OXFORD MEDICAL PUBLICATIONS

OXFORD MEDICAL PUBLICATIONSOxford Handbook ofObstetrics andGynaecology

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Oxford Handbook ofObstetrics andGynaecologyThird EditionEdited bySally CollinsSpecialist Registrar in Obstetrics and Gynaecology,The John Radcliffe Hospital,Oxford, UKSabaratnam ArulkumaranProfessor of Obstetrics and Gynaecology,St George’s Hospital Medical School,University of London, UKKevin HayesSenior Lecturer/Honorary Consultant in Obstetricsand Gynaecology, and Medical Education,St George’s Hospital Medical School,University of London, UKSimon JacksonConsultant Gynaecologist,The John Radcliffe Hospital,Oxford, UKLawrence ImpeyConsultant in Obstetrics and Fetal Medicine,The John Radcliffe Hospital,Oxford, UK1

3Great Clarendon Street, Oxford, OX2 6DP,United KingdomOxford University Press is a department of the University of Oxford.It furthers the University’s objective of excellence in research, scholarship,and education by publishing worldwide. Oxford is a registered trade mark ofOxford University Press in the UK and in certain other countries Oxford University Press, 2013The moral rights of the authors have been assertedFirst edition published 2005Second edition published 2008Third edition published 2013All rights reserved. No part of this publication may be reproduced,stored in a retrieval system, or transmitted, in any form or by any means,without the prior permission in writing of Oxford University Press,or as expressly permitted by law, or under terms agreed with the appropriatereprographics rights organization. Enquiries concerning reproductionoutside the scope of the above should be sent to the Rights Department,Oxford University Press, at the address aboveYou must not circulate this book in any other binding or cover and you mustimpose the same condition on any acquirerBritish Library Cataloguing in Publication DataData availableISBN 978–0–19–969840–0Printed in China byC&C Offset Printing Co. Ltd.Oxford University Press makes no representation, express or implied, that thedrug dosages in this book are correct. Readers must therefore always check theproduct information and clinical procedures with the most up-to-date publishedproduct information and data sheets provided by the manufacturers and the mostrecent codes of conduct and safety regulations. The authors and the publishers donot accept responsibility or legal liability for any errors in the text or for the misuseor misapplication of material in this work. Except where otherwise stated, drugdosages and recommendations are for the non-pregnant adult who is notbreast-feeding.

vContentsPreface viAcknowledgements viiAbbreviations ixContributors xxiii123456789101112131415161718192021222324Normal pregnancyPregnancy complicationsFetal medicineInfectious diseases in pregnancyMedical disorders in pregnancyLabour and deliveryObstetric anaesthesiaNeonatal resuscitationPostnatal careObstetric emergenciesPerinatal and maternal mortalityBenign and malignant tumours in pregnancySubstance abuse and psychiatric disordersGynaecological anatomy and developmentNormal menstruation and its disordersEarly pregnancy problemsGenital tract infections and pelvic painSubfertility and reproductive medicineSexual assaultContraceptionMenopauseUrogynaecologyBenign and malignant gynaecological conditionsMiscellaneous gynaecologyIndex 9569613621635653685771

viPrefaceWelcome to the third edition of this Oxford Handbook. In obstetrics andgynaecology, as in all fields of medicine, the available evidence, technologyand guidelines can move forward at a rapid pace and often prove difficultto keep up with. As the majority of junior doctors are well aware, thegaps in our knowledge often become apparent at the most inopportunemoments; this book seeks to fill those gaps rapidly and effectively. It usesthe well-known Oxford Handbook format to facilitate easy navigationaround concise, clinically relevant, evidence-based information. It can bequickly dipped into for specific answers between seeing patients in clinic oron delivery suite, as well as providing a solid, general grounding for thosejust beginning in the specialty. It also has sufficient depth and detail to provide a good starting point in the preparation for postgraduate exams. Toensure the most up-to-date information is always available, emphasis hasbeen placed on providing relevant web addresses, especially for guidelinesand useful organizations. Text boxes have also been employed to helphighlight some of the more important pieces of information.Although this handbook is most likely to be used by trainees within thespecialty, we envisage it will be useful for all those involved in women’shealth, including GPs, midwives, and medical students. We hope you find ita helpful resource and that it proves to be a valuable companion and guidein your everyday practice of obstetrics and gynaecology.

