E-Book Description
Practical Obstetrics PDF
the 21st edition of this standard reference book appears in a new, clearer layout. All chapters are updated and extended, and all diagrams are now in full color. The emphasis is continually on the transfer of practical knowledge on labor, pregnancy, and the maternity ward. Well-founded knowledge and new information are combined to present a unified system. All of those involved in the care of pregnant, laboring, and post natal women and newborns can benefit from the tried and true didactics of this volume.
E-Book Details
Table of Contents
Preface | VII
1 Physiology | 1
1.1 The mature placenta | 5
1.1.1 Structure, function | 5
1.1.2 The placenta as an endocrine organ: hCG, hPL, progesterone, and estrogen | 7
1.2 Amniotic fluid, liquor amnii | 10
1.3 Embryonic and fetal development | 11
1.4 The maternal organism | 13
2 Diagnosis of pregnancy | 17
2.1 Early pregnancy | 17
2.2 Diagnosis of late pregnancy | 18
3 Prenatal care | 19
3.1 Prenatal checkup | 19
3.1.1 History | 19
3.1.2 Obstetric examination | 22
3.1.3 General examination | 32
3.1.4 Examination of the woman at risk | 35
3.1.5 Prenatal diagnosis of genetic defects | 61
3.2 Antenatal counseling | 65
3.2.1 Lifestyle | 68
3.2.2 Common pregnancy complaints | 69
4 Maternal disorders in pregnancy | 73
4.1 Pregnancy-specific disorders | 73
4.1.1 Hyperemesis gravidarum | 73
4.1.2 Cholestasis | 73
4.1.3 Pregnancy-induced hypertension (PIH), preeclampsia, eclampsia, HELLP
syndrome | 74
4.1.4 Dermatoses of pregnancy | 84
4.2 Disorders not specific to pregnancy | 84
4.2.1 Cardiac disease | 84
4.2.2 Pulmonary tuberculosis | 86
4.2.3 Pyelonephritis in pregnancy | 86
4.2.4 Diabetes mellitus | 87
4.2.5 Thrombophilia | 91
4.2.6 Thyroid disorders | 92
4.2.7 Acute abdomen | 93
4.2.8 Adnexal tumors | 95
4.2.9 Cervical cytology | 96
5 Problems in the second half of pregnancy | 99
5.1 Preterm birth (PTB) | 99
5.2 Premature rupture of membranes; chorioamnionitis | 105
5.3 Intrauterine growth restriction (IUGR) | 107
5.4 Postterm pregnancy | 108
5.5 Stillbirth | 109
6 Disorders of the fetus | 113
6.1 Hemolytic disease | 113
6.2 Fetal alloimmune thrombocytopenia | 118
6.3 Prenatal infections | 118
6.3.1 Prenatal rubella infection, congenital rubella syndrome | 119
6.3.2 Cytomegalovirus (CMV) | 121
6.3.3 Varicella-zoster-virus (VZV) | 122
6.3.4 Herpes simplex virus (HSV) | 123
6.3.5 Virus hepatitis | 125
6.3.6 Parvovirus B19 | 126
6.3.7 AIDS, HIV seropositivity | 127
6.3.8 Pregnancy and neonatal listeriosis | 129
6.3.9 Toxoplasmosis | 129
6.3.10 Syphilis | 132
6.3.11 Gonorrhea | 134
6.3.12 Vaccination in pregnancy | 136
6.4 Malformations | 136
6.4.1 Hydrocephalus | 136
7 Normal labor | 141
7.1 Birth factors | 141
7.1.1 Fetus | 141
7.1.2 Birth route | 143
7.1.3 Force of labor, contractions | 147
7.2 Mechanism of labor | 150
7.2.1 Signs, onset of labor, preparation for labor | 151
7.2.2 History taking, examination, spontaneous vaginal delivery | 152
7.2.3 Passage of the head through the birth canal | 155
7.2.4 Station. Level of the head in the pelvis | 162
7.3 Examination of the fetus during labor | 167
7.3.1 Auscultation, amniotic fluid color | 167
7.3.2 Cardiotocography (CTG), electronic fetal monitoring (EFM) | 168
7.3.3 Fetal blood sampling (FBS) | 177
7.4 Management of labor | 180
7.4.1 Management of first stage | 180
7.4.2 Management of second stage | 189
7.5 Management of third stage | 199
7.6 Postplacental period | 204
7.7 Duration of labor | 208
8 Pathological labor | 211
