome, 98

avoiding, during maternal surgery, 202

Support, continuous, during labor, benefits of, 109

Suppressive therapy for genital herpes, 271

Surfactant

fetal lung maturity related to, 71b

tests for, 71b

Sweeping the membranes, postterm pregnancy and, 177

Symphysis pubis, formation of, 37, 39

Symptothermal method, as fertility awareness method, 250–251

Syndrome X, polycystic ovary syndrome and, 358

Synergism in chemotherapy, 389

Syphilis, 273–274

chancres in, 273, 273

diagnosis of, 266t, 274

incidence of, 273

cause of rise in, 273

organism that causes, 273

perinatal transmission of, 228–229

in pregnancy, 228–229

presentation of, 266t

prevalence of, 266t

screening recommendations for, 22, 224t

serologic tests for, 273, 274, 274b

sexual assault prophylaxis for, 332t

signs and symptoms of, 22

skin manifestations of, 228, 273, 273

spontaneous abortion related to, 185

stages of, 273–274

treatment of, 274

T₄ (thyroxine) levels during pregnancy, 51t, 53, 53, 194, 194

T. pallidum particle agglutination (TP-PA) test, 22

for syphilis, 229

Tachycardia

fetal, 114, 115t

in postpartum hemorrhage, 137

Tachypnea in postpartum hemorrhage, 137

Tamoxifen

for breast cancer, 308, 309, 309t

in chemotherapy, 389

endometrial hyperplasia/carcinoma risk associated with, 428, 430

for mastalgia, 306

for osteoporosis, 367

for ovarian carcinoma, 446

Tanner’s classification of sexual maturity, 343, 344

Tay-Sachs disease, 90

as autorecessive disorder, 85

carrier testing for, 90

ethnicity as risk factor for, 87

TBG (thyroxine-binding globulin) during pregnancy, 53, 53, 193, 194

TDF (testis-determining factor), 33

Teletherapy, 390

Telophase as mitosis stage, 80, 81

Tension headaches, during pregnancy, 233

Teratogens

antepartum use of, 74–77, 75t–76t, 77, 77t

suspected or proven, 74b

Teratomas of ovary

benign cystic, 438, 439

immature, 443

Teratospermia, infertility related to, 377t

Terbutaline for uterine relaxation, 142

Terconazole for vulvovaginal candidiasis, 262

Terminal hair in hirsutism, 355

Testes, embryology of, 34, 35, 58

Testis-determining factor, 33

Testis (seminiferous) cords, development of, 34, 35

Testosterone

conversion of, to dihydrotestosterone, 356

extraglandular production of, 356, 356t

free and bound, 356–357

in hirsutism and virilization evaluation, 355

postmenopausal levels of, 364, 364t

postoophorectomy level of, 364t

premenopausal ranges for, 364t

sex hormone-binding globulin and, 356

as teratogenic medication, 76t

Testosterone receptors, 357

Tetanus-diphtheria acellular pertussis vaccine, administration of, in immediate postpartum period, 19b, 132

Tetanus toxoid booster for sexual assault, 332t

Tetracycline(s)

