Dewhurst’s Textbook of Obstetrics & Gynaecology This book is dedicated to my wife, Gill, and my children, Alastair, Nicholas and Timothy, and to the memory of Sir Jack Dewhurst. Dewhurst’s Textbook of Obstetrics & Gynaecology
EDITED BY
D. KEITH EDMONDS FRCOG, RRACOG Consultant Obstetrician and Gynaecologist Queen Charlotte’s & Chelsea Hospital London, UK
EIGHTH EDITION
A John Wiley & Sons, Ltd., Publication This edition first published 2012 © 2007, 1999, 1995, 1986, 1981, 1976 Blackwell Science; 1972 Blackwell Publishing Ltd; 2012 John Wiley and Sons, Ltd. Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing. Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. 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, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Library of Congress Cataloging-in-Publication Data Dewhurst’s textbook of obstetrics & gynaecology. – 8th ed. / edited by D. Keith Edmonds. p. ; cm. Dewhurst’s textbook of obstetrics and gynaecology Textbook of obstetrics & gynaecology Includes bibliographical references and index. ISBN-13: 978-0-470-65457-6 (hardcover : alk. paper) ISBN-10: 0-470-65457-0 (hardcover : alk. paper) 1. Gynecology. 2. Obstetrics. I. Dewhurst, John, Sir, 1920– II. Edmonds, D. Keith. III. Title: Dewhurst’s textbook of obstetrics and gynaecology. IV. Title: Textbook of obstetrics & gynaecology. [DNLM: 1. Genital Diseases, Female. 2. Pregnancy Complications. WP 100] RG101.D5573 2011 618–dc22 2011011044 A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Set in 9.25 on 12 pt Palatino by Toppan Best-set Premedia Limited
01 2012 Contents
Contributors, viii Part 4 Maternal Medicine Professor Sir John Dewhurst, xiii 11 Hypertensive Disorders, 101 Preface to the Eighth Edition, xiv Jason J.S. Waugh and Maria C. Smith Preface to the First Edition, xv 12 Heart Disease in Pregnancy, 111 Catherine Nelson-Piercy 13 Diabetes and Endocrine Disease in Pregnancy, 121 Section 1 Obstetrics Anne Dornhorst and Catherine Williamson Part 1 Basic Science 14 Renal Disease, 137 Sarah Winfield and John M. Davison 1 Maternal Physiology, 5 15 Haematological Problems in Pregnancy, 151 Fiona Broughton Pipkin Peter Clark, Andrew J. Thomson and Ian A. Greer 2 The Placenta and Fetal Membranes, 16 16 Miscellaneous Medical Disorders, 173 Berthold Huppertz and John C.P. Kingdom Andrew McCarthy 3 Normal Fetal Growth, 26 Jason Gardosi Part 5 Fetal Medicine Part 2 Normal Pregnancy 17 Antenatal Screening, 185 Ruwan C. Wimalasundera 4 Pre-conception Counselling, 35 Mandish K. Dhanjal 18 Disorders of Fetal Growth and Assessment of Fetal Well-being, 200 5 Antenatal Care, 42 Gordon C.S. Smith and Christoph C. Lees George Attilakos and Timothy G. Overton 19 Fetal Medical Conditions, 208 Janet Brennand Part 3 Early Pregnancy Problems 20 Fetal Anomalies, 219 Sailesh Kumar 6 Spontaneous Miscarriage, 53 Catriona M. Stalder 21 Multiple Pregnancy, 230 Mark D. Kilby and Dick Oepkes 7 Recurrent Miscarriage, 60 Siobhan Quenby 8 Gestational Trophoblast Tumours, 66 Part 6 Birth Philip Savage and Michael Seckl 9 Ectopic Pregnancy, 76 22 The Normal Mechanisms of Labour, 247 Davor Jurkovic Andrés López Bernal and Errol R. Norwitz 10 Induced Abortion, 88 23 Post-term Pregnancy, 269 Gillian Flett and Allan Templeton Aaron B. Caughey
v vi Contents
