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Index

A

 

 

adnexal torsion

96–7, 422,

alpha-fetoprotein

 

 

 

 

 

693, 796

 

 

 

(AFP) 115, 727

 

abacavir 177, 178

 

bimanual vaginal

 

5-alpha reductase

574, 575

 

abdominal circumference

examination

463

ambulatory urodynamic

 

(AC) 40, 41, 148

see also ovaries

 

monitoring

660

 

abdominal examination

adolescents

 

 

 

amenorrhoea 506–7

 

gynaecological

 

benign ovarian

 

 

in adolescence 494

 

examination

462

tumours

693

 

lactational 360, 364

 

lower urinary tract

dermatological

 

primary 486–7, 494, 506

 

examination

656

conditions

492–3

secondary 494, 506

 

normal pregnancy 6–7

gynaecological

 

 

American Rheumatism

 

abdominal pain

 

disorders

494–5

Association criteria 229

 

(in pregnancy)

 

puberty, see puberty

aminoglycosides 210–11, 356

 

adnexal torsion

96–7

termination of

 

 

amitriptyline 698

 

 

bowel-related 94–5

pregnancy

526

amniocentesis

130–1, 168

 

cholecystitis (acute) 96–7

vaginal discharge

490

amnion 19

 

 

 

non-abdominal causes 97

see also children

 

amniotic fluid embolism

 

pancreatitis

97

 

adrenal adenoma

252–3

(AFE) 398–9, 412

 

pregnancy-related 90–3

adrenal carcinoma

252–3

amniotic fluid volume

 

abdominal wall defects,

adrenal gland disorders

abdominal

 

 

 

anterior 126–7

hirsutism causation 575

examination

6–7

 

abdominal wound

see also specific disorders

meconium-stained

 

infection

355

 

adrenal hyperplasia,

(MSAF) 290

 

 

abnormal lie

84, 88–9, 315

congenital

250–1

oligohydramnios

138–9

 

Abortion Act 1967 526

adrenaline, neonatal

polyhydramnios

134, 140

 

abscess, breast 355, 366,

resuscitation

346

amniotomy/artificial rupture

 

367

 

 

adrenocorticotrophic

of membranes

266,

 

absent end diastolic flow

hormone (ACTH)

276–7

 

 

 

(AEDF) 150, 151, 153

Addison’s disease 252

amoxicillin 195, 213

 

acanthosis nigrans 576–7

changes in pregnancy 24

amphetamine sulphate 442,

 

accelerations,

 

congenital adrenal

443

 

 

 

cardiotocography 282,

hyperplasia

250–1,

anaemia

 

 

 

288

 

 

480–1

 

 

 

chemotherapy side

 

ACE (angiotensin converting

Cushing’s

 

 

 

effect 758

 

 

enzyme) inhibitors 63

syndrome

252–3

fetal hydrops

132, 133,

 

acetylcholine receptor

hypopituitarism

256–7

134, 135, 136–7

 

antibodies 233

adverse events,

 

 

folate deficiency

199

 

aciclovir 164, 166, 554

practice-related

haemorrhage effect

 

acidosis, fetal

284

injuries 772–7

 

magnification

412

 

activated partial

 

age, risks for advanced

iron-deficiency 199

 

thromboplastin time

maternal 30

 

 

malnutrition

33

 

 

(APTT) 396

 

airway

 

 

 

physiological

26

 

 

acupuncture

523, 670

maternal resuscitation 374

physiological adaptation in

 

acute fatty liver

 

neonatal

 

 

 

pregnancy 199

 

of pregnancy

 

resuscitation

344, 345

undiagnosed cause of

 

(AFLP) 218–19

albumin 723

 

 

 

persistent

47

 

 

Addisonian collapse 209

alcohol consumption

vitamin B12 deficiency 199

 

Addison’s disease

252, 253

alcohol abuse in

 

anaesthesia

 

 

 

adenocarcinoma

715, 735

pregnancy

430–7

consent for gynaecological

 

clear cell 496, 748, 749

pregnancy advice 32–3

procedures 786–7

 

adenoma

 

 

alimentary system,

 

examination under

 

cervical 687

 

seegastrointestinal/

anaesthetic (EUA) 716

 

endometrial 688–9

alimentary system in

general (GA)

337

 

adenomyosis

570, 582–3,

pregnancy

29

 

local, see local anaesthesia

 

796

 

 

allergy history

4, 460–1

obstetric, see obstetric

 

adhesions 566, 585

alopecia 759

 

 

 

anaesthesia

 

 

adnexae

 

 

alpha-blockers

248

anal sphincter trauma 304

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

800 INDEX

 

analgesia

 

 

see also specific drugs

aorta, coarctation of

198

 

advanced cancer 766–7

antibody screen

46

aortic compression

 

 

chronic pelvic pain 568

anti-cardiolipin

 

 

blood pressure effects 27

 

epidural, see epidural

antibody 230–1

massive obstetric

 

 

anaesthesia/analgesia

anticholinergic drugs 670,

haemorrhage

 

 

patient-controlled

671

 

 

 

management 387

 

(PCA) 332–3

anticoagulation drugs

aortic stenosis

196

 

 

World Health

 

artificial heart valves in

Apgar scoring system

268,

 

Organization (WHO)

pregnancy 194–5

342

 

 

 

 

 

analgesic ladder 766–7

prevention of venous

apomorphine

612

 

 

anatomy 10–13, 464–9

thromboembolism

appendix

 

 

 

androgen insensitivity

(VTE)

392–3

 

appendicitis

94

 

 

syndrome (AIS) 476,

treatment of venous

primary tumour 724–5

 

477–8, 482–3

thromboembolism

aromatase inhibitors

587

 

androgen levels

480–1,

(VTE)

396–7

 

arousal disorder 608

 

574, 575

 

 

see also specific drugs

arterial embolization

387,

 

android pelvic shape 11

anticonvulsant/antiepileptic

389, 689

 

 

 

anencephaly 118–19

medication

 

 

arteriovenous

 

 

 

anorexia, advanced

fetal risks/use in

 

malformations (AVM), in

 

cancer 768

 

pregnancy

186, 187–9

pregnancy

190–1

 

 

anorexia nervosa 449

as mood stabilizers 450

artificial heart valves

194–5

 

antenatal (AN) care

pain management in

artificial rupture of

 

 

blood tests

43, 46–7

cancer 766

 

membranes (ARM)/

 

booking visit

42–3

types of

186–7, 450

amniotomy 266, 276–7

 

multiple pregnancy 76–7

vulvodynia/vestibulodynia

ascites

722–3

 

 

 

planning 44–5

management

698

aspirin

64–5, 184

 

 

preparing for delivery 48

anti-D immunoglobulin 58,

anti-phospholipid antibody

 

antepartum haemorrhage

137, 360, 530, 789

syndrome 231, 544–5

 

(APH)

 

 

antidepressant drugs 451;

artificial heart valves in

 

assessment 56–7

see also specific drugs/

pregnancy 194

 

 

management

58–9

drug types

 

 

assisted reproductive

 

 

overview 55, 380

antidiuretic hormone

technologies

 

 

see also massive obstetric

(ADH)

257, 277

(ART) 600–4

 

 

haemorrhage

anti-DNA

228

 

 

in vitro fertilization, see in

 

anterior colporrhaphy 680

antiemetic drugs

546–7

vitro fertilization (IVF)

 

anthropoid pelvic shape 11

antiepileptic drugs,

asthma

 

 

 

 

 

anti-androgens

572

see anticonvulsant/

breast-feeding benefit 364

 

antibiotic therapy

antiepileptic drugs

in pregnancy

208–9

 

 

endocarditis

 

 

antifibrinolytics

516

atenolol

63

 

 

 

prophylaxis 195

antihypertensive

 

 

atosiban

99

 

 

 

group B streptococcus

medications

62–3, 67,

atresias

 

126–7

 

 

(GBS) 172

68, 71; see also specific

atrial fibrillation (AF)

196

 

mastitis 367

 

 

drugs

 

 

 

atrophic vaginitis 551

 

 

pelvic inflammatory

anti-oestrogens 596–7

atrophy, urogenital 638,

 

disease (PID) 563

anti-phospholipid antibody

646, 651

 

 

 

pneumonia 212–13

syndrome 230–1, 542,

autoimmune disease

 

 

prelabour rupture

544–5

 

 

 

drug treatments 232

 

of membranes at

antipsychotic drugs 451

see also specific diseases

 

term 314

 

antiretroviral drugs

autoimmune idiopathic

 

preterm pre-labour

highly active

 

 

thrombocytopenic

 

rupture of membranes

antiretroviral therapy

purpura 206–7

 

 

(PPROM) 103

(HAART) 176–7,

azithromycin 528, 553, 555

 

puerperal pyrexia 353,

178–82

 

 

azoospermia 598, 599

355, 356, 357

post-exposure prophylaxis

 

 

 

 

 

 

puerperal sepsis 353

(PEP)

619

 

 

B

 

 

 

 

 

recurrent miscarriage

anti-Ro antibodies

228, 232

 

 

 

 

 

management 544–5

antithrombin III

 

 

‘baby blues’,

 

 

 

renal/urinary tract

deficiency 392

 

postpartum 455

 

 

infections

220–1, 358

antithyroid drugs

242–3

Baby-Friendly Hospital

 

sexual assault

618

anti-Xa levels 396

 

Initiative (BFHI) 362–3

 

termination of

anxiety disorders,

 

backache,

 

 

 

pregnancy

528

antenatal 446, 448

pregnancy-related

7, 52

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INDEX

801

bacterial vaginosis (BV)

551,

postnatal problems 358

booking visit 42–3

 

 

 

559

 

 

 

 

practice-related

 

borderline ovarian

 

 

 

preterm labour

 

 

injury

776–7

 

tumours 730

 

 

 

prevention 100

 

 

radiotherapy side

 

botulinum toxin A 671

 

 

 

recurrent miscarriage

543,

effects 763

 

bowel

 

 

 

 

544–5

 

 

 

reduced/absent

 

echogenicity of 128

 

 

 

Baden–Walker

 

 

sensation 655

 

postnatal problems 358

 

 

classification 674

 

 

see alsourogynaecology;

see also gastrointestinal

 

 

barbiturate abuse 444

 

specific disorders/

 

tract; specific disorders

 

 

Bartholin’s cyst 686

 

 

procedures

 

bowel habit, gynaecological

 

 

baseline rate,

 

 

 

bladder retraining 670

 

history 460

 

 

 

cardiotocography

282,

bleeding

 

 

bowel obstruction,

 

 

 

284, 288

 

 

 

in advanced cancer 768

advanced cancer 768

 

 

baseline variability,

 

 

dysfunctional uterine

 

bowel preparation 789

 

 

 

cardiotocography

 

 

(DUB) 512–19

 

bowel-related abdominal

 

 

282–3, 284, 288

 

 

in early pregnancy 530–1

pain, in pregnancy 94–5

 

 

behavioural therapy

 

 

intermenstrual (IMB)

458,

brachytherapy 738, 762

 

 

 

over-active bladder

 

 

459, 504

 

bradycardia

 

 

 

syndrome 670

 

 

postcoital (PCB) 458,

fetal 284

 

 

 

sexual dysfunction

610

459, 504

 

neonatal 344–5

 

 

 

benign neoplasms

 

 

postmenopausal

 

Brandt–Andrew’s

 

 

 

lower genital tract

686–7

(PMB) 458, 459, 736,

technique 271

 

 

 

ovarian

690–3;

 

 

737, 795

 

Braxton Hicks

 

 

 

see also ovarian cysts

quantification of

 

contractions 92

 

 

 

uterine 688–9;

 

 

‘heavy’ 533

 

BRCA gene, mutations

 

 

 

see also fibroids

 

 

see also antepartum

 

of 702, 720–1

 

 

 

benzathine penicillin

556

haemorrhage (APH);

breast

 

 

 

 

benzodiazepines

 

 

massive obstetric

 

abscess

355, 366, 367

 

 

 

abuse of

444

 

 

haemorrhage;

 

cancer of, see breast

 

 

 

psychiatric disorder

 

 

postpartum

 

cancer

 

 

 

management 448

 

haemorrhage (PPH)

changes in

 

 

 

benzylpenicillin 172

 

 

blood pressure (BP)

 

puerperium 350

 

 

 

beta-agonists

209

 

 

blood loss

 

engorgement 366

 

 

 

beta-blockers

62–3, 242–3,

parameters 383

 

mastitis

355, 366, 367

 

 

 

248; see also specific

 

hypertension, see

 

pregnancy physiology

28

 

 

drugs

 

 

 

 

hypertension

 

pregnancy symptoms

36,

 

 

betamethasone 99, 103, 696

hypotension, see

 

54

 

 

 

 

bevacizumab

760–1

 

 

hypotension

 

puerperal pyrexia

 

 

 

bilateral oophrectomy

 

measurement of 7, 60

causation 355

 

 

 

and salpingectomy

 

monitoring in labour

267

sore/cracked

 

 

 

(BSO)

689, 721, 733,

pregnancy physiology

27,

nipples 366–7

 

 

 

738

 

 

 

 

60

 

 

breast cancer

 

 

 

bimastoid diameter 16–17

blood supply, anatomy

466

breast-feeding 366, 427

 

 

biofeedback 664, 678

 

blood tests

 

hormone replacement

 

 

biopsy

 

 

 

 

blood grouping in

 

therapy (HRT)

 

 

 

bladder

658

 

 

antenatal care 46

 

risk

649

 

 

 

cervical

424

 

 

booking visit 43

 

in pregnancy 427

 

 

 

endometrial

736

 

 

congenital abnormalities

breast-feeding

 

 

 

biparietal diameter

 

 

screening

 

antibiotic drugs and 356

 

 

(BPD)

15–17, 40, 41

 

tests

112–13, 114–15

anticoagulant drugs

 

 

 

biphosphonates 766

 

 

fetal blood sampling

 

and

194

 

 

 

bipolar affective

 

 

(FBS)

132, 280–1, 289

anticonvulsant drugs

 

 

 

disorder 448, 450–2,

 

fetal hydrops 132–3

 

and

189, 450

 

 

 

456

 

 

 

 

pre-eclampsia 64, 66

 

antithyroid drugs and

243

 

 

Bishop’s score,

 

 

blood transfusion, see

 

asthma and 208–9

 

 

 

Modified 274, 275

 

transfusion

 

benefits

364

 

 

 

bitemporal diameter

16–17

boari flap

774

 

contraception/lactational

 

 

bladder

 

 

 

 

body mass index (BMI)

7,

amenorrhoea 360, 364

 

 

anatomy

466, 467

 

 

33, 258–9, 406

 

drug-related milk

 

 

 

imaging

659

 

 

 

bone mineral density

 

production

 

 

 

‘keyhole’ 123

 

 

(BMD)

590, 638, 640–1

reduction 366

 

 

 

pain 655

 

 

