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The Johns Hopkins Manual of Gynecology and Obstetrics
Labor and Delivery Pain Management-Substance Use Disorders in Pregnancy
Table of Contents
Free Topics
1 . Prepregnancy Counseling and Parental Care
14 . Genitourinary Assessment and Renal Disease in Pregnancy
21 . Neoplastic Diseases in Pregnancy
3 . Complications of Labor and Delivery
6 . Preterm Labor and Preterm Prelabor Rupture of Membranes
Cardiopulmonary Resuscitation in Pregnancy
Care of the Difficult Pregnant Patient
Cervical Insufficiency
Common Specific Congenital Anomalies
Confounding Factors in Fetal Assessment
Contributors
Definitions and General Principles
Diagnosis
Eclampsia
Emerging Infections
F - 11-1. Calculation and Dose Distribution for Initial Insulin Management in Pregnancy Nph, Neutral Protamine Hagedorn
F - 17-1. Amount of Radiation Received by the Fetus Per Radiation Source
F - 3-2. O'leary Uterine Artery Ligation
F - 6-1. Mortality Based on Gestational Age at Delivery, 2007-2016
F - 7-1. Three Types of Placenta Previa: Marginal, Partial, Complete Central Previa Refers to a Complete Previa Where the Central Portion the Placenta is Located over the Cervical Os
Fetal Growth Restriction
Fetal Heart Rate Evaluation
Figure - Mortality Based on Gestational Age at Delivery, 2007-2016
Figure - O'leary Uterine Artery Ligation
Flowchart - Algorithm for Consideration of the Use of Progestins for Reducing the Risk of Preterm Birth (PTB) - Flowchart
Flowchart - Calculation and Dose Distribution for Initial Insulin Management in Pregnancy - Flowchart
Headache
Introduction
Low-Lying Placenta
Maternal Complications
Maternal Hematologic Disorders
Mechanism of Labor
Nonhepatic Gastrointestinal Disorders
Normal and Common Changes in Pregnancy
Outcomes and Follow-up
Postpartum Endomyometritis
Preeclampsia
Preface
Routine Parental Care
Shoulder Dystocia
Suggested Reading
Suggested Readings
Surgical Diseases in Pregnancy
T - 1-1. Preconception Risk Assessment: Laboratory Testing
T - 11-6. Postpartum Glucose Tolerance Test
T - 13-5. Cardiovascular Drugs in Pregnancy
T - 1-5. Recommended Range of Total Weight Gain in Pregnancy
T - 1-7. Summary of Parental Genetic Screening Tests
T - 17-2. Treatment Options for Acute Migraine Headache in Pregnancy
T - 18-1. Recommended Psychiatric Assessments for OB/GYN Patients
T - 18-5. Lifestyle Modifications for Treatment of Psychiatric Disorders
T - 21-1. Estimated Fetal Radiation Exposure With Common Imaging Modalities
T - 2-2. Induction of Labor: Indications and Contraindications
T - 3-2. Medical Management of Postpartum Hemorrhage With Uterotonic Agents
T - 4-4. Recommendations for Antenatal Fetal Testing: Fetal Conditions
T - 6-1. Indications for Cerclage
T - 9-3. Common Congenital Cardiac Defects
T - 9-5. Gastroschisis and Omphalocele
Table - Preconception Risk Assessment: Laboratory Testing
Table - Recommended Range of Total Weight Gain in Pregnancy
Part I: Obstetrics
1. Prepregnancy Counseling and Parental Care
1 . Prepregnancy Counseling and Parental Care
Prepregnancy Care and Counseling
Routine Parental Care
Suggested Readings
T - 1-1. Preconception Risk Assessment: Laboratory Testing
T - 1-2. T-ACE Screening Tool for Alcohol Misuse
T - 1-3. Routine Parental Care
T - 1-4. Accuracy of Pregnancy Dating by Ultrasonography According to Gestational Age
T - 1-5. Recommended Range of Total Weight Gain in Pregnancy
T - 1-6. Reasons to Consider Referral for Genetic Counseling
T - 1-7. Summary of Parental Genetic Screening Tests
10. Multifetal Gestation
10 . Multifetal Gestation
Antepartum Management
Delivery
Diagnosis
F - 10-1. Types of Placentation in Dizygotic and Monozygotic Twinning
Fetal Complications
Introduction
Maternal Complications
Special Considerations
Suggested Reading
11. Endocrine Disorders of Pregnancy
11 . Endocrine Disorders of Pregnancy
Adrenal Disorders
Diabetes Mellitus
F - 11-1. Calculation and Dose Distribution for Initial Insulin Management in Pregnancy Nph, Neutral Protamine Hagedorn
F - 11-2. Thyroid Testing Algorithm
Parathyroid Disorders
Pituitary Disorders
Suggested Readings
T - 11-1. Comparison of Type 1 and Type 2 Diabetes Mellitus