24 Induction and Augmentation of Labour, 287 Part 10 Menstruation Jane E. Norman 39 The Menstrual Cycle, 487 25 Obstetric Emergencies, 296 William L. Ledger Sara Paterson-Brown 40 Contraception and Sterilization, 495 26 Malpresentation, Malposition, Sharon T. Cameron and Anna Glasier Cephalopelvic Disproportion and Obstetric Procedures, 311 41 Polycystic Ovary Syndrome and Secondary Sabaratnam Arulkumaran Amenorrhoea, 513 Adam Balen 27 Fetal Monitoring During Labour, 326 42 Menstrual Problems: Heavy Menstrual Bleeding and Sara Paterson-Brown Primary Dysmenorrhoea, 534 28 Preterm Labour, 338 Andrew W. Horne and Hilary O.D. Critchley Phillip Bennett 43 Premenstrual Syndrome, 544 29 Analgesia, Anaesthesia and Resuscitation, 356 P.M. Shaughn O’Brien Felicity Plaat 44 Menopause and the Postmenopausal Woman, 553 Nick Panay
Part 7 Postnatal Care Part 11 Inability to Conceive 30 Puerperium and Lactation, 365 45 Infertility, 567 D. Keith Edmonds Mark Hamilton 31 Neonatal Care for Obstetricians, 377 46 Assisted Reproduction, 580 Glynn Russell Geoffrey Trew and Stuart Lavery 32 Obstetric Statistics, 394 James J. Walker Part 12 Pelvic Pain
47 Pelvic Infection, 597 Section 2 Gynaecology Jonathan D.C. Ross
Part 8 Gynaecology 48 Chronic Pelvic Pain, 607 R. William Stones 33 Clinical Anatomy of the Pelvis and 49 Endometriosis, 615 Reproductive Tract, 413 Stephen Kennedy and Philippe Koninckx Alan Farthing 34 Normal and Abnormal Development of the Part 13 Urogynaecology Genital Tract, 421 D. Keith Edmonds 50 Uterovaginal Prolapse, 627 Anthony R.B. Smith 35 The Role of Ultrasound in Gynaecology, 435 Tom Bourne 51 Urinary Incontinence, 635 Dudley Robinson and Linda Cardozo 36 Hysteroscopy and Laparoscopy, 448 Adam Magos Part 14 Benign Gynaecological Disease
Part 9 Childhood and Adolescence 52 Benign Diseases of the Vulva, 695 Fiona M. Lewis and Sallie M. Neill 37 Puberty and Its Disorders, 471 53 Benign Diseases of the Vagina, Cervix D. Keith Edmonds and Ovary, 706 38 Gynaecological Disorders of Childhood and D. Keith Edmonds Adolescence, 480 54 Benign Disease of the Uterus, 715 D. Keith Edmonds Aradhana Khaund and Mary Ann Lumsden Contents vii
Part 15 Gynaecological Oncology 61 Ethical Dilemmas in Obstetrics and Gynaecology, 805 55 Malignant Disease of the Vulva and the Vagina, 729 Sheila McLean David M. Luesley 62 The Law and the Obstetrician and 56 Premalignant and Malignant Disease of the Cervix, 747 Gynaecologist, 815 Mahmood I. Shafi Bertie Leigh
57 Epithelial Ovarian Cancer, 760 Index, 823 Hani Gabra and Sarah Blagden Colour plate sections can be found facing pages 432 58 Endometrial Cancer, 776 (Plates 8.1–52.10) and 656 (Plates 52.11–55.7) Sean Kehoe
Part 16 Miscellaneous Topics
59 Sexual Dysfunction, 785 Claudine Domoney 60 Domestic Violence and Sexual Assault, 798 Maureen Dalton Contributors
Sir Sabaratnam Arulkumaran PhD, FRCS, FRCOG Fiona Broughton Pipkin MA, Dphil, Professor and Head of Obstetrics and Gynaecology FRCOG ad eundem Deputy Head of Clinical Sciences Professor of Perinatal Physiology St George’s University of London Department of Obstetrics and Gynaecology London, UK City Hospital Nottingham, UK George Attilakos MD, MRCOG Consultant in Obstetrics and Fetal Medicine Sharon T. Cameron MD, FRCOG Fetal Medicine Unit Consultant Gynaecologist University College London Hospitals NHS Foundation Trust NHS Lothian and Part-time Senior Lecturer London, UK Department of Reproductive and Developmental Sciences University of Edinburgh; Adam Balen MD, DSc, FRCOG Chalmers Sexual and Reproductive Health Service Professor of Reproductive