 

bone pain

766

 

overview 362–3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

802 INDEX

breast-feeding (Cont’d) overview of drugs and 368, 371

potential problems 366–7 psychiatric medications

and 450–1 rubella immunization

and 360 viruses and 370

breathing

maternal resuscitation 374 neonatal

resuscitation 342–3, 344, 345, 347

respiratory rate in pregnancy 27

see also specific disorders breathlessness/dyspnoea

in advanced cancer 768 CMACE

recommendations 411 in pregnancy 27, 54, 411

breech presentation breech extraction 81, 402 deeply engaged head

differentiation 8 delivery 86–7

external cephalic version (ECV) 84–5, 315

overview 82 bregma (anterior

fontanelle) 14, 15 Brenner tumour 692 bromocriptine 254–5

brow presentation 318, 319 bulimia nervosa 449 bulking agents,

peri-urethral 666 bupivacaine, spinal

anaesthesia 334

burch colposuspension 666, 671

C

C3 levels 228 CA125

benign ovarian tumour diagnosis/

management 690–1, 693

ovarian cancer diagnosis/ management 722–3, 726, 730

screening and surveillance for ovarian cancer 703, 721

cabergoline 254–5 cachexia 768 caesarean section (CS)

abnormal lie 315

anaesthetic techniques 334–7

antibiotics (prophylactic) 357

anticoagulation and 397 breech presentation 84,

86 cardiopulmonary

resuscitation (maternal) and 374

cervical cancer management 425

complications overview 310–11

consent 783

cord prolapse 401 diabetes 238

for failed operative vaginal delivery 298

fibroids and 420–1 HIV infection 180 indications for 308–6

induction of labour with previous 279

inflammatory bowel disease (IBD) 214–15

injury during 776, 777 multiple pregnancy 80–1 overview 306–7 phaeochromocytoma 248 refusal of 783

scar dehiscence 279 types of 309

vaginal birth after (VBAC) 307

wound haematoma 397 wound infection 355

calcium gluconate 71, 227 Calcium Resonium® 227 calcium supplementation,

dietary 32 calculi 567

cancer, see malignancy; specific cancer types candidiasis 551, 553–4

cannabis abuse 444 capacity, consent issues 782 captopril 62–3

caput succedaneum 15 ventouse and

artificial 294–5, 298 carbamazepine 187, 450 carbimazole 242–3 carboprost, massive

obstetric haemorrhage 386–7

carcinosarcoma 740 cardiac defects, see

congenital heart disease (CHD)/cardiac defects

cardiac disease, see heart/ cardiac disease

cardiac output

in pregnancy 27, 193 in puerperium 350

cardinal ligaments 672, 673 cardiomyopathy,

peripartum 197 cardiopulmonary

resuscitation (CPR) maternal 374 neonatal, see neonatal

resuscitation cardiotocography (CTG)/

electronic fetal monitoring (EFM)

abnormalities 284–9 classification 288–9 high-risk fetus

monitoring 153 induction of labour monitoring 276 overview of labour

use 280–1

of second twin 402 terminology 282–3 uterine rupture 93 cardiovascular disease

(CVD)

menopause 638, 650 see also heart/cardiac

disease cardiovascular system

changes in pregnancy 27 changes in

puerperium 350 carpal tunnel syndrome 52 catecholamines 248 catheterization, urinary, see

urinary catheterization cediranib 760–1 ceftriaxone 555, 563

cell cycle 756, 757 Centre for Maternal

and Child Enquiries (CMACE) 406, 410–17

cerebral palsy (CP) 77, 280–1

cerebrovascular accident (CVA)/stroke 190–1, 638

cervical cancer aetiology and

presentation 714–15 cytology, colposcopy and

histology 706–7 diagnosis 716–17 pathology and

screening 424, 704–6 in pregnancy 424–5 treatment 718–19, 761,

764

cervical cerclage 100, 544–5

 

 

 

 

 

 

 

 

 

 

INDEX

803

cervical ectropion 551

cholecystectomy

96

 

 

coarctation of aorta 198

 

 

cervical glandular

cholecystitis, acute 96–7

cocaine 440–1

 

 

 

 

intraepithelial neoplasia

cholera 183–4

 

 

 

co-cyprindiol 572, 580–1,

 

 

(cGIN) 710–11

cholestasis,

 

 

 

 

622

 

 

 

 

cervical intraepithelial

obstetric 216–17

 

 

cognition, hormone

 

 

neoplasia (CIN) 704–5,

chorioamnionitis

102, 103,

replacement therapy

 

 

706–9, 711

 

312–13

 

 

 

 

(HRT) effects

650

 

 

cervical ripening

274–5

choriocarcinoma

727,

 

cognitive behavioural

 

 

cervical sutures

100

754–5

 

 

 

 

therapy 523

 

 

 

cervical weakness 98–9,

chorion 18

 

 

 

 

coital dysfunction, see

 

 

100, 543

 

 

chorionic villus sampling

 

sexual dysfunction

 

 

cervix

 

 

(CVS) 130, 131

 

 

collagen, abnormal

 

 

anatomy 467, 672

chorionicity

 

 

 

metabolism

672

 

 

changes in pregnancy 28

determination 74

 

collapse, sudden

 

 

 

changes in

 

 

choroid plexus cysts

128,

maternal 374–5

 

 

puerperium 350

129

 

 

 

 

colorectal cancer

646

 

 

preterm labour prediction

chromosomal abnormalities

colostrum 28, 362

 

 

by transvaginal

diagnostic tests

111,

 

colour, neonatal

 

 

 

USS 101

 

130–1

 

 

 

 

assessment 342–3

 

 

vaginal examination

fetal hydrops

 

 

 

colpoperineorrhaphy,

 

 

(bimanual)

463

causation 133

 

 

posterior 680

 

 

 

chemotherapy

 

prenatal diagnosis

 

 

colporrhaphy, anterior 680

 

 

breast cancer

427

overview 108

 

 

colposcopy 424, 705, 706,

 

 

cervical cancer

719, 761

recurrent miscarriage

542

707, 710

 

 

 

 

endometrial cancer 738,

screening for 44–5,

 

colposuspension 666–71

 

 

761

 

 

111–15, 128–9

 

 

combined oral

 

 

 

 

gestational trophoblastic

types of

 

 

 

 

contraceptive pill

 

 

disease (GTD) 752,

aneuploidy

109–10

 

(COCP)

 

 

 

 

754, 755, 761

ciprofloxacin 221

 

 

breast-feeding

 

 

 

ovarian cancer

724–5,

circulation

 

 

 

 

contraindication 360

 

 

726, 727, 761

anatomy

466

 

 

 

chronic pelvic pain

 

 

overview in gynaecological

maternal resuscitation

374

treatment

568

 

 

cancer 760–1

neonatal

 

 

 

 

diabetes and postnatal

 

 

principles of

756–7

resuscitation 344–5

use 238–9

 

 

 

side effects

758–7

placental

20–1

 

 

 

dysfunctional uterine

 

 

vaginal cancer

748–9

see also cardiovascular

 

bleeding (DUB)

 

 

vulval cancer 746–7, 761

system

 

 

 

management

516–17

 

 

vulval intraepithelial

citalopram

451

 

 

 

dysmenorrhoea

 

 

 

neoplasia (VIN) 742

clear cell

 

 

 

 

management

510–11

 

 

chest compressions,

adenocarcinoma

496,

endometriosis

 

 

 

neonatal 344–5

748, 749

 

 

 

treatment

586, 587

 

 

chickenpox (varicella

clear cell carcinoma

715

epilepsy and postnatal

 

 

infection)

164–5, 212,

climacteric

636

 

 

 

use 189

 

 

 

 

370

 

 

clindamycin

167, 172, 356,

hirsutism treatment 578

 

 

children

 

 

559, 563

 

 

 

menstrual disorder

 

 

consent for treatment 783

Clinical Negligence Scheme

management in

 

 

dermatological

 

for Trusts (CNST) 792,

adolescence

494, 495

 

 

conditions

492–3

793

 

 

 

 

overview 622–3

 

 

 

fertility implications of

clitoris, anatomy

467, 468–9

polycystic ovarian

 

 

cancer 494, 498–9

clobetasol propionate 695,

syndrome

 

 

 

 

gynaecological

 

696

 

 

 

 

management

572

 

 

cancers

496

clonidine 651

 

 

 

premenstrual syndrome

 

 

gynaecological

 

clotrimazole 560

 

 

 

management

522

 

 

developmental

clotting factors

 

 

 

regimes 624–5

 

 

 

disorders 472–87

in haemophilia

204–5

 

combined test

112, 113,

 

 

puberty, see puberty

in pregnancy 26

 

 

114–15

 

 

 

 

sexual abuse 615, 616,

clozapine 451

 

 

 

communication

 

 

 

 

618–19

 

 

coagulation disorders 322

good practice

778–9

 

 

vaginal discharge 488–9

disseminated intravascular

interpretor services 409

 

 

see also adolescents

coagulopathy

 

 

neonatal resuscitation and

 

 

chlamydia 553, 594, 789

(DIC)

383, 398, 399

parent 348

 

 

 

chloroquine 167

co-amoxiclav 103, 355

 

palliative care

769

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

804 INDEX

 

complaints 772, 778–9

consent 782

 

 

tocolysis 99, 400, 401

 

complementary and

 

in children 783

 

controlled cord traction

 

alternative therapies

epidural analgesia

330

(CCT)

270–1, 320

 

chronic pelvic pain

568

female sterilization

632–3

Cooke’s balloon

388

 

over-active bladder

 

operative vaginal

 

copper-bearing

 

 

 

 

syndrome

670

 

delivery 292, 298

IUCD

628–9, 630

 

premenstrual

 

 

overview for common

cord clamping

268, 270–1

 

syndrome

523

 

gynaecological

 

delayed

347

 

 

 

 

sexual dysfunction

610

procedures 784–5

cord prolapse

86, 277,

 

complications, of pregnancy,

refusal of

 

 

278, 401

 

 

 

 

see pregnancy

 

treatment

663–4

coronal suture

14

 

 

complications

 

sexual assault

 

 

coronary heart disease

 

computed tomography

examination 616

(CrHD) 638; see also

 

(CT) scan 659, 722–3,

subfertility 783

 

heart/cardiac disease

736, 797

 

 

surgery that breaches

corpus albicans

 

502, 503

 

condylomata acuminata 686

peritoneum 786–7

corpus luteum

502, 503

 

Confidential Enquiry

 

surgery that enters uterine

cortisol levels 252–3

 

into Maternal

 

cavity 788

 

co-trimoxazole

 

182

 

 

and Child Health

 

constipation

 

 

cotyledons 19

 

 

 

 

(CEMACH)

404–5,

advanced cancer

 

counselling

 

 

 

 

408–9, 410, 430

 

symptom 768

 

CMACE

 

 

 

 

 

Confidential Enquiry

 

chemotherapy side

recommendations 409

 

into Maternal Deaths

effect 758

 

cystic fibrosis

 

 

 

 

(CEMD) 404–5, 408–9

pelvic pain causation 567

prenatal 210

 

 

Confidential Enquiry into

postnatal 358

 

diabetes

 

 

 

 

 

Stillbirths and Deaths in

in pregnancy

29, 50, 90–1

pre-pregnancy

236

 

Infancy (CESDI) 404–5

continuous urinary

 

epilepsy

 

 

 

 

 

confidentiality, sexual

incontinence 654

pre-pregnancy

188

 

abuse 616

 

 

contraception

 

 

genetic

109, 250–1, 721

 

congenital abnormalities

cessation of 30

 

HIV pre-pregnancy

176–7

 

cytomegalovirus-

 

combined oral

 

miscarriage 533

 

 

associated

162

 

contraceptive pill,

screening/prenatal

 

 

diabetes and

236

 

see combined oral

diagnosis

108, 109, 111

 

epilepsy (maternal)

 

contraceptive pill

sexual assault

 

618

 

 

and 186

 

 

(COCP)

 

 

sterilization

 

 

 

 

multiple pregnancy

77

consent in children 783

(female) 632–3

 

 

obesity and 260

 

in diabetes 238–9

 

surrogacy 603

 

 

 

prenatal diagnosis

 

emergency (EC) 618, 630

termination of

 

 

 

overview

108

 

in epilepsy 189

 

pregnancy

528

 

 

rubella-associated 156,

female sterilization

632–4

Coxsackie virus

175

 

157

 

 

injectable

 

 

creatinine

29, 222–3

 

 

toxoplasmosis-

 

progestogen 628

Crohn’s disease

214–15

 

associated

169

 

intrauterine, see

 

crown–rump length

 

 

see also specific

 

intrauterine

 

(CRL)

38–9, 794

 

 

abnormalities

 

contraceptive device

crowning

264–5

 

 

congenital adrenal

 

(IUCD)/intrauterine

cryoprecipitate

 

383, 384

 

hyperplasia

250–1, 476,

system (IUS)

 

cube pessary 678, 679

 

480–1

 

 

post-molar

 

 

Cushing’s syndrome

252–3,

 

congenital cystic

 

pregnancy

752–3

481

 

 

 

 

 

adenomatoid

 

post-partum

360, 364, 624

cyclophosphamide 232

 

malformation

 

post-termination 624

cyproterone acetate

 

 

(CCAM) 124–5, 134

in premature

 

 

580–1

 

 

 

 

 

congenital genital tract

menopause 642

cystadenocarcinomas 722,

 

malformations 472–1,

progesterone-only pill

728–9

 

 

 

 

542

 

 

(POP) 360, 626–7

cystadenomas

692

 

 

congenital heart block 228

progestogen-only

 

cystectomy 422, 693

 

congenital heart disease

subdermal implant 628

cystic fibrosis (CF) 126–7,

 

(CHD)/cardiac defects

transdermal patch

625

210–11

 

 

 

 

fetal medicine 120–1,

vaginal ring 625

 

cystitis 220–1

 

 

 

133, 134

 

 

contractions (uterine)

interstitial (IC)

567, 658

 

maternal 192–3, 198

266–7, 330, 358

 

radiotherapy side

 

 

Conn’s syndrome 252

Braxton Hicks 92, 266

effect 763

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INDEX

805

cystocele/

 

detrusor over-activity

cocaine

440–1, 443

 

 

cystourethrocele 674,

(DO) 668, 669

ecstasy

442–3

 

 

 

675, 676

detrusor pressure

660, 662

hallucinogens/lysergic

 

 

cystometry

660, 661–2

dexamethasone 250–1, 481

acid diethylamide/

 

 

cystoplasty,

 

diabetes insipidus

257

mescaline 445

 

 

 

augmentation 671

diabetes mellitus

234–9

opiates

438–9

 

 

 

cystourethrography,

gestational 47, 240–1, 258,

overview

32–3, 430–4

 

 

micturating 659

259, 571

 

sedatives

444

 

 

 

cystourethroscopy 658

diagnostic tests,

 

tobacco

32–3, 434, 445

 

 

cysts

 

 

chromosomal

 

volatile substances

445

 

 

cervical 687

abnormalities

111,

drugs (medication)

 

 

 

choroid plexus cysts 128,

130–1

 

history

4, 460

 

 

 

129

 

diamorphine, in

 

male subfertility

 

 

 

ovarian, see ovarian cysts

labour 328–9

 

causation 598–9

 

 

vaginal

686

diaphragmatic hernia 124

neonatal resuscitation 346

 

 

vulval

686

diarrhoea

 

osteoporosis risk

 

 

 

cytomegalovirus

chemotherapy side

factors

639

 

 

 

(CMV)

162–3, 370

effect 758

 

overview of breast-feeding

 

 

cytotoxic agents

radiotherapy side

and

368, 371

 

 

 

classes of 757

effect 763

 

overview of pregnancy

 

 

see also chemotherapy

diathermy, ovarian 596–7

use

261

 

 

 

 

 

 

dietary advice

 

placental barrier/

 

 

 

D

 

 

in pregnancy 33, 183

transfer 22–3

 

 

 

 

 

premenstrual syndrome

pregnancy planning 34–5

 

 

danazol

522, 587

management

523

teratogenisis, see

 

 

 

dating of pregnancy 2–3,

dietary supplements

teratogenisis

 

 

 