as breastfeeding contraindication, 133

teratogenesis associated with, 75t

Tetralogy of Fallot, uncorrected maternal, as pregnancy contraindication, 211

Thalassemia, 87, 90

Theca cells, reproductive maturation of, 338, 339

Theca lutein cyst, 437

with hydatidiform mole, 394t, 395

Thecomas of ovary, 444

Thelarche, 343

Thiazide for hypertension in pregnancy, 211t

Third-trimester bleeding, 163–167

abruptio placentae, 163, 164b, 165t, 166–167, 167

blood replacement products for, 164

causes of, 164b

differential diagnosis in, 163

incidence of, 163

patient history in, 163–164

physical examination in, 163–164

placenta previa, 163, 164–166, 164b, 165, 165t

uterine rupture, 167

vasa previa, 167, 167

Thorax, changes in, during pregnancy, 48, 48

Threatened abortion, 186, 187

Thrombocytopenia with pregnancy-related hypertension, 208

Thromboembolism, venous, during pregnancy, 50

Thromboxane in pregnancy-related hypertension, 207

Thyroid autoantibodies, spontaneous abortion related to, 185

Thyroid disease, screening recommendations for, 23

Thyroid disease in pregnancy, 193–195

laboratory screening for, 194

management of

diagnoses during and after pregnancy, 194–195

existing, in pregnancy, 194, 194b

pathophysiology of, 193–194, 194

Thyroid function

neonatal, 193, 194

during pregnancy, 53–54, 53, 193

Thyroid gland, fetal, 58

Thyroiditis, postpartum, 193, 195

Thyroid-stimulating hormone (TSH) testing for thyroid function in pregnancy, 194, 194, 195

Thyroid storm, 193, 194

symptoms of, 194b

treatment of, 194

Thyrotoxicosis, 193

Thyrotropin levels during pregnancy, 51t, 53

Thyroxine-binding globulin (TBG) during pregnancy, 53, 53, 193, 194

Thyroxine (T₄) levels during pregnancy, 51t, 53, 53, 194, 194

Tinidazole for trichomonas infections, 262

TNM staging system for breast cancer, 308, 309t

TOA (tuboovarian abscesses) in pelvic inflammatory disease, 270

Tobacco use

as cervical intraepithelial neoplasia risk factor, 411

intrauterine growth restriction associated with, 153

during pregnancy, 77

premature ovarian failure related to, 368

premature rupture of membranes and, 170

spontaneous abortion related to, 185

in vulvar cancer, 406

in vulvar intraepithelial neoplasia, 404

Tocodynamometer

external, for fetal monitoring, 99

for preterm labor, 159

Tocodynamometry for uterine activity monitoring, 105, 106

Tocolytic therapy

for preterm labor, 158, 160, 160t

contraindications to, 161

prophylactic, for myomectomy during pregnancy, 426

TOLAC (Trial of labor after cesarean), 104, 104b

Topoisomerase inhibitors in chemotherapy, 388, 388t

application for, 390t

side effects of, 390t

Topotecan

as antineoplastic drug, 388, 388t, 390t

for ovarian carcinoma, 446

Toxoplasmosis

in pregnancy, 230

prevention of, 230

treatment of, 230

TP-PA (T. pallidum particle agglutination) test, 22

for syphilis, 229

Transabdominal ultrasonography for ectopic pregnancy, 182, 182

Transcription of deoxyribonucleic acid to ribonucleic acid, 79–80

Transdermal contraceptive patch, 243, 243

pregnancy rates within first year, 238t

Transformation zone

in cervical epithelium, 41

in cervical intraepithelial neoplasia, 409, 410, 411

Transfusion

in isoimmunization, 218

platelet, for HELLP syndrome, 211

Transition zone of cervical epithelium, 41

Translocation as chromosome structure abnormality, 82, 84, 84t

reciprocal, 82, 84, 84t

Robertsonian, 82, 84t

Transvaginal ultrasonography (see Ultrasonography, transvaginal)

Transverse diameter of pelvis, 39, 40

Transverse presentation, antepartum evaluation of, 68

Trastuzumab

for breast cancer, 309

as chemotherapeutic agent, 391

Trauma in pregnancy, 203

fetal assessment in, 203

management of, 203

Travel during pregnancy, 73

Treponema pallidum, 273

infections (see Syphilis)

placental transmission of, 228

Treponemal-specific tests for syphilis, 229

Treponemal tests for syphilis, 274, 274b

Tretinoin, teratogenesis associated with, 74t

Trial of labor after cesarean (TOLAC), 104, 104b

benefits of, 104

guidelines for, 104, 104b

risks of, 104

Triamcinolone acetonide for lichen simplex chronicus, 401

Trichloroacetic acid for human papillomavirus, 273

Trichomonal vulvovaginitis, 262

clinical presentation of, 262

conditions associated with, 262

diagnosis of, 262, 262

secretion characteristics in, 260t, 262

treatment of, 262–263

Trichomoniasis, sexual assault prophylaxis for, 332t

Tricyclic antidepressants for vulvodynia, localized, 403

Triiodothyronine (T₃) levels during pregnancy, 51t, 53, 194

Trimethoprim-sulfamethoxazole for urinary tract infections, 285

Triploidy, altered chromosome number in, 81

Trisomies

altered chromosome number in, 81, 83t

characteristics of, 83t

live birth incidence of, 83t

Trisomy 13, genetic screening for, 87

Trisomy 18 (see Edwards syndrome)

