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Home , Cryptomenorrhea, Culdocentesis, Endometrial cancer, Hysteroscopy, Interstitial pregnancy

Index

abdominal 222–6 for 72–3 breast, abdominal mass 100–11 half-lives of drugs 410 anatomy 383 classification 100 anatomy, benign disease 302–13 differential diagnosis 100, 101 for abdominal hysterectomy 219 biopsies 377 examination for 102 for myomectomy 219 blood supply 383 history taking for 102 of breast 383 bloody secretions from nipple 305 minimal care/treatment 107 of pelvic floor 285 breast care programs 388 ovarian cysts 109 androgen insensitivity 88 congenital abnormalities 312 ovarian tumors 105–6 , spinal 243, 245 core biopsy 305 101 aneuploidy 136 differential diagnosis of diseases tubo-ovarian 109 angiosarcoma of breast 388 306–12 ultrasound 105 angurya cuts 276 examination of 8 abdominal palpation 4 172 clinical 303 123–32 anti-fibrinolytic therapy for self-examination 373 complete cf incomplete 124 dysfunctional abnormal uterine excisional biopsy for diagnosis 306 induction 125 bleeding 230 fibrocystic changes 310 infected 28–9 antiemetics 354, 398 history taking and 303 medical 125 antiphospholipid syndrome 135, 140 infections 307 methods for unsafe 128 appendicitis 36, 39, 62 magnetic resonance imaging 304 minimum care/treatment 37 inhibitors 227 mammography 304, 374–6 missed, management 130 ascites drainage in palliative care 413 minimal invasive breast biopsy 305 post-abortion care 129 Asherman’s syndrome 88, 137 nerve supply 384 septic 197 audit, clinical 435–54 ultrasound examination of 14, 304 signs and symptoms 36 autologous blood transfusion 121–2 breast 367–89 unsafe and complications 128 breast-conserving 385 see also 187 385–6, 403 actinomycin D 405 barriers to health service use 468 clinical examination 370 acute Crohn’s disease 63 behavioral therapy 76 early detection/prevention 387 acute diverticulitis 62 benign disease of breast 302–13 endocrine therapy 386 acute intestinal obstruction 62 beta-thalassemia 63 epidemiology 368 acute 53–64 bimanual vaginal palpation 6 exulcerated 372 acute renal failure in hyperemesis bivalve speculum 4, 5 histological presentation 368 gravidarum 49 bladder prolapse 249 history taking for 370 acute severe menstrual blood loss 230 bladder pain syndrome 75–6 in men 387 , endometrial 356–63 bladder stones 236 in 387 adhesions 76 bleeding, in young patient 387 intrauterine 137 abnormal premenopausal 91–5 incidence 369 subfertility and 179 acute severe menstrual loss 230 inflammatory 387 adnexa, examination by bimanual dysfunctional abnormal uterine laboratory investigations for 374 vaginal palpation 7 bleeding 229–32 magnetic resonance imaging for 376 adolescents, gynecology in 295–301 from nipple 305 pain in 413 Adriamycin 405 in first-trimester pregnancy 21–33, palliative care for 387, 413 adult male circumcision 197 34 presentation and course 369 adverse drug reactions 458 danger signs for ectopic psychological response to 388, 413 AIDS 200–10 pregnancy 25 radiotherapy 387, 393 see also HIV laboratory investigations 24 surgical techniques for 383–5 algorithm for acute pelvic pain in for 23 TNM classification 369 pregnancy 53 signs and symptoms of 22 treatment allocation, alopecia 399 ultrasound 24 locally advanced disease 381 amebic perforation of large bowel 63 pre-pubertal vaginal 300 metastatic and recurrent disease ameboma 63 bleomycin 405 382 84–90 blood transfusion, autologous 121–2 stage I disease 379 anal sphincter injury 260–3 bowel, amebic perforation of 63 stage II disease 380 analgesia, BRCA1 and BRCA2 and ovarian treatments for 377–82 analgesic ladder 409, 410 cancer risk 345 ultrasound examination 374