38–9

 

 

normal pregnancy 32

see also specific drugs/

 

 

decelerations,

premenstrual syndrome

drug types

 

 

 

cardiotocography 282,

management

523

drugs (recreational),

 

 

 

284, 285–8

diethylstilbestrol (DES) 748,

see drug abuse (in

 

 

deep vein thrombosis

749

 

pregnancy)

 

 

 

(DVT)

 

D-dimers 395

 

ductus venosus

 

 

 

flying in pregnancy 184

disseminated intravascular

Doppler

150

 

 

 

postnatal

352, 355

coagulopathy (DIC) 383,

duloxetine

664

 

 

 

symptoms and signs 394

398, 399

 

duodenal atresia 126–7

 

 

see also venous

dizygotic twins 74, 75

dural puncture 332

 

 

 

thromboembolism

documentation/record

dysfunctional uterine

 

 

(VTE)

 

keeping 384, 778–9

bleeding (DUB)

512–19

 

 

de-infibulation 471

domestic abuse 416–17

dysgerminoma 727

 

 

 

delivery, seelabour and

donor insemination 602–3

dyskaryosis, cervical

705,

 

 

delivery

 

dopamine receptor

706, 707

 

 

 

 

dementia, hormone

agonists 254–5

dysmenorrhoea 510–11

 

 

replacement therapy

Doppler ultrasound

dyspareunia

606–7, 609

 

 

(HRT) and 650

ductus venosus

150

dyspnoea, see

 

 

 

denominator,

ovarian cancer

 

breathlessness/dyspnoea

 

 

terminology 17

screening 703

dysuria 655

 

 

 

 

Depo-Provera® 628

pelvic pain 796

 

 

 

 

 

 

 

depression

 

umbilical artery

150–2

E

 

 

 

 

 

antenatal

446, 449, 451

uterine artery 64, 148,

 

 

 

 

 

postnatal

42–3, 62–3, 359,

151

 

early pregnancy assessment

 

 

454–5

 

double bubble (duodenal

units (EPAUs) 530

 

 

dermatological conditions

atresia) 126–7

early pregnancy deaths 412

 

 

children and

doughnut pessary

678, 679

early pregnancy imaging

 

 

adolescents 492–3

Down’s syndrome (trisomy

794

 

 

 

 

 

vulval dermatoses 694–7,

21) 109

 

early pregnancy problems

 

 

699

 

screening for 111–15, 236

bleeding 530–1

 

 

 

dermoid cyst 692, 693,

doxycycline 528, 553,

ectopic pregnancy

90–1,

 

 

727

 

 

556, 563

 

412, 534–7, 794

 

 

descent

264–5

drug abuse (in pregnancy)

hyperemesis

 

 

 

desire disorder 608

amphetamine

 

gravidarum 243, 546

 

 

desmopressin 205

sulphate 442

miscarriage, see

 

 

 

detrusor myomectomy 671

cannabis 444

 

miscarriage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

806 INDEX

early pregnancy problems

(Cont’d)

pregnancy of unknown location (PUL) 531, 538–9, 540–1

termination of pregnancy, see termination of pregnancy (TOP)

eating disorders 449 Ebstein’s anomaly 450–2 echogenic bowel 128 echogenic intracardiac

foci 128 echovirus 175 ECOG (Eastern

Co-operative Oncology Group) performance status, vulval cancer 745, 757

eclampsia 70, 71, 410 ecstasy 442–3

ectopic pregnancy 90–1, 412, 534–7, 794

eczema 364, 493, 696 Edinburgh Postnatal

Depression Scale (EPDS) 454

education, see information provision/education

Edward’s syndrome 110 efornithine

hydrochloride 580–1 egg donation 602 Eisenmenger’s

syndrome 196 electrical stimulation, stress

urinary incontinence management 664

electrocardiography (ECG) fetal ECG ST waveform

analysis 280–1 myocardial infarction 197

electrolysis 578

electronic fetal monitoring, see cardiotocography (CTG)/electronic fetal monitoring (EFM)

embolectomy 396–7 emboli

amniotic fluid embolism (AFE) 398–9, 412 cerebrovascular accident (CVA) causes in

pregnancy 191 see also pulmonary

embolism; venous thromboembolism (VTE)

embolization, arterial 387, 389, 689

embryology, female genital tract 473

embryonal carcinoma 727

endometrial

 

embryonal

 

 

hyperplasia 732–3,

rhabdomyosarcoma

734–5

 

 

 

(sarcoma

 

endometrial polyps 688–9

botryoides)

464, 715,

endometriosis

 

748–9

 

 

in adolescents

495,

emergencies (obstetric)

686, 692

 

amniotic fluid embolism

diagnosis

584–5, 686,

(AFE)

398–9, 412

692, 796

 

cord prolapse 86, 277,

overview

582–3

278, 401

 

treatment

586–7

fetal distress of second

endometritis 354, 356

twin 402

 

endometrium

 

massive obstetric

anatomy

467

 

haemorrhage, see

imaging

794–5

 

massive obstetric

menstrual cycle

haemorrhage

physiology

502–4

shoulder dystocia 238,

thickness (ET)

736, 795

376–9

 

 

see also specific disorders/

sudden maternal

procedures

 

collapse 374–5

endotracheal tube

uterine inversion 322–3,

(ETT), neonatal

400

 

 

resuscitation

346, 347

venous thromboembolism,

engagement, fetal head 8–9,

see venous

264

 

 

 

thromboembolism

enterocele

674, 675

(VTE)

 

 

enteroviruses 175

emtricitabine 177, 178

Entonox®, see nitrous oxide

endocarditis

 

(Entonox®)

 

prophylaxis

195

eosinophils, in pregnancy

endocrine system

26

 

 

 

placenta as endocrine

epidural anaesthesia/

organ

22

 

analgesia

 

pregnancy

 

 

advantages/disadvantages

physiology 24–5

of analgesia

332–3

see also specific disorders

caesarean section

endocrinopathies

anaesthesia

335–6

amenorrhoea

 

combined spinal epidural

causation

507

(CSE)

336

 

female subfertility

contraindications to 333,

examination 594

397

 

 

 

recurrent miscarriage 543

haematoma 397

see also specific disorders

in haemophilia

204–5

endodermal sinus

overview of epidural

tumours

727

analgesia 330–1

endofascial

 

 

passive descent 268

condensation 672

patient-controlled

endometrial ablation 518,

analgesia as

 

788

 

 

alternative

332–3

endometrial cancer

siting technique 333

aetiology

648, 734

epilepsy, in

 

 

endometrial stromal

pregnancy 186–9

sarcoma 740

episiotomy

268, 300–3,

histology

734–5

329, 358

 

 

hormone replacement

shoulder dystocia

therapy (HRT)

management 378

and 648

 

epithelial tumours 495,

investigation

736–7, 795

692, 729

 

 

presentation

736

Epstein–Barr virus

screening

702–3

(EBV)

175

 

treatment

738–9, 761,

erectile dysfunction 612

764

 

 

ergometrine 386–7

 

 

 

 

 

 

 

 

 

 

INDEX

807

erythrocyte sedimentation

fetal blood sampling

high-risk fetus

 

 

 

rate (ESR)

26

 

(FBS) 132, 280–1, 289

monitoring

150–3

 

 

erythromycin

556

 

fetal fibronectin (FFN) 101

in labour

 

 

 

 

Essure 634

 

 

fetal growth assessment,

cardiotocography, see

 

 

ethambutol 213

 

ultrasound 40–1, 148

cardiotocography

 

 

ethnicity, perinatal mortality

fetal head

 

 

 

(CTG)/electronic

 

 

risk factor

406

anatomy

14–17

 

fetal monitoring

 

 

evacuation of retained

moulding

15

 

(EFM)

 

 

 

products of conception

presenting parts

16–17

overview 280–1

 

 

(ERCP) 532–3, 788, 789

fetal heart (FH) monitoring

overview

146–7

 

 

examination under

auscultation

6–7, 148,

prolonged pregnancy 106

 

 

anaesthetic (EUA),

267, 280

 

 

fetal mortality

 

 

 

cervical cancer

 

cardiotocography, see

acute fatty liver

 

 

diagnosis

716

 

cardiotocography

of pregnancy

 

 

exercise

 

 

(CTG)/electronic fetal

(AFLP) 218–19

 

 

premenstrual syndrome

monitoring (EFM)

phaeochromocytoma

 

 

management

523

fetal hydrops

 

 

248

 

 

 

 

 

preparation for

 

definition

132

 

see alsointrauterine death/

 

 

pregnancy 30

immune (Rhesus

 

stillbirth

 

 

 

exomphalos

126

 

iso-immunization) 132,

fetal movements

36, 148

 

 

expected date of delivery

135–7, 360

 

fetal position 9

 

 

 

(EDD) 2–3, 38

non-immune 132–4

fetal postmaturity

 

 

external cephalic version

fetal lie 6–7

 

 

syndrome 105

 

 

(ECV) 84–5, 315

abnormal lie 84, 88–9,

fetoplacental circulation 20,

 

 

external rotation

264–5

315

 

 

 

21

 

 

 

 

 

 

 

 

fetal medicine

 

fetotoxicity

261; see also

 

 

F

 

 

cardiac defects 120–1

teratogenesis

 

 

 

 

 

chromosomal

 

fibroids 688, 689

 

 

face presentation

318–19

abnormalities

dysfunctional uterine

 

 

fallopian (uterine) tubes

screening 111–15

bleeding (DUB) 514

 

 

anatomy 464, 465, 467

diagnostic tests

130–1

imaging

688, 794–5

 

 

benign neoplasms 689

fetal hydrops 132–7

in pregnancy 91, 420–1

 

 

BRCA mutation

 

fetal surveillance

 

recurrent miscarriage

 

 

management 721

overview 146–7

542

 

 

 

 

 

tubal carcinoma

728

gastrointestinal

 

fibroma 728

 

 

 

Fallot’s tetralogy 198

defects 126–7

fibromyalgia 567

 

 

family history

3, 4, 42–3,

high-risk fetus

 

fibronectin, fetal (FFN)

 

 

460, 640

 

 

identification/

101

 

 

 

 

 

fatigue 36

 

 

monitoring 148–53

FIGO staging

 

 

 

female genital mutilation

intrauterine growth

cervical cancer

717

 

 

(FGM) 301, 470–1

restriction

 

endometrial cancer 739

 

 

femur length, fetal

40–1

(IUGR)

142–5

ovarian cancer

723

 

 

Ferriman–Gallwey Score 577

lung defects

124–5

vaginal cancer

749

 

 

fertility

 

 

neural tube

 

 

vulval cancer 747

 

 

body weight effects 33

defects 118–19

Filshie clips

632–3, 634

 

 

cervical cancer

 

oligohydramnios

138–9

finasteride

 

580–1

 

 

fertility-sparing

polyhydramnios

140

fistulae 768, 776, 777

 

 

surgery

718–19

prenatal diagnosis

fluconazole

560

 

 

 

chemotherapy effects 759

overview 108

fluoxetine

451

 

 

 

childhood cancer

soft markers/

 

flutamide

580–1

 

 

 

implications

494,

normal variant

flying, in pregnancy 184

 

 

498–9

 

 

screening 128–9

folate deficiency

 

 

 

congenital adrenal

structural abnormalities

anaemia

199

 

 

 

hyperplasia (CAH)

diagnosis 116

folic acid

 

 

 

 

 

and 480–1

 

types of

 

 

 

epilepsy in pregnancy 186,

 

 

premature menopause

aneuploidy 109–10

188

 

 

 

 

 

management

642

urinary tract

 

folate deficiency

 

 

see also subfertility and

defects 122–3

anaemia 199

 

 

reproductive medicine

see also specific disorders

supplementation in normal

 

 

fesoterodine

671

 

fetal monitoring/surveillance

pregnancy 32, 118

 

 

fetal alcohol

 

 

high-risk fetus

 

thalassaemia management

 

 

syndrome

436–7

identification

148

in pregnancy 203

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

808 INDEX

 

follicle-stimulating hormone

gastroschisis

126

pelvic inflammatory

 

 

(FSH)

 

 

 

Gellhorn pessary 679

disease

563

 

 

 

amenorrhoea

 

 

 

gemeprost 527, 532

renal tract infection

221

 

investigation

507

 

general anaesthesia (GA),

germ cell tumours

692–3,

 

GnRH analogues’

 

caesarean section 337

729

 

 

 

 

 

effect 590

 

 

 

general practitioners (GPs),

German measles, see rubella

 

hypopituitarism

256–7

home birth role 325,

gestational diabetes

 

 

menopause

 

 

 

326

 

(GDM) 47, 240–1, 258,

 

investigations

640

 

genetic counselling

259, 571

 

 

 

 

 

menstrual cycle

503

 

congenital adrenal

gestational trophoblastic

 

follicular phase, menstrual

hyperplasia 250–1

disease (GTD)

750–1,

 

cycle 502, 503

 

 

malignancy

721

761

 

 

 

 

 

fontanelles 14, 15

 

 

after trisomy 21

choriocarcinoma

754–5

 

foot drop, intrapartum

359

diagnosis 109

hydatidiform mole

 

 

forceps delivery

292–4,

genetic diagnosis,

750–3

 

 

 

 

 

295–8

 

 

 

pre-implantation 602

giardiasis, breast-feeding

 

foreign body, genital

 

genetic factors, ovarian

benefit 364

 

 

 

tract 551

 

 

 

cancer 702, 720–1

glassy cell carcinoma 715

 

Fothergill repair

682

 

genetic mutation

glucose, neonatal

 

 

 

fractures, bone

638

 

BRCA gene, mutations

resuscitation 346

 

 

frequency, urinary

36, 655

of 702, 720–1

glue sniffing

445

 

 

 

frequency/volume

 

 

intracytoplasmic

glycaemic control, diabetes

 

chart 656, 657, 663, 668

sperm injection

in pregnancy 238–9

 

fresh frozen plasma

 

transmission 600–1

glycogen synthesis/

 

 

(FFP) 383, 384

 

 

genital tract

 

deposition

28

 

 

 

frontal suture 14

 

 

changes in pregnancy 28

gold therapy

232

 

 

 

full blood count (FBC),

 

changes in

 

gonadectomy

477–8, 483

 

antenatal care

46

 

puerperium 350

gonadotrophin

24

 

 

 

 

 

 

 

puerperal pyrexia

gonadotrophin-releasing

 

G

 

 

 

causation 354

hormone (GnRH) 503–4,

 

 

 

 

sepsis and maternal

588

 

 

 

 

 

gallbladder disease

 

mortality 410

deficiency

588

 

 

 

hormone replacement

see also specific disorders/

GnRH test

522–3

 

 

therapy and 648–9

procedures

in menstrual cycle 503–4

 

see also specific disorders

genital tract infections

as a treatment 588

 

 

gallstones 96–7

 

 

 

bacterial vaginosis, see

gonadotrophin-releasing

 

Gartner’s cysts

686

 

bacterial vaginosis (BV)

hormone (GnRH)

 

 

Gaskin manouevre 378

 

candidiasis 551, 553–4

analogues 590, 591

 

gastrointestinal/alimentary

pelvic inflammatory

dysfunctional

 

 

 

 

system

 

 

 

disease

490, 561–3

uterine bleeding

 

 

advanced gynaecological

sexually transmitted

(DUB)

516–17

 

 

cancer symptoms

768

infections, see sexually

dysmenorrhoea

510–11

 

breast-feeding

 

 

 

transmitted

endometriosis 587

 

 

benefits 364

 