T - 11-2. Goals for Glycemic Control in Pregnancy
T - 11-3. Initial Management of Diabetic Ketoacidosis
T - 11-4. Gestational Diabetes Risk Assessment
T - 11-5. Criteria for Diagnosis of Gestational Diabetes From Oral Glucose Tolerance Testing
T - 11-6. Postpartum Glucose Tolerance Test
T - 11-7. Thyroid Function Test Results in Pregnancy Compared With Hyperthyroid and Hypothyroid Conditions
T - 11-8. Indications for Thyroid Function Testing in Pregnancy
T - 11-9. Indications for TSH Receptor Antibody Testing in Pregnancy
Thyroid Disorders
12. Hypertensive Disorders of Pregnancy
12 . Hypertensive Disorders of Pregnancy
Chronic Hypertension
Definitions of Hypertensive Disorders
Eclampsia
Gestational Hypertension
HELLP Syndrome
Preeclampsia
Suggested Readings
13. Cardiopulmonary Disorders of Pregnancy
13 . Cardiopulmonary Disorders of Pregnancy
Cardiac Disorders
Respiratory Disorders
Suggested Readings
T - 13-1. New York Heart Association (NYHA) Functional Classification
T - 13-2. Modified World Health Organization Risk Classification of Cardiovascular Disease and Pregnancy
T - 13-3. Risk Factors for Cardiac Events for Patients With Congenital Heart Disease
T - 13-4. Comprehensive Clinical Classification of Pulmonary Hypertension
T - 13-5. Cardiovascular Drugs in Pregnancy
T - 13-6. Asthma Medications in Pregnancy
14. Genitourinary Assessment and Renal Disease in Pregnancy
14 . Genitourinary Assessment and Renal Disease in Pregnancy
Introduction
Kidney and Urinary Tract Disorders
Suggested Readings
15. Gastrointestinal Disease in Pregnancy
15 . Gastrointestinal Disease in Pregnancy
Gallbladder Disorders
Introduction
Liver Disorders
Nonhepatic Gastrointestinal Disorders
Suggested Readings
T - 15-1. Liver Function Test Changes During Normal Pregnancy
16. Autoimmune Disease in Pregnancy
16 . Autoimmune Disease in Pregnancy
Autoimmune Disorders Encountered in Pregnancy
Common General Management Concerns
Introduction
Pathophysiology
Suggested Readings
T - 16-1. Commonly Used Medications in Women of Childbearing Age With Autoimmune Disease
T - 16-2. Distinguishing Between Preeclampsia and Lupus Flare
T - 16-3. Diagnostic Criteria for Diagnosis of Antiphospholipid Syndrome
17. Neurologic Diseases in Pregnancy
17 . Neurologic Diseases in Pregnancy
Carpal Tunnel Syndrome
Chronic Neurologic Diseases
F - 17-1. Amount of Radiation Received by the Fetus Per Radiation Source
F - 17-2. The Rates of Major Anomalies Associated With in Utero Exposure to Various Antiepileptic Medications at 2 and 12 Months of Life
Headache
Introduction
Postpartum Compression Nerve Injuries
Suggested Readings
T - 17-1. History and Physical Exam Findings That Should Prompt Further Headache Workup
T - 17-2. Treatment Options for Acute Migraine Headache in Pregnancy
T - 17-3. Common Postpartum Nerve Palsies and Mechanisms of Injury
18. Psychiatric Disorders in the Pregnant and Postpartum Patient
18 . Psychiatric Disorders in the Pregnant and Postpartum Patient
Anxiety Disorders and Pregnancy
Care of the Difficult Pregnant Patient
Introduction
Mood Disorders and Pregnancy
Obsessive-Compulsive Disorder and Pregnancy
Peripartum Treatment of Psychiatric Illness
Posttraumatic Stress Disorder and Pregnancy
Primary Psychotic Disorders and Pregnancy/Postpartum
Suggested Readings
T - 18-1. Recommended Psychiatric Assessments for OB/GYN Patients
T - 18-2. Indications for Referral to a Psychiatrist
T - 18-3. Diagnostic Criteria for Major Depressive Disorder
T - 18-4. Common Medications Used to Treat Psychiatric Disease With Their Associated Pregnancy and Lactation Risks
T - 18-5. Lifestyle Modifications for Treatment of Psychiatric Disorders
19. Substance Use Disorders in Pregnancy
19 . Substance Use Disorders in Pregnancy
Breastfeeding and Postpartum Issues
Definitions and General Principles
Epidemiology, Pathophysiology, and Maternal/Fetal Effects by Drug Category
Labor and Delivery Pain Management
Management and Referral
Screening and Routine Care
Suggested Readings
T - 19-1. DSM-5 Criteria for Substance Use Disorder
T - 19-2. Sample Screening Tool: 4P's Plus T Questionnaire
T - 19-3. Suggested Pharmacologic Treatment Regimens for Acute Withdrawal and Maintenance Therapy