477 GYNECOLOGY FOR LESS-RESOURCED LOCATIONS , chemo-radiation 392 community palliative care team 420 as contraception 149 chemotherapy 395–406 complementary therapies for chronic prescribing during 462 alopecia 399 pelvic pain 77 use of drugs during 460, 461 combination 396 168 budgeting for health promotion 472 common drugs 404–6 use in sexually transmitted infection dose 396 prevention 197 cancer, extravasation 400 condylomata acuminata 192 basic in low-resource febrile 397 in children and adolescents 299 setting 391–406 for 385–6 congenital syphilis 191 breast 367–89 for endometrial adenocarcinoma congenital uterine malformations 136 cervical 317–34 362 contraception 147–69 community health volunteers 419 for high-risk 339 choices of 148 endometrial 353–63, 365, 392, 402 multi-agent 341 condoms 168 HIV and 204, 205 single-agent 341 considerations 147 344–52, 393, 401, hematological toxicity 397 copper 155–8 412 hemorrhagic cystitis 399 eligibility criteria 149, 150 uterine corpus 356–66 hypersensitivity 400 emergency 165–8 candidiasis, vulvovaginal 188 in advanced stage ovarian cancer female 158–61 in children and adolescents 298 349 methods 152 404 in gynecological 401–3 HIV and 168, 207 carcinosarcoma 363 in low-resource settings 349 implants 154 uterine, chemotherapy 402 intraperitoneal 349 lactation amenorrhea method 149 catheter, landmark studies in ovarian cancer long-acting reversible blockage 267 348, 349 contraceptives 152 care of after fistula repair 266 mucositis 400 oral 163–5 central nervous system disorders 89 nausea and vomiting 398 -only pills 165 317–34 neoadjuvant in epithelial ovarian use of oral for abnormal uterine biopsy 325 cancer 350 bleeding 230 diagnosis and treatment 331 neurotoxicity 399 vasectomy 161 endocervical curettage 326 protocol for epithelial ovarian when to start 153 FIGO staging of 331 cancer 354, 355 contractures 236 HIV and 204 pulmonary side-effects 401 copper intrauterine device 155–8 HPV and 319 safe handling of cytotoxic drugs 462 emergency contraception 166 incidence 317, 318 skin changes 399 core biopsy of breast 305 investigations for 324 toxicity 396 corticosteroid use in hyperemesis natural history of 319 waste management and safety 401 gravidarum 46 pain in 412 children, gynecology in 295–301 Crohn’s disease, acute 63 palliative care in 412 Chlamydia trachomatis 30, 189 cryotherapy 327–8 pre-malignant lesion treatment 326 340 cryptococcal meningitis 415 primary prevention 321 chronic pelvic pain 66–77, 278 cryptomenorrhea 61 radiotherapy in 392 circumcision, 25, 119 secondary prevention 322 adult male 197 cyclophosphamide 405 sub-Saharan Africa: a case study 320 see also female genital mutilation cystadenomas 301 treatment 327 404 cystitis, hemorrhagic 399 141–3 clinical audits 435–54 290 189 , cysts, simple ovarian 109 , neurinoma of 279 cytology of breast cancer 376 examination by bimanual vaginal restoral of 281–3 palpation 6 cold knife conization 329–30 dactinomycin use in molar pregnancy examination using speculum 5 18 341 friable 31 community, defibulation 280 hostile 172, 179 accessing women in need 470 delayed 89 incompetent 136 attitudes to fistula in 271 depot acetate cervical cerclage for 141–3 barriers to health service use 468 161 diagnosis 142 healthcare at community level 467 in malignancies of 30, 317–34 model of care in 419 49 polyps 31 palliative care in 417, 418 dermatitis, cesarean section, promotion of health in 471–5 urine 236 after fistula repair 270 response to abortion 129 vulvovaginitis and contact fistula after 258 sensitization dermatitis 297 chancroid ulcers 192 to breast care 388 and 137 chaperones required for gynecological to health promotion 471 dietary guidelines for hyperemesis examination 3 community health volunteers 419 gravidarum 47