 

infections (STIs);

fibroids 689

 

 

 

 

chemotherapy side

 

specific infections

hirsutism 580–1

 

 

 

effects 758

 

 

vaginal discharge, see

pelvic pain

568

 

 

 

pelvic pain causation

565,

vaginal discharge

gonadotrophin-releasing

567

 

 

 

genital tract

 

hormone (GnRH)

 

 

pregnancy physiology

29

malformations 472–4,

antagonists

590–1

 

 

radiotherapy side

 

507

 

gonorrhoea

551, 555

 

 

effects 763

 

 

genital tract trauma,

graft rejection

225

 

 

symptoms of

 

 

 

post-partum

grand multipara, induction

 

pregnancy

50

 

haemorrhage

of labour

278

 

 

 

see also specific disorders/

causation

322

granisetron

546–7

 

 

 

structures

 

 

 

genitalia

 

granulocyte

 

 

 

 

 

gastrointestinal defects,

 

ambiguous

476–8

colony-stimulating factor

 

fetal 126–7, 140

 

anatomy of

 

(GCSF) 758

 

 

 

gastrointestinal obstruction

external 468–9

granulosa cell tumour

728

 

in advanced cancer 768

genitoplasty

478

Graves’ disease 242–3

 

 

fetal 126–7

 

 

 

gentamicin

 

gravidity, terminology

3

 

gastro-oesophageal

 

endocarditis

group A streptococcus

 

reflux 29, 50, 92–3

 

prophylaxis 195

(GAS) 174

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INDEX

809

group B streptococcus

heart/cardiac disease

perinatal concerns

180–1

 

 

(GBS) 172, 314

congenital, see congenital

postnatal concerns

182

 

 

growth and puberty

heart disease (CHD)/

pregnancy and 176–7

 

 

disorders 484–7

cardiac defects

sexual assault and

619

 

 

growth hormone 256–7

management in

HIV-1 integrase strand

 

 

gynaecoid pelvic shape 11

pregnancy 192–7,

transfer inhibitor

177;

 

 

gynaecological

234–5

see also specific drugs

 

 

anatomy 10–13, 464–9

maternal mortality 414–15

Hodge pessary 678, 679

 

 

gynaecological disorders

see also cardiovascular

home birth 324–6

 

 

 

pelvic pain causation 565,

disease (CVD)

hormone replacement

 

 

566

heart rate/heartbeat

therapy (HRT)

 

 

 

see also specific disorders

auscultation of maternal 7

add-back 522, 590

 

 

 

gynaecological

blood loss effects 383

alternatives to 651

 

 

 

examination 462–3

fetal, see fetal heart (FH)

benefits 646

 

 

 

gynaecological

monitoring

hydatidiform mole

752–3

 

 

history 458–61

neonatal

overview 644–5

 

 

 

 

assessment 342–3

risks 648–9

 

 

 

H

heart valves, artificial 194–5

uncertainties 650

 

 

 

heartburn

hormones

 

 

 

haematology, chemotherapy

(gastro-oesophageal

changes in

 

 

 

effects 758

reflux) 29, 50, 92–3

puerperium 350

 

 

haematoma, anticoagulation

heparin

see also specific hormones

 

 

therapy and risk 397

low molecular weight, see

human chorionic

 

 

 

haematuria 655

low molecular weight

gonadotrophin

 

 

 

haemodynamics

heparin (LMWH)

(hCG) 22, 502, 540–1

 

 

changes in normal

unfractionated 396

early pregnancy problem

 

 

pregnancy 193

hepatitis A 183–4

assessment 530

 

 

ectopic pregnancy

hepatitis B (HBV)

ectopic pregnancy

534–5,

 

 

management 537

breast-feeding 370

536–7

 

 

 

placental circulation

infection in

molar pregnancy 540–1,

 

 

20–1

pregnancy 170–1

752–3

 

 

 

pregnancy physiology 26

screening 46

ovarian cancer 727

 

 

haemoglobin

vaccination 46, 170–1,

post-miscarriage

 

 

 

electrophoresis 47

183–4, 360

levels 533

 

 

 

haemoglobinopathies 47;

hepatitis C 182

pregnancy of unknown

 

 

see also specific

hereditary non-polyposis

location (PUL)

538–9,

 

 

disorders

colorectal cancer

540–1

 

 

 

haemolysis, elevated

(HNPCC) 720, 734

pregnancy testing 37

 

 

liver enzymes, and

hernia

in puerperium 350

 

 

 

low platelets (HELLP)

diaphragmatic 124

Human Fertilization and

 

 

syndrome 70–1, 218

pelvic pain causation 567

Embryology Authority

 

 

haemophilia 204–5

herpes simplex virus

(HFEA) Act 1990

783

 

 

haemorrhage, see

(HSV) 166, 370, 554

human immunodeficiency

 

 

antepartum

highly active

virus, see HIV (human

 

 

haemorrhage (APH);

antiretroviral therapy

immunodeficiency virus)

 

 

bleeding; massive

(HAART) 176–7,

human lymphotropic virus

 

 

obstetric haemorrhage;

178–82

(HTLV-1) 370

 

 

 

postpartum

hirsutism 574–81

human normal

 

 

 

haemorrhage (PPH)

histology

immunoglobulin

 

 

 

haemorrhoids 52

benign ovarian

(HNIG) 158–9, 183–4

 

 

Haig Ferguson forceps 294

tumours 692

human papillomavirus

 

 

hallucinogens 445

cervical cancer 706–7,

(HPV) 558, 686

 

 

 

haloperidol 451

715, 716

vaccination 558, 710–11,

 

 

health check, general

endometrial cancer 734–5

742

 

 

 

34–5

endometrial

human placental lactogen

 

 

head circumference (HC),

hyperplasia 732–3

(hPL) 24–5, 350

 

 

 

fetal 40, 148

HIV (human

hydatidiform mole 750–3

 

 

head position, neonatal

immunodeficiency virus)

hydralazine 63, 68

 

 

 

resuscitation 344, 345

antenatal care 178–9

hydronephrosis 122

 

 

 

headaches,

antenatal screening 46,

hydrosalpinx 689

 

 

 

pregnancy-related 54,

176

21-hydroxylase

 

 

 

411

breast-feeding 370

deficiency 250–1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

810 INDEX

hymen, imperforate 472–3, 474

hyperaldosteronism 252 hyperandrogenism 570, 572 hyperbilirubinaemia 136–7 hyperemesis

gravidarum 243, 546 hyperglycaemia

fetal 234 maternal 234, 238

hyperkalaemia 227 hyperprolactinaemia 254–5 hypertension

Conn’s syndrome 252 chronic 60, 62, 65 hypertensive crisis 248 obesity and 258 postnatal

management 62–3 postpartum 62 pre-eclampsia, see

pre-eclampsia pregnancy-induced 27, 62 pulmonary 196

renal disease outcome prediction 223 secondary causes 65 treatment principles in

pregnancy 63 hyperthyroidism

post-partum thyroiditis 246

thyrotoxicosis 242–3 hypertrichosis 574 hypoglycaemia

antenatal care 236 fetal 238

neonatal 234, 346 hypogonadotrophic

hypogonadism 498, 598–9

hypokalaemia 252 hyponatraemia 277, 546 hypopituitarism 256–7 hypotension

amniotic fluid embolism 399

in pregnancy 27

risk reduction in caesarean section 306

spinal anaesthesia complication 334

hypothalamic hypogonadism 588

hypothalamus amenorrhoea

causation 507 hypothalamic–pituitary–

ovarian (HPO) axis 502–4

late effects of cancer therapy 498

see also specific disorders hypothermia

neonatal 342 therapeutic 347

hypothyroidism 244–6 hypoxia, fetal 280–1 hysterectomy

BRCA gene mutation 721 cervical cancer 718–19 cervical glandular

intraepithelial neoplasia (cGIN) 710

dysfunctional uterine bleeding (DUB) 518–19

endometrial cancer 738 endometrial

hyperplasia 733 endometriosis 586 fibroids 689 massive obstetric

haemorrhage 387, 388

prolapse aetiology 672 ureter injury 466

hysterocontrastsalpingography (HyCoSy) 595, 796

hysteropexy 682, 683 hysterosalpingogram

(HSG) 595, 796, 798 hysteroscopy 514, 634

I

ICD-10

maternal mortality terms 407

psychiatric disorders 448–9

substance abuse terms 430

idiopathic thrombocytopenic purpura (ITP), autoimmune 206–7

iliac artery ligation 387–8 imaging 659, 722–3, 736,

794–8

see also specific imaging modalities

imipramine 451 imiquimod cream 558, 742 immunization, see

vaccination/immunization immunological male

subfertility 599 immunosuppressive

therapy 224–5 impaired glucose tolerance

(IGT), gestational 240–1

implantation, of blastocyst 18

in vitrofertilization (IVF) 600–1

dating of pregnancy 38 in HIV infection 176–7 multiple pregnancy 72 surrogacy 603

incident reporting 790 inclusion cysts 686 induction (of labour) (IOL)

cervical ripening 274–5 counselling 106 indications 106, 272 methods 276–7 prelabour rupture

of membranes management 314

special

circumstances 278–9 uterine rupture risk 307

infection complications of

pelvic 354

genital tract, seegenital tract infections

placenta as barrier to 22 pregnancy and infectious

diseases, see infectious diseases (in pregnancy)

prelabour rupture of membranes at term 314

prevention in termination of pregnancy 528

puerperal pyrexia 352, 353–7

recurrent miscarriage 543, 544–5

respiratory 182, 212–13 urinary tract (UTI) 91,

355, 358 wound 354, 355

see alsosepsis; specific types of infection

infectious diseases (in pregnancy)

cytomegalovirus (CMV) 162–3

enteroviruses 175 Epstein–Barr virus (EBV) 175

group A streptococcus (GAS) 174

group B streptococcus (GBS) 172

hepatitis B 46, 170–1, 183–4

herpes simplex 166 human immunodeficiency

virus (HIV) 176–82

Listeria monocytogenes 175

malaria 167, 183 measles 158–9, 163 parvovirus B19 160–1 rubella 46, 156–7, 163 syphilis 46, 175 toxoplasmosis 168–9 travel advice 183 vaccination for 183–4 varicella 164–5

inferior vena cava compression 27, 60

inferior vena caval filter 396–7

inflammatory bowel disease (IBD) 214–15

information provision/ education

booking visit 42–3 gynaecological cancer

sources 713

sexual dysfunction 610 see also counselling

inguinal ligament 10–11 inherent growth potential,

identification of 142 inhibin 728

injuries (practice-related) bladder and urethral

injury 776–7 overview 772 ureteric injury 774–5

insulin

diabetes management in labour/ post-partum 238–9

gestational diabetes management 240–1

human placental lactogen (hPL) effect 24–5

hyperkalaemia treatment 227

insulin sensitizers 572, 596–7 insulin stress test 256–7 integrated test 114, 115 intelligence, breast-feeding

and 364 intermenstrual bleeding

(IMB) 458, 459, 504 internal rotation 186–7 interstitial cystitis (IC) 567,

658 intervillous space,

haemodynamics 20, 21 intestinal obstruction 94–5 intracytoplasmic sperm

injection (ICSI) 600–1 intrapartum death

home birth risk 324 vaginal birth after CS 307

intrauterine contraceptive device (IUCD)/ intrauterine system (IUS)

copper-bearing IUCD 628–9, 630

levonorgestrelreleasing 516–17, 587, 629

intrauterine death/stillbirth definitions/

classification 404, 405 induction of labour 278–9 obesity and 260

obstetric

cholestasis 216–17 rates 405, 406

risk in multiple pregnancy 77

of a twin 79

see also fetal mortality; intrauterine growth

restriction (IUGR) causes 144

fetal postmaturity syndrome symptoms 105

oligohydramnios complication 138

overview 142–3 selective 78 symmetric and

asymmetric 145 intrauterine

insemination 602 intravaginal devices

(pessaries) 678, 679 iodine 25, 32

radioactive 242–3 iron-deficiency anaemia 199 iron overload 200–1, 202–3 iron supplementation 32,

199, 203, 412 irritable bowel syndrome

(IBS) 567

irritant dermatitis 493 isoniazid 212–13

itching, see pruritus/itching

J

jaundice 136–7, 219 Jehovah’s Witnesses 783 Joel–Cohen incision 309

K

Kallman’s syndrome 588 Keilland’s forceps 294, 295 ketoacidosis 234–5 ketoconazole 580–1 ‘keyhole’ bladder 123 Kiwi Omni cup 294–5 Kleihauer test 58–9, 137 Klinefelter’s syndrome

(47 XXY) 110

INDEX 811

L

labetalol 63, 68, 71 labia majora 467, 468–9 labia minora 467, 468–9 labial adhesions 492 labour and delivery

abdominal pain 92 abnormal lie 315 anaesthesia, see obstetric

anaesthesia

breech presentation 26, 81, 84, 86–7

caesarean section, see caesarean section (CS)

diabetic patients 238–9 episiotomy, see

episiotomy

fetal monitoring, see fetal monitoring, in labour

first stage 266–7 HIV infection 180 home birth 324–6

induction of labour, see induction (of labour) intrapartum death 307,

324

malpresentations 316–19 meconium-stained

liquor 290

multiple pregnancy 80–1 neonatal resuscitation,

see neonatal resuscitation

obstetric

cholestasis 216–17 operational vaginal

delivery, see operational vaginal delivery

overview 264–5 perineal trauma, see

perineal trauma post-partum haemorrhage,

see post-partum haemorrhage (PPH)

preparation for 48 preterm, see preterm

labour and delivery prolapse aetiology 672 retained placenta and

placenta accreta 320–1 second stage 268–9 subarachnoid

haemorrhage (SAH) and 190–1

third stage 270–1 twins 80–1 vaginal birth after

caesarean section (VBAC) 307, 309

812 INDEX

 

lactational

 

 

 

 

 

leukotriene receptor

treatment of venous

 

amenorrhoea 360, 364

antagonists 209

thromboembolism

 

lambda (posterior

 

 

levator ani muscles

672,

396–7

 

 

 

fontanelle)

14, 15

 

673

 

 

lumbar lordosis 7

 

 

lambdoid suture

14

 

levonorgestrel

 

lung auscultation,

 

 

 

lamivudine

177, 178, 181

emergency

 

maternal 7

 

 

 

lamotrigine

188, 450

 

contraception

630

lung defects, fetal

124–5

 

laparoscopy

 

 

 

 

levonorgestrel-releasing

lung hypoplasia 124

 

 

cervical cancer

718–19

IUD

516–17, 587, 629

luteal phase, menstrual

 

consent 786–7

 

 

lichen planus 696

 

cycle 502, 503

 

 

cystectomy

693

 

 

lichen sclerosus 492–3,

luteinizing hormone (LH)

 

and dye test

595

 

 

694–5

 

 

amenorrhoea

 

 

 

ectopic pregnancy

534–5,

lidocaine

329

 

investigation

507

 

536–7

 

 

 

 

 

lie (fetal)

6–7

 

GnRH analogues’

 

 

endometriosis

584–5, 586

abnormal 84, 88–9, 315

effect 590

 

 

 

female sterilization 632–3,

life expectancy,

 

hypopituitarism

256–7

634

 

 

 

 

 

women 636, 643

menstrual cycle

502, 503

 

laparoscopic

 

 

 

 

lifestyle

 

 

polycystic ovary syndrome

 

colposuspension

 

advice in pregnancy 32–3,

(PCOS) 570

 

 

666–7

 

 

 

 

 

42–3

 

