266. Obstetrics And Gynecology: Essentials

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266. Obstetrics And Gynecology: Essentials

266. Obstetrics And Gynecology: Essentials

 

 

CATEGORY: Medical & Medicine – 500 Courses

COURSE NUMBER: 266

FEES: 555/- INR only

CERTIFICATE VALIDITY: Lifetime

CERTIFICATES DELIVERY: In 48 hours

BOOKS/ MANUALS: Pages

Syllabus

Part I Patient Care
1 Life-Long OB/GYN Care for Women . . . . . . . . 3
From Birth to Adolescence . . . . . . . . . . . . . . . . 4
The Reproductive Years . . . . . . . . . . . . . . . . . . . 5
Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2 OB/GYN Examinations and Evaluations . . . . 15
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Physical Examination . . . . . . . . . . . . . . . . . . . . . 17
Laboratory Evaluations . . . . . . . . . . . . . . . . . . . 19
Diagnostic Imaging Procedures . . . . . . . . . . . . 21
3 Embryology of the Female Reproductive
System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Genital Embryogenesis . . . . . . . . . . . . . . . . . . . 25
Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
4 The Menstrual Cycle and Fertilization . . . . . . 31
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
The Menstrual Cycle . . . . . . . . . . . . . . . . . . . . . . 32
Fertilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
5 Genetics and Genomic Applications
in OB/GYN Practice . . . . . . . . . . . . . . . . . . . . . . 41
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Impact of Genetics and Genomics
on OB/GYN Practice . . . . . . . . . . . . . . . . . . . . . . 42
Basic Concepts of Genetics . . . . . . . . . . . . . . . . 42
Types and Mechanisms
of Genetic Abnormalities . . . . . . . . . . . . . . . . . . 43
Diagnosis and Management . . . . . . . . . . . . . . . 50
6 Pap Smear and Human Papilloma
Virus Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Pap Smear Terminology . . . . . . . . . . . . . . . . . . . 57
Types of Pap Smear, Their Sensitivity,
and Screening Guidelines . . . . . . . . . . . . . . . . . 59
Human Papilloma Virus DNA Testing . . . . . . . . 61
Management . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
7 Genetic Screening and Obstetric Procedures 65
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Screening Strategies . . . . . . . . . . . . . . . . . . . . . 65
Diagnostic Testing . . . . . . . . . . . . . . . . . . . . . . . 68