Treatment
2. Normal Labor and Delivery, Operative Delivery, and Malpresentations
2 . Normal Labor and Delivery, Operative Delivery, and Malpresentations
Assisted Spontaneous Vaginal Delivery
Cesarean Section
Fetal Heart Rate Evaluation
Introduction
Malpresentations
Management of Normal Labor and Delivery
Mechanism of Labor
Obstetric Lacerations
Operative Vaginal Delivery
Shoulder Dystocia
Stages and Phases of Labor
Suggested Readings
T - 2-1. Components of the Bishop Score
T - 2-2. Induction of Labor: Indications and Contraindications
T - 2-3. Fetal Heart Tracing Interpretation, Categories, and Criteria
Vaginal Birth After Cesarean Section
20. Hematologic Disorders of Pregnancy
20 . Hematologic Disorders of Pregnancy
Fetal Hematologic Disorders
Maternal Hematologic Disorders
Suggested Readings
T - 20-1. Classification of Anemia by Mean Corpuscular Volume (MCV)
T - 20-2. Common Anemias Encounters in Pregnancy
T - 20-3. Laboratory Studies in Various Anemias
T - 20-4. Findings in Thalassemia
T - 20-5. Inherited Thrombophilias and Risk of Venous Thromboembolism (VTE) in Pregnancy
T - 20-6. Thrombophilia Testing
T - 20-7. Anticoagulation Regimens in Pregnancy
T - 20-8. von Willebrand Disease Classification
T - 20-9. Atypical Blood Group Antibodies and Incidence of Hemolytic Disease of the Fetus and Newborn (HDFN)
21. Neoplastic Diseases in Pregnancy
21 . Neoplastic Diseases in Pregnancy
General Treatment Concepts
Introduction
Outcomes and Follow-up
Specific Neoplastic Carcinomas
Suggested Readings
T - 21-1. Estimated Fetal Radiation Exposure With Common Imaging Modalities
T - 21-2. Common Cancers in Pregnancy
22. Skin Conditions in Pregnancy
22 . Skin Conditions in Pregnancy
Introduction
Normal and Common Changes in Pregnancy
Skin Conditions Outside of Pregnancy and the Response to Pregnancy
Skin Conditions Unique to Pregnancy
Suggested Readings
23. Surgical Disease and Trauma in Pregnancy
23 . Surgical Disease and Trauma in Pregnancy
Cardiopulmonary Resuscitation in Pregnancy
Perioperative Considerations for Nonobstetric Surgery
Suggested Readings
Surgical Diseases in Pregnancy
T - 23-1. Fetal Radiation Exposure From Common Radiologic Procedures
Trauma in Pregnancy
24. Postpartum Care and Breastfeeding
24 . Postpartum Care and Breastfeeding
Breastfeeding
Common Postpartum Complications
Routine Postpartum Care
Suggested Readings
T - 24-1. Benefits of Breastfeeding
T - 24-2. Postpartum Breast Tenderness
25. Obstetric Anesthesia
25 . Obstetric Anesthesia
F - 25-1. Pudendal Block Technique
F - 25-2. Placement of Spinal and Epidural Anesthesia
Introduction
Overview of Obstetric Analgesia/Anesthesia
Pain Pathways
Suggested Readings
T - 25-1. Use of Anesthesia in Obstetric Situations
T - 25-2. Epidural/Spinal Anesthetics
T - 25-3. Parenteral Medications for Labor Analgesia
Types of Obstetric Analgesia/Anesthesia
3. Complications of Labor and Delivery
3 . Complications of Labor and Delivery
Chorioamnionitis
Embolic Disease
F - 3-1. B-Lynch Suture
F - 3-2. O'leary Uterine Artery Ligation
Postpartum Endomyometritis
Septic Pelvic Thrombophlebitis
Suggested Readings
T - 3-1. Etiologies of Postpartum Hemorrhage
T - 3-2. Medical Management of Postpartum Hemorrhage With Uterotonic Agents
Umbilical Cord Prolapse
Uterine Dehiscence or Rupture
Uterine Inversion
4. Fetal Assessment
4 . Fetal Assessment
Background
Confounding Factors in Fetal Assessment
F - 4-1. Reactive Nonstress Test
F - 4-2. Fetal Heart Tracing With Late Decelerations
F - 4-3. Evaluation of Umbilical Artery Flow by Doppler Velocimetry
Indications for Fetal Testing
Methods of Fetal Assessment
Suggested Readings
T - 4-1. Summary of Antenatal Testing
T - 4-2. Biophysical Profile
T - 4-3. Recommendations for Antenatal Fetal Assessment: Maternal/Pregnancy Conditions
T - 4-4. Recommendations for Antenatal Fetal Testing: Fetal Conditions
5. Parental Complications
5 . Parental Complications
Amniotic Fluid Disorders
Cervical Insufficiency
Fetal Growth Restriction
Intrauterine Fetal Demise
Nausea and Vomiting of Pregnancy
Postterm and Late-Term Pregnancy
Suggested Readings
T - 5-1. Differential Diagnosis of Nausea and Vomiting of Pregnancy
