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GYNECOLOGY

CHAPTER 1

PHASES OF LIFE

1.1 EMBYOLOGY: FEMALE SEXUAL DIFFERENTIATION............. 3

• Sexual Differentiation and development........................... 3
• Mullerian Anomalies......................................................... 10
• Disorders Of Sexual Development..................................... 13

1.2 BIRTH TO PUBERTY........................................................... 33

• Birth to Puberty............................................................... 33
• Normal Puberty............................................................... 34
• Precocious Puberty.......................................................... 44

1.3 REPRODUCTIVE YEARS..................................................... 54

• Steroidogenesis................................................................ 54
• Female Hormones and Antihormone Therapy................... 63
• The Menstrual Cycle......................................................... 72

1.4 PERIMENOPAUSE AND MENOPAUSE................................ 80

- Perimenopause................................................................... 82

-Menopause......................................................................... 83

CHAPTER 2

METHODS OF CONTRACEPTION   

• Classification........................................................................ 100
• Tier 1; Intrauterine device, Subdermal Implants, Sterilization. 105
• Tier 2; Injectables, Pills, Patch, Ring....................................... 118
• Tier 3; Barriers, Periodic Abstinence, Spermicides,................. 132
• Medical Eligibility Criteria (MEC) ......................................... 137

CHAPTER 3

FEMALE SEXUAL RESPONSE

• Normal female sexual response........................................ 145
• Female Sexual Dysfunction............................................... 153
• Sexual Crimes................................................................... 161

CHAPTER 4

ENDOCRINAL DISORDERS

• Dysmenorrhea................................................................. 165
• Premenstrual Syndrome, PMDD....................................... 172
• Polycystic ovarian syndrome............................................ 176
• Hyperandrogenism in the female...................................... 193
• Hyperprolactinemia......................................................... 213
• Amenorrhea and anovulation........................................... 223
• Endometriosis.................................................................. 251
• Adenomyosis................................................................... 284
• Abnormal uterine bleeding............................................... 293

CHAPTER 5

INFERTILITY AND ASSISTED REPRODUCTION

• Definition and epidemiology............................................. 323
• Male factor...................................................................... 326
• Female factor................................................................... 338
• Assessment of female factor............................................. 347
• Treatment of female factor.............................................. 363

Assisted Reproductive Technology......................................... 376

• • Pituitary Suppression Protocols................................ 377
  • Ovarian Stimulation................................................. 381
  • Egg Collection.......................................................... 385
  • In-Vitro fertilization and embryo culture................... 386
  • Embryo Selection and transfer.................................. 388
  • Frozen Thawed Embryo transfer............................... 391
  • The poor responder................................................. 394
  • Ovarian Hyperstimulation Syndrome OHSS............... 397
  • Multifetal gestation and other concerns................... 400

CHAPTER 6

ONCOLOGY

• Basics of oncology............................................................ 403
• Basics of Chemotherapy................................................... 411
• Basics of Radiotherapy..................................................... 413
• Malignant disease of the cervix......................................... 418
• Malignant disease of the vagina........................................ 445
• Malignant disease of the Vulva......................................... 450
• Neoplastic diseases of the Uterus..................................... 459
  • Endometrial Hyperplasia.......................................... 459
  • Endometrial Carcinoma............................................ 461
  • Uterine sarcoma...................................................... 474
  • Uterine Leiomyoma................................................. 478
• Ovarian Neoplasm............................................................ 505
• Breast Disorders and Neoplasm........................................ 542

CHAPTER 7

ANATOMICAL DISORDERS

• Pelvic Organ Prolapse....................................................... 547
• Urinary Incontinence........................................................ 578
• Genitourinary Fistula........................................................ 603
• Fecal Incontinence and Recto-vaginal fistula...................... 629
• Retroverted Retroflexed uterus ....................................... 645
• Uterine inversion............................................................. 649

CHAPTER 8

GYNECOLOGICAL INFECTIONS

• Basics of genital tract infections........................................ 653
• Vulvar lesions and infections............................................. 659
• Vaginal infections............................................................. 684
• Infections of the cervix..................................................... 705
• Infections of the upper genital tract.................................. 722
  • • Endometritis........................................................... 722
    • Tuberculosis........................................................... 723
    • Pelvic Inflammatory Disease.................................... 725
• Chronic Pelvic Pain........................................................... 737
• Wound infections............................................................. 739

APPENDIX

• Note on Blood Supply of the Pelvis.................................... 750
• Gynecology Admission Sheet............................................ 753
• Consent Forms................................................................. 755
• Preoperative Protocol ...................................................... 762
• Postoperative Protocol..................................................... 763
• Operative Data Forms...................................................... 765
• Patient IVF Instructions Leaflet......................................... 769

OBSTETRICS

CHAPTER 1

NORMAL PREGNANCY

• • Fertilization, Implantation, an early development.......... 3
  • Extra-fetal Structures.................................................... 10
  • Fetal Circulation........................................................... 16
  • Formation, Abnormalities & functions of the placenta... 18
  • Maternal adaptation..................................................... 40
  • Preconceptional Care................................................... 48
  • Prenatal Care and Diagnosis of pregnancy..................... 49