478 Index differential diagnosis, chronic pelvic pain 71–3 gynecological care after 279 abdominal masses 100, 101 diagnosis 71 health complications 277–80 bleeding in first-trimester pregnancy treatment 72 history and practice 275 21 , absence of 87 labial fusion after 296 306–12 Enterobius vermicularis 297, 298 obstructed labor after 278 breast lesions 302 epidemiology, prevalence 275 117 disease association and impact 431 prevention 281 fistula 241 in disease management 428 types of 276, 277 lower in first in disease prevention 429 female sterilization 158–61 trimester pregnancy 35 measures of disease frequency fertility, ovarian tumors 105 426–8 preservation in ovarian cancer 351 189 models of 426 subfertility 170–80 disability-adjusted life years 431 of gynecological disease 425–33 fertility awareness methods 152 discharge, wet mounts for vaginal 5–6 statistics in 432–3 fibroadenoma 308, 309–10 disease burden 430 epirubicin 405 fibrocystic changes in breast 310 disease frequency measures 426–8 epithelial ovarian cancer 401 fibroids 212–28 disease management and epidemiology equipment required for gynecological choice of therapy 216 428 examination 3 definition 212 diverticulitis, acute 62 etoposide 406 examinations for 215–16 404 examination 2–18 expectant management 218 documentation for ultrasound 12, 17 abdominal palpation 4 future treatments 227 405 after female genital mutilation 280 history taking for 214 drama groups for health promotion 474 bimanual vaginal palpation 6 locations 213 drug management cycle 456 breast 8 medical treatment 218 drugs, clinical 303, 370 pregnancy-related complications of adverse reactions 458 for abdominal mass 102 treatment 217 fetotoxic 462 for abnormal premenopausal uterine recurrent miscarriage and 137 good prescribing practice 457 bleeding 93 risk factors for 213 interactions 458, 459–60 for abortion 124 surgery for 219–26 management of 456–64 for acute pelvic pain 56, 57 symptoms 213 monitoring of use and consumption for amenorrhea 85 treatment 217 457 for bleeding in first-trimester FIGO staging, procurement and distribution 457 pregnancy 22, 23 of cervical cancer 331 safe handling of cytotoxic drugs for cervical cancer 323 of endometrial adenocarcinoma 360 462–4 for chronic pelvic pain 69–70 of ovarian cancer 345 storage 457 for 81 of uterine 364 teratogenic 461 for fistulae 240 fistula 233–74 use in pregnancy and lactation 460 for lower abdominal pain in first abdominal repair 257 dysfunctional abnormal uterine trimester pregnancy 36 after cesarean section 258 bleeding 229–32 for molar pregnancy 338 after female genital mutilation and dysgenesis, gonadal 86 for postmenopausal uterine bleeding obstructed labor 278 dysmenorrhea 59, 79–83 97 anesthetic for 243 278 for recurrent miscarriage 139 background 233 for subfertility 174 cf postpartum stress 241 early pubertal development 296 for 288 classification of 237–9 ectopic pregnancy 59, 115–22 for uterine fibroids 214 community attitudes 271 danger signs for 25 in children and adolescents 295 conservative management 241 minimum care/treatment 37, 119 inspection of 4 early repair 242 prevention 116 laboratory investigations 16 easy repair step-by-step 249–57 risk factors 116 recto-vaginal 8 examination for 240 signs and symptoms 36, 116 using speculum 4 failed repair 259, 269 emergency contraception 165–8 excision, female genital mutilation 276 fecal incontinence and 294 emetogenicity 398 extravasation 400 Goh’s classification 273 endometrial adenocarcinoma 356–63 history taking 239 adjuvant treatment 362 fascial damage and fistula 236 inoperable 259 incidence 356 fecal incontinence 293 obstructed labor injury complex pathology 357 female genital mutilation 275–84 235–7 surgery 361 and HIV transmission 280 postoperative care 265–70 symptoms and diagnoses 359 clitoris restoration after 281–3 preoperative preparations 242 402 cultural issues 276 prevalence 233 radiotherapy in 392 defibulation 280 prevention 272 endometrial stromal tumor 365 definition 275 prognosis 239 endometriosis 60 examination difficulties after 280 recto-vaginal 263–5

479 GYNECOLOGY FOR LESS-RESOURCED LOCATIONS

