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Access to the eBook is limited to the first individual who redeems the PIN, located on the inside cover of this book, at studentconsult.inkling.com and may not be transferred to another party by resale, lending, or other means. 2015v1.0 Llewellyn-Jones Fun d a m e n t a ls of Ob s t e t ric s and Gyn a e c o lo g y This page intentionally left blank 1 0 th EDITION Lle we llyn-Jone s Fu n d a m e n t a ls o f Ob s t e t ric s a nd Gy n a e c o lo g y Je re m y Oa t s MBBS DM FRCOG FRANZCOG Chair Victorian, Consultative Council on Obstetric and Paediatric Mortality and Morbidity, Australia; Consultant Obstetrician and Gynaecologist, Royal Women’s Hospital, Melbourne, Australia; Professorial Fellow, Melbourne School of Population and Global Health, University of Melbourne, Australia Su za n n e Ab ra h a m MSc PhD (Med) MAPS Associate Professor in Perinatal and Women’s Health, Faculty of Medicine, University of Sydney, Sydney, Australia Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto © 2017, Elsevier Limited. All rights reserved. Sixth edition © Mosby Professional Ltd 1994 Seventh edition © Elsevier Limited 1999 Eighth edition © Elsevier Limited 2005 Ninth edition © Elsevier Limited 2010 The right of Jeremy Oats and Suzanne Abrahams to be identi ed as author of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the Publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this eld are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identi ed, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. ISBN: 978-0-7020-6065-6 International Edition ISBN: 978-0-7020-6064-9 Ebook ISBN: 978-0-7020-6066-3 Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Content Strategist: Pauline Graham Content Development Specialist: Fiona Conn Project Manager: Anne Collett Design: Christian Bilbow Illustration Manager: Nichole Beard Illustrator: Richard Tibbitts Marketing Manager: Deborah Watkins The publisher’s policy is to use paper manufactured from sustainable forests Co n ten ts Preface ..................................................................vi 21. Abnormal fetal presentations .................172 Acknowledgements ............................................vii 22. Abnormal labour (dystocia) ..................185  1. Gynaecological and obstetric 23. Disorders in the puerperium ..................198 history and examination ..............................1 24. Obstetric operations .................................203  2. Ovulation and the menstrual cycle ..........10 25. The epidemiology of obstetrics ..............215  3. Conception and placental 26. The newborn infant ..................................221 development ................................................19 27. The low-birthweight infant ......................231  4. Embryo and fetus .......................................30 28. Disorders of menstruation ......................235  5. Physiological and anatomical 29. Psychological and physical changes in pregnancy .................................34 disorders of the menstrual cycle .............245  6. Antenatal care ............................................40 30. Human sexuality .......................................251  7. Physiological and anatomical 31. Conception control ...................................257 changes in childbirth ..................................57 32. Infertility ....................................................267  8. Course and management of 33. Infections of the genital tract..................272 childbirth ......................................................70 34. Atrophic and dystrophic conditions ......282  9. The puerperium ..........................................90 35. Endometriosis and adenomyosis ............286 10. Minor complications of pregnancy .........100 36. Benign tumours, cysts and 11. Miscarriage and abortion ........................105 malformations of the genital tract..........294 12. Extra-uterine pregnancy/ectopic 37. Premalignant and malignant gestation .....................................................113 conditions of the female 13. Antepartum haemorrhage .......................119 genital tract ................................................305 14. Hypertensive diseases in pregnancy ......124 38. Uterovaginal displacements, 15. Cardiovascular, respiratory, damage and prolapse ...............................318 haematological, neurological and 39. The urinary tract and its gastrointestinal disorders in relationship to gynaecology ....................325 pregnancy ...................................................131 40. The breast ..................................................332 16. Endocrine disorders in pregnancy .........141 41. Gynaecological problems in 17. Infections during pregnancy....................146 childhood and adolescence .....................336 18. Diseases of the placenta and 42. The menopause .........................................341 membranes ................................................152 43. Anatomy of the female 19. Variations in the duration of genital tract ................................................348 pregnancy ...................................................158 20. The at-risk fetus ........................................163 Index...........................................................365 v Pre ace When Derek Llewellyn-Jones prepared the f rst edition o Fundamentals of Obstetrics and Gynaecology, the pro essions’ perception o the priorities o women’s health was somewhat di erent to those 50 years on. Maternity and gynaecological care was primarily medical in ocus, and management was based on the teachings, personal experience and belie s o senior clinicians. Modern women’s health care is now ounded on collaboration between the multiple members o the team – midwi e, nurse, obstetrician, gynaecologist, dietitian, physiotherapist, paediatrician, specialist physician, ultrasonologist, oncologist, social worker – and the woman at the centre. Decisions about management are, or should be, based on the best available quality evidence com- municated to the woman and her amily in comprehensible language with total acceptance that the f nal decision on what treatment is decided on is the woman’s. It is appropriate to recall that Derek Llewellyn-Jones was a pioneer in writing accessible in ormation or women o all ages, explaining how their bodies unctioned and the causes o many o the common conditions they might experi- ence. The internet has now become the primary source o in ormation or many women, and the challenge or the practitioner is to assist women in sorting through and being able to assess this vast array o literature. This tenth edition continues the legacy and philosophy o Derek Llewellyn-Jones, with the objec- tive o providing the student o women’s health with the undamentals o this vital area, based on the best available and proven in ormation that will enable them to practise high quality, empathetic health care. Jeremy Oats Suzanne Abraham vi Ackn owled gem en ts We particularly wish to thank Dr Ricardo Palma-Dias for reviewing and updating, where required, the ultrasound images. We remain indebted to Dr Neil Roy for his advice on the neonatal content, Dr Suzanne Garland for the infectious diseases sections and Dr Helen Savoia for the haematological components. In addition we acknowledge the assistance of the late Dr Aldo Vacca for his guidance on the vacuum extractor and OmniCup photograph, Dr John Bell, John Gocking, Dr Jenny King, Gwen Moody, Dr Diane Payton, Susan Hart and the Down Syndrome Association for their generous provi- sion of pathology and clinical photographs and Dr Amanda Sampson for ultrasound images. Our gratitude also to our colleagues and especially Dr Robert Lahoud, Professor Rod Baber and Professor Amanda McBride for their advice and assistance in updating various sections of this edition. To the team at Elsevier – Fiona Conn, Anne Collett, Pauline Graham – our appreciation for their persistence, patience and professionalism and to Susan and Glyn for their ongoing support. vii This page intentionally left blank