CHAPTER 2

NORMAL LABOR

• • Basics of Obstetrics....................................................... 65
  • Phases of Parturition overview..................................... 77
  • Phase 1........................................................................ 78
  • Phase 2........................................................................ 79
  • Phase 3........................................................................ 81
    • Management of Normal Labor................................ 91
  • Phase 4........................................................................ 108
    • Management of Normal Puerperium....................... 114
• Pain Control in Obstetrics................................................ 117
  • Opioid Analgesics......................................................... 117
  • Nitrous Oxide Inhalation............................................... 118
  • Regional Analgesia........................................................ 119
  • General Anesthesia....................................................... 124

CHAPTER 3

MATERNAL SHOCK AND COLLAPSE

• • Maternal Shock and Collapse........................................ 127
  • Hypovolemic Shock...................................................... 129
• • Septic Shock................................................................. 144
  • Disseminated Intravascular Coagulopathy..................... 150
  • Transfusion Reactions................................................... 155
  • Respiratory Morbidity in The Critically Ill Patient: Pulmonary Edema, Adult Respiratory Distress...................................................... 157
  • Maternal Cardiac Arrest – Perimortem C-Section........... 160

CHAPTER 4

ABNORMAL LABOR

• • Abnormalities of The Expulsive Forces........................... 163
  • Abnormal passage – Contracted Pelvis.......................... 167
  • Abnormal Passenger..................................................... 171
    • Cephalopelvic Disproportion................................... 171
    • Malposition and Malpresentations.......................... 172
      • General Scheme............................................ 172
      • Occipito-posterior......................................... 180
      • Face Presentation......................................... 188
      • Brow Presentation........................................ 191
      • Shoulder Presentation................................... 192
      • Compound & Cord Presentation.................... 193
      • Breech Presentation...................................... 195
    • Shoulder Dystocia................................................... 209
  • Abnormal Pattern (Prolonged labor)............................. 214
• Induction and Augmentation of Labor.............................. 224
• Obstetric Operations........................................................ 243
• Birth after C-Section (VBAC-TOLAC).................................. 255
• The Newborn................................................................... 264
• Puerperal infections and puerperal sepsis........................ 280
• Secondary postpartum hemorrhage................................. 291

CHAPTER 5

OBSTETRIC ULTRASOUND

• • Gestational Zones......................................................... 297
  • Maternal Abdomen and Pelvis...................................... 298
• • Scan before 11 weeks................................................... 298
  • 11-14 weeks scan......................................................... 301
  • Fetal Biometry.............................................................. 302
  • 18-24 weeks scan......................................................... 303
    • Skull and cranium................................................... 303
    • Face and Neck........................................................ 309
    • Fetal Heart............................................................. 310
    • Fetal Abdomen....................................................... 320
    • Fetal Genitalia........................................................ 329
    • Vertebral Column and limbs.................................... 330
    • Placenta................................................................. 331
    • Amniotic Fluid........................................................ 336
  • Obstetric Doppler......................................................... 338

CHAPTER 6

FETOLOGY

• Fetal Assessment …………………………………………………………… 347
  • Assessment of fetal maturity........................................ 347
  • Antepartum Assessment of fetal well-being.................. 351
  • Intrapartum Assessment of fetal well-being.................. 366
• Prenatal Diagnosis of Fetal anomalies.............................. 389
• Fetal Growth Disorders………………………………………………….. 411
  • Fetal growth Restriction and SGA.................................. 411
  • Large for gestational age LGA........................................ 425
  • Hydrops fetalis............................................................. 428
• Fetal Anemia (Including Rh Alloimmunization)................. 433
• Fetal Death and Still birth................................................. 458
• Fetal Therapy................................................................... 471

CHAPTER 7

OBSTETRIC DISORDERS

• Pregnancy Disorders Guide (Scheme)............................... 477
• Obstetrical Complications
  • Amniotic Fluid (AF) Disorders........................................ 485
    • AF Volume disorders Polyhydramnios..................... 485
    • AF Volume disorders Oligohydramnios.................... 492
    • Meconium in AF..................................................... 497
    • Preterm Prelabor Rupture of membranes................ 499
    • Chorioamnionitis.................................................... 510
  • Disorders of Gestational Age......................................... 513
    • Preterm Birth......................................................... 513
    • Prolonged Pregnancy.............................................. 534
    • Elective Birth at Term............................................. 537
    • Multifetal Pregnancy.............................................. 539