social consequences 236 analysis of patient flow 442 analysis of patient flow through 442 surgeon experience and 246 at community level 467 healthcare organization in 467 treatment 241–71 at hospital level 467 main service areas 443 ureteric 236, 241, 260 building blocks of 465 quality improvement in 440 vault 257 clinical audit and quality referral and district level 467 vesico-vaginal, cause and nature 235 improvement 453 tertiary level 468 Waaldijk’s system 273 components of system 436 tracking of patient flow 444 flow chart, definition of quality 435 hospital palliative care model 421 for a gynecology unit 437 integration and linkages 469 hospital palliative care team 420 for abnormal premenopausal uterine link between sexually transmitted HPV, see human papillomavirus bleeding 94 infection/HIV and service 195 human virus (HIV) for amenorrhea diagnosis 86, 87 management of drugs 456–64 200–10 for differential diagnosis of breast measurements of performance 445 cancers and 205 disease 306 organization 465, 466 cervical cancer 204, 326 for ectopic pregnancy diagnosis 119 overcoming barriers to use 468 contraception and 168 for first-trimester bleeding 34 patient interviews 447 cryptococcal meningitis in 415 for lower abdominal pain 186 performance gaps 453 description 200 for management of chronic pelvic project planning and budgeting 473 gynecological problems 201 pain 67 promotion of health 471 immune reconstitution inflamma- for postmenopausal uterine bleeding quality improvement circle 441 tory syndrome 414 98 quality improvement in hospitals magnitude of problem 201 for subfertility treatment 178 440 menstrual disorders 205 for 185 referral and district level hospitals miscarriage 206 5-fluorouracil 404 467 palliative care in 414 foreign bodies 236 staff interviews 447 pelvic inflammatory disease and 203 vulvovaginitis in children and tertiary level hospitals 467 prevention and sexually transmitted adolescents 297 vertical programs 469 infection treatment 194 friable cervix 31 Helicobacter pylori in hyperemesis reproductive health 206 fusion of labia 296 gravidarum 41 reproductive health services and 279, 280 209 307 107, 279, 280 sero-discordant couples 208 gastroenteritis 63 hemoglobinopathies 63 sexually transmitted infection 203 genetic factors in recurrent miscarriage hemorrhagic cystitis 399 transmission and female genital 136 hemorrhoids 32 mutilation 280 genital herpes 192 herbal remedies for chronic pelvic pain tuberculosis in 204 genital tumors in children and 77 WHO clinical staging 202 adolescents 301 herpes, genital 192 human papillomavirus (HPV), genital ulcer disease 190 history taking 1–2 cancers and 205 genital wart 192 for abdominal mass 102 links to cervical cancer 319 genitourinary side-effects of chemo- for abnormal premenopausal uterine hydatidiform mole 29 therapy 399 bleeding 92 see also gestational trophoblastic germ ovarian cancer 351, 352 for abortion 124 disease germ cell tumors 301 for acute pelvic pain 54 179 chemotherapy 402 for amenorrhea 84 , gestational trophoblastic disease 29, for breast cancer 370 imperforate 87 337–43 for breast disease 303 speculum examination 4 chemotherapy 403 for chronic pelvic pain 66–9 hyperemesis gravidarum 40–50 radiotherapy 393 for dysmenorrhea 80 clinical consequences 47 ginger use in hyperemesis gravidarum for fistulae 239 consequences of 43 46 for lower abdominal pain in first diagnosis 42 gishiri cuts 276 trimester pregnancy 36 dietary guidelines 47 Goh’s classification of fistula 273 for 290 etiology 40 gonadal dysgenesis 86 for postmenopausal uterine bleeding Helicobacter pylori and 41 gonadotropin-releasing hormone 96 immunological factors 41 analogs for fibroids 227 for recurrent miscarriage 139 management 44 gonorrhea 30, 189 for sexually transmitted infection 193 medical therapies 44–7 granuloma inguinale 192 for subfertility 173 prognosis 49 granulosa cell ovarian cancer 351 for urinary incontinence 287 risk factors 41 granulosa cell tumors 301 for uterine fibroids 214 hyperprolactinemia 89, 179 in children and adolescents 295 hypersensitivity to chemotherapy 400 Haemophilus ducreyi 192 HIV, see human immunodeficiency in hyperemesis health promotion 471–5 virus gravidarum 48 healthcare, hospital, hysterectomy,