Trisomy 21 (see Down syndrome)

True pelvis (lesser pelvis), 37, 39

TSH (thyroid-stimulating hormone) testing for thyroid function in pregnancy, 194, 194, 195

Tubal abortion, 179

Tubal ligation

complications of, 254–255, 254t

ectopic pregnancy after, 257–258

failure rates for, 254, 254t

noncontraceptive benefits of, 258

reversal of, 258

techniques for, 253–258, 255, 256

Tubal pregnancy

clinical findings in, 180–181

clinical scenarios resulting in, 179

incidence of, 179, 180

pathophysiology and risk factors for, 179–180

symptoms of, 180

Tubal rupture, 179

Tuberculosis as breastfeeding contraindication, 133

Tuberculosis skin testing, high-risk factor for, 471t

Tuboovarian abscesses (TOA) in pelvic inflammatory disease, 270

treatment of, 270

Tumor debulking for ovarian carcinoma, 445

Tumor vaccines for ovarian carcinoma, 391

Tunica albuginea, 34, 35

Turner syndrome, 44, 86

in delayed puberty, 346, 346, 346b

Twin(s)

conjoined, 145

dizygotic, 145

fraternal, 145

identical, 145

incidence of, 145

in molar pregnancy, 395

monoamniotic, 147

monozygotic, 145

Twin-twin transfusion syndrome, 146–147

UAE (uterine artery embolization) for uterine leiomyomata, 426

Ultrasonography

accuracy of, in determining gestational age, 177

for antepartum evaluation, 68

for breast disorders, 304

for breast mass, 313

for cervical abnormality evaluation, 68

diagnostic applications of, 311–312, 312

Doppler

for fetal heart rate evaluation, 63, 67, 68

to measure peak velocity of middle cerebral artery, 220, 220

of umbilical artery, 71

for endometriosis, 291

for fetal growth assessment, 69

for fetal macrosomia, 156

for genetic screening, 89, 89b

for gestational age assessment, 66

of hydatidiform mole, 394, 394, 395

for intrauterine growth restriction, 154

of multifetal gestation, 148

for placental abnormality evaluation, 68

for pregnancy diagnosis, 63

ectopic, 180, 181, 182

hCG level correlations, 181, 181, 182

of premature rupture of membranes, 170–171

for preterm labor evaluation

of cervix, 159

of fetus, 159

of renal system, 52

saline infusion during, 311–312, 312

transabdominal, 311, 312

for ectopic pregnancy, 182, 182

in labor evaluation, 94

transvaginal, 311, 312

for assessing cervical length in preterm labor, 159

for ectopic pregnancy, 181–182, 182

for endometrial hyperplasia, 429, 430

for infertility evaluation, 375b

for ovarian masses, 436

for placental and cervical abnormalities, 68

for pregnancy diagnosis, 63

for uterine leiomyomata, 424, 425

Ultrasound surgery, focused, MRI-guided, for uterine leiomyomata, 426

Ultraviolet light for vulvar psoriasis, 402

Umbilical arteries

circulation physiology of, 55, 56

Doppler flow ultrasonography of, 71

Umbilical cord

blood banking, 123, 125–126

blood gas values from, 125, 125t

care of, during third stage of labor, 102, 102

compression

amnioinfusion to relieve, 117

heart rate changes associated with, 118, 169

immediate care of, 123

Umbilical vein, circulation physiology of, 55, 56

Umbilical vesicle, 34, 34

Ureaplasma urealyticum, spontaneous abortion related to, 185

Ureter(s)

changes in, during pregnancy, 52

postpartum changes in, 130

relative position of uterine artery to, 43, 43

Ureteral calculi in adnexal space, 435

Ureteral cancer, screening recommendations for, 92

Urethra, postpartum changes in, 130

Urethral gland, inspection and examination of, 12, 12

Urethral meatus, inspection and examination of, 12

Urethritis

atrophic, in menopause, 366

in gonorrhea, 269

nongonococcal, chlamydial infection as cause of, 267

Urethrocele, 278, 279

Urge urinary incontinence, 281, 282t (see also Urinary incontinence)