 

lymphadenectomy 718–19,

 

ovarian diathermy

596–7

female subfertility

738, 746

 

 

 

laparotomy

 

 

 

 

management

596

lymphatic drainage, pelvic

 

ectopic pregnancy

536–7

polycystic ovarian

organs 467

 

 

 

massive obstetric

 

 

syndrome (PCOS) 572

lymphocytes, in

 

 

 

haemorrhage 387–8

postnatal issues 360

pregnancy 26

 

 

 

ovarian cancer

724–3

 

preparation for

 

lymphoma, of cervix

715

 

uterine inversion

400

 

pregnancy 30

 

Lynch syndrome (hereditary

 

large loop excision of the

recurrent miscarriage

non-polyposis colorectal

 

transformation zone

management

545

cancer (HNPCC)) 720,

 

(LLETZ) 424, 704–5,

sexual dysfunction

734

 

 

 

708–9, 710, 716

 

 

treatment 610

lysergic acid diethylamide

 

laser, hirsutism

 

 

 

stress urinary

 

(LSD) 445

 

 

 

treatment

578

 

 

incontinence

664

 

 

 

 

lassitude 36

 

 

 

 

ligaments, pelvic 10–11

M

 

 

 

last menstrual period (LMP)

linea nigra

6

 

 

 

 

expected date of delivery

listeriosis/Listeria

 

macrosomia 260, 272

 

(EDD) calculation

2–3,

monocytogenes

33, 175

magnesium sulphate

71,

38

 

 

 

 

 

lithium 450–2

 

208–9, 233

 

 

 

gynaecological history

458

liver enzymes, HELLP

magnetic resonance imaging

 

laxatives, postnatal

358

syndrome 70–1

(MRI)

 

 

 

legislation

 

 

 

 

 

local anaesthesia

 

cervical cancer

716

 

 

complaints 772, 778–9

episiotomy 300, 329

congenital uterine

 

 

Human Fertilization and

postnatal pain

 

abnormalities 798

 

Embryology Authority

management

358

endometrial cancer

736

 

(HFEA) Act 1990

783

pudendal nerve block 329

fibroids 794–5

 

 

 

overview of medico-legal

lochia 350

 

lower urinary tract

659

 

aspects 780–1

 

 

long-acting thyroid

 

ovarian masses and

 

 

medical/clinical

 

 

stimulator (LATS) 25

gynaecological

 

 

negligence

779, 780–1,

longitudinal lie 88, 89

malignancy 797

 

792, 793

 

 

 

 

Lovset’s manouevre 87

malaria 167, 183

 

 

 

Mental Capacity Act

 

low birth weight, perinatal

malignancy

 

 

2005

782

 

 

 

mortality risk factor

cervical, see cervical cancer

 

practice-related

 

 

406

 

 

chemotherapy, see

 

 

injuries 772

 

 

low molecular weight

chemotherapy

 

 

sexual assault

614

 

heparin (LMWH)

endometrial, see

 

 

termination of

 

 

 

anti-phospholipid antibody

endometrial cancer

 

pregnancy

526

 

syndrome 230–1

fertility implications of

 

leiomyomata, see fibroids

artificial heart valves in

childhood 494, 498–9

 

leiomyomatosis, IV

688

pregnancy 194–5

gynaecological cancers in

 

leiomyosarcoma

740

 

prevention of venous

childhood 496

 

 

leukaemias, breast-feeding

thromboembolism

imaging of

 

 

 

benefit

364

 

 

 

184, 392–3

 

gynaecological 797

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INDEX 813

metastatic disease

764

amniotic fluid

 

mefenamic acid

516–17

 

multidisciplinary

 

 

embolism 398, 412

Meig’s syndrome 728

 

approach to

 

 

 

Confidential Enquiry

melanoma, vulval/

 

 

gynaecological

712–13

into Maternal Deaths

vaginal

747

 

 

 

ovarian, see ovarian cancer

(CEMD) 404–5, 408–9

membranes, artificial

 

pain/pain

 

 

 

 

 

definitions 407

 

separation 274

 

 

management

766–7

direct/indirect causes

meningocele

118

 

 

palliative care

 

 

 

 

of death (Centre

meningococcus

183–4

 

principles

769

 

for Maternal and

menopause

 

 

 

 

in pregnancy, see

 

 

Child Enquiries

consequences

581, 606–7,

 

malignancy (in

 

(CMACE)) 410–17

637–9, 672

 

 

 

pregnancy)

 

 

 

general anaesthesia 337

history taking and

 

 

radiotherapy, see

 

heart disease and 193,

investigations

640–1

 

radiotherapy

 

 

196, 197, 198

 

hormone replacement

 

risk of malignancy index

home birth 326

 

therapy, see hormone

 

(RM() 690–1, 693, 722

phaeochromocytoma

replacement therapy

 

screening, see screening

248

 

(HRT)

 

 

 

 

subtle symptoms of

psychiatric disorders 359,

overview

636

 

 

 

gynaecological

461

446, 456

 

premature

642–3

 

symptoms of advanced

sepsis 353, 410, 411

menorrhagia

494, 512, 513

 

gynaecological

768

substance abuse

432–3

menstrual cycle, physiology

 

vaginal discharge

 

 

suicide 359, 416, 446,

of 502–4

 

 

 

characteristics

551

448, 456

 

menstrual disorders

 

vaginal cancer

748–9

uterine inversion

400

in adolescence

494–5

 

vulval cancer

744–7,

venous thromboembolism

amenorrhoea, see

 

761, 764

 

 

 

 

(VTE) 352, 390–1,

amenorrhoea

 

 

malignancy (in pregnancy)

410–11

 

dysmenorrhoea 510–11

 

androgen insensitivity

maternal obstetric

 

imaging 794–5

 

 

 

syndrome and

 

paralysis 359

 

oligomenorrhoea

494,

 

testicular

483

 

maternal resuscitation

506–8

 

 

 

 

breast cancer

427

 

massive obstetric

see also specific disorders

 

cervical cancer

424–5

haemorrhage

384

menstrual history

 

 

ovarian cancer

426

sudden collapse

374

in gynaecological

 

 

overview 423

 

 

 

McRoberts’

 

history

458

 

 

thyroid nodules

 

246–7

manouevre 376–7, 378

pregnancy dating

2–3, 38

 

malnutrition

33

 

 

 

measles 158–9, 163

Mental Capacity Act

 

malposition

17

 

 

 

 

German, see rubella

2005 782

 

 

 

malpresentations

 

 

 

mumps, measles rubella

mental health problems

 

in labour 316–19

 

(MMR) vaccine 156–7,

postnatal

 

 

 

 

 

see also specific

 

 

 

158–9

 

identification

359

 

malpresentations

meconium aspiration

see also specific disorders

 

Manchester repair

682

syndrome 290

 

mentovertical

 

 

 

Marfan’s syndrome

198

meconium-stained

 

diameter

16–17

 

massive obstetric

 

 

 

liquor 290, 347

meptazinol

328–9

 

 

haemorrhage

 

 

 

medical/clinical

 

mescaline

445

 

 

 

causes 380

 

 

 

 

negligence 779, 780–1,

mesonephric cysts

686

 

CMACE statistics/

 

792, 793

 

mesonephric ducts

472,

 

recommendations

medical disorders

 

473

 

 

 

 

 

412

 

 

 

 

 

CMACE recommendations

metastatic disease 764

 

medical

 

 

 

 

 

on pregnancy and

metformin

572, 596–7

 

management

386–7

pre-existing 415

methadone

434, 439

 

pathophysiology

382–3

normal pregnancy health

methotrexate

 

 

 

resuscitation

384

 

check 34

 

autoimmune disease 232

 

surgical

 

 

 

 

 

secondary sexual

 

ectopic pregnancy 536,

 

management

388–9

dysfunction 608–9

537

 

 

 

 

 

mastitis 355, 366, 367

see also specific disorders

inflammatory bowel

 

maternal age, risks for

medication, see drugs

disease (IBD)

214–15

 

advanced

30

 

 

 

(medication); specific

methyldopa

62–3

 

 

maternal mortality

 

 

drugs/drug types

metronidazole 551, 528,

 

acute fatty liver

 

 

 

medroxyprogesterone

557, 559, 563

 

 

 

of pregnancy

 

 

acetate 516–17, 578,

micturating

 

 

 

 

(AFLP)

218–19

587

 

cystourethrography 659

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

814 INDEX

micturition

frequency of 36, 655 gynaecological history

enquiry 460

see also urogynaecology; specific disorders

middle cerebral artery (MCA)

Doppler 150

peak systolic velocity (PSV) 136–7, 160–1

mifepristone 527, 532 Mirena IUS® 516–17, 629 miscarriage

amniocentesis and risk of 131

classification 531, 538 diagnosis 531, 794

early pregnancy bleeding and 530–1

fibroids and risk of 420 management 531–3 maternal mortality 412 obesity and 260

pain 90 recurrent 542–5

misoprostol 278–9, 386–7, 527, 532

mitral regurgitation, in pregnancy 196

mitral stenosis, in pregnancy 196

mixed urinary incontinence 654

molar pregnancy 243, 540–1

Molluscum contagiosumvirus 493

monitoring

fetal, see fetal monitoring/ surveillance

labour overview 267 monozygotic twins 74, 75 morning sickness 36, 50 mucositis 758, 763 mucus plug 28

Mullerian (paramesonephric) ducts 472, 473, 476–8

multidisciplinary team (MDT), gynaecological cancer 712–13, 769

multiple pregnancy antenatal care 76–7 fetal distress of second

twin 402 labour 80–1 overview 72

perinatal mortality risk factor 406

problems in monochorionic, diamniotic twins 78–9

reduction of pregnancy number 100–1

types 74–5 see alsotwins

mumps, measles and rubella (MMR) vaccine 156–7, 158–9

musculoskeletal system pelvic muscle

anatomy 10–11 pelvic pain causation 567 pregnancy

symptoms 52–3 myasthenia gravis 233 mycophenolate

mofetil 224–5 myelomeningocele 118 myocardial infarction

menopause 638

in pregnancy 197, 415 myomectomy 91, 420,

421, 689 myometrial

β-adrenoreceptors 440

N

Nabothian cysts 687 Naegele’s rule 2–3 naloxone 346

nasal bone, fetal 113 natural killer (NK) cells 543,

544

nausea and vomiting advanced cancer

symptom 768 chemotherapy side

effect 758 hyperemesis

gravidarum 243, 546 morning sickness 36, 50 radiotherapy side

effect 763 necrotizing enterocolitis

(NEC) 103 negligence, medical/

clinical 779, 780–1, 792, 793

neonatal mortality, see perinatal mortality neonatal resuscitation

ABC 344–5 communication with

parents 348 drugs 346 overview 340–1

poor response to 346 practical aspects 342–3 recent advances 347 stopping 348

nephropathy 234–5 nerve entrapments 567

neural tube defects 118–19 neuroendocrine

tumours 715 neurological disorders

chemotherapy side effects 759

pelvic pain causation 567 see also specific disorders

neuromodulation 671 neuropathic pain 567, 766 neutropenic sepsis 758 Neville-Barnes forceps 294,

295

nevirapine 177, 178, 181 Nexplanon® 628 nicotine replacement

therapy 445

nifedipine 62–3, 68, 71, 99 nimodipine 190–1 nitrofurantoin 221 nitrous oxide

(Entonox®) 328 nocturia 655 nocturnal enuresis 655

non-nucleoside analogue reverse transcriptase (NNRTI) 177, 182; see also specific drugs

non-steroidal anti-inflammatory drugs (NSAIDs)

adolescent pelvic pain 495 autoimmune disease 232 dysfunctional uterine

bleeding 516 perineal pain 358 polyhydramnios 140

norethisterone 494, 516–17 normal pregnancy

blood tests (antenatal) 46–7

booking visit 42–3

dating of pregnancy 38–9 delivery preparation 48 diagnosis of

pregnancy 36–7 engagement of fetal

head 8–9

fetal head anatomy and presenting parts 14–17

health check (general) 34–5

obstetric history 2–4 obstetric physical

examination 6–7 pelvic anatomy 10–13 physiology of 24–9 placental circulation 20–1 placental

development 18–19 placental functions 22–3

 

 

 

INDEX

815

planning antenatal (AN)

oestrogen therapy

in pregnancy

426

 

care 44–5

hormone replacement

presentation

722

 

preparing for 30, 34–5

therapy, see hormone

rare tumours

727–9

 

supplements and lifestyle

replacement therapy

risk of malignancy index

 

advice 32–3

(HRT)

 

 

(RMI)

690–1

 

ultrasound fetal growth

over-active bladder

screening

702–3

 

assessment 40–1

syndrome

670–1

treatment

724–3, 761, 764

 

nortriptyline 451

premenstrual

 

 

ovarian cysts

 

 

nuchal fold, increased 128

syndrome

522

in adolescence 495

 

nuchal translucency

sexual dysfunction 610

diagnosis

690–1

 

scan 112, 113, 114

oligohydramnios

138–9

histology

583, 692

 

nucleic acid amplification

oligomenorrhoea

494,

imaging 796, 797

 

test (NAAT) 553

506–8

 

 

management 693

 

nucleoside analogue reverse

oligozoospermia

598

pain causation 565

 

transcriptase inhibitors

omphalocele

 

 

in pregnancy

422, 426

 

(NRTI) 177

(exomphalos)

126

ovarian diathermy 596–7

 

 

 

ondansetron 546–7

ovarian disorders

 

O

 

oophorectomy 426

amenorrhoea

 

 

bilateral oophorectomy

causation

507

 

obesity

 

and salpingectomy

hirsutism causation 575

 

fertility and 33

(BSO) 689, 721,

see also specific disorders

 

gynaecological

733, 738

 

 

ovarian failure

 

 

examination 463

oophoropexy 499

chemotherapy side

 

polycystic ovarian

operative vaginal delivery

effects

759

 

syndrome (PCOS)

criteria 296–7

 

premature (POF) 507,

 

and

570, 571

instruments 294–5

642–3

 

 

 

risks in pregnancy 258–60

overview 292–3

ovarian hyperstimulation

 

oblique lie 88–9, 315

pudendal nerve block 329

syndrome (OHSS) 604

 

obstetric anaesthesia

trial of instrumental

ovarian (adnexal)

 

caesarean section

vaginal delivery 298

torsion

96–7, 422,

 

techniques 334–7

operculum 28

 

 

693, 796

 

 

 

epidural, see epidural

opiate drug abuse 434,

ovarian tumours

 

anaesthesia/analgesia

438–9; see also

benign 689–93;

 

pain relief in labour

substance abuse

see also ovarian cysts

 

328–9

opioid analgesia

 

imaging of ovarian

 

obstetric cholestasis

side effects 767

masses 797

 

216–17

in WHO analgesic

malignant, see ovarian

 

obstetric history 2–4,

ladder 766–7

cancer

 

 

 

42–3, 458

oral glucose tolerance test

ovaries

 

 

 

obstetric physical

(OGTT) 240, 241

anatomy 464, 465, 467

 

examination 6–7

Organization of Teratology

bimanual vaginal

 

occipitoanterior (OA) fetal

Information Specialists

examination 463

 

positions 9, 17

(OTIS) 261

 

 

imaging of ovarian

 

occipitofrontal

orgasmic disorder 608, 610

masses 797

 

diameter 16–17

osteoporosis 638, 639,

cancer therapy

 

occipitoposterior (OP) fetal

646, 651

 

 

effects

498, 759

 

positions 9

ovarian arteries

 

menstrual cycle

 

occipitotransverse (OT)

anatomy 466

 