480 Index

abdominal 222–6 irritable bowel syndrome 73–5 magnetic resonance imaging, anatomy for 219 diagnosis 74 for breast 304 for cervical cancer 332 treatment 74 for breast cancer 376 surgical technique for 223–6 isosfamide 405 malaria 64 vaginal, male breast cancer 387 for pelvic organ prolapse 292 Jadelle® 154 male sterilization 161 procedure 231 juxta-cervical fistula 239, 248 Mallory Weiss tears in hyperemesis 18, 176, 216 juxta-urethral fistula 237, 248 gravidarum 48 216 malnutrition and fistula 237 for fibroids 227 Kaposi 205 mammary Paget disease 369, 388 kidney, renal damage and fistula 236 mammography 304, 374 immune reconstitution inflammatory management of drugs 456–64 syndrome 414 labia, fusion of 296 Manchester procedure 292 immunological factors in hyperemesis labor, obstructed and fistula 235 manual 130–2 gravidarum 41 laboratory investigations 16 mastectomy 383, 384 87 for abdominal mass 104 non-puerperalis 307 Implanon® 154 for abnormal premenopausal uterine mastitis puerperalis 306 implant contraception 154 bleeding 93 mastodynia 307 incarcerated 38 for acute pelvic pain 57 Mayer–Rokitansky–Küster–Hauser incompetent cervix 136 for bleeding in first-trimester syndrome 87 diagnosis 142 pregnancy 24 measures of disease frequency in management 142 for breast 304, 306 epidemiology 426–8 incomplete miscarriage 27 for breast cancer 374 , normal development 296 incontinence, for chronic pelvic pain 70 meningitis, cryptococcal 415 after fistula repair 259 for dysmenorrhea 82 menorrhagia around menarche 300 fecal 293 for fistula 241 , fistula and 237 for molar pregnancy 338 acute severe menstrual blood loss pelvic organ prolapse and 285–94 for postmenopausal uterine bleeding 230 urinary 286–90 97 cervical cancer identification and infection, for recurrent miscarriage 139 326 after female genital mutilation 277 for uterine fibroids 216 difficulties after female genital breast 307 of endometrial adenocarcinoma mutilation 279 cervical cancer identification and presurgery 360 disorders and HIV 205 326 lactation, use of drugs in 460, 461 physiology of 171 infected abortion 28 lactation amenorrhea method 149 and fistula 236 post-abortion 193 , methotrexate 404 recurrent miscarriage and 138 for acute pelvic pain 58 use in molar pregnancy 341 reproductive tract 183–98 for fibroids 228 microbicides 197 sexually transmitted 183–98 late pubertal development 296 micromastia 312 subfertility and 176 364 mid-vaginal fistula 237, 247 urinary tract 61 levator plasty 293 for emergency and 30–1 , contraception 167 vulvovaginitis in children and dysfunctional abnormal uterine milk duct 311 adolescents 297 bleeding 230 minimal invasive breast biopsy 305 , emergency contraception 166 miscarriage 25–8 after female genital mutilation 278 intrauterine device 158 definition 26 fistula and 237 lichen sclerosus 296, 298 definition and prevalence 134 investigations for 71 lipoma 309 etiology 26 276 long-acting reversible contraceptives HIV and 206 reversal 280 152 incomplete 27 inflammatory breast cancer 387 loop electrosurgical excision procedure minimum care/treatment 37 interstitial pregnancy 120 328–9 missed 28 interval cytoreductive surgery in lower abdominal pain, flow chart 186 recurrent 134–44 advanced ovarian cancer 350 luteal phase defect 138 management of 140 intra-cervical fistula 239 , palpation 8 pregnancy after 138 intrauterine adhesions 137 lymph nodes, anatomy of 383 risk factors for 135 intrauterine device, 383, 385 unexplained 141 copper 155 lymphogranuloma venereum 192 signs and symptoms 36 ectopic pregnancy and 116 Lynch syndrome, ovarian cancer risks spontaneous 27, 123–4 emergency contraception 166 and 345 management 130 insertion 155–8 threatened 28 levonorgestrel 158 McCune–Albright syndrome 301 missed abortion 130 intravenous pyelography 18, 216 macromastia 312 60

