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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_160_библиотеки_им_акад_М_И_Перельмана
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CONTENTS ix
CHAPTER 37 NUTRITION AND EXERCISE IN PREGNANCY 164
Maricela Rodriguez-Gutierrez, MD
CHAPTER 38 OBSTETRIC ULTRASOUND 169
Debra Linker, MD
CHAPTER 39 PRENATAL DIAGNOSIS 175
Isha Wadhawan, MD
CHAPTER 40 ANTEPARTUM FETAL SURVEILLANCE 178
Laurin Cristiano, MD
V complications of preGnancy
CHAPTER 41 GENETICS IN PREGNANCY 183
Isha Wadhawan, MD
CHAPTER 42 CERVICAL INSUFFICIENCY AND CERCLAGE 189
Erin Burnett, MD
CHAPTER 43 NAUSEA AND VOMITING IN PREGNANCY 193
Alyssa Scott, MD
CHAPTER 44 DISORDERS OF FETAL GROWTH 196
Maiuyen Nguyen, MD
CHAPTER 45 AMNIOTIC FLUID DISORDERS 199
Jared Roeckner, MD
CHAPTER 46 ALLOIMMUNIZATION 201
Debra Linker, MD
CHAPTER 47 RENAL DISEASE IN PREGNANCY 203
Rebecca M. Geer, MD
CHAPTER 48 PREGESTATIONAL AND GESTATIONAL DIABETES 206
Kristen M. McMaster, MD
CHAPTER 49 HYPERTENSION IN PREGNANCY 211
Erin Burnett, MD
CHAPTER 50 THYROID DISEASE IN PREGNANCY 216
Kristen M. McMaster, MD
CHAPTER 51 AUTOIMMUNE DISEASES IN PREGNANCY 220
Anna Karina Celaya, MD
CHAPTER 52 NEUROLOGIC ISSUES IN PREGNANCY 224
Stephanie G. Valderramos, MD, PhD
CHAPTER 53 PULMONARY DISEASE IN PREGNANCY 227
Antonio Bonet, MD
CHAPTER 54 CARDIOVASCULAR DISEASE IN PREGNANCY 232
Bao Tran, MD
CHAPTER 55 INFECTIONS IN PREGNANCY 236
Kristina Galyon, DO
CHAPTER 56 SURGERY DURING PREGNANCY 241
Ella Speichinger, MD
CHAPTER 57 TRAUMA IN PREGNANCY 245
Stacy M. Yadava, MD
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x CONTENTS
CHAPTER 58 ALCOHOL AND DRUG ABUSE DURING PREGNANCY 249
Tina A. Nguyen, MD
CHAPTER 59 OBESITY IN PREGNANCY 255
Jared Roeckner, MD
CHAPTER 60 MULTIPLE GESTATION 257
Erin Burnett, MD
VI labor, delivery, and postpartum
CHAPTER 61 LABOR AND VAGINAL DELIVERY 263
Kelly A. Best, MD
CHAPTER 62 INTRAPARTUM FETAL SURVEILLANCE 272
Laurin Cristiano, MD
CHAPTER 63 CESAREAN DELIVERY AND VAGINAL BIRTH AFTER CESAREAN DELIVERY 279
Erin C. Chong, MD
CHAPTER 64 OBSTETRIC ANESTHESIA 284
Daniela Karagyozyan, MD, Lee Coleman, MD, and Mark Zakowski, MD
CHAPTER 65 PRETERM LABOR AND PRETERM PREMATURE RUPTURE OF MEMBRANES 295
Enid T. Kuo, MD
CHAPTER 66 PLACENTA PREVIA AND PLACENTAL ABRUPTION 303
Christine Djapri, MD
CHAPTER 67 MALPRESENTATION 309
Jared Roeckner, MD
CHAPTER 68 POSTPARTUM HEMORRHAGE 312
Shant Ashdjian, MD
CHAPTER 69 NEWBORN RESUSCITATION 315
Tiffany Pedigo, MD
CHAPTER 70 POSTPARTUM CARE 322
Stephanie G. Valderramos, MD, PhD
INDEX 327
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xi
CONTRIBUTORS
Alin Lina Akopians, MD, PhD
Reproductive Endocrinology and Infertility Fellow
Department of Obstetrics and Gynecology
Ronald Reagan-UCLA Medical Center
Los Angeles, California
Shant Ashdjian, MD
Attending Physician
Department of Obstetrics and Gynecology
Kaiser Permanente Downey Medical Center
Downey, California
Mary Anne M. Baquing, MD
Resident Physician
Department of Obstetrics and Gynecology
Harbor-UCLA Medical Center
Torrance, California
Kelly A. Best, MD
Program Director and Attending Physician
Department of Obstetrics and Gynecology
University of Florida College of Medicine
Jacksonville, Florida
Antonio Bonet, MD
Assistant Professor
Division of Pulmonary and Critical Care
Department of Medicine
Olive View-UCLA Medical Center
Sylmar, California;
Fellowship in Pulmonary and Critical Care Medicine
Department of Medicine
Cedars-Sinai Medical Center
Los Angeles, California
Erin Burnett, MD
Assistant Professor
Program Director, Ultrasound and Prenatal Diagnosis