Medicine and Surgery Royal Infirmary of Edinburgh Leeds Teaching Hospitals; Edinburgh, UK The Leeds Centre for Reproductive Medicine Seacroft Hospital Linda Cardozo MD, FRCOG Leeds, UK Professor of Urogynaecology Department of Urogynaecology Phillip Bennett BSc, PhD, MD, FRCOG King’s College Hospital Professor of Obstetrics and Gynaecology London, UK Imperial College London London, UK Aaron B. Caughey MD, MPP, MPH, PhD Professor and Chair Sarah Blagden PhD, FRCP Department of Obstetrics and Gynaecology Senior Lecturer in Medical Oncology Oregon Health & Science University Ovarian Cancer Action Research Centre Portland, OR, USA Imperial College London Hammersmith Campus London, UK Peter Clark BSc, MD, FRCP, FRCPath Consultant Haematologist and Honorary Reader Tom Bourne PhD, FRCOG Department of Transfusion Medicine Consultant Gynaecologist Ninewells Hospital and Medical School Queen Charlotte’s & Chelsea Hospital Dundee, UK Imperial College NHS Trust London, UK Hilary O.D. Critchley BSc, MD, FRCOG, FMedSci MRC Centre for Reproductive Health Janet Brennand MD, FRCOG University of Edinburgh Consultant in Fetal and Maternal Medicine The Queen’s Medical Research Institute Southern General Hospital; Edinburgh, UK Honorary Clinical Senior Lecturer University of Glasgow Glasgow, UK
viii Contributors ix
Maureen Dalton FRCOG, FFFLM, FFSRH Anna Glasier BSc, MD, DSc, FRCOG, FFPHC, OBE Clinical Lead Adviser Peninsula SARCs (Exeter, Plymouth and Honorary Professor Truro) University of Edinburgh Clinical Sciences and Community Consultant Obstetrician and Gyanecologist Health Royal Devon and Exeter Hospital Edinburgh; Exeter, UK School of Hygiene and Tropical Medicine University of London John M. Davison BSc, MD, MSC, FRCOG London, UK Institute of Cellular Medicine Newcastle University Ian A. Greer MD, MFFP, FRCP, FRCOG Newcastle upon Tyne, UK Consultant Obstetrician and Executive Pro-Vice-Chancellor Faculty of Health and Life Sciences Mandish K. Dhanjal BSc, MRCP, FRCOG University of Liverpool Consultant Obstetrician and Gynaecologist Liverpool, UK Honorary Senior Lecturer Queen Charlotte’s & Chelsea Hospital Mark Hamilton MD, FRCOG Imperial College Healthcare NHS Trust Department of Obstetrics and Gynaecology London, UK University of Aberdeen Aberdeen Maternity Hospital Claudine Domoney MBBChir, MRCOG Aberdeen, UK Consultant Obstetrician and Gynaecologist, Chair of the Institute of Psychosexual Medicine Andrew W. Horne PhD, MRCOG Chelsea and Westminster Hospital MRC Centre for Reproductive Health London, UK University of Edinburgh The Queen’s Medical Research Institute Anne Dornhorst DM, FRCPath, FRCP Edinburgh, UK Hammersmith Hospital Imperial College Healthcare NHS Trust Berthold Huppertz PhD London, UK Professor of Cell Biology Institute of Cell Biology, Histology and Embryology Alan Farthing MD, FRCOG Medical University of Graz Consultant Gynaecologist Graz, Austria Imperial College NHS Trust London, UK Davor Jurkovic MD, FRCOG Consultant Gynaecologist Gillian Flett FRCOG, FFSRH, MIPM Pregnancy and Gynaecology Assessment Unit Clinical Lead Sexual Health King’s College Hospital Consultant Sexual and Reproductive Health London, UK Centre for Sexual and Reproductive Health Aberdeen, UK Sean Kehoe MA, MD, DCH, FRCOG, FHEA Lead Gynaecological Oncologist Hani Gabra PhD, FRCP Oxford Gynaecological Cancer Centre Professor of Medical Oncology Churchill Hospital Ovarian Cancer Action Research Centre Oxford, UK Imperial College London Hammersmith Campus London, UK