481 GYNECOLOGY FOR LESS-RESOURCED LOCATIONS molar pregnancy 337–43 incidence 344 psychological issues 416 for 341 management of epithelial 347–51 social issues 416 choriocarcinoma 340 pain in 412 vs invasive therapy 407 examination and investigation 338 palliative care in 412 WHO definition 408 high-risk disease 339 prevention 346 palpation incidence 337 radiotherapy in 393 abdominal 4 persistent 339 risk factors 345 bimanual vaginal 6 prognostic score index 340 survival rates 344 breast 9 radiotherapy in 393 ultrasound features of 346 lymph node 8 signs and symptoms 337 , papilloma of milk duct 311 treatment 338 minimum care/treatment 38 paracervical block 127 morphine, oral 411 signs and symptoms 36 partner notification 196 mortality from infected abortion 28 ovarian cysts, simple 109 patient flow 442 mucositis 400 ovarian tumors tracking 444 Müllerian anomalies 136, 137 benign 106, 108 patient interviews 447 muscle damage and fistula 236 borderline 108 peau d’orange 303 musculoskeletal pain 63 common benign tumors 106 57 myomectomy, differential diagnosis of malignant pelvic floor, pathophysiology of adverse events 220 and benign 105 dysfunction 286 anatomy for 219 , pelvic floor muscle dysfunction 76 definition 220 complications and pain 60 pelvic inflammatory disease 58, 189–90 surgical technique for 221 polycystic ovary syndrome 89 cervical cancer identification and vaginal 222 premature ovarian failure 86 326 ovulation pain 60 HIV and 203 non-patent tubes after 172 Naegele’s rule 22 404 tubo-ovarian masses in 109 nausea, pain, pelvic organ prolapse, chemotherapy and 398 acute pelvic 53–64 and incontinence 285–94 hyperemesis gravidarum 40–50 analgesic ladder 409, 410 examples of 290 Neisseria gonorrhoeae 189 assessment by visual analog scale history taking for 290 nephrolithiasis 62 411 non-surgical treatment 291 nerve damage and fistula 236 bladder pain syndrome 75–6 POP-Q schedule 291 neurinoma, clitoral 279 chronic pelvic 66–77 simplified POP-Q 291 neurotoxicity 399 description 408 surgical treatment 292–3 nipple discharge 305, 307 in breast cancer 413 pelvic pain, non-Hodgkin lymphoma 205 in cervical cancer 412 acute, breast 369 in ovarian cancer 412 algorithm 53 non-steroidal anti-inflammatory drugs lower abdominal, flow chart for 186 causes of 54, 55 (NSAIDs), lower abdominal in first trimester classification 53 for dysfunctional abnormal uterine pregnancy 35–9 diagnosis and treatment 58–64 bleeding 230 musculoskeletal 63 symptoms associated with 56 for dysmenorrhea 82 neuropathic 411 chronic 66–77 for endometriosis 72 on ovulation 60 adhesions 76 norethisterone enanthate 161 psychological aspects of after female genital mutilation management 76 278 obstructed labor, after female genital round ligament 39 bladder pain syndrome 75–6 mutilation 278 somatic and neuropathic pathways dysmenorrhea 79–83 obstructed labor injury complex 235–7 409 endometriosis 71–3 obstruction, acute intestinal 62 treatment in low-resource setting history taking 66–9 ophthalmia neonatorum 190, 197 409 irritable bowel syndrome 73–5 oral contraception 163–5 palliative care 407–21 management algorithm 67 ovarian cancer 344–52 analgesic ladder 409, 410 physical examination 69 adjuvant treatment 348 ascites drainage 413 unexplained 76 advanced stage 349 collaboration between hospital and performance, measurements 445 chemotherapy landmark studies community 420 persistent gestational trophoblastic 348, 349 for breast cancer 387 disease, surgery for 342 classification 346 for cervical cancer 333 persistent gestational trophoblastic diagnosis 346 general principles 418 339 epithelial 347–51 hospital services 417–21 personal data for history taking 1 chemotherapy 401 in community 417–21 for pelvic organ prolapse 291 FIGO staging 345 in HIV/AIDS 414 pharaonic circumcision 276 germ cell 351, 352 oral morphine 411 phyllodes tumor 311, 313, 369, 388 granulosa cell 351 principles of 408 physiology of female cycle 171

