Oxford Handbook of Obstetrics and Gynaecology (Oxford Medical Handbooks)
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Fully revised for a third edition, the best-selling Oxford Handbook of Obstetrics and Gynaecology is now better than ever. It includes new algorithms for patient management, new images and full colour photographs, and new and expanded topics including female genital mutilation, consent for operations, and pre-operative assessment.
Written and reviewed by a team of highly experienced clinicians and academics, and UK trainees, this handbook is a perfect starting point for preparation for postgraduate exams. Practical advice is presented with key evidence-based guidelines, supported by web references, providing the most up-to-date clinical information as well as the perfect starting point for preparation for postgraduate exams.
The indispensable, concise and practical guide to all aspects of obstetric and gynaecological medical care, diagnosis, and management, this is the must have resource for all specialist trainees, junior doctors and medical students, as well as a valuable aide memoir for experienced clinicians.
(at a dating or nuchal translucency scan). As most women in the UK now have USS at some stage in their pregnancy, diagnosis is rarely missed. Chorionicity Determining chorionicity allows risk stratiﬁcation for multiple pregnancy and is best done by ultrasound in the 1st trimester or early in the 2nd. The key indicators are: • Obviously widely separated sacs or placentae—DC. • Membrane insertion showing the lambda (λ) sign—DC. • Absence of λ sign <14wks diagnostic of MC. • Fetuses of different
cardiotocography, p. 153.) Counselling Most units in the UK advise induction of labour by 42wks because of the increased perinatal mortality and morbidity beyond this time. However, many women regard elective induction of labour as interference with the natural phenomenon of childbirth. It is therefore important to discuss the issue sensitively and respect the woman’s decision. Written information should be provided clearly outlining the arguments for and against induction to ensure the woman is
Diaphragmatic hernia. • Pleural effusions. Twin-to-twin transfusion syndrome Recipient from volume overload and donor from anaemia (see b Twin-to-twin transfusion syndrome, p. 78). Placental Chorioangioma. 133 134 CHAPTER 3 Fetal medicine Non-immune hydrops: treatment The prognosis depends on the underlying cause. Where treatment is not possible, the option of TOP should be discussed. In the 3rd trimester, delivery may be a better alternative than in utero treatment. If severe
4 Infectious diseases in pregnancy Measles Indigenous measles was rare in the UK after the introduction of the MMR vaccine in 1988. Unfortunately, measles has seen an increase recently due to decreased uptake of routine vaccination. 2007 saw 971 cases in England and Wales, the biggest rise in reported measles cases since records began in 1995. Epidemiology • • • • RNA paramyxovirus. Spread by respiratory droplets—person to person (highly infectious). Incubation 9–12 days. Infectious for 2–5
pelvic cavity. • Anthropoid: a long, narrow and oval-shaped pelvis due to the assimilation of the sacral body to the ﬁfth lumbar vertebra. • Android: the inlet is heart-shaped and the cavity is funnel-shaped with a contracted outlet. • Platypolloid: a wide pelvis ﬂattened at the brim with the sacral promontory pushed forward. Android 20 Anthropoid 25 Gynaecoid % women 50 Platypolloid Name 5 Pelvic shape Pelvic inlet Pelvic outlet Pelvic arch Fig. 1.4 Basic shapes of the female