Practical Obstetrics and Gynaecology Handbook for O&G Clinicians and General Practitioners

Autobiography of Yean Leng LIM

Thiam Chye Tan, Kim Teng Tan, Eng Hseon Tay, S P Chonkar

• Publisher: WSPC
• Year: 2014
• eBook ISBN: 9789814522960
• Edition: 2
• Topic: Medizin
• Subtopic: Familien- & Hausarztpraxis

This handbook provides an evidence-based approach to common obstetrics & gynaecological problems faced by O & G clinicians and general practitioners in their daily practice. It is the only book available with current evidence-based recommendations and protocols in O & G.

Compiled by experienced experts, this new edition contains 24 new chapters. The existing chapters have been updated using the latest evidence. The authors have included multiple flow charts and detailed practical approaches to various gynaecology and obstetric issues. The book will be a valuable and quick practical guide to everyone — not only to general practitioners and O & G clinicians, but also to medical students and resident doctors. Topics like "Approach to Ectopic Pregnancy" and "Pelvic Inflammatory Disease" will provide invaluable guidance to even emergency medicine doctors.

Contents:

• Obstetrics:
  • Pre-Conception Preparation
  • Routine Antenatal Follow-Up
  • Vaccination in Pregnancy
  • Approach to Bleeding in Early Pregnancy
  • Approach to Spontaneous Miscarriage
  • Approach to Recurrent Spontaneous Miscarriage (RSM)
  • Approach to Abdominal Pain in Pregnancy
  • Obstetric & Gynaecological (O&G) Causes of Abdominal Pain in Early Pregnancy
  • Obstetric & Gynaecological (O&G) Causes of Abdominal Pain in Late Pregnancy
  • Non Obstetric & Gynaecological (Non O&G) Causes of Abdominal Pain in Pregnancy: Simple Approach by Site of Pain
  • Non Obstetric & Gynaecological (Non O&G) Causes of Abdominal Pain in Pregnancy
  • Approach to Ectopic Pregnancy (EP)
  • Approach to Gestational Trophoblastic Disease (GTD)
  • Termination of Pregnancy (TOP)
  • Medical Disorders and Potential Risk Factors in Pregnancy
  • Multiple Pregnancy
  • Infections in Pregnancy
  • Skin Disorders in Pregnancy
  • Approach to Depression in Pregnancy
  • Medications in Pregnancy and Lactation
  • Approach to Postnatal Problems
  • Lactation and Breastfeeding
  • Frequently Asked Questions on Pregnancy
• Investigations in Obstetrics:
  • Routine Antenatal Blood Investigations and Infective Screening
  • Approach to Prenatal Screening for Thalassemia
  • Miscellaneous Antenatal Blood Investigations
  • Screening for Chromosomal Defects
  • Prenatal Invasive Diagnostic Tests
  • Ultrasonography and Foetal Doppler in Obstetrics
  • Approach to Screening Scan Foetal Abnormalities
  • Laboratory Values in Normal Pregnancy
  • An Overview of Serum Human Chorionic Gonadotropin (HCG)
• Gynaecology:
  • Amenorrhoea
  • Abnormal Uterine Bleeding (AUB)
  • Adolescent Abnormal Uterine Bleeding (AUB)
  • Premenstrual Syndrome (PMS)
  • Dysmenorrhoea
  • Chronic Pelvic Pain (CPP)
  • Polycystic Ovarian Syndrome (PCOS)
  • Approach to Gynaecological Cancers
  • Pap Smear Screening and Management of Abnormal Pap Smears
  • Post Coital Bleeding (PCB)
  • Human Papilloma (HPV) Vaccines and HPV Testing — Salient Facts for Clinical Practice
  • Vulvar and Vaginal Lesions
  • Post Menopausal Bleeding (PMB)
  • Thickened Endometrium
  • Polyps (Cervical/Endometrial)
  • Fibroid
  • Endometriosis and Adenomyosis
  • Ovarian Cyst
  • Pelvic Organ Prolapse (POP)
  • Voiding and Urinary Disorders
  • Vaginal Discharge and Recurrent Vulvovaginal Candidiasis
  • Pelvic Inflammatory Disease (PID)
  • Sexually Transmitted Infections (STI)
  • Oral Hormonal Contraception
  • Non-Oral Contraception/Contraception for Lactating Mothers
  • Choice of Contraception
  • Contraception in Patients with Medical Conditions and Drug Interactions
  • Intrauterine Contraceptive Device (IUCD) and Associated Dilemmas
  • Emergency Contraception
  • Menopause
  • Osteoporosis
  • Hormone Replacement Therapy (HRT)
  • Subfertility, Semen Analysis and Management of Azoospermia
  • Approach to Hyperprolactinaemia
  • Approach to Galactorrhoea
  • Sexual Dysfunctional Problems
  • Mammogram, Breast Ultrasound Scan and Breast Biopsy
  • Breast Cancer Screening
• Investigations in Gynaecology:
  • Ovarian Tumour Markers
  • Female Hormonal Profile
  • Imaging Modalities in Gynaecology
  • Role of Interventional Radiology (IR) in Obstetrics and Gynaecology