Uric acid, pregnancy-related hypertension effects on, 208

Urinalysis for urinary tract infections, 285

Urinary bladder

physiologic changes in, during pregnancy, 52

training programs for, 283

Urinary calculi during pregnancy, 202

Urinary frequency during pregnancy, 52

Urinary incontinence, 281–284

characteristics of, 282t

detrusor overactivity, 281, 282t

evaluation of, 282

mixed, 282

nonsurgical treatment options for, 283

overflow, 282, 282t

in pelvic support defects, 278

prevalence of, 281

stress, 281–282, 282t

surgical therapy for, 283–284, 283

urge, 281, 282t

Urinary tract disorders

maternal diabetes and, 193

in pregnancy, 201–202

Urinary tract infections (UTIs) in pregnancy, 201, 284–286

in adnexal space, 435

clinical history of, 284

definitions of, 285b

fetal macrosomia associated with, 155

incidence and prevalence of, 201, 284

laboratory evaluation of, 285

organisms that cause, 284

recurrent, 285, 285b

risk factors for, 284, 284b

signs and symptoms of, 284

treatment of, 285

Urine

intermittent leakage of, during pregnancy, 170

pH of, 170

vaginal secretions distinguished from, 170

Urine culture

in asymptomatic bacteriuria, 201

in preterm labor evaluation, 159

for pyelonephritis, 201

for urinary tract infections, 285

Urine LH kits for infertility evaluation, 373, 378

Urine output in immediate postpartum period, 132

Urine pregnancy tests, 63

ectopic pregnancy and, 181

Urine retention, postpartum, 130, 131, 141

Urodynamic testing

indications for, 282

multichannel, 283

single-channel, 282

Urogenital diaphragm, 40, 40

Urogenital folds, 37, 38

Urogenital ridges, 33

in embryology, 34

Urogenital sinus, development of, 36, 37, 37, 38

Urogenital system

anatomy of, 40–41, 40, 42, 43, 43

embryology of, 33, 34, 35

Urogynecology procedures, 318

Urologic conditions associated with chronic pelvic pain, 299t

Urorectal septum

development of, 37

formation of, 37

Uterine abnormalities, infertility associated with, 374, 374

Uterine artery

ligation of, 140, 140

relative position of, to ureter, 43, 43

Uterine artery embolization (UAE) for uterine leiomyomata, 426

Uterine atony

bimanual massage for, 140, 140

maternal diabetes as cause of, 191

postpartum hemorrhage due to, 102, 138

management of, 138b, 139–140, 140

predisposing factors for, 137, 137b

risk factors for, 137, 137b

Uterine bleeding

abnormal, 352–353

anatomic causes of, 352

anovulatory, 352

complications of, 352

diagnosis of, 352–353

endometrial stimulation and, 352

luteal phase defect in, 352

midcycle spotting and, 352

sonohysterography in diagnosing cause of, 312, 312, 352

treatment of, 353

types of, 350b

with endometrial hyperplasia/carcinoma, 427, 428, 430

with leiomyomata, 424

postmenopausal, causes of, 431, 432t

Uterine body

anatomy of, 41, 42

cancer of, 427–434 (see also Endometrial carcinoma)

wall layers of, 41, 42

Uterine cavity, curettage of, in diagnosis of ectopic pregnancy, 182

Uterine contractions

in abnormal labor, evaluation of, 105–106, 106

breastfeeding stimulation of, 130

in false labor, 93, 94

fetal heart rate changes with, 70

palpation during, 94

“power” of, evaluation of, 105–106, 106

in preterm labor, 157, 161

with pyelonephritis, 201

Uterine fibroids as dysmenorrhea cause, 296 (see also Leiomyomata, uterine)

