Clinical Protocols…fin rev3:Clinical Protocols…fin rev3 30/10/07 10:35 Page 1 CLINICAL PROTOCOLS in OBSTETRICS and GYNECOLOGY TURRENTINE THIRD EDITION JOHN E TURRENTINE The first edition of Clinical Protocols in Obstetrics and Gynecology (published in 2000) quickly became known as ‘the tan book’ and was used as a definitive reference by physicians and other health-care practitioners, residents, and students alike. With the topics in simple alphabetical order, the layout made it easy to locate solutions to everyday clinical problems and to ensure that everyone in an office or hospital team worked consistently. Now enlarged, revised, and updated in a third THIRD EDITION CLINICAL PROTOCOLS in edition, the book retains and enhances the straightforward layout, flow charts, and OBSTETRICS CLINICAL PROTOCOLS in simple presentation of relevant statistics that made its previous editions an international bestseller and includes some further illustrations also. OBSTETRICS and This up-to-date and authoritative Ob/Gyn compilation should help anyone pass the ACOG written or Oral Board examinations and be invaluable for use as a quick- reference while practicing Obstetrics and Gynecology. GYNECOLOGY FROM REVIEWS OF PREVIOUS EDITIONS: A strong point of this edition is the wide range of topics that are covered. Not only and are all the subspecialties represented, but medically related topics, including primary care medicine, are also included. Fertility and Sterility GYNECOLOGY There is a lot of groundwork behind these seemingly simple rules… it certainly is a valuable contribution to this particular category of medical literature… It will be of use to specialists in hospitals and private practice, residents, students and the nursing staff. THIRD EDITION Acta Obstetricia et Gynecologica Scandinavica ABOUT THE AUTHOR: John E Turrentine MD DMin is Clinical Professor of Obstetrics and Gynecology for the Medical College of Georgia and Director/Instructor for Dalton State College for Surgical Technology, University of Georgia, USA. ISBN 978-0-415-43996-1 www.informahealthcare.com 9 78041 5 439961 CLINICAL PROTOCOLS in OBSTETRICS AND GYNECOLOGY CLINICAL PROTOCOLS in OBSTETRICS AND GYNECOLOGY THIRD EDITION John E Turrentine MD DMin Clinical Professor of Obstetrics and Gynecology Medical College of Georgia Director/Instructor Dalton State College of Surgical Technology University of Georgia USA © 2008 Informa UK Ltd First published in the United Kingdom in 2008 by Informa Healthcare, Telephone House, 69-77 Paul Street, London EC2A 4LQ. Informa Healthcare is a trading division of Informa UK Ltd. Registered Offi ce: 37/41 Mortimer Street, London W1T 3JH. Registered in England and Wales number 1072954. Tel: +44 (0)20 7017 5000 Fax: +44 (0)20 7017 6699 Website: www.informahealthcare.com All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication, the ultimate responsibility rests with the prescribing physician. Neither the publishers nor the authors can be held responsible for errors or for any consequences arising from the use of information ciontained herein. For detailed prescribing information or instructions on the use of any product or procedure discussed herein, please consult the prescribing information or instructional material issued by the manufacturer. A CIP record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Data available on application ISBN-10: 0 415 43996 5 ISBN-13: 978 0 415 43996 1 Distributed in North and South America by Taylor & Francis 6000 Broken Sound Parkway, NW, (Suite 300) Boca Raton, FL 33487, USA Within Continental USA Tel: 1 (800) 272 7737; Fax: 1 (800) 374 3401 Outside Continental USA Tel: (561) 994 0555; Fax: (561) 361 6018 Email: [email protected] Distributed in the rest of the world by Thomson Publishing Services Cheriton House North Way Andover, Hampshire SP10 5BE, UK Tel: +44 (0)1264 332424 Email: [email protected] Composition by Exeter Premedia Services Pvt. Ltd., Chennai, India Printed and bound in India by Replika Press Pvt Ltd Contents Foreword vii Sidney L Sellers About the author viii Introduction ix Notice to readers x Obstetrics and gynecology A–Z 1 Appendix 411 List of abbreviations 427 v Foreword What a pleasure it would have been in ‘my day’ to have this type of book to utilize before taking the Boards. Also, there were many times during my practice when I needed a fast refresher on symptoms presented that were not commonplace for my practice. Regardless of the length or the volume of any one doctor’s practice, there are always questions that demand confi rmation on one’s memory of those details. This book