 

activity 502–4

 

fetal positions 9

ligation 387–8

 

see also specific disorders

 

occiput 14

ovarian cancer

 

 

over-active bladder

 

oedema

 

aetiology 720–1

syndrome 668–71

 

ovarian

692

borderline ovarian

overflow incontinence 654

 

perineal

350

tumours 730

ovulation 502, 503

 

oesophageal atresia 126–7

chemotherapy

724–5,

anovulation

592

 

oestradiol

24

726, 727

 

 

induction of

596–7

 

oestrogen levels

in childhood/

 

 

suppression agents 522

 

changes in

adolescence

494–5, 496

Oxford system,

 

puerperium 350

histological subtypes 729

modified 677

 

in menopause 636

hormone replacement

oxprenolol 63

 

menstrual cycle 502, 503

therapy (HRT)

oxybutynin

671

 

pregnancy

risk 650

 

 

oxygen saturation 411

 

physiology 24–5, 28

investigation

722–3

oxytocin 24, 28

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

816 INDEX

 

breech presentation 86

 

paramesonephric ducts 472,

perineal tears 302–4, 329,

 

cervical ripening

274

 

473, 476–8

 

 

 

350, 358

 

 

 

eclampsia management

71

paravaginal repair,

 

postnatal constipation

 

ergometrine and, see

 

prolapse 680

 

 

358

 

 

 

Syntometrine®

 

parity 3

 

 

 

 

 

postnatal pain

358

 

 

hydatidiform mole

 

paroxetine

451

 

 

perineal wound

 

 

 

management

727

 

partogram

267

 

 

 

infection 354

 

 

 

induction of labour 276–7,

parvovirus B19

160–1

perineoplasty 680

 

278, 279, 307

 

 

Patau’s syndrome 110

perineum

 

 

 

massive obstetric

 

 

patient-controlled analgesia

anatomy 468, 469

 

 

haemorrhage 386–7

 

(PCA) 332–3

 

 

changes in

 

 

 

poor progress in first

 

Paulik’s grip 8

 

 

 

puerperium

350

 

stage

270–1

 

 

peak expiratory flow rate

see also specific disorders/

 

retained placenta

 

 

(PEFR)

208–9

 

procedures

 

 

 

management

320, 321

peak systolic velocity

peripheral neuropathy 759

 

shoulder dystocia

 

(PSV) 136–7, 160–1

peritoneal endometriotic

 

management

379

 

pelvic adequacy

 

 

lesions 583

 

 

 

third stage

 

 

 

assessment

13

 

peri-urethral injections 666

 

management

271

 

pelvic anatomy

10–13,

pessaries, prolapse

 

 

 

 

 

 

 

464–6, 467

 

 

 

management

678, 679

 

P

 

 

 

 

pelvic brim

11

 

 

 

pethidine 328–9

 

 

 

 

 

 

 

pelvic examination

462–3,

Pfannenstiel incision

309

 

paclitaxel

726

 

 

656–7

 

 

 

 

 

phaeochromocytoma

248

 

pad test

658

 

 

 

pelvic floor

 

 

 

 

 

phenytoin 187

 

 

 

paediatrics, see adolescents;

anatomy

672–3

 

phosphodiesterase

 

 

children

 

 

 

muscle strength

 

inhibitors 612

 

 

Paget’s disease of the

 

assessment

676, 677

physiotherapy, prolapse

 

vulva

741

 

 

 

muscle training/

 

management

678

 

 

pain/pain management

 

exercises

664, 678

pica 36

 

 

 

acute pelvic pain 564–5,

pelvic inflammatory

pituitary gland

 

 

796

 

 

 

 

disease

490, 561–3

amenorrhoea

 

 

 

chronic pelvic pain

 

pelvic inlet

12–13

 

causation 507

 

 

(CPP) 566–8, 582, 796

pelvic girdle pain

52

changes in pregnancy 24

 

CMACE

 

 

 

pelvic outlet

12–13

hypopituitarism 256–7

 

recommendations

409

pelvic pain

 

 

 

 

 

hypothalamic–pituitary–

 

ectopic pregnancy 537

acute 564–5, 796

 

ovarian (HPO)

 

 

endometriosis 582,

 

in adolescence

495

axis 502–4

 

 

586, 587

 

 

 

chronic (CPP)

566–8,

late effects of cancer

 

fibroid-related 420

 

582, 796

 

 

 

 

therapy 498

 

 

gynaecological

 

 

imaging 796

 

 

 

tumours 254–5

 

 

cancers

766–7

 

pelvic venous

 

 

 

 

placenta

 

 

 

imaging in pelvic pain

 

congestion

566

 

circulation 20–1

 

796

 

 

 

 

penicillamine

232

 

cocaine’s effect on

 

 

menstruation-related/

 

penicillin 175

 

 

 

 

placentation 440

 

dysmenorrhoea 504,

performance status

745, 757

delivery of 270–1

 

 

510–11

 

 

 

peri-anal intraepithelial

development of 18–19

 

miscarriage

533

 

neoplasia (AIN)

711

essential functions 22–3

 

neuropathic

567

 

peri-menopause

636

manual removal of

 

 

pelvic pain in

 

 

perinatal mortality

 

(MROP) 321

 

 

adolescence

495

 

home birth

324, 326

post-partum haemorrhage

 

postnatal 358

 

 

key findings

406

 

(PPH) and abnormal

 

pregnancy and abdominal,

multiple pregnancy 77

site 322–3

 

 

 

see abdominal pain (in

overview

404–5

 

retained 320–1

 

 

pregnancy)

 

 

sickle cell disease

201

see also specific disorders

 

sexual pain disorders

609

substance abuse

433

placenta accreta

320–1,

 

vulval 698–9

 

 

perineal infiltration, local

322–3

 

 

 

palliative care

764, 769

 

anaesthetic

329

placenta increta

320, 322–3

 

palpation (abdominal),

 

perineal injections, sexual

placenta praevia (PP)

 

 

normal pregnancy 6–7

dysfunction

610

antepartum haemorrhage

 

pancreatitis 97

 

 

perineal oedema

350

and 55, 56–9

 

 

paracetamol

358

 

 

perineal trauma

 

 

post-partum haemorrhage

 

paramesonephric cysts

686

episiotomy, see episiotomy

and 322–3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INDEX

817

placenta percreta 320, 322–3

secondary 352, 380

overview

108

 

 

 

placental abruption

shoulder dystocia and risk

see also screening

 

 

 

antepartum haemorrhage

of 379

pre-operative assessment,

 

 

and 55, 56–7, 58–9

see also massive obstetric

gynaecological

 

 

 

fibroid differentiation 91

haemorrhage

procedures 789

 

 

 

placental (utero-placental)

post-partum thyroiditis 246

presentation

 

 

 

insufficiency 144, 146

pre-eclampsia

abdominal palpation to

 

 

plasma volume, in

clinical features and

determine 6–7

 

 

 

pregnancy 26

investigations 66

breech, see breech

 

 

 

platelet concentrate 383, 384

definition 62, 63

presentation

 

 

 

platelets

 

management 67–8

fetal head diameters and

 

 

autoimmune idiopathic

maternal mortality 410

presenting parts

16–17

 

 

thrombocytopenic

obesity and 258, 259

terminology 17

 

 

 

purpura 206–7

overview 64–5

preterm labour and

 

 

 

epidural

 

post-partum hypertension

delivery

 

 

 

 

contraindications 333

differentiation 62

multiple pregnancy

76, 77

 

 

HELLP syndrome 70–1

pregnancy complications

overview

98–9

 

 

 

in pregnancy 26

abdominal pain 90–7

prediction and

 

 

 

platypolloid pelvic shape 11

antepartum haemorrhage

prevention 100–1

 

 

pleural effusion

722–3

(APH) 55–9, 380

specific neonatal

 

 

 

fetal 134

 

blood pressure physiology

resuscitation

 

 

 

pneumonia 212–13

background 60

issues

342, 347

 

 

 

primary pneumocystis

breech presentation, see

tocolysis

99, 400, 401

 

 

(PCP) 182

 

breech presentation

preterm pre-labour

 

 

 

podophyllotoxin cream/

eclampsia 70, 71, 410

rupture of membranes

 

 

solution 558

HELLP syndrome 70–1,

(PPROM) 100, 102–3

 

 

polycystic ovarian syndrome

218

HIV infection 180

 

 

 

(PCOS) 507, 508, 570–3,

hypertension 62–3;

induction of labour

278

 

 

596–7, 692

 

see also eclampsia;

primary ovarian failure

 

 

polyhydramnios

134, 140

pre-eclampsia

(POF) 592

 

 

 

polyps

 

minor symptoms 50–4

prochlorperazine 546–7

 

 

cervical 687

 

multiple pregnancy 72–81

procidentia

674

 

 

 

endometrial 688–9

pre-eclampsia, see

progestogen therapy

 

 

 

position of the presenting

pre-eclampsia

chronic pelvic pain

 

 

 

part, terminology 17

preterm labour 77,

treatment 568

 

 

 

postcoital bleeding

98–101

dysfunctional

 

 

 

(PCB) 458, 459, 504

preterm pre-labour rupture

uterine bleeding

 

 

 

posterior urethral valve

of membranes 100,

(DUB) 516–17

 

 

 

syndrome 122–3

102–3, 180, 278

endometrial cancer

738

 

 

postmenopausal bleeding

prolonged

endometrial

 

 

 

(PMB) 458, 459, 736,

pregnancy 104–6

hyperplasia 732, 733

 

 

737, 795

 

transverse/oblique/

endometriosis

 

 

 

postnatal care

 

unstable lie 88–9, 315

management 586, 587

 

 

breastfeeding and related

pregnancy of unknown

hormone replacement

 

 

issues 362–70

location (PUL) 531,

therapy, see hormone

 

 

contraception

360

538–9, 540–1

replacement therapy

 

 

HIV infection

182

pregnancy test 37, 789

(HRT)

 

 

 

 

lifestyle 360

 

prelabour rupture of

injectable

628

 

 

 

major postnatal

membranes (PROM)

premenstrual syndrome

 

 

problems 352–9;

preterm, seepreterm

management 522

 

 

see also specific

prelabour rupture of

preterm labour

 

 

 

problems

 

membranes (PPROM)

prevention 100

 

 

 

maternal immunization 360

at term 312–14

progesterone-only pill

 

 

normal changes in

premature ovarian failure

(POP)

360, 626–7

 

 

puerperium 350

(POF) 507, 642–3

progestogen-only

 

 

 

postnatal depression 42–3,

premenstrual dysphoric

subdermal implant 628

 

 

62–3, 359, 454–5

disorder 521

types in combined oral

 

 

post-partum haemorrhage

premenstrual

contraceptive pill

 

 

(PPH) 322–3

syndrome 520–3

(COCP) 622–3

 

 

 

causes 322–3, 380, 401

prenatal diagnosis

see alsocombined oral

 

 

oxytocin use in increased

genetic counselling

contraceptive pill

 

 

risk 271

 

after 109

(COCP)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

818 INDEX

progesterone levels changes in

puerperium 350 ectopic pregnancy 534–5 menstrual cycle

physiology 502, 503 pregnancy of unknown

location (PUL) 538–9 pregnancy physiology 24

proguanil 167

prolactin levels 24, 28, 243, 254–5, 507

prolactinomas 254–5 prolapse

aetiology 672 assessment 675–7 classification 674–5 management 678–83 prevention 678

related anatomy 672, 673 prolonged pregnancy 104–6 propiverine 671 propylthiouracil

(PTU) 242–3 prostaglandins

bronchoconstrictive action and asthma 208–9

cervical ripening 274 induction of labour 276,

278, 279, 307 miscarriage 532 termination of

pregnancy 527 protease inhibitors

(PIs) 176–7, 182;

see also specific drugs proteinuria, in

pre-eclampsia 67, 68 pruritus/itching

idiopathic vulval itching 698–9

pregnancy-related 54, 216–17

pruritus vulvae 698, 699 pseudomyxoma

peritonei 724–5 psoas hitch 774 psoriasis 493

vulval 696–7

psychiatric illness/disorders co-existing substance

abuse 432

depression, see depression maternal mortality

and CMACE recommendations 416

overview of antenatal 446 psychiatric

medications 450–2 puerperal psychosis 456

psychological care, sexual assault 618

psychological issues female subfertility 597 pain management

in advanced cancer 766–7

pelvic pain 567 polycystic ovarian

syndrome 573 psychological symptoms, menopause 637

puberty 484–5 delayed 486–7 precocious 484–5

pubic ligaments 10–11 pudendal nerve block 329 puerperal psychosis 456 puerperium

care in, see postnatal care normal changes in 350 puerperal pyrexia 352,

353–7

puerperal sepsis 353 pulmonary artery wedge

pressure 399 pulmonary embolism (PE)

postnatal 352, 355 sudden maternal

collapse 374 symptoms and signs 394 see also venous

thromboembolism (VTE)

pulmonary hypertension 196

pulmonary oedema, in pregnancy 196, 411

pulse (maternal), monitoring in labour 267

pyelonephritis 220–1 pyometra 736 pyosalpinx 689 pyrazinamide 213

Q

quadruplet test 112–13, 114, 115

quality of life

hormone replacement therapy 650

prolapse 676

urinary symptoms 656 quickening, see fetal

movements quinine 167

R

rabies 183–4 radiant warmer/

Resuscitaire 340–1, 342, 347

radioactive iodine 242–3 radiography 659, 722–3,

797, 798 radiotherapy

breast cancer in pregnancy 427

cervical cancer 718–19 endometrial cancer 738 overview in gynaecological

cancers 764 principles 762 side effects 763 vaginal cancer 748

vulval cancer 746–7 raltegravir 177, 178–9, 181 rashes,

pregnancy-related 54, 163

RECIST (response, evaluation, criteria in solid tumours) criteria 756–7

recombinant activated factor VII 383

record keeping/ documentation 384, 778–9

rectocele 674, 675, 676 rectum, anatomy 466–7 red cell volume/mass, in

pregnancy 26 reflux oesophagitis 29,

50, 92–3

refusal of treatment 783 Reiter’s syndrome 553 remifentanil 332–3 renal agenesis 122

renal disease chronic 222–3 in systemic lupus

erythematosus (SLE) 228

see also specific disorders renal failure, acute 226–7 renal pelvic dilatation,

mild 128

renal system, changes in pregnancy 29

renal tract abnormalities, genital tract malformations and 474

renal tract infections, in pregnancy 220–1

renal transplantation, after pregnancy 224–5

reproductive function, seefertility; subfertility and reproductive medicine

residual check 658 respiratory depression,

epidural analgesia 332

respiratory distress syndrome 234

respiratory system changes in pregnancy 27 puerperal pyrexia

causation 355

see also specific disorders respiratory infections 182,

212–13 respiratory rate, in

pregnancy 27 restitution 328 Resuscitaire/radiant

warmer 340–1, 342, 347 resuscitation

maternal 374 neonatal, see neonatal

resuscitation retinopathy 234–5 reversed end diastolic flow

(REDF) 150, 152 Rhesus D negative,

antepartum haemorrhage management 58–9

Rhesus iso-immunization (Rhesus disease/immune hydrops) 132, 135–7, 360

rifampicin 213

ring pessary 678, 679 risk assignment, antenatal

monitoring 146–7 risk management,

clinical 790–3

risk of malignancy index (RMI) 690–1, 693, 722

Rokitansky

syndrome 472–3, 474 Rotterdam criteria 570 round ligament pain 90–1 Rovsing’s sign 94

rubella 156–7

antenatal screening 46 breast-feeding 370 non-vesicular rash

investigation 163 vaccination 156–7, 158–9,

360 Rubin II 378

rupture of membranes (ROM)

artificial (ARM)/ amniotomy 266, 276–7

HIV infection 180 prelabour 312–13 preterm pre-labour, see

preterm pre-labour rupture of membranes (PPROM)

spontaneous (SROM) 138–9

Rusch balloon 387–8

S

sacral nerve stimulation 671 sacrocolpoplexy 682–3 sacroiliac ligaments 10–11 sacrospinous

ligament 10–11 fixation 682

sacrotuberous ligament 10–11

sagittal suture 14, 15 saline infusion

sonography 794–5 salpingectomy 536–7

bilateral oophorectomy and salpingectomy (BSO) 689, 721, 733, 738

salpingo-oophorectomy 702

salpingotomy 536–7 sarcomas 740

sarcoma botryoides (embryonal rhabdomyosarcoma) 464, 715, 748–9

schizophrenia 448 sciatica 52 screening

cervical cancer 424, 704–6 chlamydia 553, 594 chromosomal

abnormalities 44–5, 111–15, 128–9

gynaecological cancer overview 700 normal variant in fetal medicine 128–9 ovarian cancer 702–3,