Uterine fundus

anatomy of, 41, 42

height of

in fetal growth assessment, 67

in fetal macrosomia diagnosis, 156

in gestational age assessment, 63

in intrauterine growth restriction, 153, 153

subsequent antepartum evaluation of, 67, 67, 68

in hydatidiform mole, 393, 394t, 395

Uterine malignancy, 423

Uterine massage, bimanual, for uterine atony, 140, 140

Uterine prolapse, 278, 279, 280, 281

Uterine rupture, 167

Uterine sarcoma, ifosfamide for, 390t

Uterine tubes (see also Fallopian tube[s])

infertility associated with, 374–376

ligation of (see Tubal ligation)

Uteroplacental insufficiency

fetal responses to, 113

intrauterine growth restriction associated with, 152

late fetal heart rate decelerations and, 117

with pregnancy-related hypertension, 208

Uteroplacental unit, 113

Uterosacral ligament fixation for pelvic support defects, 281

Uterosacral ligaments, 41

palpation of, 15

Uterosacral nodularity associated with endometriosis, 289, 290

Uterus

absence of, 44, 44

anatomy of, 41–43, 42, 43

anomalies of

intrauterine growth restriction associated with, 153

recurrent pregnancy loss related to, 186

bicornuate, 44, 44

bimanual examination of, 14–15, 14

technique variations for, 15

blood supply to, 43, 43

Couvelaire, 166

dehiscence of, 142, 167

double, 44, 44

enlargement of, as uterine atony risk, 137b, 139

embryology of, 33, 34

inversion during delivery, 102

postpartum hemorrhage due to, 142, 142

involution of, postpartum, 129

palpation of, during pregnancy, 68

pelvic support of, 41, 42

physical examination of, immediate postpartum, 102, 131

physiologic change in

with ectopic pregnancy, 181

during pregnancy, 56

position of

related to cervical position, 15

variations in, 41, 43

postpartum homeostasis physiology of, 131

retroverted, 41, 42

rupture of, 167

postpartum hemorrhage due to, 142

in sexual response, 323

Uterus didelphys, 44, 44

Vaccinations, recommended, 18, 19b

Vacuum aspiration for induced abortions, 187

Vacuum extraction

device used for, 111, 111

neonatal risks of, 111

Vagina

anatomy of, 41, 42

artificial, creation of, 346

bacterial concentrations in, 169

benign masses of, 407

bimanual examination of, 14–15

biopsy of, 314

blood supply to, 41

cancer of, 407–408

staging of, 407, 408t

dryness of, in menopause, 365

embryology of, 34, 35

in female sexual response, 325, 325b, 326

hematomas of, 141–142

inspection of, 12, 13–14, 14

intraepithelial neoplasia (VAIN) of, 404

normal ecosystem of, 259–260, 260t

pH range of, 259, 260t

postpartum physiology of, 129–130

reproductive cycle manifestations in, 342

transverse septum of, 347

Vaginal birth after cesarean (VBAC), 104, 104b

Vaginal bleeding

with ectopic pregnancy, 180

with endometrial carcinoma, 431, 432

with hydatidiform mole, 393, 395

during labor, 93

in pelvic inflammatory disease, 269

postpartum, 132

Vaginal cancer, 407–408

staging of, 407, 408t

survival rates for, 408

treatment of, 407–408

Vaginal delivery

blood loss associated with, 137

fetal macrosomia, 156

laboring positions for, 98

operative, 110–111, 111

Vaginal discharge

in endometrial carcinoma, 431–432

in pelvic inflammatory disease, 270

during pregnancy, 78

Vaginal examination

comprehensive (see Pelvic examination)

digital (see Digital examination)

tools for (see Speculum)