Department of Obstetrics and Gynecology
University of Florida Medical Center
Jacksonville, Florida;
Fellowship in Maternal and Fetal Medicine
Emory University School of Medicine
Atlanta, Georgia
Paul Buzad, MD
Associate Professor
David Geffen School of Medicine at UCLA
Los Angeles, California;
Attending Physician
Department of Obstetrics and Gynecology
Olive View-UCLA Medical Center
Sylmar, California
Jacob Casey, MD
Resident Physician
Department of Obstetrics and Gynecology
Los Angeles County/University of Southern
California Medical Center
University of Southern California
Los Angeles, California
Anna Karina Celaya, MD
Assistant Professor
David Geffen School of Medicine at UCLA
Los Angeles, California;
Attending Physician
Department of Obstetrics and Gynecology
Harbor-UCLA Medical Center
Torrance, California
Zaid Q. Chaudhry, MD
David Geffen School of Medicine at UCLA
Department of Obstetrics and Gynecology
Division of Female Pelvic Medicine and
Reconstructive Surgery
Los Angeles, California
Judy H. Chen, MD
Assistant Clinical Professor
Department of Obstetrics and Gynecology
Los Angeles County/University of Southern
California Medical Center
Los Angeles, California
Erin C. Chong, MD
Resident Physician
Department of Obstetrics and Gynecology
Harbor-UCLA Medical Center
Torrance, California
Lee Coleman, MD
Assistant Professor
Assistant Program Director for Obstetric
Anesthesiology
Department of Anesthesiology
Cedars Sinai Medical Center
Los Angeles, California
Laurin Cristiano, MD
Resident Physician
Department of Obstetrics and Gynecology
Ronald Reagan-UCLA Medical Center
Los Angeles, California
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xii CONTRIBUTORS
Christine Djapri, MD
Resident Physician
Department of Obstetrics and Gynecology
University of Florida Medical Center
Jacksonville, Florida
Hai-Lang Duong, MD
Visiting Assistant Professor of Obstetrics and
Gynecology
David Geffen School of Medicine at UCLA
Los Angeles, California;
Chief, Section of Maternal-Fetal Medicine
Department of Obstetrics and Gynecology
Olive View-UCLA Medical Center
Sylmar, California
Ramy Eskander, MD
Assistant Professor
David Geffen School of Medicine at UCLA
Los Angeles, California;
Attending Physician
Department of Obstetrics and Gynecology
Harbor-UCLA Medical Center
Torrance, California
Kristina Galyon, DO
Maternal Fetal Medicine Fellow
Department of Obstetrics and Gynecology
Harbor-UCLA Medical Center
Torrance, California
Lisa Garcia, MD
Assistant Professor of Clinical Obstetrics and
Gynecology
David Geffen School of Medicine at UCLA
Los Angeles, California;
Department of Obstetrics and Gynecology
Olive View-UCLA Medical Center
Sylmar, California
Rebecca M. Geer, MD
Resident Physician
Department of Obstetrics and Gynecology
Harbor-UCLA Medical Center
Torrance, California
Carrie E. Jung, MD
Resident Physician
Department of Obstetrics and Gynecology
Los Angeles County/University of Southern
California Medical Center
Los Angeles, California
Daniela Karagyozyan, MD
Fellow
Obstetric Anesthesiology
Cedars-Sinai Medical Center
Los Angeles, California
Lirona Katzir, MD
Visiting Assistant Professor
Department of Obstetrics and Gynecology
Olive View-UCLA Medical Center
Sylmar, California
Enid T. Kuo, MD
Associate Residency Program Director
Kaiser Permanente Los Angeles Medical Center
Los Angeles, California
Debra Linker, MD
Physician
Department of Obstetrics and Gynecology
Palo Alto Foundation Medical Group
Palo Alto Foundation Medical Clinics and the Sutter
Health System
Mountain View, California
Elena Martinez, MD
Program Director and Attending Physician
Kaiser Permanente Los Angeles Medical Center