720–1

psychiatric disorders 446, 454

structural abnormalities (fetal) 44–5, 116

for thalassaemia 203 scuba diving 30 seizures

eclampsia 70, 71 first seizure in

pregnancy differential diagnosis 186–7

see also epilepsy

selective serotonin-reuptake inhibitors (SSRIs) 451, 522, 651

semen abnormality 599

normal analysis 598 Sengstaken–Blakemore

tube 388 sentinel lymph node

biopsy 746–7

INDEX 819

separation bleeding 271 sepsis

chemotherapy and neutropenic 758

CMACE recommendations 411

genital tract 410 maternal mortality 408–9,

410 puerperal 353

serious untoward incident (SUI) 790

serotonin and noradrenalin reuptake inhibitors (SNRIs) 451, 522,

651, 664 Sertoli–Leydig cell

tumour 692, 728 sertraline 451, 454–5 serum integrated

test 114–15 sex-cord stromal

tumours 495, 496, 692, 728, 729

sex development, disorders of (DSD) 476–83

sex hormone-binding globulin (SHBG) 507, 574, 575

sexual abuse/assault 489, 490, 493, 495, 613–19

in children 615, 616, 618–19

sexual dysfunction female (FSD) 606–11,

637, 646 male 599, 612 sexual history 459

Sexual Offences Act 2003 570

sexually transmitted infections (STIs) 551, 490, 552–8

sexual assault 618–19 Sheehan’s syndrome 256–7 shelf pessary 678, 679 shoulder dystocia 238,

376–9 shoulders, delivery

of 264–5, 268

sickle cell disease/trait 47, 200–1

sildenafil 612 Simpson’s forceps 294 sinciput 14

sinusoidal pattern 284 skin

changes in pregnancy 6, 29 pregnancy symptoms 54 radiotherapy side

effects 763 rashes 54, 163

820 INDEX

 

small for gestational age

preterm pre-labour

suboccipitobregmatic

 

(SGA) 142

 

 

rupture of membranes

diameter 16–17

 

smoking 32–3, 434, 445

(PPROM) 103

suboccipitofrontal

 

social history 3, 4, 461

stillbirth, see intrauterine

diameter 16–17

 

sodium bicarbonate,

 

death/stillbirth

substance abuse (in

 

neonatal

 

 

stool softeners 358

pregnancy)

 

resuscitation

346

streptococcus infections, in

alcohol abuse 436–7

 

sodium valproate 450

pregnancy

172, 174, 314

drug abuse 438–45

 

solifenacin 671

 

 

streptomycin

213

overview 430–4

 

spectinomycin 555

 

stress

 

 

suction, neonatal

 

speculum

 

 

in pregnancy

30

resuscitation 344, 347

 

examination

462–3

reduction in premenstrual

sudden unexpected adult/

 

sperm, male

 

 

syndrome

arrhythmic deaths

 

subfertility 598–9

management 523

(SADS) 408–9

 

sperm retrieval

598–9

stress urinary incontinence

suicide 359, 416, 446,

 

spina bifida 118

 

 

(SUI) 654, 663–7

448, 456

 

spinal anaesthesia

 

‘stretch and sweep’ 274

sulfasalazine 214–15

 

anatomy 331

 

 

striae

6, 29

 

sulphonamides 221

 

caesarean section

334,

stroke

190–1, 638

supine hypotension

336

 

 

structural abnormalities

syndrome 27

 

combined spinal epidural

(fetal)

 

supplementation (dietary),

 

(CSE) 336

 

 

screening/diagnosis 44–5,

in pregnancy 32, 118

 

urinary

 

 

116

 

surrogacy 603

 

catheterization

358

see also specific

sutures, fetal head

 

spiral arteries 20, 21

abnormalities

anatomy 14, 15

 

spiramycin 168

 

 

subacute sclerosing

swallowing abnormalities,

 

spironolactone

580–1

panencephalitis 158

fetal 140

 

spontaneous rupture

subarachnoid

 

Swansea criteria 219

 

of membranes

 

haemorrhage (SAH), in

symphysiotomy 378–9

 

(SROM) 138–9

 

pregnancy

190–1

symphysis fundal height

 

squamous cell

 

 

subfertility and reproductive

(SFH) 6–7, 148, 259

 

carcinoma 694, 715

medicine

 

symphysis pubis discomfort,

 

ST waveform analysis

assisted

 

postnatal 358–9

 

(STAN), fetal

 

reproduction 600–4

symphysis pubis dysfunction

 

ECG 280–1

 

 

consent 783

(SPD) 52, 92

 

stabilizing induction

278

endometriosis 495, 582–7

syntocinon 278

 

station 17

 

 

female subfertility 592–7

Syntometrine® 271, 320

 

sterilization, female

632–4,

gonadotrophin-

syphilis 46, 175, 556

787

 

 

releasing hormone

systemic lupus erythematosus

 

steroid therapy

 

 

(GnRH), see

(SLE) 228–9

 

Addison’s disease

252

gonadotrophin-

 

 

antenatal, see steroid

releasing

 

T

 

therapy (antenatal)

hormone (GnRH);

 

asthma 208–9

 

 

gonadotrophin-

tachyarrhythmias, fetal 134

 

autoimmune idiopathic

releasing hormone

tachycardia, fetal 284

 

thrombocytopenic

(GnRH) analogues;

tadalafil 612

 

purpura 206–7

 

gonadotrophin-

tamoxifen 366, 427

 

congenital adrenal

 

releasing antagonists

tamponade, uterine 387–8

 

hyperplasia

250–1, 481

hirsutism and

Tanner stages 485

 

hyperemesis

 

 

virilization 250–1,

teicoplanin, endocarditis

 

gravidarum

546–7

574–81

 

prophylaxis 195

 

inflammatory bowel

male subfertility 598–9

temperature (body)

 

disease 214–15

ovarian hyperstimulation

monitoring in labour 267

 

metastatic disease pain

syndrome (OHSS) 604

neonatal

 

management 766

polycystic ovarian

resuscitation 340–2,

 

recurrent miscarriage 545

syndrome

347

 

vulval dermatoses

695,

(PCOS)

507, 508,

tenofovir 177, 178

696

 

 

570–3, 596–7, 692

tension-free vaginal tape

 

steroid therapy (antenatal)

sexual dysfunction 606–12

(TVT) 667

 

in diabetes 238

 

see alsofertility

teratogenesis

 

pre-eclampsia

68

 

submentobregmatic

anticonvulsant drugs 186,

 

preterm labour 99

diameter 16–17

187–8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INDEX

821

autoimmune disease

receptor stimulating

menstrual

 

 

 

 

drugs

232

 

antibodies

242–3

disorders 794–5

 

 

chemotherapy

759

thyroid storm

242

ovarian masses and

 

 

cocaine 440

 

 

thyroidectomy

242–3

gynaecological

 

 

methotrexate

536

thyroiditis, post-partum 246

malignancy

703,

 

 

overview

22–3, 261

thyrotoxicosis

242–3

736, 797

 

 

 

 

teratomas

692, 727

thyroxine (T4) levels 25,

pelvic pain

796

 

 

terminal care

769

242–4, 246, 256–7

post-menopausal bleeding

 

 

termination of pregnancy

thyroxine therapy

244–5,

(PMB) 795

 

 

 

(TOP)

 

 

 

 

246–7

 

 

preterm labour

 

 

consent

788

 

 

tibolone 610, 644

prediction

101

 

 

in children

783

tidal volume, in

 

subfertility

796

 

 

contraception

 

pregnancy

27

 

urogynaecology 798

 

 

following

624

tinnitus 759

 

 

transverse lie/

 

 

 

management

528–9

tissue heart valves 194–5

presentation

84, 88–9,

 

 

methods

527

 

tissue perfusion, blood loss

315

 

 

 

 

 

multiple pregnancy 78

effects 383

 

 

trapped ovary

 

 

 

overview

526

 

tobacco use, in

 

syndrome

566

 

 

testosterone levels 507,

pregnancy

32–3, 434,

trastuzumab

427

 

 

574, 640

 

 

 

445

 

 

travel, pregnancy

 

 

testosterone therapy

tocolysis 99, 400, 401

advice

183–4

 

 

hormone replacement

tolterodine 671

 

trichomonas

551557

 

 

therapy

644

tone, neonatal

 

 

tricuspid regurgitation 113

 

 

sexual dysfunction 610

assessment

342–3

tricyclic antidepressants 451

 

 

tetanus 183–4

 

toxoplasmosis

168–9

triiodothyronine (T3) 25,

 

 

tetracyclines

210–11, 221

tranexamic acid 204–5,

242–3, 244

 

 

 

thalassaemia

47, 202–3

516–17

 

 

trimethoprim

221

 

 

thalidomide

214–15

transcutaneous electrical

triple test

112–13, 115

 

 

theca lutein cysts 692

nerve stimulation

trisomy 13

110

 

 

 

thecoma 692

 

 

(TENS) 328

 

trisomy 18 110

 

 

 

thiamine 546–7

 

transdermal combined

trisomy 21, see Down’s

 

 

deficiency of

546

hormonal contraceptive

syndrome (trisomy 21)

 

 

threadworms

493

patch 625

 

 

trospium 671

 

 

 

three-swab test

776

transformation zone

tubal carcinoma

728

 

 

thrombocytopaenia

(TZ) 704

 

 

tubal occlusion

632–3, 634

 

 

causes in pregnancy 207

large loop excision of

tubal patency,

 

 

 

chemotherapy side

(LLETZ)

424, 704–5,

assessment 595

 

 

effect

758

 

708–9, 710, 716

tuberculosis (TB) 212–13

 

 

thromboembolism, obesity

transfusion

 

 

tumour markers

 

 

 

and 258

 

 

 

consent/refusal

783,

CA19.9 722

 

 

 

thrombolysis 396–7

786–7

 

 

CA125, see CA125

 

 

thrombophilia

 

 

graft rejection and 225

CEA 722

 

 

 

 

recurrent miscarriage 542

massive obstetric

Turner’s syndrome (45

 

 

venous thromboembolism

haemorrhage 383, 384

XO) 110

 

 

 

 

(VTE) and

390, 391,

parvovirus B19

160–1

twin reversed arterial

 

 

392–3

 

 

 

Rhesus disease

136–7

perfusion (TRAP) 78–9

 

 

thrombophlebitis 355

transobturator tape

twins

 

 

 

 

 

thrush (candidiasis) 551,

(TOT) 667

 

antenatal care

76–7

 

 

553–4

 

 

 

 

transplantation, renal

fetal distress of second

 

 

thyroid-binding globulin

224–5

 

 

twin

402

 

 

 

(TBG)

25

 

 

transvaginal scan (TVS)

labour 80–1

 

 

 

thyroid gland

 

 

BRCA mutation

 

multiple pregnancy

 

 

changes in pregnancy 25

surveillance

721

overview 72

 

 

thyroid function tests

dysfunctional uterine

problems in

 

 

 

(TFTs)

243, 640

bleeding (DUB) 513,

monochorionic,

 

 

see also specific disorders

514

 

 

diamniotic twins 78–9

 

 

thyroid nodules

246–7

early pregnancy

530, 531,

twin-to-twin transfusion

 

 

thyroid-stimulating hormone

532, 794

 

 

syndrome (TTTS) 78,

 

 

(TSH) 25, 242–5, 246–7,

ectopic pregnancy 534–5,

79, 133, 134, 140

 

 

256–7

 

 

 

 

536–7

 

 

types 74–5

 

 

 

 

thyroid stimulating

endometriosis 584–5

vanishing twin

 

 

 

hormone (TSH)

hirsutism 577

 

syndrome 77

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

822 INDEX

twins (Cont’d)

see also multiple pregnancy two-vessel umbilical

cord 128

U

ulceration, vulval 493 ulcerative colitis

(UC) 214–15 ulipristal 630 ultrasound scan (USS)

anomaly scan 116 cardiac defects 120–1 gastrointestinal

defects 127 lung defects 124–5 neural tube

defects 118–19 soft markers/

normal variant screening 128–9

urinary tract defects 122–3

chromosomal abnormalities screening 112, 113

congenital uterine abnormalities 798

dating scan 2–3, 38 Doppler, see Doppler

ultrasound early pregnancy

overview 794

ectopic pregnancy 534–5, 794

fetal growth

assessment 40–1, 148 fetal hydrops 132 fibroids 794–5 hydatidiform mole 751 intrauterine devices 798 lower urinary tract 659 miscarriage 528, 531,

532, 794 ovarian masses and

gynaecological malignancy 703, 722–3, 797

pelvic pain 796 post-menopausal bleeding

(PMB) 795 pre-eclampsia

management 68 pre-operative

assessment 789 risk of malignancy index

(RMI) 691 saline infusion

sonography 794–5 subfertility 796

termination of pregnancy 528

transvaginal scan (TVS), seetransvaginal scan (TVS)

urogynaecology 798 umbilical arteries/veins 20,

21

umbilical artery Doppler 150–2

umbilical cord 19 controlled cord traction

(CCT) 270–1, 320 cord clamping 268, 270–1,

347

cord prolapse 86, 277, 278, 401

two-vessel 128 UNICEF, Baby Friendly

Hospital Initiative (BFHI) 362–3

unstable lie 88–9 urethral caruncle 686 urethral injury,

practice-related 460–3 urethral pain 655 urethral prolapse 686 urethral syndrome 567 urethral valve,

posterior 122–3 ureterocele 122 ureters

anatomy 466 practice-related

injury 774–5

see also specific disorders urgency (urinary) 655

urge urinary incontinence 654

uric acid 29

urinary catheterization, postnatal urinary retention 358

urinary frequency 36, 655 urinary incontinence

classification of 636–8 definition 655

urinary retention, postnatal 358

urinary tract anatomy 466 assessment of

lower 656–62 fetal urine

production 138–9, 140 pelvic pain causation 565,

567

pregnancy physiology 29 pregnancy symptoms 54 urinary symptoms

in gynaecological history 460

see also urogynaecology; specific disorders/ procedures

urinary tract defects, fetal 122–3, 138–9

urinary tract infection (UTI) 91, 355, 358

urinary tract injuries, practice-related 772–4

urine testing

in labour 267 lower urinary tract

assessment 658 urodynamic stress

incontinence (USI) 662, 663

urodynamics 660–2, 668–9, 797

uroflowmetry 660, 661, 797 urogenital symptoms,

menopause 638, 646, 651

urography,IV 659, 798 urogynaecology

assessment of lower urinary tract 656–62

imaging 798 over-active bladder

syndrome 668–71 prolapse, see prolapse stress urinary incontinence

(SUI) 663–7 urinary incontinence

classification 654 urinary symptoms 655

ursodeoxycholic acid 216–17

uterine anomalies 472–3, 474, 542, 798

uterine artery anatomy 466

Doppler 64, 148, 151 embolization 387, 389,

689 ligation 387–8

uterine atony 322–3, 386–7, 388, 401

uterine bleeding, dysfunctional (DUB) 512–19

uterine contractions, see contractions (uterine)

uterine fibroids, see fibroids uterine inversion 322–3,

400

uterine involution 364 uterine/uterovaginal

prolapse 674, 675, 682, 683; see also prolapse

uterine rupture 93, 278, 307, 322–3

uterine sarcomas 740

 