Vaginal hysterectomy, 317

laparoscopic-assisted, 317

Vaginal intraepithelial neoplasia (VAIN)

cervical neoplasias associated with, 407

diagnosis of, 407

treatment of, 407

types of, 407

Vaginal plate, formation of, 34, 37

Vaginal ring, contraceptive, 243, 243

Vaginal secretions

normal characteristics of, 260, 260t

pH of, 170

sources of, 260

urine distinguished from, 170

Vaginal specula, types of, 12–14, 12

Vaginal vault prolapse, 278, 279

Vaginectomy

for vaginal cancer, 407, 408

for vaginal intraepithelial neoplasia, 407

Vaginismus, 324t

Vaginitis

atrophic, 263, 366

candidal (see Candidiasis, vulvovaginal)

desquamative inflammatory, 263

Vaginosis (see Bacterial vaginosis)

VAIN (see Vaginal intraepithelial neoplasia [VAIN])

Valacyclovir

for herpes simplex virus infection, 272

for sexual assault, 332t

Valproic acid, teratogenesis associated with, 75t

Valvular heart disease, infectious, in pregnancy, 211

Variability in fetal heart rate, 116t, 114, 114

Variable expressivity, genetic disorders and, 217

Varicella infection

congenital, 231

intrauterine growth restriction associated with, 106–107

in pregnancy, 231

rash in, 231, 231

Varicella pneumonia, 231

Varicella vaccination, high-risk factor for, 471t

Varicella zoster immune globulin, 231

Varicose veins during pregnancy, 78

Vasa previa, 167, 167

Vascular changes with pregnancy-related hypertension, 234

Vascular spiders during pregnancy, 54

Vasectomy, 253, 254

complications of, 253, 254t

failure rates for, 253, 254t

Vasomotor disturbances in ectopic pregnancy, 180

Vasomotor instability, hot flushes and, 364–365

Vaso-occlusive crisis in sickle cell disease, 217, 218

Vasospasm, maternal, causes of, 207

VDRL (Venereal Disease Research Laboratory) test, 22

for syphilis, 202

Vein(s)

of ovaries, 44

of uterus, 43

of vagina, 41

varicose, during pregnancy, 78

Velamentous insertion in vasa previa, 167

Venereal Disease Research Laboratory (VDRL) test, 22

for syphilis, 202

Venereal warts (see Condyloma acuminata)

Venlafaxine

for menopausal symptoms, 370

sexual response and, 325

Ventricles in fetal circulation, 55, 56

Vesicovaginal fistula, 282, 282

Vestibular glands, inflammation of, 403

Vestibule, anatomy of, 40, 40

Vibroacoustic stimulation, fetal heart rate and, 114, 118

Villoglandular endometrial carcinoma, 431t

Vinblastine as antineoplastic drug, 388, 388t

Vinca (plant) alkaloids in chemotherapy, 388, 388t

applications for, 390t

side effects of, 390t

Vincristine as antineoplastic drug, 388, 388t, 390t

Vinorelbine for ovarian carcinoma, 446

VIN (see Vulvar intraepithelial neoplasia [VIN])

Violence

domestic, 334–336 (see also Domestic violence)

sexual assault as, 329–333 (see also Sexual assault)

