Clinical Obstetrics & Gynaecology THIRD EDITION Brian A. Magowan, MB, CHB, FRCOG, DIPFETMED Consultant Obstetrician and Gynaecologist, The Borders General Hospital, Melrose UK Philip Owen, MB, BCH, MD FRCOG Consultant Obstetrician and Gynaecologist, Princess Royal Maternity Unit, Glasgow UK Andrew Thomson, MB CHB, MRCOG, MD Consultant Obstetrician and Gynaecologist, Royal Alexandra Hospital, Paisley UK Table of Contents Cover image Title page Copyright page Dedication Foreword Preface Contributors SECTION 1: Fundamentals 1. Clinical pelvic anatomy Introduction Obstetric anatomy The pelvic organs during pregnancy Anatomical points for obstetric analgesia Gynaecological anatomy Anatomy of the lower urinary tract 2. Human embryogenesis Introduction Nomenclature Fertilization to implantation (0–6 GD) Implantation and formation of the germ layers (7–18 GD) Organogenesis (19–56 + GD) 3. History and examination Introduction Gynaecological history Gynaecological examination Obstetrical history Obstetrical examination 4. Imaging in obstetrics and gynaecology Introduction Obstetrics Gynaecology SECTION 2: Gynaecology 5. Paediatric gynaecology Introduction Normal puberty Delayed puberty Precocious puberty Abnormal genital tract development Sexual abuse Paediatric vaginal discharge 6. Disorders of sex development (DSD) Introduction Definitions Some fundamental principles Normal sex differentiation Genital differentiation Incidence of DSD Classification of DSD Summary Management and prospects 7. The normal menstrual cycle Introduction Endocrine control of the menstrual cycle The ovarian cycle The uterine cycle Other cyclical changes 8. Amenorrhoea Introduction Primary amenorrhoea Secondary amenorrhoea Summary of clinical management 9. Infertility Introduction Definitions Age and fertility Causes of infertility Diagnosis History and examination Investigations and their interpretation Treatment Assisted conception The UK Human Fertilisation and Embryology Act 10. Early pregnancy care Miscarriage Sepsis Recurrent miscarriage Conclusion 11. Heavy menstrual bleeding and dysmenorrhoea Heavy menstrual bleeding Dysmenorrhoea 12. Pelvic pain Introduction History Examination Acute pelvic pain Chronic pelvic pain (CPP) 13. Endometriosis Introduction Incidence Aetiology Clinical presentation Examination Endometriosis and infertility Investigation Management Fertility treatment Complications, prognosis and long-term sequelae 14. Premenstrual syndrome Introduction Aetiology Clinical presentation Differential diagnosis Management 15. The menopause Introduction Physiology Signs and symptoms (Table 15.1) Long-term effects Osteoporosis Diagnosis Hormonal therapy Non-hormonal treatment 16. Genital prolapse Introduction Aetiology Classification Symptoms Signs Management 17. Urinary incontinence Introduction Types of urinary incontinence The mechanism of continence Aetiology Clinical presentation Diagnostic evaluation Treatment 18. Ovarian neoplasms Introduction Natural history Aetiology Pathology Spread Presentation Investigation and staging Tumour markers Treatment Survival 19. Uterine neoplasia Introduction Incidence Aetiology Clinical features and diagnosis Pathology Prognostic factors Treatment Recurrence Summary 20. Cervical neoplasia Introduction Cervical intraepithelial and cervical cancer screening Cervical cancer