Jason Gardosi MD, FRCSE, FRCOG Honorary Professor of Maternal and Perinatal Health University of Warwick; Director West Midlands Perinatal Institute Birmingham, UK x Contributors
Stephen Kennedy MA, MD, MRCOG William L. Ledger MA, DPhil, FRCOG, FRANZCOG Professor of Reproductive Medicine and Head of Department Professor and Head of Department of Obstetrics and Nuffield Department of Obstetrics and Gynaecology; Gynaecology Co-Director University of New South Wales Oxford Maternal and Perinatal Health Institute Royal Hospital for Women Green Templeton College Sydney, Australia University of Oxford; Clinical Director Women’s Services Christoph C. Lees MD, MRCOG Oxford Radcliffe Hospitals NHS Trust Consultant in Obstetrics and Fetal–Maternal Medicine The Women’s Centre Lead, Fetal Medicine Oxford, UK The Rosie Hospital Addenbrookes NHS Trust Aradhana Khaund MD, MRCOG Cambridge, UK Locum Consultant in Obstetrics and Gynaecology Department of Obstetrics and Gynaecology Bertie Leigh Hon FRCPCH, FRCOG ad eundem Southern General Hospital Solicitor South Glasgow University Hospitals Senior Partner Hempsons Glasgow, UK Hempsons London, UK Mark D. Kilby MD, FRCOG Professor of Fetal Medicine Fiona M. Lewis MD, FRCP School of Clinical and Experimental Medicine Wexham Park Hospital College of Medical and Dental Sciences Slough, UK; University of Birmingham; St John’s Institute of Dermatology Fetal Medicine Centre St Thomas′ Hospital Birmingham Women’s Foundation Trust London, UK Birmingham, UK Andrés López Bernal MD, DPhil (Oxon) John C.P. Kingdom MD, FRCSC, FRCOG School of Clinical Sciences Department of Obstetrics and Gynecology University of Bristol; Samuel Lunenfeld Research Institute St Michael′s Hospital Mount Sinai Hospital Bristol, UK Toronto, Canada David M. Luesley MA, MD, FRCOG Philippe Koninckx MD, PhD Professor of Gyanecological Oncology Nuffield Department of Obstetrics and Gynaecology University of Birmingham University of Oxford Birmingham, UK Oxford, UK; Department of Obstetrics and Gynecology Mary Ann Lumsden MD, FRCOG University of Leuven Head of Section Leuven, Belgium Reproductive and Maternal Medicine University of Glasgow Sailesh Kumar FRCS, FRCOG, FRANZCOG, DPhil(Oxon), Royal Infirmary CMFM Glasgow, UK Consultant and Senior Lecturer in Fetal Medicine, Obstetrics and Gynaecology Andrew McCarthy FRCOG Queen Charlotte’s & Chelsea Hospital Consultant Obstetrician Imperial College London Imperial College Healthcare London, UK London, UK
Stuart Lavery MBBS, MRCOG Hammersmith Hospital London, UK Contributors xi
Sheila McLean LLB, MLitt, PhD, LLD (Edin), Nick Panay BSc, MRCOG, MFSRH LLD (Abertay, Dundee), FRSE, FRCGP, FBS, FMedSci, Consultant Gynaecologist, Specialist in Reproductive Medicine FRCP (Ed), FRSA Queen Charlotte’s & Chelsea Hospital; Professor of Law and Ethics in Medicine Chelsea and Westminster Hospital Institute of Law and Ethics in Medicine West London Menopause & PMS Centre; University of Glasgow Honorary Senior Lecturer Glasgow, UK Imperial College London London, UK Adam Magos BSc, MB, BS, MD, FRCOG Consultant Gynaecologist/Honorary Senior Lecturer Sara Paterson-Brown FRCS, FRCOG Royal Free Hospital Consultant Obstetrician and Gynaecologist London, UK Clinical Lead for Labour Ward and Maternity Risk Queen Charlotte’s & Chelsea Hospital Imperial College NHS Healthcare Trust Sallie M. Neill