8.1 Malpresentations and malpositions of the occiput | 211
8.1.1 Persistent occipitotransverse position (POT) | 211
8.1.2 High anteroposterior head | 214
8.1.3 Occipitoposterior position | 215
8.1.4 Extended presentations | 220
8.2 Breech presentation | 233
8.2.1 Classification, diagnosis, differential diagnosis | 234
8.2.2 Mechanism of labor | 236
8.2.3 Antenatal counseling | 244
8.2.4 Mode and management of delivery | 245
8.3 Transverse lie/shoulder presentation | 264
8.3.1 Course of labor in transverse lie | 266
8.3.2 Management of transverse lie | 268
8.4 Multifetal gestations | 270
8.4.1 Antenatal care | 272
8.4.2 Birth complications, mode | 275
8.5 Pathological contractions, uterine dystocia | 278
8.6 Arrested labor | 280
8.7 Cervical priming and induction of labor | 282
8.8 Intrauterine (perinatal) hypoxia | 284
8.9 Cord complications: presentation, prolapse | 288
8.9.1 Cord presentation | 288
8.9.2 Cord prolapse | 288
8.10 Arm complications: Compound presentation, arm presentation, prolapse | 290
8.11 Shoulder dystocia | 292
8.12 Cephalopelvic disproportion (CPD) | 294
8.12.1 Generally contracted pelvis | 296
8.12.2 Funnel-shaped pelvis | 302
8.12.3 Long pelvis | 303
8.13 Uterine rupture | 306
8.14 Management of birth after prior cesarean section | 311
8.15 Amniotic fluid embolism (AFE) | 312
9 Obstetrical operations | 315
9.1 Indication | 315
9.2 Preparation for the operation | 316
9.3 Episiotomy, perineotomy | 316
9.4 Laceration of the vagina, perineum, clitoris, labia | 320
9.5 Forceps operation | 322
9.6 Vacuum extraction, ventouse extraction (VE) | 332
9.7 Cesarean section | 335
9.8 Combined version | 340
9.8.1 Version from transverse lie | 340
9.8.2 Version from cephalic presentation | 343
9.9 Dismembering operations: perforation, cranioclasm | 343
10 Antepartum and postpartum hemorrhage | 351
10.1 Miscarriage, spontaneous abortion | 351
10.1.1 Induced abortion | 351
10.1.2 Spontaneous abortion | 352
10.2 Gestational trophoblastic disease (GTD) | 360
10.3 Ectopic pregnancy | 363
10.4 Placenta previa | 369
10.5 Placental abruption | 374
10.6 Velamentous insertion | 379
10.7 Postpartum hemorrhage (PPH) | 380
10.7.1 Separation hemorrhage, atonic PPH | 380
10.7.2 Hemorrhage from a laceration | 388
11 Normal puerperium | 391
11.1 Process of involution | 391
11.1.1 Position and attitude of the uterus in the puerperium | 392
11.1.2 Closure of the cervix | 392
11.1.3 Fundal height in the first days postpartum | 393
11.2 Wound-healing processes in the puerperium | 393
11.2.1 Lochia | 394
11.3 Lactation | 395
11.4 Resumption of ovarian function | 396
11.5 Clinical picture of the puerperal period | 397
11.5.1 The postpartum pulse | 397
11.5.2 Temperature postpartum | 398
11.5.3 Monitoring fundal height | 398
11.5.4 Monitoring lochia | 398
11.5.5 Micturition in early puerperium | 399
11.5.6 Bowel movements | 400
11.5.7 Postpartum exercises | 400
11.5.8 Ambulation postpartum – early ambulation | 400
11.5.9 Discharge from hospital and the end of the clinical puerperium | 400
11.5.10 Breastfeeding | 401
12 Pathological puerperium | 405
12.1 Puerperal fever = childbed fever | 405
12.1.1 Localized puerperal infections | 406
12.1.2 Disseminated puerperal infection | 407
12.2 Hemorrhage in the puerperal period | 412
12.2.1 Retained placental tissue and placental polyp | 412
12.2.2 Puerperal endometritis | 413
12.2.3 Functional hemorrhage in the puerperium | 414
12.2.4 Bleeding from birth traumas in the puerperium | 414
12.3 Injury to the symphysis pubis | 414