viiAcknowledgementsWe would like to thank all our second edition authors, especially thetrainees at the John Radcliffe and St George’s hospitals. Additionally, weare very grateful to those who have gone the extra mile to ensure thatour third edition chapters are up to date, especially Charlotte Bennett,Lucy MacKillop, and Jo Morrison who reviewed the highly specializedareas of neonatology, maternal medicine, and oncology to ensure thatthey contained the best available evidence. We would also like to thankthe doctors of all grades who anonymously reviewed some of the text,providing valuable feedback and further fine-tuning the finished manuscript. To conform to the Oxford Handbook style and to avoid overlapand repetition, some contributions have been considerably edited and wethank all our authors for their understanding. We are most grateful toProf. Basky Thilaganathan for providing many of the ultrasound imagesand Ms Penny Trotter for the colposcopy pictures. Last, but definitelynot least, we would like to thank our partners and families who continueto remain so patient and supportive throughout this project, especiallyBerni O’Connor ‘for doing all the real work on the home front’ and DavidReynard ‘for putting up with all this’.Sally Collins, Sabaratnam Arulkumaran,Kevin Hayes, Simon Jackson, and Lawrence ImpeyLondon and Oxford, October 2012

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ixAbbreviationspprimaryssecondary vepositive–venegativeA&EAccident and EmergencyAAAlcoholics AnonymousAATaspartate aminotransferaseABCairway, breathing, and circulationABGarterial blood gasesACabdominal circumferenceACEangiotensin converting enzymeACEIangiotensin-converting enzyme c hormoneADHantidiuretic hormoneAEDFabsent end diastolic flowAFatrial fibrillationAFEamniotic fluid embolismAFIamniotic fluid indexAFLPacute fatty liver of pregnancyAFPalpha-fetoproteinAINperi-anal intraepithelial neoplasiaAISandrogen insensitivity syndromeAJCCAmerican Joint Committee on CancerALPalkaline phosphataseALTalanine transaminaseAMHantimüllerian hormoneANantenatalANAantinuclear antibodyAPHantepartum haemorrhage

xABBREVIATIONSAPRAntiretroviral Pregnancy RegistryAPSantiphospholipid syndromeAPTTactivated partial thromboplastin timeARDSadult respiratory distress syndromeAREDFabsent/reversed end diastolic flowARMartificial rupture of membranesARTassisted reproductive technologiesASDatrial septal defectASISanterior superior iliac spinesASTaspartate amniotransferaseAVMarteriovenous malformationAWEaceto-white epitheliumAXRabdominal X-rayBCEBacillus Calmette–Guerinbdtwice dailyBEPbleomycin, etoposide, and cisplatinBFHIBaby-Friendly Hospital InitiativeBMblood sugar monitoringBMDbone mineral densityBMIbody mass indexBOTSBorderline Ovarian Tumour StudyBPblood pressureBPDbiparietal diameterBRCAbreast cancer geneBSObilateral salpingo-oophrectomyBVbacterial vaginosisCA125cancer antigen 125CAHcongenital adrenal hyperplasiaCAIScomplete androgen insensitivity syndromecARTcombination antiretroviral therapyCBAVDcongenital bilateral absence of the vas deferensCBTcognitive-behavioural therapyCCAMcongenital cystic adenomatoid malformationCCTcontrolled cord traction

ABBREVIATIONSCEAcarcinoembryonic antigenCEMACH Confidential Enquiry into Maternal and Child HealthCEMDConfidential Enquiry into Maternal DeathsCESDIConfidential Enquiry into Stillbirths and Deaths in InfancyCFcystic fibrosisCFTRcystic fibrosis transmembrane conductance regulationcGINcervical glandular intraepithelial neoplasiaCHDcongenital heart diseaseCINcervical intraepithelial neoplasiaCLcorpus luteumCMACECentre for Maternal and Child EnquiriesCMVcytomegalovirusCNScentral nervous sytemCNSTClinical Negligence Scheme for TrustsCOCPcombined oral contraceptive pillCPcerebral palsyCPPchronic pelvic painCPRcardiopulmonary resuscitationCrHDcoronary heart diseaseCRLcrown–rump lengthCRPC-reactive proteinCSCaesarean sectionCSEcombined spinal epiduralCSFcerebrospinal fluidCTcomputed tomographyCTGcardiotocographyCVcyclophosphamide and vincristineCVAcerebrovascular accidentCVDcardiovascular diseaseCVPcentral venous pressureCVSchorionic villus samplingCXRchest X-rayDCDAdichorionic, diamnioticDESdiethylstilbestrolxi