Readership: O&G clinicians, general practitioners, medical students and the interested public. Key Features:

• It is evidence based, compiled by experienced experts

Part 1

OBSTETRICS

“The Dream” 2013

Description: “For the womb has dreams” — Anais Nin.

Chapter 1

PRE-CONCEPTION PREPARATION

OBJECTIVES:

TO IMPROVE PREGNANCY OUTCOME

1)	Optimising medical conditions prior to pregnancy
2)	Avoid teratogenic drugs
3)	Screen for infections and genetic blood disorders
4)	Encourage appropriate counselling sessions

1. Optimising Medical Conditions Prior to Pregnancy — to Improve the Prognosis for both Mother and Baby

a. Diabetes mellitus

• Use contraception until glucose control is achieved.
• Self-monitor glucose level
• Refer to dietician for diabetic diet control
• Check for retinopathy, nephropathy and coronary heart disease.
• HbA₁c — aim for <6%
• Achieve good glycaemic control before conception to reduce the risk of miscarriage, congenital malformation and stillbirth
• Attend counselling on risks of pregnancy, frequency of follow up and need for close monitoring
• Take the required amount of folic acid — 5 mg per day

b. Hypertension

• Ensure optimal blood pressure control (maintain below 140/90 mmHg).
• Take antihypertensives as required
• Stop ACE inhibitors, angiotensin II receptor antagonists, Thiazide diuretics. Change medication to safe antihypertensives once the patient becomes pregnant (e.g. Methyldopa, Labetalol, Nifedipine)

c. Cardiac Disease in pregnancy

• Optimise maternal status
• Co-manage with cardiologist. Include a complete evaluation including an echocardiogram.
• Patients need to understand maternal and foetal risks
• Maternal risks include pulmonary oedema, arrhythmias, stroke, cardiac arrest, aortic aneurysm/dissection, venous thromboembolism and death
• Discussion of foetal risks – increased perinatal morbidity and mortality (intrauterine growth restriction, preterm labour, foetal acidosis and foetal death)
• Awareness of risk of transmission of cardiac defect to offspring — risk of recurrence varies with specific parental defect. The frequent recurrent lesions include: Ventricular septal defect, coarctation of aorta, hypoplastic left heart syndrome.
• Cardiac surgery improves fertility. Repair defects prior to pregnancy if indicated, do necessary medication adjustments. If condition can be cured, do so before pregnancy (ASD, PDA, some forms of coarctation). If condition can be ameliorated, do so before pregnancy (MS, MR, AS, Tetralogy, VSD with mild pulmonary hypertension, PS)
• Pregnancy before valve replacement (prosthetic) should be advised
• Patients with valve replacements should be aware of the need for continuous monitoring and therapeutic anticoagulation. In women on long-term Warfarin who are planning to conceive, pregnancy tests should be done if patients miss their menses, to ensure prompt adjustment of anticoagulation therapy if needed.
• Predictors for adverse cardiac events include:
  • Pulmonary hypertension
  • Maternal cyanosis
  • Poor maternal functional class (NYHA 3/4)
  • History of arrhythmias
  • Maternal anticoagulants
• High risk lesions include:
  • Severe aortic stenosis
  • Symptomatic mitral stenosis (NYHA class II-IV)
  • Aortic or mitral regurgitation (NYHA class III-IV)
  • Aortic or mitral valve disease with left ventricular dysfunction (left ventricular ejection fraction <40% )
  • Severe pulmonary hypertension (Pulmonary artery pressure >75% of systemic pressure)

(Key: MS- mitral stenosis, MR- mitral regurgitation, AS- aortic stenosis, VSD-ventricular septal defect, PS-pulmonary stenosis )

d. Thyroid disorders

• Optimise control
• Co-m...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Foreword to the 2nd Edition
• History of KK Women’s and Children’s Hospital
• Preface
• About the Authors and Chief Editor
• Acknowledgements
• PART 1: OBSTETRICS
• PART 2: INVESTIGATIONS IN OBSTETRICS
• PART 3: GYNAECOLOGY
• PART 4: INVESTIGATIONS IN GYNAECOLOGY
• References
• Index