T - 5-2. Treatment of Nausea and Vomiting in Pregnancy
6. Preterm Labor and Preterm Prelabor Rupture of Membranes
6 . Preterm Labor and Preterm Prelabor Rupture of Membranes
F - 6-1. Mortality Based on Gestational Age at Delivery, 2007-2016
F - 6-2. Algorithm for Consideration of the Use of Progestins for Reducing the Risk of Preterm Birth (PTB) Aif Transvaginal Ultrasound (TVU) Cervical Length (Cl) Screening is Performed. B17- Hydroxyprogesterone Caproate (17-P) 250 mg Intramuscularly Every Week from 16-20 to 36 Weeks, if Selected Weighing the Risk and Benefits of Research to Late Discussed on the Prior Page. Cfor Example, Daily 200-mg Suppository or 90-mg Gel from Time of Diagnosis of Short Cl to 36 Weeks
Preterm Labor
Preterm PRELABOR Rupture of Membranes
Suggested Readings
T - 6-1. Indications for Cerclage
T - 6-2. Indomethacin and Nifedipine Tocolytic Overview
7. Third-Trimester Bleeding
7 . Third-Trimester Bleeding
Abruptio Placentae
F - 7-1. Three Types of Placenta Previa: Marginal, Partial, Complete Central Previa Refers to a Complete Previa Where the Central Portion the Placenta is Located over the Cervical Os
Introduction
Low-Lying Placenta
Placenta Previa
Suggested Readings
T - 7-1. Important Steps in the Diagnosis and Management of Third-Trimester Vaginal Bleeding
Vasa Previa
8. Perinatal Infections
8 . Perinatal Infections
Bacterial Infections
Emerging Infections
Introduction
Protozoan Infections
Suggested Readings
Viral Infections
9. Congenital Anomalies
9 . Congenital Anomalies
Chromosomal Abnormalities With Associated Congenital Anomalies
Common Specific Congenital Anomalies
Epidemiology
Etiology
Introduction
Screening and Management
Suggested Readings
T - 9-1. Factors Associated With Increased Risk for Congenital Anomalies
T - 9-2. Common Aneuploidies With Associated Findings
T - 9-3. Common Congenital Cardiac Defects
T - 9-4. Neural Tube Defects
T - 9-5. Gastroschisis and Omphalocele
T - 9-6. Skeletal Dysplasias
Part II: General Gynecology
26. Primary and Preventive Care
26. Primary and Preventive Care
Annual Well Woman Visit
Cancer
Care for Lesbians, Bisexual, and Transgender Women
Counseling
F - 26-1. Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2019
F - 26-2. Recommended Adult Immunization Schedule by Medical Conditions and Other Indications, United States, 2019
Heart and Vascular Conditions
Immunizations
Infectious Diseases
Introduction
Metabolic, Endocrine, and Nutritional Conditions
Other Primary Care Problems
Screening for Other Medical Conditions
Suggested Readings
T - 26-1. Leading Causes of Death Among Females of All Races in the United States (2017)
T - 26-2. American College of Cardiology/American Heart Association Treatment and Follow-up Guidelines for Hypertension (2017)
27. Infections of the Genital Tract
27. Infections of the Genital Tract
Infections of the Lower Female Genital Tract
Infections of the Upper Genital Tract
Introduction
Screening
Suggested Readings
T - 27-1. Treatment of Condyloma Acuminat
T - 27-10. Treatment of Gonococcal Infections
T - 27-11. Treatment of Pelvic Inflammatory Disease, Including Tubo-ovarian Abscess
T - 27-2. Treatment of Pediculosis Pubis and Scabies
T - 27-3. Treatment of Herpes Simplex Virus
T - 27-4. Treatment of Syphilis
T - 27-5. Clinical Findings of Vaginitis
T - 27-6. First-Line Therapy for Treatment of Bacterial Vaginosis
T - 27-7. Features of Vulvovaginal Candidiasis
T - 27-8. Treatment of Vulvovaginal Candidiasis
T - 27-9. Treatment of Chlamydia Infections
28. Contraception and Sterilization
28. Contraception and Sterilization
Barrier Methods
Emergency (Postcoital) Contraception
F - 28-1. Tiers of Effectiveness of Family Planning Methods
Fertility Awareness-Based Methods
Highly Effective Contraceptive Methods
Introduction
Short-Acting Hormonal Contraceptive Methods
Suggested Readings
T - 28-1. Percentage of Women Experiencing an Unintended Pregnancy During the First Year of Typical Use and the First Year of Perfect Use of Contraception and the Percentage Continuing Use at the End of the First Year, United States
Tiers of Effectiveness
29. Abortion
29. Abortion
Complications
Medication Abortion
Pregnancy Termination