Los Angeles, California
Travis W. McCoy, MD
Piedmont Reproductive Endocrinology Group
Asheville, North Carolina;
Fellowship in Reproductive Endocrinology and
Infertility
University of Louisville
Louisville, Kentucky
Kristen M. McMaster, MD
Maternal-Fetal Medicine Fellow
University of Mississippi Medical Center
Jackson, Mississippi
Erin Mellano, MD
Department of Obstetrics and Gynecology
Division of Female Pelvic Medicine and
Reconstructive Surgery
David Geffen School of Medicine at UCLA
Los Angeles, California
Hannah Newmark, MD
Resident Physician
Department of Obstetrics and Gynecology
Harbor-UCLA Medical Center
Torrance, California
Maiuyen Nguyen, MD
Attending Physician
Department of Obstetrics and Gynecology
Kaiser Permanente Downey Medical Center
Downey, California
Tina A. Nguyen, MD
Assistant Professor
Maternal-Fetal Medicine
Department of Obstetrics and Gynecology
David Geffen School of Medicine at UCLA
Los Angeles, California
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CONTRIBUTORS xiii
Michelle S. Özcan, MD
Assistant Professor
Associate Residency Program Director
Department of Obstetrics and Gynecology
University of Florida College of Medicine
Jacksonville, Florida
Susan Park, MD
Assistant Clinical Professor
Division of Gynecology Oncology
Department of Obstetrics and Gynecology
University of California–Riverside
Riverside, California
Ryan Pedigo, MD
Assistant Professor
David Geffen School of Medicine at UCLA
Los Angeles, California;
Attending Physician and Clerkship Director
Department of Emergency Medicine
Harbor-UCLA Medical Center
Torrance, California
Tiffany Pedigo, MD
Chief Resident Physician
Department of Pediatrics
Ronald Reagan-UCLA Medical Center
Los Angeles, California
Carlos Rangel, MD
Physician
Adventist Health Central Valley
Hanford, California
Maricela Rodriguez-Gutierrez, MD
Physician
Department of Obstetrics and Gynecology
Kaiser Permanente;
Adjunct Clinical Assistant Professor
Department of Obstetrics and Gynecology
Keck School of Medicine of University of Southern
California
Los Angeles, California
Jared Roeckner, MD
Resident Physician
Department of Obstetrics and Gynecology
University of Florida Medical Center
Jacksonville, Florida
Rachel Rosenheck, MD
Physician
Los Angeles County/University of Southern
California Medical Center
Los Angeles, California
Alyssa Scott, MD
Attending Physician
Department of Emergency Medicine
St. Francis Medical Center
Lynwood, California
Whitney Sigala, MD
Resident Physician
Department of Obstetrics and Gynecology
Harbor-UCLA Medical Center
Torrance, California
Manpreet Singh, MD
Ultrasound Fellow
Department of Emergency Medicine
Harbor-UCLA Medical Center
Torrance, California
Ella Speichinger, MD
Assistant Professor
David Geffen School of Medicine at UCLA
Los Angeles, California;
Attending Physician
Department of Obstetrics and Gynecology
Olive View-UCLA Medical Center
Sylmar, California
Lauren W. Sundheimer, MD
Fellow, Reproductive Endocrinology and Infertility
Department of Obstetrics and Gynecology
David Geffen School of Medicine at UCLA
Cedars-Sinai Medical Center
Los Angeles, California
Julia Switzer, MD
Clinical Instructor
University of Illinois at Chicago School of
Medicine
Chicago, Illinois
Bao Tran, MD
Chief Cardiology Fellow
Department of Medicine
Division of Cardiology
Ronald Reagan-UCLA Medical Center
Los Angeles, California
Stephanie G. Valderramos, MD, PhD
Fellow and Clinical Instructor
Division of Maternal-Fetal Medicine
Department of Obstetrics and Gynecology
University of California–Los Angeles School of
Medicine
Los Angeles, California
Isha Wadhawan, MD