Virtue-based ethics, 26t, 27

Vision, changes in, during pregnancy, 54

Vital signs

assessment in infant, 123

with prehypertension, 7, 9t

Vitamin A, teratogenesis associated with, 76t

Vitamin A deficiency, hydatidiform mole associated with, 393

Vitamin K for newborn bleeding prevention, 58, 123

Vitamin therapy

for pregnancy, recommendations for, 72

for premenstrual syndrome, 382–383

Vomiting of pregnancy, 53, 197–198, 198, 199b, 200

antepartum care for, 77–78

Vulva

anatomy of, 40, 40

biopsy of, 399

cancer of, 405–407

Bartholin gland, 407

evaluation of, 406

FIGO staging of, 406, 406t

melanoma, 406–407

natural history of, 406

prognosis of, 406

treatment of, 406

common dermatoses of, 399–403

benign, 399

classification of, using histologic morphology, 399, 400t

dermatitis, 402, 402t

lichen planus, 400, 401, 402t

lichen sclerosis, 399–401, 400, 400t, 402t

lichen simplex chronicus, 400, 401, 402t

psoriasis, 401–402, 402t

vulvodynia, localized, 403, 403

diseases of, 399–407

cancer, 405–407

common dermatoses, 399–403

diagnostic aids for, 399

neoplasia of, 403–405

Paget, 405

susceptibility to, 399

symptoms of, 399

dysplasia of, 403

hematomas of, 141–142

lesions of, 403

neoplasia of, 403–405

grading systems for, 403, 404t

intraepithelial, 403–405

Paget’s disease, 405, 405

VIN, differentiated type, 404t, 405

VIN, usual type, 404–405, 404, 404t

VIN 1, 403–404, 404t

normal ecosystem of, 259

physiologic changes in, during pregnancy, 56

postpartum changes in, 129

Vulvar biopsy, 314, 314

Vulvar cancer, 405–407

of Bartholin’s gland, 407

incidence and prevalence of, 405

melanoma and, 406–407

natural history of, 406

predictive factors for, 406

signs and symptoms of, 405

staging classification for, 406, 406t

survival rates for, 406

treatment of, 406

Vulvar dermatitis, 402

categories of, 402

diagnosis of, 402

histologic pattern in, 402

lesions in, 402

treatment of, 402

Vulvar intraepithelial neoplasia (VIN), 403–405

grading systems for, 403, 404t

variations in appearance of, 404, 404

VIN, differentiated type, 404t, 405

disorders associated with, 405

VIN, usual type, 403–404, 404t

cervical intraepithelial neoplasia and, 404

clinical findings in, 404

human papillomavirus associated with, 404

subtypes of, 405

treatment of, 405

VIN 1, 403–404, 404t

Vulvectomy

for carcinoma of the Bartholin gland, 407

for Paget’s disease of the vulva, 405

for vaginal cancer, 407–408

for vulvar cancer, 406, 407

Vulvodynia, localized, 403

Vulvovaginal candidiasis (see Candidiasis, vulvovaginal)

Vulvovaginitis, 259–263

atrophic vaginitis, 263

bacterial vaginosis, 260–262, 260t, 261

candidiasis, 260t, 261–262, 261, 262b

causes of, 259

consequences of, 259

desquamative inflammatory vaginitis, 263

evaluation of, 259

laboratory tests for, 259

symptoms of, 259

trichomoniasis, 260t, 262, 262

Warfarin

intrauterine growth restriction associated with, 153

teratogenesis associated with, 77t

Water-soluble vitamins, excretion of, during pregnancy, 52

Weight, residual postpartum retention of, 133

Weight gain

antepartum evaluation of, 66

with oral contraceptives, 244

during pregnancy

fetal macrosomia associated with, 155

intrauterine growth restriction associated with, 153

recommendations for, 66–67, 72–73, 73t

Weight loss, postpartum, 130, 133

Western blot test

for acquired immunodeficiency syndrome, 274

for human immunodeficiency virus testing, 227

Wharton jelly in vasa previa, 167, 167

White blood cell count

in pelvic inflammatory disease, 270

postpartum, 130

during pregnancy, 51t, 52

with premature rupture of membranes, 170, 172

in trichomonas vulvovaginitis, 262

WIC (Women, Infants, and Children) Federal Supplement Food Program, 73

Wickham striae, 401

Willow bark, antepartum use of, 74

WNT4 (ovary-determining gene), 33

Wolffian ducts, development of, 34, 35, 36

Woman’s Health Record, ACOG, 3, 447–464

Women, changing demographics of, in the U.S., 2, 2

World Health Organization (WHO)

bone mineral density scores of, 20

endometrial hyperplasia classification of, 427, 428

grading system for vulva intraepithelial neoplasia, 404, 404t

sexual dysfunctions defined by, 325

X chromosome, role of, in genetic sex determination, 33

X-linked disorders

dominant, 85, 85b

inheritance pattern in, 85–86

recessive, 85, 85b

Y chromosome, role of, in genetic sex determination, 33

Yolk sac, development of, 33

Yuzpe method of emergency contraception, 251

Zavanelli maneuver for shoulder dystocia, 156

Zidovudine for HIV/AIDS syndrome, 227, 275

Z-vaginoplasty for transverse septum, 347