Suggested Readings
Surgical Abortion
30. First and Second Trimester Pregnancy Loss and Ectopic Pregnancy
30. First and Second Trimester Pregnancy Loss and Ectopic Pregnancy
Assessment of Pregnancy Location and Viability in the First Trimester
Early Pregnancy Loss in the First Trimester
Ectopic Pregnancy
Introduction
Second-Trimester Pregnancy Loss
Suggested Readings
T - 30-1. Minimal Expected Rate of Increase in -Human Chorionic Gonadotropin (-hCG) in 48 Hours by Initial -hCG Value
T - 30-2. Absolute and Relative Contraindications to Methotrexate Treatment for Ectopic Pregnancy
T - 30-3. Methotrexate Dosing Regimens
31. Abnormal Uterine Bleeding
31. Abnormal Uterine Bleeding
Differential Diagnosis of Abnormal Uterine Bleeding
Evaluation of Abnormal Uterine Bleeding
F - 31-1. International Federation of Gynecology and Obstetrics (PALM-COEIN) Classification System for Causes of Abnormal Uterine Bleeding in Nongravid Women of Reproductive Age
Imaging Techniques and Tissue Sampling Methods
Introduction
Management of Abnormal Uterine Bleeding
Menstrual Dimensions
Specific Causes of Abnormal Uterine Bleeding
Suggested Readings
T - 31-1. Differential Diagnosis of Abnormal Uterine Bleeding by Age Group
32. Chronic Pelvic Pain
32. Chronic Pelvic Pain
Differential Diagnosis of Pelvic Pain
Evaluation of Chronic Pelvic Pain
Introduction
Management of Chronic Pelvic Pain
Suggested Readings
T - 32-1. Differential Diagnosis of Chronic Pelvic Pain
Types of Pelvic Pain
33. Uterine Leiomyomas and Benign Adnexal Masses
33. Uterine Leiomyomas and Benign Adnexal Masses
Adnexal Masses
Introduction
Suggested Readings
T - 33-1. Differential Diagnosis of Pelvic Masses
T - 33-2. International Federation of Gynecology and Obstetrics Classification System for Fibroids
T - 33-3. Diagnostic Imaging for Uterine Leiomyomas
Uterine Masses
34. Breast Diseases
34. Breast Diseases
Anatomy
Breast Cancer
Breast Exam
Common Breast Disorders and Complaints
F - 34-1. Anatomy of the Breast
F - 34-2. Algorithm for Evaluation of Nipple Discharge
F - 34-3. A,chr(10)A 53-Year-Old Woman With Bloody Discharge from the Nipple Mediolateral View of the Right Breast Demonstrates Casting Calcifications Involving a Large Part of the Breast Extending to the Nipple. The Calcifications are Nonuniform, Irregular, and Branched (Arrow), and They Form a Dot-Dash Linear Pattern. They are Aligned With the Ductal System.chr(10)chr(10)chr(10)B,chr(10)A 60-Year-Old Woman With a Palpable Mass and No Other Pertinent History. Mediolateral View of the Right Breast Reveals a Spiculated Mass (Arrow) With Architectural Distortion. Within the Center of the Mass, Irregular (Pleomorphic) Microcalcifications are Present (Arrowhead). The Diagnosis is Carcinoma, Largely Dcis, of Comedo Type
Introduction
Suggested Readings
T - 34-1. Breast Cancer Screening Techniques and Guidelines
T - 34-2. American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) Mammography Assessment Categories
T - 34-3. 5-Year Breast Cancer Relative Survival Rates Based on the SEER Database
35. Benign Vulvar Disorders
35. Benign Vulvar Disorders
Anatomy of the Vulva
Benign Vulvar Cysts
Benign Vulvar Lesions
Dermatoses and Inflammatory Conditions
F - 35-1. Superficial Vulvar Musculature and Vascular Supply of the Vulva
Infectious Diseases of the Vulva
Suggested Readings
Vulvar Pain Syndromes
36. Female Sexual Function and Dysfunction
36. Female Sexual Function and Dysfunction
Diagnosis of Sexual Disorders
Epidemiology
Introduction
Physiology of Sexual Function
Sexual Dysfunction Disorders
Sexual Function and Special Populations
Suggested Readings
T - 36-1. Physiologic Female Sexual Response
Theories of Sexual Function
37. Intimate Partner and Sexual Violence
37. Intimate Partner and Sexual Violence
Intimate Partner Violence
Sexual Violence
Suggested Readings
T - 37-1. SAFE Questionnaire
T - 37-2. Abuse Assessment During Pregnancy
T - 37-3. Reproductive Coercion Script
T - 37-4. Exit Plan for Domestic Violence Intervention
38. Pediatric Gynecology
38. Pediatric Gynecology
Ambiguous Genitalia
Common Pediatric Gynecology Complaints
Congenital Anomalies of the Female Reproductive Tract
Disorders of Puberty