482 Index pituitary gland disorders and clinical audit as tool for sex cord stromal tumors 402 amenorrhea 89 improvement 452 sexual abuse, Poland’s syndrome 312 definition 435 in children and adolescents 299 polycystic ovary syndrome 89, 177 dimensions of 438 trauma after 301 polyploidy 136 factors enabling improvement 437 sexual development stages of Tanner polyps, obstacles to improvement 439 295 cervical 31 patient interviews 447 sexually transmitted infections (STI), endometrial 140 staff interviews 447 183–98 post-coital test 174 quality improvement circle 441 common 183, 184 posterior wall speculum 4, 5 quality-adjusted life years 430 complications 184 postmenopausal uterine bleeding 96–9 management 195 pre-pubertal vaginal bleeding 300 radiotherapy, management and treatment 184 precocious puberty 300 combined chemo-radiation 392 prevention 196 pregnancy, for breast cancer 387 transmission and HIV 203 acute pelvic pain in 53 for cervical cancer 333 Sheehan’s syndrome 89 bleeding in first-trimester 21–33, for endometrial adenocarcinoma sickle-cell disease 63 34 362 side-effects, breast cancer in 387 for metastatic molar disease 343 adverse drug reactions 458 cervical cancer treatment in 326 in breast cancer 393 chemotherapy 396–401 checklist for diagnosis 151 in cervical cancer 392 depot medroxyprogesterone acetate ectopic 59 115–22 in endometrial cancer 392 162 HIV and 207–9 in gestational trophoblastic disease drug interactions 458, 459–60 hyperemesis gravidarum 40–50 393 genitourinary of chemotherapy 399 interstitial 120 in low-resource setting 391–5 norethisterone enanthate 163 lower abdominal pain in first in ovarian cancer 393 of radiotherapy 394 trimester 35–9 in vulval cancer 393 oral contraception 164 management after recurrent side-effects 394 tubal occlusion 161 miscarriage 141 recto-vaginal fistula 235 Sino-implant® 154 molar 29–30, 29, 337–43 290 social issues in palliative care 416 twin 339 recto-vaginal examination 8 speculum, use of drugs in 460 recurrent miscarriage 134–44 for chronic pelvic pain examination premature ovarian failure 86 reproductive health and HIV 206, 209 69 premenopausal abnormal uterine reproductive tract infections 183–98 insertion technique 5 bleeding 91–5 risk of malignancy index 105 use of 4 prescribing, use of nasal in children and good prescribing practice 457 sacropexy 293 adolescents 295, 296 in lactation 462 sacrospinous fixation 293 sperm quality 173, 175 in pregnancy 461 safety, safe handling of cytotoxic drugs spinal anesthesia 243, 245 prevention and epidemiology 429 462–4 spiritual care 417 primary amenorrhea 84 saline contrast hysterosonography 14, spontaneous miscarriage 27, 130 primary dysmenorrhea 80 216 staff interviews 447 privacy, required for gynecological sarcoma, statistics 432 examination 3 breast 369, 388 sterilization, female 158 deficiency 138, 140 undifferentiated 366 sub-Saharan Africa case study of progestogen for dysfunctional abnormal uterine 363–6 cervical cancer 320 uterine bleeding 230 schistosomiasis, subchorionic bleeding 32 progestogen-only pills 165 subfertility and 176 subfertility 170–80 promotion of health 471 urogenital 30 causes of 172–3 psychological aspects of pain screening, definition 170 management 76 for breast cancer 389 examinations for 174 psychological issues in palliative care for cervical cancer 323, 324 history taking for 173 416 for endometrial adenocarcinoma incidence 170 puberty, 358 male 179 delayed 89 for sexually transmitted infection prevention 180 early pubertal development 296 195 treatment 177 late pubertal development 296 for syphilis 196 sunna circumcision 276 pyelography, intravenous 18 ovarian cancer 346 surgery, pyelonephritis 62 secondary amenorrhea 85 anal sphincter injury repair 260–3 107 secondary dysmenorrhea 80 breast-conserving surgery 385 pyomyositis 63 selective prostaglandin receptor challenges in low-resource setting modulators 227 347 quality, self-assessment 451 clitoral restoration after female audits and improvements 435–54 septic abortion 197 genital mutilation 281–3