can easily fulfi ll each of those needs. This is an excellent compilation of the up-to-date knowledge on almost any topic within Obstetrics and Gynecology. It could be used for studying for medical school exams and written and oral boards, for research on subjects that do not occur in a particular practice very often, and for a complete and very user-friendly resource for any Obstetric and Gynecology library. It would be particularly valuable within a residency program for rapid access to details of a certain diagnosis. The book is organized in a simple, yet in-depth way to fi nd the pertinent information desired – topic, subjects within that topic – symptoms, diagnosis, treatments – and then the details and statistics. Looking up a topic is as logical and easy as using a dictionary. During the time that John and I practiced together, he was well-trained in surgery and fully knowledgeable and enthusiastic about specifi cs and diagnostic details in the Obstetrics and Gynecologic fi eld, always researching the most up-to-date study results and protocols. He taught medical fi eld students at Dalton State College and did excellent, in-depth presentations for various pharmaceutical companies. His expertise in diagnosing, surgery, research and teaching provided an ideal basis for creating this excellent resource for Obstetrics and Gynecology students, residents and physicians. It is a pleasure watching John use these talents to benefi t others who follow in the fi eld. Sidney L Sellers MD Obstetrics and Gynecology Dalton, GA, USA Practiced 1957 – 2006 at the Emory School of Medicine, Atlanta, GA, USA vii About the Author Dr John E Turrentine is a Clinical Professor of Obstetrics and Gynecology for the Medical College of Georgia and Director/Instructor for the Dalton State College of Surgical Technology. He is an avid lecturer and instructor for minimally invasive surgeries, especially in the area of total laparoscopic hysterectomy, female urinary incontinent and prolapse procedures, and most signifi cantly is the innovator and expert on MIVH (minimally invasive vaginal hysterectomy). Having been in Ob/Gyn practice for over 25 years, Dr Turrentine teaches other physicians how to pass the ACOG Board Certifying Exams. Dr Turrentine received his Medical Doctorate from the Medical College of Georgia and is a Doctor of Ministry from the Trinity Theological Seminary. He is a Board Certifi ed Diplomat and Fellow of the American Board of Obstetrics and Gynecology. He is an Ordained Minister through FCF (Faith Christian Fellowship). He has served on multiple boards, including chairmanship positions for the ACOG Satellite Symposium, Young Life, and the Appalachian Women’s Enrichment Center for the Pregnancy Crisis Centers throughout North Carolina, Tennessee, and North Georgia. He has been featured on MSNBC, PAX TV, MCG Alumni Magazine, and other TV, Newspaper, and Magazines. Dr Turrentine is recognized worldwide for his previous books, Clinical Protocols in Obstetrics and Gynecology (The TAN Book) 1st and 2nd editions, Surgical Transcriptions in Obstetrics and Gynecology and Surgical Transcriptions and Pearls in Obstetrics and Gynecology. Dr Turrentine’s primary love is his family. His family includes a supportive wife, a son in medical school, another son in pre-law, a daughter studying for a horticultural degree, and another daughter still at home. His other interests include teaching history, ethics, philosophy, swimming, running, and hiking. He holds a private pilot certifi cate, including seaplane rating, and is a current SSI and PADI Master Diver and Divemaster. viii Introduction This book is the most up-to-date Ob/Gyn textbook compiled to help anyone both pass the ACOG Written or Oral Board Examinations and also use as a reference while practicing Ob/Gyn. It is in simple alphabetical order so it is easy to fi nd solutions to everyday problems. Every effort was made to list the main topics on the left-hand side of the page. The “meat” of the matter or subject has been listed in the middle, including etiologies, symptoms, diagnoses, and treatment modes. To the far right, whenever possible, answers to percentages or minutia have been listed, so this book makes an excellent study guide. The same and sometimes improved fl ow charts and pictures are included that made the TAN book a best-selling medical textbook. These all make for a quick reference and study guide. If you know this book, you WILL pass your certifi cation exam. You will also practice excellent Ob/Gyn. ix Notice to readers Our knowledge in clinical sciences is constantly changing.