F - 38-1. Tanner Stages of Development
Gynecologic Evaluation of a Prepubertal Child
Gynecologic Evaluation of an Adolescent
Introduction
Suggested Readings
T - 38-1. Treatment of Specific Vulvovaginal Infections in the Prepubertal Child
T - 38-2. Causes of Endometrial Shedding in Children
T - 38-3. An Overview of Causes of Delayed Puberty
Part III: Reproductive Endocrinology and Infertility
39. The Menstrual Cycle
39. The Menstrual Cycle
F - 39-1. The Normal Menstrual Cycle
Introduction
Menstrual Cycle Overview
Phases of the Menstrual Cycle
Suggested Readings
40. Infertility and Assisted Reproductive Technologies
40. Infertility and Assisted Reproductive Technologies
Complications of Assisted Reproductive Technologies
Controlled Ovarian Hyperstimulation and Protocols for in Vitro Fertilization
Differential Diagnosis
Evaluation
F - 40-1. Saline Infusion Sonohysterography Demonstrating a Posterior Submucosal Fibroid in the Uterine Cavity
F - 40-2. Hysterosalpingogram (HSG) Showing Large Right Hydrosalpinx
Fertility Preservation
Infertility
Oocyte Retrieval, Culture, Fertilization, and Transfer
Suggested Readings
T - 40-1. Infertility Evaluation
T - 40-2. World Health Organization Semen Analysis Parameters
T - 40-3. In Vitro Fertilization (IVF) Success Rates by Diagnosis
Third-Party Reproduction
Treatment for Infertility
Treatments Beyond Ovulation Induction With Timed Intercourse
41. Recurrent Pregnancy Loss
41. Recurrent Pregnancy Loss
Epidemiology and Definition
Etiologies
Evaluation
Suggested Readings
T - 41-1. Evaluation for Recurrent Pregnancy Loss
Treatment Principles
42. Menstrual Disorders: Endometriosis, Dysmenorrhea, and Premenstrual Dysphoric Disorder
42. Menstrual Disorders: Endometriosis, Dysmenorrhea, and Premenstrual Dysphoric Disorder
Dysmenorrhea
Endometriosis
Premenstrual Disorder: Premenstrual Dysphoria and Premenstrual Dysphoric Disorder
Suggested Readings
43. Evaluation of Amenorrhea
43. Evaluation of Amenorrhea
Definition
Etiologies of AmenorrheaSystematic Evaluation
Evaluation of Amenorrhea
Suggested Readings
T - 43-1. Differential Diagnosis of Primary Amenorrhe
T - 43-2. Pathologic Causes of Secondary Amenorrhe
44. Polycystic Ovary Syndrome and Hyperandrogenism
44. Polycystic Ovary Syndrome and Hyperandrogenism
Androgen-Producing Ovarian Or Adrenal Tumors
Androgens in the Female
Causes of Hyperandrogenism
Cushing Syndrome
Definition and Androgen Physiology
Diagnosis of Hyperandrogenism
F - 44-1. Algorithm for Evaluation of Hirsutism/Hyperandrogenism
F - 44-2. Pathophysiology of Polycystic Ovarian Syndrome
F - 44-3. Steroid Pathway and Enzyme Mutations Associated With Congenital Adrenal Hyperplasia
Idiopathic and Drug-Induced Hirsutism
Nonclassical (Late-Onset) Congenital Adrenal Hyperplasia
Polycystic Ovary Syndrome
Signs and Symptoms of Hyperandrogenism
Suggested Readings
45. Definitions and Epidemiology of Menopause
45. Definitions and Epidemiology of Menopause
F - 45-1. The Stages of Reproductive Aging Workshop +10 Staging System for Reproductive Aging in Women
Hormonal Replacement Therapy Study Summaries
Introduction
Physiology of Menopause
Special Concerns for Menopausal Women
Suggested Readings
Symptoms
T - 45-1. Treatment Options for Vasomotor Menopausal Symptoms
Part IV: Female Pelvic Medicine and Reconstructive Surgery
46. Urinary Incontinence and Lower Urinary Tract Symptoms
46. Urinary Incontinence and Lower Urinary Tract Symptoms
Etiology and Risk Factors
Impact on Health
Introduction
Patient Evaluation
Suggested Readings
Treatment
Types of Urinary Incontinence and Lower Urinary Tract Symptoms
Urinary Retention
47. Pelvic Organ Prolapse
47. Pelvic Organ Prolapse
Epidemiology
F - 47-1. The Pelvic Organ Prolapse Quantification (POP-Q) System Components and Anatomic Reference Points
F - 47-2. A,chr(10)Ring With Support Pessarychr(10)chr(10)chr(10)B,chr(10)Gellhorn Pessary
Introduction
Pelvic Organ Prolapse Signs and Symptoms
Recommended Evaluation for Patient With Suspected Prolapse
Risk Factors
Suggested Readings
T - 47-1. Description of the Pelvic Organ Prolapse Quantification System
T - 47-2. Description of Pelvic Organ Prolapse Staging System
Treatment of Pelvic Organ Prolapse