Part II Obstetrics
Section I Normal Obstetrics
8 Maternal–Fetal Physiology . . . . . . . . . . . . . . . 75
Maternal Physiology . . . . . . . . . . . . . . . . . . . . . . 75
Fetal Physiology . . . . . . . . . . . . . . . . . . . . . . . . . 77
9 Preconception and Antepartum Care . . . . . . 81
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Preconception Care . . . . . . . . . . . . . . . . . . . . . . 81
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Antepartum Care . . . . . . . . . . . . . . . . . . . . . . . . 85
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
10 Intrapartum Care and Fetal Surveillance . . . 91
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Fetal Heart Rate: Normal
and Pathologic Patterns . . . . . . . . . . . . . . . . . . . 92
Other Methods for Intrapartum
Fetal Surveillance . . . . . . . . . . . . . . . . . . . . . . . . 96
Fetal Metabolic Status Assessment . . . . . . . . . . 97
Interventions for Altered Heart Rate Patterns . 97
11 Labor and Delivery . . . . . . . . . . . . . . . . . . . . . . 99
Labor Physiology . . . . . . . . . . . . . . . . . . . . . . . . 99
Mechanics of Labor . . . . . . . . . . . . . . . . . . . . . . 99
The Fetus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Cardinal Movements of Labor . . . . . . . . . . . . . . 101
Progress of Labor . . . . . . . . . . . . . . . . . . . . . . . . 104
Operative Vaginal Delivery . . . . . . . . . . . . . . . . 105
12 Immediate and Postpartum Newborn Care . 107
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
The Respiratory Transition . . . . . . . . . . . . . . . . . 107
The Circulatory Transition . . . . . . . . . . . . . . . . . 108
The Thermoregulatory Transition . . . . . . . . . . . 108
Newborn Management . . . . . . . . . . . . . . . . . . . 110
Discharge Procedures . . . . . . . . . . . . . . . . . . . . 113
Managing Neonatal Jaundice . . . . . . . . . . . . . . 113
General Laboratory Evaluation . . . . . . . . . . . . . 114
Section II Abnormal Obstetrics
13 Ectopic Pregnancies . . . . . . . . . . . . . . . . . . . . . 119
Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Etiology and Pathophysiology . . . . . . . . . . . . . . 119
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Treatment Options . . . . . . . . . . . . . . . . . . . . . . . 122
14 Spontaneous Abortion . . . . . . . . . . . . . . . . . . 127
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Incidence and Risk Factors . . . . . . . . . . . . . . . . . 128
Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Post-Treatment Evaluation and Counseling . . . 131
15 Pathological Labor and Delivery . . . . . . . . . . 135
Preterm Labor . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Abnormal Labor . . . . . . . . . . . . . . . . . . . . . . . . . 145
16 Pre-Eclampsia–Eclampsia Syndrome . . . . . . . 149
Definition and Diagnosis . . . . . . . . . . . . . . . . . . 149
Prevalence and Epidemiology . . . . . . . . . . . . . . 151
Etiology and Pathophysiology . . . . . . . . . . . . . . 151
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Physical Examination . . . . . . . . . . . . . . . . . . . . . 152
Laboratory Testing . . . . . . . . . . . . . . . . . . . . . . . 152
Treatment of Pre-eclampsia . . . . . . . . . . . . . . . . 153
Treatment of Severe Pre-eclampsia . . . . . . . . . 154
Treatment of Eclampsia . . . . . . . . . . . . . . . . . . . 155
Antihypertensive Therapy . . . . . . . . . . . . . . . . . 155
17â•… Rhesus Isoimmunization . . . . . . . . . . . . . . . . . 159
Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Prevalence and Epidemiology . . . . . . . . . . . . . . 160
Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Pathophysiology . . . . . . . . . . . . . . . . . . . . . . . . . 161
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Physical Examination . . . . . . . . . . . . . . . . . . . . . 162
Laboratory Testing . . . . . . . . . . . . . . . . . . . . . . . 162
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
18 Multifetal Pregnancy . . . . . . . . . . . . . . . . . . . . 167
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Prevalence and Epidemiology . . . . . . . . . . . . . . 168
Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Pathophysiology . . . . . . . . . . . . . . . . . . . . . . . . . 170
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Laboratory Testing . . . . . . . . . . . . . . . . . . . . . . . 173
Management . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Labor and Delivery in Multifetal Births . . . . . . . 175
Triplets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
19 Preterm Birth and
Fetal Growth Restrictions . . . . . . . . . . . . . . . . 179
Preterm Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Fetal Growth Restriction . . . . . . . . . . . . . . . . . . 180
Prevalence and Epidemiology . . . . . . . . . . . . . . 181
Etiology and Pathophysiology . . . . . . . . . . . . . . 182
History Taking: Preterm Labor . . . . . . . . . . . . . 183
History Taking: Fetal Growth Resriction . . . . . . 184
Physical Examination: Preterm Labor . . . . . . . . 184
Physical Examination: Fetal Growth Restriction 185
Laboratory Testing: Preterm Labor . . . . . . . . . . 186
Treatment Options . . . . . . . . . . . . . . . . . . . . . . . 186

20 Premature Rupture of Membranes
and Third Trimester Bleeding . . . . . . . . . . . . . 191
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Prevalence and Epidemiology . . . . . . . . . . . . . . 192
Etiology and Pathophysiology . . . . . . . . . . . . . . 192
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Physical Examination . . . . . . . . . . . . . . . . . . . . . 195
Laboratory Testing . . . . . . . . . . . . . . . . . . . . . . . 196
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
21 Hypertension in Pregnancy . . . . . . . . . . . . . . 203
Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
Prevalence and Epidemiology . . . . . . . . . . . . . . 204
Etiology and Pathophysiology . . . . . . . . . . . . . . 205
Medical History . . . . . . . . . . . . . . . . . . . . . . . . . 206
Physical Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Laboratory Studies . . . . . . . . . . . . . . . . . . . . . . . 206
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Special Concerns . . . . . . . . . . . . . . . . . . . . . . . . 208
22 Postpartum Hemorrhage and Infection . . . . 211
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
Prevalence and Epidemiology . . . . . . . . . . . . . . 212
Etiology and Risk Factors . . . . . . . . . . . . . . . . . . 213
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Physical Evaluation . . . . . . . . . . . . . . . . . . . . . . . 214
Management . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
23 Infectious Diseases in Pregnancy . . . . . . . . . . 219
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Viral Infections . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Pregnancy in the HIV Era . . . . . . . . . . . . . . . . . . 223
Bacterial Infections . . . . . . . . . . . . . . . . . . . . . . . 225
Toxoplasmosis . . . . . . . . . . . . . . . . . . . . . . . . . . 229
24 Perinatal and Maternal Mortality . . . . . . . . . 233
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Epidemiology and Etiology . . . . . . . . . . . . . . . . 233
Management and Prevention . . . . . . . . . . . . . . 235
25 Psychiatric Issues during
and after Pregnancy . . . . . . . . . . . . . . . . . . . . 241
Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . 241
Genetics of Psychiatric Disorders . . . . . . . . . . . 242
Risk Factors for the Expectant Mother
during Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . 242
Risk Factors for the Fetus during Pregnancy . . 242
Postpartum Complications . . . . . . . . . . . . . . . . 242
Addressing Psychiatric Issues during Pregnancy 243
Postpartum Mood Disorders . . . . . . . . . . . . . . . 247
26 Other Medical Complications in Pregnancy . 251
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
Prevalence and Epidemiology . . . . . . . . . . . . . . 254
Etiology and Pathophysiology . . . . . . . . . . . . . . 255
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257