 

 

 

 

 

 

INDEX

823

uterine size, normal

advanced cancer

768

postnatal

352, 355, 360

 

 

pregnancy

7

in childhood 488–9

pre-operative

 

 

 

 

uterine tamponade 387–8

endometrial cancer 736

assessment

789

 

 

uterine tubes, see fallopian

pregnancy-related 28, 54

prevention

392–3

 

 

 

(uterine) tubes

vaginal embryonal

 

treatment

396–7

 

 

 

uterine veins

20, 21

rhabdomyosarcoma 464

see also deep vein

 

 

 

utero-placental

vaginal examination (VE)

thrombosis (DVT);

 

 

circulation

20, 21

bimanual 462–3

 

pulmonary embolism

 

 

utero-placental

induction of labour 276

(PE)

 

 

 

 

 

 

insufficiency 144, 146

in labour 267

 

ventilation, neonatal

 

 

 

uterosacral ligaments 672,

prelabour rupture

resuscitation

344, 345,

 

 

673

 

of membranes at

346, 347

 

 

 

 

 

uterus

 

term 312–13

ventouse (vacuum

 

 

 

anatomy 464–6, 467,

PV bleeding and

56

extraction) 292–3,

 

 

672, 673

 

vaginal intraepithelial

294–8

 

 

 

 

 

 

benign neoplasms 688–9;

neoplasia (VAIN) 711

ventral sacroiliac

 

 

 

see also fibroids

vaginal melanoma

747

ligament

10–11

 

 

 

changes in

 

vaginal ring,

 

ventricular septal

 

 

 

puerperium 350

contraceptive

625

defect

121

 

 

 

 

late effects of cancer

vaginal septae 472–3, 474

vertex, fetal head

 

 

 

therapy

498

vaginal trainers/dilators 610

anatomy

14

 

 

 

 

measurement

vaginal vault prolapse 682

vertex presentation

17

 

 

anomalies 40

vaginismus 609

 

vesicoureteric reflux 29

 

 

pregnancy physiology 28

vaginoplasty 478

 

vestibulodynia 612, 698

 

 

vaginal examiination

valproate 187

 

video-urodynamics 660, 798

 

 

(bimanual) 463

valvotomy, fetal 134

villi, placental 18, 19

 

 

see also specific disorders/

vancomycin, endocarditis

viruses, breastfeeding

 

 

procedures

prophylaxis 195

and 370

 

 

 

 

 

vaccination/immunization

vanillylmandelic acid

vitamin K

 

 

 

 

 

 

anti-D

 

(VMA) 248

 

epilepsy management in

 

 

immunoglobulin 58,

vanishing twin syndrome 77

pregnancy

186, 188

 

 

137, 360, 530, 789

vardenafil 612

 

obstetric

 

 

 

 

 

 

hepatitis B virus (HBV) 46,

varicella infection

164–5,

cholestasis

216–17

 

 

170–1, 183–4, 360

212, 370

 

voiding difficulties,

 

 

 

human papillomavirus

varicose veins 53

 

urinary

655

 

 

 

 

(HPV) 558, 710–11, 742

vasa praevia 55

 

volatile substance

 

 

 

mumps, measles and

vascular endothelial growth

abuse 445

 

 

 

 

rubella (MMR) 156–7,

factor (VEGF)

760–1

volume replacement,

 

 

158–9

 

vascular pregnancy

neonatal

 

 

 

 

 

rubella 360

 

symptoms 52–3

resuscitation

346

 

 

 

 

vasomotor symptoms,

vomiting, see nausea and

 

 

V

 

menopause 637, 646,

vomiting

 

 

 

 

 

 

651

 

Von Willebrand’s

 

 

 

vacuum extraction

vestibule, anatomy 468–9

disease

205

 

 

 

 

(ventouse) 292–3,

virilization 250–1, 574–7

vulva

 

 

 

 

 

 

294–8

 

vitamin B12 deficiency 199

anatomy

467, 468–9

 

 

vagina

 

vitamin supplementation 32

benign neoplasms

686

 

 

anatomy 464–5, 466, 467,

venous congestion 566

idiopathic itch and

 

 

 

672, 673

 

venous thromboembolism

pain 698–9

 

 

 

 

benign neoplasms 686

(VTE)

 

Paget’s disease of

741

 

 

changes in pregnancy 28

combined oral

 

skin care

697

 

 

 

 

changes in

 

contraceptive pill

squamous cell

 

 

 

 

puerperium 350

(COCP) risk 623

carcinoma 694

 

 

 

see also specific disorders

diagnosis 394–5

 

see also specific disorders

 

 

vaginal bleeding, advanced

flying and pregnancy 184

vulval cancer

744–7, 761, 764

 

 

cancer 768

hormone replacement

vulval dermatitis

696

 

 

vaginal cancer

748–9

therapy (HRT)

vulval dermatoses 694–7,

 

 

vaginal cones

664, 678

risk 645

 

699; see also specific

 

 

vaginal delivery/birth, see

maternal mortality 352,

disorders

 

 

 

 

 

labour and delivery

390–1, 410–11

vulval intraepithelial

 

 

 

vaginal (PV) discharge 550

overview of pregnancy-

neoplasia (VIN)

711,

 

 

in adolescence 490

related 390–1

741–2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

824 INDEX

vulval melanoma 747 vulval psoriasis 696–7

vulval ulceration 493, 698–9 vulval vestibulitis 609 vulvodynia/vestibulodynia

698 vulvovaginitis 488–9

W

warfarin

artificial heart valves in pregnancy 194–5

venous thromboembolism (VTE) treatment 396–7

warts 493, 558 weight/body mass index

(BMI) 7, 33, 258–9, 406 Wernicke’s

encephalopathy 546

Wertheim’s hysterectomy 718–19

white cell count (total), in pregnancy 26

Wickham’s striae 696 Wolffian (mesonephric)

ducts 472, 473 Woods’ screw/reverse

screw 378

World Health Organization (WHO)

analgesic ladder 766–7 Baby-Friendly Hospital

Initiative (BFHI) 362–3 screening principles 700

work, during pregnancy 35 wound infection

abdominal 355 perineal 354

Wrigley’s forceps 294, 295

X

X-RAY 659, 722–3, 797, 798

Y

Yasmin® 622 yellow fever 183–4

yolk sac tumours 727

Z

Zanvanelli manouevre 378–9

zidovudine 177, 178, 180–1, 182

zinc supplementation 32

Plate 1 Lichen sclerosus (note the labial fusion and leukoplakia).

Plate 2 Colposcopy image 1: normal cervix.

Plate 3 Colposcopy image 2: ectropion in a nulliparous woman.

Plate 4 Colposcopy image 3: abnormal transformation zone (stained with acetic acid).

Plate 5 Colposcopy image 4: squamous cell carcinoma of the cervix.

Plate 6 Colposcopy image 5: endocervical polyp.

Plate 7 Colposcopy image 6: cervical wart.

Plate 8 Colposcopy image 7: Nabothian follicles (note the regularly branching tree-like vessels often seen over the cysts).

Common drugs: safety and usage in pregnancy and breast-feeding

Drug

Risk*

Conclude

Alternatives

Breast-feeding

Antibiotics

 

 

 

 

Metronidazole

Possible increased risk of preterm labour

Caution

Clindamycin

Safe

Penicillins

Nil known

Use if indicated

N/A

Safe

Erythromycin

Nil known

Use if indicated

N/A

Safe

Cephalosporins

Nil known

Use if indicated

N/A

Safe

Co-amoxiclav

Possible increased neonatal risk if preterm birth

Caution

Penicillins

Safe

Tetracyclines

Discolour teeth if 2nd trimester

Avoid

Erythromycin

Safe

Trimethoprim

Folic acid antagonsist

Avoid

Cephalosporins

Safe

Fundamentals: bacterial infection in pregnancy requires treatment

 

 

 

 

 

 

 

 

Analgesics

 

 

 

 

Non-steroidals

Closure of fetal ductus arteriosus, fetal oliguria,

Caution (avoid for analgesia)

Paracetamol

Safe

(normal dose)

possible cerebral haemorrhage

Monitor fetus with ultrasound

 

 

 

 

 

 

Aspirin (low dose)

Nil known

Use if high risk of pre-clampsia

N/A

Safe

Paracetamol

Nil known

Safe

N/A

Safe

Opiates

Maternal/fetal dependency

Only if severe pain or drug

Methadone if

Beware

 

 

dependency

opiate addict

accumulation

Fundamentals: best use paracetamol, plus codeine if more severe

 

 

 

 

 

 

 

 

Anticoagulants

 

 

 

 

Warfarin

Teratogenic

Only if artificial heart valves

LMWH

Safe

 

Fetal haemorrhage

(seek advice)

 

 

LMWH

Maternal bleeding in od

If indicated

N/A

Safe

 

Safe for fetus

 

 

 

Fundamentals: anticoagulation is probably underused in pregnancy, warfarin only used in exceptional circumstances

*Note background risk of congenital malformations 1–2%

Antihypertensives

 

 

 

 

ACE inhibitors

Fetal renal failure teratogenic (3% risk)

Avoid nifedipine

Methyldopa

Captopril safe

Methyldopa

Nil known

Best 1st line

N/A

Safe

B-Blockers

Possible IUGR if early

Caution, 3rd line

Methyldopa

Safe

Ca antagonists

Nil known

Best 2nd line (e.g. nifedipine)

N/A

Safe

Thiazide diuretics

Maternal hypovolaemia

Avoid

Methyldopa

Safe

 

Fetal thrombocytopenia

 

 

 

Fundamentals: severe hypertension in pregnancy is common and life threatening and requires treatment. Avoid ACE inhibitors prenatally

Endocrine/ hormone treatments

 

 

 

Thyroid hormone

Replacement therapy

Use if indicated

N/A

Safe

Propylthiouracil

Fetal hypothyroidism (rare)

Use, minimum dose

N/A

Monitor thyroid

Carbimazole

Fetal hypothyroidism (rare), aplasia cutis

Use, minimum dose

Propylthiouracil

Monitor thyroid

Insulin

Replacement therapy, maternal hypoglycaemia

Use with usual precautions

N/A

Safe

Metformin

probably safe, little data

Caution

Insulin

safe

Fundamentals: treatment of underlying disease greatly reduces maternal and fetal risks.

 

 

 

 

 

 

 

Immunosuppresants

 

 

 

 

Ciclosporin

Nil known

Continue, monitor levels

N/A

Probably safe

Azathioprine

Minimal

Continue if indicated

N/A

Safe

Prednisolone

No fetal effects

Use minimum dose

N/A

Safe

 

Maternal gestational diabetes, hypertension

 

 

 

Fundamentals: treatment of underlying disease (e.g. transplant) imperative and reduces maternal and, therefore, fetal risks.

Common drugs: safety and usage in pregnancy and breast-feeding (Cont.)

Drug

Risk*

Conclude

Alternatives

Breast-feeding

Psychiatric medications

 

Tricyclics

Largely safe

SSRIs

Paroxetine teratogenic (3% risk)

 

Others probably safe

Lithium

Teratogenic (cardiac) (10% risk)

Neuroleptics

Possible very mild teratogenicity

 

Largely unknown (avoid clozapine)

Use if high risk of relapse

Fluoxetine

Safe

Use if high risk of relapse

Fluoxetine

Safe

(avoid paroxetine, fluoxetine

 

 

best)

 

 

Use only if high risk of relapse

Difficult

Watch for toxicity

Usually continue because of

Difficult

Probably safe

risk of relapse

 

 

Fundamentals: psychiatric disease is a major problem during/ after pregnancy so treatment may need to continue

Antiepileptics

 

 

 

 

Sodium valproate

Impaired childhood cognition

Minimize combinations

Carbamazepine

Safe

 

Teratogenic (4–9% risk)

Consider change if <12 weeks

N/A

 

Carbamazepine

Teratogenic (1–3% risk)

Usually continue

N/A

Safe

Lamotrigine

Teratogenic (1–5% risk)

Usually continue

N/A

Safe

Fundamentals: best sorted pre conceptually. Seizure control imperative, but minimize combinations and doses. High dose folic acid

 

 

 

 

 

 

Other drugs

 

 

 

 

Steroids (lung

Nil known with single course

Use if high risk for preterm

N/A

N/A

maturation: β- and

 

delivery.

 

 

dexamethasone)

 

Betamethasone best

 

 

Beta-agonists

Nil known at anti-asthmatic doses

Use if indicated, e.g. asthma

N/A

Safe

Ursodeoxycholic acid

 

Use if indicated, e.g. cholestasis

N/A

Not indicated

 

 

 

 

 

*Note background risk of congenital malformations 1–2%

Normal maternal ranges in pregnancy

Full blood count

Hb

10.5–14.0g/dL

Levels higher if routine supplementation given

WBC

5–11.0g/dL

Levels unchanged in pregnancy, but rise in

 

 

labour

Platelets

100–450 × 109/L

Slight drop towards term

Note: high Hb associated with worse perinatal outcomes. Rapid drop in platelets suggestive of complications in PET

Thyroid function

Free T4

11–22pmol/L

Slightly lower in early pregnancy

Free T3

43–5pmol/L

Slightly lower in early pregnancy

TSH

0–4µ/L

Aim for 1.5–2.0 if replacement therapy

 

Note: undertreated and subclinical hypothyroidism associated with cognitive

deficit in childhood

 

 

 

 

Renal function

 

 

 

 

 

Urea

2.8–3.8mmol/L

Lowered in pregnancy

Creatinine

50–80µmol/L

Lowered in pregnancy

Uric acid

0.14–0.2/0.35

×10 should be <gestation in weeks after 20wks

 

µmol/L

 

Na+

135–145mmol/L

Unchanged in pregnancy

K+

3.5–4.5mmol/L

Usually slightly low in pregnancy

Protein excr. <0.3g/24h

Slightly raised

 

Note: increased renal excretion in pregnancy. High creatinine/uric acid

common with PET

 

 

 

 

Liver function

 

 

ALP

<500IU/L

Raised in pregnancy

ALT

<30IU/L

Slightly reduced in pregnancy

AST

<35IU/L

Slightly reduced in pregnancy

Albumin

28–37g/L

Slightly reduced in pregnancy

 

Note: rapid rise in liver enzymes common with complications of PET

 

 

 

Other

 

 

 

 

 

ESR

>30

Elevated; no clinical use in pregnancy

CRP

<8

Unchanged by pregnancy

Glucose

<6.0 fasting

Slight fall in pregnancy

 

<8.0 after food

 

Note: tight glucose control improves outcomes with maternal diabetes

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