12.4 Mastitis puerperalis | 416
12.5 Pelvic vein thrombosis | 420
12.6 Postpartum thyroiditis | 422
12.7 Psychiatric disorders | 422
M. Obladen
13 The newborn | 425
13.1 The healthy newborn | 425
13.1.1 The baby and its parents | 425
13.1.2 Initial care | 425
13.1.3 Examination | 426
13.1.4 Screening program | 428
13.1.5 Other preventative measures | 429
13.2 Diet and care | 429
13.2.1 Lactation, breastfeeding, medication in breast milk | 429
13.2.2 Dietary plan for artificial feeding | 431
13.2.3 Dietary disorders | 432
13.2.4 Care of the healthy newborn | 432
13.3 Postnatal adaptation | 433
13.3.1 Physiological adaptation | 433
13.3.2 Pathological adaptation | 438
13.4 Birth trauma | 443
13.5 The preterm baby | 446
13.5.1 Gestational age | 446
13.5.2 Complications | 446
13.5.3 Diseases of preterm babies | 447
13.6 Hypotrophic newborn | 451
13.7 The infant of the diabetic mother (IDM) | 452
13.7.1 Glucose metabolism and hypoglycemia | 452
13.7.2 Fetopathia diabetica and complications | 453
13.8 Common newborn diseases | 454
13.8.1 Respiratory disorders | 454
13.8.2 Anemia, polycythemia, hyperviscosity | 455
13.8.3 Hyperbilirubinemia, icterus, phototherapy | 456
13.8.4 Hemolytic disease (HD) | 457
13.8.5 Drug addiction, drug withdrawal | 459
13.8.6 Neonatal seizures | 459
13.9 Common congenital abnormalities | 459
13.9.1 Gastrointestinal tract | 460
13.9.2 Congenital cardiac malformations | 463
13.9.3 Skeletal malformations | 463
13.9.4 Down syndrome | 466
13.9.5 Alcohol embryopathy, -fetopathy (fetal alcohol syndrome; FAS) | 467
13.10 Neonatal infections | 468
13.10.1 Immune status of the neonate | 468
13.10.2 Sepsis and GBS infection | 468
13.10.3 Other vertical infections | 469
13.11 Level of Care and Regionalization | 470
13.11.1 Prenatal transfer to a perinatal center | 470
13.11.2 Neonatal consultation | 470
13.11.3 Indications for transfer to neonatal intensive care unit (NICU) | 471
13.11.4 Transfer to NICU not indicated | 471
13.11.5 Postnatal transport | 471
Index | 475
1 Physiology | 1
1.1 The mature placenta | 5
1.1.1 Structure, function | 5
1.1.2 The placenta as an endocrine organ: hCG, hPL, progesterone, and estrogen | 7
1.2 Amniotic fluid, liquor amnii | 10
1.3 Embryonic and fetal development | 11
1.4 The maternal organism | 13
2 Diagnosis of pregnancy | 17
2.1 Early pregnancy | 17
2.2 Diagnosis of late pregnancy | 18
3 Prenatal care | 19
3.1 Prenatal checkup | 19
3.1.1 History | 19
3.1.2 Obstetric examination | 22
3.1.3 General examination | 32
3.1.4 Examination of the woman at risk | 35
3.1.5 Prenatal diagnosis of genetic defects | 61
3.2 Antenatal counseling | 65
3.2.1 Lifestyle | 68
3.2.2 Common pregnancy complaints | 69
4 Maternal disorders in pregnancy | 73
4.1 Pregnancy-specific disorders | 73
4.1.1 Hyperemesis gravidarum | 73
4.1.2 Cholestasis | 73
4.1.3 Pregnancy-induced hypertension (PIH), preeclampsia, eclampsia, HELLP
syndrome | 74
4.1.4 Dermatoses of pregnancy | 84
4.2 Disorders not specific to pregnancy | 84
4.2.1 Cardiac disease | 84
4.2.2 Pulmonary tuberculosis | 86
4.2.3 Pyelonephritis in pregnancy | 86
4.2.4 Diabetes mellitus | 87
4.2.5 Thrombophilia | 91
4.2.6 Thyroid disorders | 92
4.2.7 Acute abdomen | 93
4.2.8 Adnexal tumors | 95
4.2.9 Cervical cytology | 96
5 Problems in the second half of pregnancy | 99
5.1 Preterm birth (PTB) | 99
5.2 Premature rupture of membranes; chorioamnionitis | 105
5.3 Intrauterine growth restriction (IUGR) | 107
5.4 Postterm pregnancy | 108
5.5 Stillbirth | 109