Laboratory Testing . . . . . . . . . . . . . . . . . . . . . . . 259
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
27 Post-Term Pregnancy . . . . . . . . . . . . . . . . . . . . 265
Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Pathophysiology . . . . . . . . . . . . . . . . . . . . . . . . . 266
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Physical Examination . . . . . . . . . . . . . . . . . . . . . 267
Management and Treatment . . . . . . . . . . . . . . 268
Part III Gynecology
Section I General Gynecology
28 Contraception and Sterilization . . . . . . . . . . . 275
Addressing Contraception with Patients . . . . . 275
Contraceptive Methods . . . . . . . . . . . . . . . . . . . 276
29 Therapeutic Abortion . . . . . . . . . . . . . . . . . . . 285
Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
History and Legality . . . . . . . . . . . . . . . . . . . . . . 285
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
30 Vaginitis and Vulvitis . . . . . . . . . . . . . . . . . . . . 293
Vaginitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Vulvitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
31 Sexually Transmitted Diseases . . . . . . . . . . . . 305
Screening and Risk Factors . . . . . . . . . . . . . . . . 305
Non-Ulcerative Lesions . . . . . . . . . . . . . . . . . . . . 305
Ulcerative Lesions . . . . . . . . . . . . . . . . . . . . . . . . 306
Viral Infections . . . . . . . . . . . . . . . . . . . . . . . . . . 309
32 Pelvic Inflammatory Disease . . . . . . . . . . . . . 311
Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Signs and Symptoms . . . . . . . . . . . . . . . . . . . . . 311
Long-Term Complications . . . . . . . . . . . . . . . . . 311
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312
33 Endometriosis and Adenomyosis . . . . . . . . . . 315
Endometriosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Adenomyosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
34 Chronic Pelvic Pain . . . . . . . . . . . . . . . . . . . . . . 325
Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Prevalence and Epidemiology . . . . . . . . . . . . . . 326
Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
Physical Examination and Laboratory Studies . 327
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Interdisciplinary Pain Practice . . . . . . . . . . . . . . 328
35 Pelvic Relaxation, Urinary Incontinence,
and Urinary Tract Infection . . . . . . . . . . . . . . . 331
Pelvic Relaxation . . . . . . . . . . . . . . . . . . . . . . . . . 331
Urinary Incontinence . . . . . . . . . . . . . . . . . . . . . 333
Urinary Tract Infection . . . . . . . . . . . . . . . . . . . . 336