CHAPTER 8

BLEEDING IN PREGNANCY

• Etiology of Obstetric Bleeding.......................................... 571
• Bleeding in early pregnancy............................................. 572
  • Abortion...................................................................... 572
  • Cervical Insufficiency.................................................... 599
  • Ectopic Pregnancy........................................................ 603
  • Gestational Trophoblastic Disease................................. 621
• Antepartum Hemorrhage................................................. 647
  • Placental Abruption...................................................... 649
  • Placenta Previa............................................................. 654
  • Management of APH.................................................... 658
  • Vasa-Previa.................................................................. 670
  • Rupture of the Uterus................................................... 671
• Postpartum Hemorrhage.................................................. 677
  • Obstetric Injuries.......................................................... 691
  • Secondary PPH............................................................. 697

CHAPTER 9

SYSTEMIC AND Medical DISORDERS IN PREGNANCY

• Hypertensive disorders in Pregnancy............................... 702
• Endocrinal Disorders........................................................ 736
  • Diabetes Mellitus – Gestational Diabetes....................... 737
  • Thyroid disorders......................................................... 763
  • Parathyroid disorders................................................... 776
  • Adrenal disorders......................................................... 780
  • Pituitary disorders........................................................ 787
• Immunological Disorders................................................. 789
  • Antiphospholipid Syndrome......................................... 789
  • Systemic Lupus Erythematosus..................................... 796
  • Rheumatic and Musculoskeletal Diseases...................... 805
• Hematological Disorders.................................................. 807
  • Anticoagulants............................................................. 808
  • Thromboprophylaxis.................................................... 814
  • Thromboembolic disorders
  • Superficial Thrombophlebitis................................... 823
  • Deep Vein Thrombosis............................................ 823
  •  Pulmonary Embolism............................................. 830
  • Amniotic fluid embolism syndrome......................... 834
  • Maternal Anemia.......................................................... 836
  • Hemoglobinopathies.................................................... 849
  • Hemolytic anemias....................................................... 859
  • Disorders of Hemostasis................................................ 862
• Renal and Urinary Tract Disorders.................................... 868
  • Urinary tract infections................................................. 869
  • Urinary Calculi.............................................................. 876
  • Acute Nephritic Syndrome............................................ 877
  • Acute kidney Injury...................................................... 880
  • Chronic R6enal Disease................................................. 882
  • Renal Transplant Patient…………………............................. 885

• Gastrointestinal Disorders............................................... 886
  • Intrahepatic Cholestasis of Pregnancy........................... 886
  • Acute fatty liver of Pregnancy....................................... 890
  • Acute Cholecystitis........................................................ 894
  • Hyperemesis gravidarum.............................................. 897
  • Obesity in pregnancy.................................................... 905
  • Pregnancy after Bariatric Surgery.................................. 909
  • Appendicitis in pregnancy............................................. 915
• Cardiovascular Disorders................................................. 916
  • Effects, Diagnosis and Management.............................. 916
  • Specific Cardiac Lesions.................................................... 934
    • Valvular Heart Disease, Congenital Heart Disease, Pulmonary Hypertension, Cardiomyopathies, Heart Failure, Infective Endocarditis, Arrhythmias, Diseases of The Aorta, Ischemic Heart Disease
• Seizure Disorder............................................................... 957
• Psychiatric Disorders........................................................ 963
• Substance abuse and Addiction........................................ 967
• Abdominal Pain in Pregnancy........................................... 969

CHAPTER 10

INFECTIONS IN PREGNANCY

• • Classification................................................................ 972
  • Congenital Infections.................................................... 973
    • Toxoplasma............................................................ 973
    • Parvovirus.............................................................. 976
    • Syphilis................................................................... 977
    • Rubella................................................................... 980
    • HZV........................................................................ 982
    • CMV....................................................................... 984
    • HSV........................................................................ 986
    • Coxachie virus........................................................ 990
    • Zika virus................................................................ 990
• • • Malaria................................................................... 991
    • Listeria................................................................... 993
  • Peripartum Infections................................................... 994
    • Bacterial: GAS, GBS, MRSA...................................... 994
    • Viral Hepatitis......................................................... 1003
    • Human Immune Deficiency Virus............................. 1010
    • Human Papilloma Virus........................................... 1016
    • Cervicitis (Gonorrhea, Chlamydia)........................... 1017
    • Vaginitis (Vaginosis, Trichomonas, Candida)............ 1019
    • Tuberculosis........................................................... 1020
  • Infectious Diseases....................................................... 1023
    • Air-Borne infections (Influenza, COVID)................... 1023
    • Food-Borne infections............................................. 1028
    • Vector Borne Infections.......................................... 1029
    • Bioterrorism........................................................... 1030
  • Vaccines....................................................................... 1031

CHAPTER 11

Biostatics and Research

• • Vital statistics............................................................... 1037
  • Ethics in Obstetrics and Gynecology.............................. 1040
  • Research methodology................................................. 1041
  • Medical statistics.......................................................... 1043
  • Epidemiological definitions........................................... 1049

APPENDIX

• • Antenatal Card............................................................. 1053
  • Obstetric Scan Report................................................... 1057
  • Obstetric Admission Sheet............................................ 1060
  • Induction of labor Sheet............................................... 1059
  • Labor and Delivery Standing Orders.............................. 1063

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