6 Disorders of the fetus | 113
6.1 Hemolytic disease | 113
6.2 Fetal alloimmune thrombocytopenia | 118
6.3 Prenatal infections | 118
6.3.1 Prenatal rubella infection, congenital rubella syndrome | 119
6.3.2 Cytomegalovirus (CMV) | 121
6.3.3 Varicella-zoster-virus (VZV) | 122
6.3.4 Herpes simplex virus (HSV) | 123
6.3.5 Virus hepatitis | 125
6.3.6 Parvovirus B19 | 126
6.3.7 AIDS, HIV seropositivity | 127
6.3.8 Pregnancy and neonatal listeriosis | 129
6.3.9 Toxoplasmosis | 129
6.3.10 Syphilis | 132
6.3.11 Gonorrhea | 134
6.3.12 Vaccination in pregnancy | 136
6.4 Malformations | 136
6.4.1 Hydrocephalus | 136
7 Normal labor | 141
7.1 Birth factors | 141
7.1.1 Fetus | 141
7.1.2 Birth route | 143
7.1.3 Force of labor, contractions | 147
7.2 Mechanism of labor | 150
7.2.1 Signs, onset of labor, preparation for labor | 151
7.2.2 History taking, examination, spontaneous vaginal delivery | 152
7.2.3 Passage of the head through the birth canal | 155
7.2.4 Station. Level of the head in the pelvis | 162
7.3 Examination of the fetus during labor | 167
7.3.1 Auscultation, amniotic fluid color | 167
7.3.2 Cardiotocography (CTG), electronic fetal monitoring (EFM) | 168
7.3.3 Fetal blood sampling (FBS) | 177
7.4 Management of labor | 180
7.4.1 Management of first stage | 180
7.4.2 Management of second stage | 189
7.5 Management of third stage | 199
7.6 Postplacental period | 204
7.7 Duration of labor | 208
8 Pathological labor | 211
8.1 Malpresentations and malpositions of the occiput | 211
8.1.1 Persistent occipitotransverse position (POT) | 211
8.1.2 High anteroposterior head | 214
8.1.3 Occipitoposterior position | 215
8.1.4 Extended presentations | 220
8.2 Breech presentation | 233
8.2.1 Classification, diagnosis, differential diagnosis | 234
8.2.2 Mechanism of labor | 236
8.2.3 Antenatal counseling | 244
8.2.4 Mode and management of delivery | 245
8.3 Transverse lie/shoulder presentation | 264
8.3.1 Course of labor in transverse lie | 266
8.3.2 Management of transverse lie | 268
8.4 Multifetal gestations | 270
8.4.1 Antenatal care | 272
8.4.2 Birth complications, mode | 275
8.5 Pathological contractions, uterine dystocia | 278
8.6 Arrested labor | 280
8.7 Cervical priming and induction of labor | 282
8.8 Intrauterine (perinatal) hypoxia | 284
8.9 Cord complications: presentation, prolapse | 288
8.9.1 Cord presentation | 288
8.9.2 Cord prolapse | 288
8.10 Arm complications: Compound presentation, arm presentation, prolapse | 290
8.11 Shoulder dystocia | 292
8.12 Cephalopelvic disproportion (CPD) | 294
8.12.1 Generally contracted pelvis | 296
8.12.2 Funnel-shaped pelvis | 302
8.12.3 Long pelvis | 303
8.13 Uterine rupture | 306
8.14 Management of birth after prior cesarean section | 311
8.15 Amniotic fluid embolism (AFE) | 312
9 Obstetrical operations | 315
9.1 Indication | 315
9.2 Preparation for the operation | 316
9.3 Episiotomy, perineotomy | 316
9.4 Laceration of the vagina, perineum, clitoris, labia | 320
9.5 Forceps operation | 322
9.6 Vacuum extraction, ventouse extraction (VE) | 332
9.7 Cesarean section | 335
9.8 Combined version | 340
9.8.1 Version from transverse lie | 340
9.8.2 Version from cephalic presentation | 343
9.9 Dismembering operations: perforation, cranioclasm | 343
10 Antepartum and postpartum hemorrhage | 351
10.1 Miscarriage, spontaneous abortion | 351
10.1.1 Induced abortion | 351
10.1.2 Spontaneous abortion | 352
10.2 Gestational trophoblastic disease (GTD) | 360
10.3 Ectopic pregnancy | 363
10.4 Placenta previa | 369
10.5 Placental abruption | 374