48. Anal Incontinence
48. Anal Incontinence
Etiology
Introduction
Patient Evaluation
Suggested Readings
Treatment
Part V: Gynecologic Oncology
49. Cervical Intraepithelial Neoplasia
49. Cervical Intraepithelial Neoplasia
Diagnostic Categories via Colposcopy: Histology
Diagnostic Categories: Cytology
Epidemiology of Cervical Neoplasia
F - 49-1. Screening Recommendations for Immunocompromised or HIV-Positive Women
F - 49-2. Management of Atypical Squamous Cells of Undetermined Significance (ASC-US) and Low-Grade Squamous Intraepithelial Lesion (LSIL) in Human Immunodeficiency Virus (HIV)-Positive and Immunocompromised Individuals Abbreviations: Colpo, Colposcopy; Hpv, Human Papillomavirus
Management Strategies: Cytologic Abnormalities
Management Strategies: Histologic Abnormalities
Management Strategies: hrHPV Positive on Primary Screening
Primary Prevention
Screening Guidelines
Screening Methods
Suggested Readings
T - 49-1. Summary of the USPSTF, ACOG, SGO, and ASCCP Cervical Cancer Screening Recommendations for Average-Risk Women 2018
T - 49-2. Natural History of Untreated Cervical Intraepithelial Neoplasia
50. Cervical Cancer
50. Cervical Cancer
Cervical Cancer and Global Health
Disease Progression, Staging, and Prognosis
Epidemiology of Cervical Cancer
F - 50-1. Anatomic Pathways of Spread in Invasive Cervical Cancer
F - 50-2. Diagram of Pelvic Anatomy and Types of Hysterectomy
Introduction
Management of Cervical Cancer
Screening, Presentation, and Diagnosis
Suggested Readings
T - 50-1. International Federation of Gynecology and Obstetrics (FIGO) Staging System for Carcinoma of the Cervix, 2009 Versus 2018
T - 50-2. Allowable Staging Procedures for Cervical Cancer
T - 50-3. Classes of Hysterectomy
51. Cancer of the Uterine Corpus
51. Cancer of the Uterine Corpus
Epidemiology of Uterine Cancer
Introduction
Management of Uterine Cancer
Posttreatment Surveillance
Presentation, Evaluation, and Diagnosis
Prognostic Factors
Risk Factors for Uterine Cancer
Screening
Staging and Prognosis
Suggested Readings
T - 51-1. Risk Factors for Endometrial Cancer
T - 51-2. Staging of and National Comprehensive Cancer Network Management Recommendations for Endometrial Carcinoma by Stage and Grade
T - 51-3. Classification of Endometrial Hyperplasia
T - 51-4. Endometrial Cancer Surveillance Recommendations
T - 51-5. Staging of Endometrial Stromal Sarcoma and Leiomyosarcoma
Uterine Sarcoma
52. Ovarian Cancer
52. Ovarian Cancer
Epidemiology of Ovarian Cancer
Epithelial Ovarian Tumors
Germ Cell Ovarian Tumors
Introduction
Sex Cord-Stromal Ovarian Tumors
Special Considerations in Ovarian Cancer
Suggested Readings
T - 52-1. Classification of Ovarian Neoplasms
T - 52-2. International Federation of Gynecology and Obstetrics (FIGO) Staging System for Carcinoma of the Ovary, Fallopian Tube, and Primary Peritoneal Cancer
T - 52-3. Surgical Staging Procedures for Ovarian Cancer
T - 52-4. Stage Distribution and 5-Year Survival for Ovarian Cancer (2009-2015)
T - 52-5. Serum Markers for Germ Cell and Sex Cord-Stromal Ovarian Tumors
53. Hereditary Cancer Syndromes
53. Hereditary Cancer Syndromes
Identification of High-Risk Women and Referral Strategies
Introduction
Specific Hereditary Gynecologic Cancer Syndromes
Suggested Readings
T - 53-1. Features Suggestive of Hereditary Cancer
T - 53-2. Recommended Components of Pretest Cancer Genetic Evaluation
T - 53-3. BRCA1 and BRCA2 Penetrance: Cumulative Lifetime Cancer Risk
T - 53-4. Surveillance and Risk-Reduction Considerations for Known Mutation Carriers
T - 53-5. Lynch Syndrome Lifetime Cancer Risks Up to Age 70 y
T - 53-6. Three Approaches to Guide Who Should Receive Genetic Screening for Lynch Syndrome
Targeted Therapy for Mutation Carriers
54. Premalignant and Malignant Disease of the Vulva and Vagina
54. Premalignant and Malignant Disease of the Vulva and Vagina
Malignant Neoplastic Diseases of the Vagina
Malignant Neoplastic Diseases of the Vulva
Premalignant Neoplastic Diseases of the Vulva and Vagina
Suggested Readings
T - 54-1. International Federation of Gynecology and Obstetrics Staging for Carcinoma of the Vulva (2009) and 5-Year Survival