Section II Breasts
36 The Breast and Benign Breast Disease . . . . . 341
Breast Structure and Function . . . . . . . . . . . . . . 341
Breast Examination . . . . . . . . . . . . . . . . . . . . . . . 341
Lactation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
Breast-Feeding . . . . . . . . . . . . . . . . . . . . . . . . . . 342
Mastitis, Breast Abscess, and Galactocele . . . . 343
Breast-Feeding and Amenorrhea . . . . . . . . . . . . 343
Breast-Feeding and Contraception . . . . . . . . . . 343
Nipple Discharge . . . . . . . . . . . . . . . . . . . . . . . . 344
Breast Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344
Breast Problems in Children and Adolescents . 344
Approach to the Palpable Breast Mass . . . . . . . 345
37 Breast Cancer: Prevention, Screening,
Diagnosis, and Treatment . . . . . . . . . . . . . . . . 351
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Breast Cancer Genetics . . . . . . . . . . . . . . . . . . . 352
Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 352
Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Medical Care for Breast Cancer Survivors . . . . . 356
Section III Procedures
38 Surgical Procedures in Gynecology . . . . . . . . 363
Historical Perspective . . . . . . . . . . . . . . . . . . . . . 363
Vaginal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . 363
Abdominal Surgery . . . . . . . . . . . . . . . . . . . . . . 364
Laparoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
Hysteroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
Common Gynecologic Procedures . . . . . . . . . . 366
Office Procedures . . . . . . . . . . . . . . . . . . . . . . . . 374
Part IV Reproductive Endocrinology, Infertility,
and Related Topics
39 Amenorrhea and Dysfunctional
Uterine Bleeding . . . . . . . . . . . . . . . . . . . . . . . . 378
Amenorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
Secondary Amenorrhea . . . . . . . . . . . . . . . . . . . 378
Primary Amenorrhea . . . . . . . . . . . . . . . . . . . . . 382
Dysfunctional Uterine Bleeding . . . . . . . . . . . . 384
40 Polycystic Ovary Syndrome, Hirsutism,
and Virilization . . . . . . . . . . . . . . . . . . . . . . . . . 387
Definition and Diagnosis . . . . . . . . . . . . . . . . . . 387
Prevalence and Epidemiology . . . . . . . . . . . . . . 388
Etiology and Pathophysiology . . . . . . . . . . . . . . 388
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
Physical Examination . . . . . . . . . . . . . . . . . . . . . 390
Laboratory Tests . . . . . . . . . . . . . . . . . . . . . . . . . 391
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Hirsutism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394
Virilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394

41 Dysmenorrhea: Painful Menstruation . . . . . . 397
Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Prevalence and Epidemiology . . . . . . . . . . . . . . 397
Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398
Physical Examination and Laboratory Studies . 399
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
Treatment Failure . . . . . . . . . . . . . . . . . . . . . . . . 402
42 Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Diagnostic Tests . . . . . . . . . . . . . . . . . . . . . . . . . 404
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406
Lifestyle Changes to Improve Fertility
and Pregnancy Outcome . . . . . . . . . . . . . . . . . . 409
Assisted Reproductive Technology . . . . . . . . . . 409
Ovarian Hyperstimulation Syndrome . . . . . . . . 410
Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
Psychosocial Aspects . . . . . . . . . . . . . . . . . . . . . 411
Social and Ethical Issues . . . . . . . . . . . . . . . . . . . 411
43 Premenstrual Syndrome ……………… 415
Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
Prevalence and Epidemiology . . . . . . . . . . . . . . 416
Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
Physical Examination and Laboratory Studies . 417
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
44 Perimenopause, Menopause,
and Postmenopause: Consequences
of Ovarian Reproductive Aging . . . . . . . . . . . 421
Definition and Diagnosis . . . . . . . . . . . . . . . . . . 421
Etiology and Epidemiology . . . . . . . . . . . . . . . . 423
Physiology of Ovarian Aging . . . . . . . . . . . . . . . 423
Clinical Presentation . . . . . . . . . . . . . . . . . . . . . 425
Premature (Primary) Ovarian Failure . . . . . . . . 426
Surgical Menopause . . . . . . . . . . . . . . . . . . . . . . 427
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427
The Future of Hormone Therapy . . . . . . . . . . . . 429
Part V Gynecologic Oncology
45 The Biology of Cancer . . . . . . . . . . . . . . . . . . . 435
Cervical Cancer is Caused by the Human
Papilloma Virus . . . . . . . . . . . . . . . . . . . . . . . . . . 435
Endometrial Cancer is Caused by Unopposed
Estrogen Stimulation . . . . . . . . . . . . . . . . . . . . . 436
Endometrial and Ovarian Cancers are
Caused by Germ-Line Mutations in DNA
Mismatch Repair Genes . . . . . . . . . . . . . . . . . . . 436
Breast and Ovarian Cancers can be Caused
by Mutations in BRCA1 and BRCA2 . . . . . . . . . . 437
Evolving Issues in Cancer Biology . . . . . . . . . . . 437