483 GYNECOLOGY FOR LESS-RESOURCED LOCATIONS

cold knife conization 329–30 Trichomonas vaginalis 189 cancers of 356–66 cryotherapy 327–8 trichomoniasis 189 congenital uterine malformations debulking of ovarian cancer 347 tubal occlusion, 136 defibulation after female genital incisions for 162 examination by bimanual vaginal mutilation 280 side-effects 161 palpation 7 easy fistula repair step-by-step technique 159 incarcerated 38 249–57 tuberculosis, rupture and vault fistula 257 failed fistula repair 269 HIV and 204 for breast cancer 378, 382 of breast 307, 308 vaccines, against HPV 321 for dysfunctional abnormal uterine urogenital 31 vacuum aspiration, manual 130–2 bleeding 230 tubo-ovarian masses 109 , normal flora 186 for endometrial adenocarcinoma 361 Turner syndrome 86 vaginal bleeding, prepubertal 300 for endometriosis 73 typhoid perforation 62 vaginal examination for chronic pelvic for fibroadenoma of breast 309–10 pain 69 for fibroids 219–26 ulipristil acetate, emergency vaginal hysterectomy procedure 231 for fistulae 242–71 contraception 166 vaginal myomectomy 222 for pelvic organ prolapse 292–3 ultrasound, vaginitis 187 for persistent gestational tropho- breast 14 vaginosis bacterial 187 blastic disease 342 for abdominal mass 105 vasectomy 161 for phyllodes tumor 313 for acute pelvic pain 57 vault fistula 257 for recto-vaginal fistula 263–5 for bleeding in first-trimester venous thromboembolism, in for urinary incontinence 289 pregnancy 24 hyperemesis gravidarum 49 interval cytoreductive in advanced for breast cancer 374 vesico-vaginal fistula, cause and nature ovarian cancer 350 for breast examination 304 235 landmark studies in ovarian cancer for chronic pelvic pain 70 vinblastine 405 debulking 350 for dysmenorrhea 81 vincristine 405 loop electrosurgical excision for uterine fibroids 215 visual analog scale, for pain assessment procedure 327–8 in subfertility 175 411 postoperative care after fistula introduction to 10–16 vitamin deficiency, in hyperemesis 265–70 of endometrial adenocarcinoma 359 gravidarum 47 surgeon experience and 246 ovarian cancer 346 vomiting, technique for abdominal saline contrast hysterosonography chemotherapy and 398 hysterectomy 223–6 14 hyperemesis gravidarum 40–50 technique for myomectomy 221 transabdominal 11 vulva, inspection of 4 termination of pregnancy 126 transvaginal 11 vulval cancer, radiotherapy in 393 vaginal hysterectomy 231 unexplained chronic pelvic pain 76 vulvovaginal candidiasis 188 syphilis 190 ureteric fistula 236, 241, 260 vulvovaginitis, in children and breast disease 307 urinary incontinence 286–90 adolescents 296 congenital 191 fistula and 237 screening 196 history taking for 287 Waaldijk’s system of fistula classification pathophysiology of 287 273 teratogenicity 461 treatments 289 wart, genital 192 301 types of 286 warts, genital, in children and termination of pregnancy, urinary retention, adolescents 299 in hyperemesis gravidarum 49 acute 36 Wernicke’s encephalopathy 47 techniques 125–7 after female genital mutilation 277 wet mount 5 β-thalassemia 63 31, 61 WHO classification, of endometrial threadworm 297, 298 after female genital mutilation 278 adenocarcinoma 358 thrombophilia and recurrent urine dermatitis 236 miscarriage 138, 140 urogenital schistosomiasis 30 X-ray, thyroid disease and recurrent urogenital tuberculosis 31 abdominal for acute pelvic pain 58 miscarriage 137 uterine bleeding, chest 375 traditional healer, fistula treatment by abnormal premenopausal 91–5 236 postmenopausal 96–9 young patients, gynecology in 295–301 traditional healers, chronic pelvic pain uterine carcinosarcoma, chemotherapy 77 402 Zingiber officinale 46 trauma, uterine fibroids 212–8 in children and adolescents 301 363–6 vaginal and perigenital lacerations uterus, 32 absence of 87

484