T - 54-2. International Federation of Gynecology and Obstetrics Staging Classification of Vaginal Cancer and 5-Year Survival
55. Gestational Trophoblastic Disease
55. Gestational Trophoblastic Disease
Classification of Gestational Trophoblastic Disease: Etiology, Pathology, and Clinical Presentation
Diagnosis and Management
F - 55-1. Follow-Up of Molar Pregnancy
F - 55-2. Management of Persistent Gestational Trophoblastic Disease
Introduction
Suggested Readings
T - 55-1. Comparison of Complete Versus Partial Hydatidiform Mole
T - 55-2. International Federation of Gynecology and Obstetrics Staging System for Gestational Trophoblastic Neoplasia
T - 55-3. International Federation of Gynecology and Obstetrics/World Health Organization Prognostic Scoring Index for Gestational Trophoblastic Neoplasia
Types of Trophoblastic Cells
56. Chemotherapy, Antineoplastic Therapy, and Radiation Therapy
56. Chemotherapy, Antineoplastic Therapy, and Radiation Therapy
Cell Cycle
Chemotherapy, Targeted Therapy, and Hormonal Agents
Common Side Effects of Chemotherapy, Targeted Therapy, and Hormonal Agents
F - 56-1. Phases of the Cell Cycle, Relative Time Intervals, and Sites of Action of the Various Classes of Antineoplastic Agents
Introduction
Primary Treatment Modalities According to Cancer Site
Radiation Therapy
Suggested Readings
T - 56-1. Chemotherapeutic Agents Commonly Used in Gynecologic Cancers and Their Most Common Toxicities
57. Palliative and End-of-Life Care
57. Palliative and End-of-Life Care
Advance Care Planning
Caregiver Support
Communication
Definitions
End-Of-Life Care Issues
Suggested Readings
Symptom Management
T - 57-1. Opioid Analgesics: Equivalent Dosing for Various Narcotic Formulations
Part VI:Surgery in Obstetrics and Gynecology
58. Anatomy of the Female Pelvis
58. Anatomy of the Female Pelvis
Abdominal Wall
F - 58-1. Layers of the Anterior Abdominal Wall Cephalad to the Arcuate Line
F - 58-2. Layers of the Anterior Abdominal Wall Caudal to the Arcuate Line
F - 58-3. Vasculature and Laparoscopic Landmarks of the Anterior Abdominal Wall
F - 58-4. Illustration of Attachment of Rectovaginal Fascia (RVF) and Arcus Tendineus Fascia Pelvis (ATFP) to the Pelvic Sidewall
F - 58-5. Surgical Spaces of the Pelvis
F - 58-6. Vulva and Perineum
F - 58-7. Superficial Compartment of the Vulva
F - 58-8. Pelvic Diaphragm
Lymphatic Drainage of the Pelvis
Nerves of the Pelvis and Perineum
Pelvic Viscera
Suggested Readings
Surgical Spaces of the Pelvis
Vasculature of the Abdomen and Pelvis
Vulva and Perineum
59. Surgical Approaches in Gynecologic Surgery
59. Surgical Approaches in Gynecologic Surgery
Introduction
Laparotomy in Operative Gynecology
Minimally Invasive Surgery in Gynecology
Suggested Readings
60. Perioperative Care and Complications of Gynecologic Surgery
60. Perioperative Care and Complications of Gynecologic Surgery
Enhanced Recovery After Surgery
Intraoperative Complications
Postoperative Complications
Preoperative Care
Suggested Readings
T - 60-1. Thromboprophylaxis for Gynecologic Procedures
T - 60-2. Indications for Antibiotic Prophylaxis
T - 60-3. Nerve Injuries During Gynecologic Surgery
T - 60-4. Guidelines for Fluid Management During Operative Hysteroscopy
61. Critical Care
61. Critical Care
Cardiovascular Critical Care
F - 61-1. Classification and Diagnosis of Hyponatremia
Fluids and Electrolytes
Hematologic Critical Care
Infectious Diseases
Introduction
Renal Failure
Respiratory Critical Care
Special Obstetric Considerations in Critical Care
Suggested Readings
T - 61-1. Hemodynamic Profiles for Critical Care Diagnosis
T - 61-2. Updated Advanced Trauma Life Support Classification for Hemorrhagic Shock
T - 61-3. Selected Vasoactive Agents in Critical Care
T - 61-4. Normal Values and Expected Changes in Various Acid-Base Disorders
T - 61-5. Criteria for Sepsis and Related Disorders
T - 61-6. Surviving Sepsis Campaign Recommendations
62. Quality, Safety, and Value in Women's Health
62. Quality, Safety, and Value in Women's Health
Background
Clinical Innovation
Continuous Improvement
Introduction
Quality Assurance
Suggested Readings
Front Matter
Contributors
Preface
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