46 Gestational Trophoblastic Disease:
Molar Pregnancy . . . . . . . . . . . . . . . . . . . . . . . 441
Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
Hydatidiform Mole . . . . . . . . . . . . . . . . . . . . . . . 441
Malignant Disease: Gestational
Trophoblastic Neoplasia . . . . . . . . . . . . . . . . . . . 444
47 Vulvar and Vaginal Lesions . . . . . . . . . . . . . . . 447
Types of Lesion . . . . . . . . . . . . . . . . . . . . . . . . . . 447
48 Cervical Neoplasia and Cancer . . . . . . . . . . . . 453
Cervical Neoplasia . . . . . . . . . . . . . . . . . . . . . . . 453
Cervical Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . 457
49 Uterine Leiomyomas . . . . . . . . . . . . . . . . . . . . 461
Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462
Treatment for Uterine Fibroids . . . . . . . . . . . . . 462
Uterine Sarcomas . . . . . . . . . . . . . . . . . . . . . . . . 467
50 Endometrial Cancer . . . . . . . . . . . . . . . . . . . . . 471
Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471
Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . 472
Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472
Physical Examination . . . . . . . . . . . . . . . . . . . . . 472
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472
Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473
Staging and Surgical Treatment . . . . . . . . . . . . 473
Adjuvant Treatment . . . . . . . . . . . . . . . . . . . . . . 474
Post-treatment Follow-up . . . . . . . . . . . . . . . . . 474
Uterine Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . 474
51 Ovarian and Fallopian Tube Cysts
and Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477
Ovarian Tumors . . . . . . . . . . . . . . . . . . . . . . . . . 477
Fallopian Tube and Mesosalpingeal Cysts . . . . . 483
Fallopian Tube Cancer . . . . . . . . . . . . . . . . . . . . 483
Part VI Human Sexuality
52 Sexuality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Sexual Identity . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Sexual Response in Men and Women . . . . . . . . 487
Sexual Dysfunction in the General Population . 488
The Sexual History . . . . . . . . . . . . . . . . . . . . . . . 488
Common Sexual Problems in Women . . . . . . . 489
Treatment of Female Sexual Dysfunction . . . . . 491
Adolescent Sexuality . . . . . . . . . . . . . . . . . . . . . 492
Postpartum Sexual Dysfunction . . . . . . . . . . . . 492
Sexuality in Chronic Illness . . . . . . . . . . . . . . . . 492
Sexuality in Older Adults ………………. 492
53 Domestic Violence and Sexual Assault . . . . . 495
Domestic Violence . . . . . . . . . . . . . . . . . . . . . . . 495
Sexual Assault . . . . . . . . . . . . . . . . . . . . . . . . . . . 496

Part VII Professional Behavior, Ethics, and Legalitis
54 Medical Economics and Social Issues . . . . . . 501
Population Health Promotes Economic
Growth and Stability . . . . . . . . . . . . . . . . . . . . . 501
Health Economics Issues
in Developed Countries . . . . . . . . . . . . . . . . . . . 501
Health Economics Issues in Countries
with Rapidly Growing Economies . . . . . . . . . . . 505
Health Economics Issues in Developing
and Poor Countries . . . . . . . . . . . . . . . . . . . . . . . 505
55 Provider–Patient Communications
and Interactions . . . . . . . . . . . . . . . . . . . . . . . . 507
Core Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507
Provider–Patient Communications . . . . . . . . . . 508
Special Challenges in the Provider–
Patient Relationship . . . . . . . . . . . . . . . . . . . . . . 513
Physician–Physician Interactions . . . . . . . . . . . 515

56 Clinical Ethics in Obstetrics and Gynecology . 517
Medical Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . 517
Ethical Dilemmas in Obstetrics:
the Fetus as Patient . . . . . . . . . . . . . . . . . . . . . . 519
Ethical Dilemmas in Obstetrics:
the Neonate as Patient . . . . . . . . . . . . . . . . . . . . 522
Ethical Dilemmas in Gynecology . . . . . . . . . . . . 522
General Guidelines for Making Ethical Decisions 524
57 Legal Issues in Obstetrics and Gynecology . . 527
Licensure, Certification, Credentialing,
and Privileges . . . . . . . . . . . . . . . . . . . . . . . . . . . 528
Standard of Care . . . . . . . . . . . . . . . . . . . . . . . . . 528
Adverse Outcomes . . . . . . . . . . . . . . . . . . . . . . . 528
Informed Consent . . . . . . . . . . . . . . . . . . . . . . . 529
Risk Management . . . . . . . . . . . . . . . . . . . . . . . . 530
Elements of Medical Negligence . . . . . . . . . . . . 530
Common Areas of Increased Liability Risk . . . . 530
Special Legal Provisions in the United States . . 531
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 533

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