Resident Physician
Department of Obstetrics and Gynecology
Ronald Reagan-UCLA Medical Center
Los Angeles, California
Alexandra Walker, DO
Resident Physician
Department of Obstetrics and Gynecology
University of Florida Medical Center
Jacksonville, Florida
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xiv CONTRIBUTORS
Cecilia K. Wieslander, MD
Associate Professor
David Geffen School of Medicine at UCLA
Los Angeles, California;
Attending Physician
Department of Obstetrics and Gynecology
Olive View-UCLA Medical Center
Sylmar, California
Stacy M. Yadava, MD
Resident Physician
Department of Obstetrics and Gynecology
Santa Clara Valley Medical Center
San Jose, California
Danny Younes, MD
Resident Physician
Department of Obstetrics and Gynecology
Harbor-UCLA Medical Center
Torrance, California
Mae Zakhour, MD
Fellow and Clinical Instructor
Division of Gynecologic Oncology
Department of Obstetrics and Gynecology
University of California-Los Angeles/Cedars-Sinai
Medical Center
Los Angeles, California
Mark Zakowski, MD
Chief of Obstetric Anesthesiology
Cedars-Sinai Medical Center;
Adjunct Associate Professor
Charles R. Drew University of Medicine and Science
Los Angeles, California
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xv
PREFACE
We are pleased to have the opportunity to provide you with the fourth edition of OB/GYN Secrets, which has
been completely revamped. The field of obstetrics and gynecology has rapidly evolved in the past 11 years
since the last edition; cervical cancer screening alone has been revised multiple times! Our goal in this edi-
tion is to provide the most up-to-date, evidence-based medicine available in an easy-to-read format
designed for students on their OB/GYN rotation, OB/GYN residents, and allied health professionals inter-
ested in learning more about the specialty.
We hope this book will assist learners in preparing for their examinations as well as their care of
patients. We would like to acknowledge all of the contributors to the prior three editions of this text and
thank them for setting the groundwork for this important subject. In addition, we are indebted to the many
authors who lent their time and expertise to making this edition possible. A special thanks to our section
editors, Dr. Travis McCoy and Dr. Lejla Delic, for their efforts and time spent making this publication exceptional.
We hope you enjoy the newest OB/GYN Secrets!
Sincerely,
Amanda Mularz, MD
Steven Dalati, MD
Ryan Pedigo, MD
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1
TOP 100 SECRETS
These secrets summarize the concepts, principles, and most salient details of obstetrics
and gynecology.
1. Combination oral contraceptives (OCPs) work primarily by inhibiting ovulation through
suppression of LH and FSH.
2. OCPs decrease the risk of ovarian and endometrial cancers.
3. Symptoms of menopause include irregular then absent menses, hot flashes, and
vaginal atrophy or dryness.
4. Midcycle surge of luteinizing hormone (LH) predicts impending ovulation.
5. The order of puberty is: growth spurt, thelarche, adrenarche, peak growth, then
menarche.
6. The three most common causes of primary amenorrhea are gonadal dysgenesis,
müllerian agenesis, and androgen insensitivity.
7. The most common cause of secondary amenorrhea is pregnancy.
8. Androgen insensitivity and müllerian agenesis are two syndromes characterized
by breast development and the absence of a uterus; they can be differentiated by
obtaining a karyotype.
9. Premenstrual syndrome (PMS) is defined as emotional and physical symptoms that
occur at the same time each month prior to the menstrual cycle.