10.6 Velamentous insertion | 379
10.7 Postpartum hemorrhage (PPH) | 380
10.7.1 Separation hemorrhage, atonic PPH | 380
10.7.2 Hemorrhage from a laceration | 388
11 Normal puerperium | 391
11.1 Process of involution | 391
11.1.1 Position and attitude of the uterus in the puerperium | 392
11.1.2 Closure of the cervix | 392
11.1.3 Fundal height in the first days postpartum | 393
11.2 Wound-healing processes in the puerperium | 393
11.2.1 Lochia | 394
11.3 Lactation | 395
11.4 Resumption of ovarian function | 396
11.5 Clinical picture of the puerperal period | 397
11.5.1 The postpartum pulse | 397
11.5.2 Temperature postpartum | 398
11.5.3 Monitoring fundal height | 398
11.5.4 Monitoring lochia | 398
11.5.5 Micturition in early puerperium | 399
11.5.6 Bowel movements | 400
11.5.7 Postpartum exercises | 400
11.5.8 Ambulation postpartum – early ambulation | 400
11.5.9 Discharge from hospital and the end of the clinical puerperium | 400
11.5.10 Breastfeeding | 401
12 Pathological puerperium | 405
12.1 Puerperal fever = childbed fever | 405
12.1.1 Localized puerperal infections | 406
12.1.2 Disseminated puerperal infection | 407
12.2 Hemorrhage in the puerperal period | 412
12.2.1 Retained placental tissue and placental polyp | 412
12.2.2 Puerperal endometritis | 413
12.2.3 Functional hemorrhage in the puerperium | 414
12.2.4 Bleeding from birth traumas in the puerperium | 414
12.3 Injury to the symphysis pubis | 414
12.4 Mastitis puerperalis | 416
12.5 Pelvic vein thrombosis | 420
12.6 Postpartum thyroiditis | 422
12.7 Psychiatric disorders | 422
M. Obladen
13 The newborn | 425
13.1 The healthy newborn | 425
13.1.1 The baby and its parents | 425
13.1.2 Initial care | 425
13.1.3 Examination | 426
13.1.4 Screening program | 428
13.1.5 Other preventative measures | 429
13.2 Diet and care | 429
13.2.1 Lactation, breastfeeding, medication in breast milk | 429
13.2.2 Dietary plan for artificial feeding | 431
13.2.3 Dietary disorders | 432
13.2.4 Care of the healthy newborn | 432
13.3 Postnatal adaptation | 433
13.3.1 Physiological adaptation | 433
13.3.2 Pathological adaptation | 438
13.4 Birth trauma | 443
13.5 The preterm baby | 446
13.5.1 Gestational age | 446
13.5.2 Complications | 446
13.5.3 Diseases of preterm babies | 447
13.6 Hypotrophic newborn | 451
13.7 The infant of the diabetic mother (IDM) | 452
13.7.1 Glucose metabolism and hypoglycemia | 452
13.7.2 Fetopathia diabetica and complications | 453
13.8 Common newborn diseases | 454
13.8.1 Respiratory disorders | 454
13.8.2 Anemia, polycythemia, hyperviscosity | 455
13.8.3 Hyperbilirubinemia, icterus, phototherapy | 456
13.8.4 Hemolytic disease (HD) | 457
13.8.5 Drug addiction, drug withdrawal | 459
13.8.6 Neonatal seizures | 459
13.9 Common congenital abnormalities | 459
13.9.1 Gastrointestinal tract | 460
13.9.2 Congenital cardiac malformations | 463
13.9.3 Skeletal malformations | 463
13.9.4 Down syndrome | 466
13.9.5 Alcohol embryopathy, -fetopathy (fetal alcohol syndrome; FAS) | 467
13.10 Neonatal infections | 468
13.10.1 Immune status of the neonate | 468
13.10.2 Sepsis and GBS infection | 468
13.10.3 Other vertical infections | 469
13.11 Level of Care and Regionalization | 470
13.11.1 Prenatal transfer to a perinatal center | 470
13.11.2 Neonatal consultation | 470
13.11.3 Indications for transfer to neonatal intensive care unit (NICU) | 471
13.11.4 Transfer to NICU not indicated | 471
13.11.5 Postnatal transport | 471
Index | 475
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