10. Fibroids are estrogen-sensitive, fibromuscular, benign tumors that are thought to
originate from a monoclonal cell line. They can cause abnormal uterine bleeding,
dysmenorrhea, pelvic pressure, and even bladder and bowel symptoms.
11. Fibroids can be treated medically, surgically, or with uterine artery embolization.
12. The phases of the sexual response cycle are excitement, plateau, orgasm, and
resolution.
13. Genito-pelvic pain/penetration disorder is often associated with a history of sexual
abuse or trauma.
14. Polycystic ovarian syndrome (PCOS) is a diagnosis of exclusion and requires two or
more of the following: anovulation or oligo-ovulation, clinical or biochemical evidence of
hyperandrogenism, and polycystic ovaries on ultrasound.
15. Endometriosis is endometrial tissue outside the uterus; it can cause pelvic pain,
dyspareunia, and infertility.
16. Adenomyosis is endometrial tissue in the myometrium; it can cause heavy menstrual
bleeding and dysmenorrhea.
17. Not all pelvic pain is gynecologic in origin.
18. The ulcer of primary syphilis is usually single and painless, while the ulcer of herpes is
usually multiple and painful.
19. Trichomoniasis and candidiasis are diagnosed with microscopy by visualizing the
organisms in vaginal discharge; bacterial vaginosis is diagnosed by the “whiff test” and
the presence of “clue cells.”
20. Although PID is usually a polymicrobial infection, it generally begins with infection with
either N. gonorrhoeae or C. trachomatis.
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2 TOP 100 SECRETS
21. Approximately 8-20% of clinically recognized pregnancies and 13-26% of
unrecognized pregnancies end in miscarriage.
22. Autosomal trisomies are the most common chromosomal abnormality in miscarriages,
but the most common single karyotype is monosomy X.
23. Legalization of abortion has significantly reduced the number of women hospitalized
with abortion-related complications.
24. An initial infertility evaluation should include a menstrual calendar, ultrasound to
evaluate uterine anatomy, luteal phase progesterone level to assess for ovulation, and
semen analysis.
25. Risks of ovulation induction include multiple gestation and ovarian hyperstimulation.
26. In vitro fertilization (IVF), can be used to overcome tubal disease or male factor
infertility; it involves ovarian stimulation with injectable gonadotropins, egg retrieval,
fertilization, and subsequent embryo transfer.
27. Stress incontinence is loss of urine due to increased intra-abdominal pressure, urethral
hypermobility, or intrinsic sphincter deficiency.
28. Urge incontinence is loss of urine due to detrusor instability.
29. Women are almost nine times more likely to be killed by a current or former intimate
partners than by a stranger.
30. The incidence of intimate partner violence is variable during pregnancy and
postpartum.
31. High-risk strains of human papillomavirus (HPV) cause genital dysplasia and may lead
to invasive cancer.
32. Regular screening with Pap smears has led to a significant decrease in the incidence
of cervical cancer.
33. Cervical cancer is clinically staged (i.e., it does not involve surgical exploration).
34. Treatment of cervical cancer depends on stage; surgery is usually appropriate up to
Stage IIA.
35. Vulvar cancer is predominantly squamous; spread to superficial inguinal nodes occurs
via lymphatic channels.
36. Paget’s disease of the vulva may be associated with underlying adenocarcinoma, and
excision is recommended.
37. Important risk factors for endometrial cancer include obesity, anovulation, and use of
tamoxifen.
38. Endometrial cancer most commonly presents with abnormal uterine bleeding,
especially postmenopausal bleeding.
39. Sex cord and germ cell tumors are usually diagnosed at early stages and are highly
curable; epithelial ovarian cancer usually presents at late stages.
40. Epithelial ovarian cancer is surgically staged and treated with a combination of
cytoreductive surgery and chemotherapy.
41. In a normal pregnancy, beta-hCG levels increase by approximately 50-100% every
48 hours.
42. The discriminatory zone is the beta hCG level at which an intrauterine pregnancy
should be seen on ultrasound; it is generally considered to be between 1,500 and
2,500 mIU/mL.
43. Ectopic pregnancies usually present with abdominal pain and abnormal vaginal
bleeding.
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