FRCP St John’s Institute of Dermatology London, UK St Thomas’s Hospital London, UK Felicity Plaat BA, MBBS, FRCA Consultant Anaesthetist & Honorary Senior Lecturer Queen Charlotte’s & Chelsea Hospital Catherine Nelson-Piercy MA, FRCP, FRCOG Imperial College School of Medicine Consultant Obstetric Physician London, UK Professor of Obstetric Medicine Guy’s and St Thomas’ Foundation Trust Queen Charlotte’s & Chelsea Hospital Siobhan Quenby BSc, MBBS, MD, FRCOG London, UK Professor of Obstetrics Clinical Science Research Institute University of Warwick Jane E. Norman MD, FRCOG Professor of Maternal and Fetal Health University Hospital – Walsgrave Campus MRC Centre for Reproductive Biology Coventry, UK University of Edinburgh The Queen’s Medical Research Centre Dudley Robinson MD, FRCOG Edinburgh, UK Consultant Urogynaecologist/Honorary Senior Lecturer Department of Urogynaecology King’s College Hospital Errol R. Norwitz MD, DPhil (Oxon) Department of Obstetrics London, UK Gynecology and Reproductive Sciences Yale New Haven Hospital Jonathan D.C. Ross MD, FRCP New Haven, CT, USA Professor of Sexual Health and HIV Whittall Street Clinic Birmingham, UK P.M. Shaughn O’Brien DSc, MD, FRCOG Professor of Obstetrics and Gynaecology Keele University School of Medicine Glynn Russell MBChB, FCPSA, FRCP, FRCPCH Stoke on Trent, UK Division of Neonatology Imperial College Healthcare NHS Trust London, UK Dick Oepkes MD, PhD Department of Obstetrics Leiden University Medical Centre Philip Savage PhD, FRCP Leiden, Netherlands Consultant in Medical Oncology Charing Cross Hospital Imperial Hospitals NHS Trust Timothy G. Overton BSc, MRCGP, MD, FRCOG Consultant in Obstetrics and Fetal Medicine London, UK St Michael’s Hospital University Hospitals Bristol NHS Foundation Trust Bristol, UK xii Contributors
Michael Seckl PhD, FRCP Allan Templeton CBE, MD, FRCOG, FRCP, FMedSci Director University of Aberdeen Charing Cross Gestational Trophoblastic Disease Centre and Aberdeen Maternity Hospital Supraregional Tumour Masker Assay Service Aberdeen, UK Charing Cross Hospital Imperial College NHS Healthcare Trust Andrew J. Thompson BSc, MD, MRCOG London, UK Consultant Obstetrician and Gynaecologist Royal Alexandra Hospital Mahmood I. Shafi MB, Bch, MD, DA, FRCOG Paisley, UK Consultant Gynaecological Surgeon and Oncologist Addenbrookes Hospital Geoffrey Trew MBBS, MRCOG Cambridge, UK Hammersmith Hospital London, UK Anthony R.B. Smith MD, FRCOG The Warrell Unit James J. Walker MD, FRCP, FRCOG, FRSM St Mary’s Hospital Department of Obstetrics and Gynaecology Manchester, UK St James’s University Hospital Leeds, UK Gordon C.S. Smith MD, PhD Department of Obstetrics and Gynaecology Jason Waugh BSc (hons), MBBS, DA, MRCOG The Rosie Hospital Consultant Obstetrics and Maternal Medicine Addenbrookes NHS Trust Royal Victoria Infirmary Cambridge, UK Newcastle upon Tyne, UK
Maria C. Smith MD, MRCOG Catherine Williamson MD Senior Lecturer/Consultant Obstetrician Institute of Reproductive and Developmental Biology Reproductive and Vascular Biology Group Imperial College London Institute of Cellular Medicine London, UK Newcastle University Newcastle upon Tyne, UK Ruwan C. Wimalasundera BSc, MBBS, MRCOG Consultant Obstetrician & Lead for Fetal Medicine Catriona M. Stalder MBChB, MRCOG Queen Charlotte’s & Chelsea Hospital Consultant Obstetrician & Gynaecologist Imperial College NHS Healthcare Trust Queen Charlotte’s & Chelsea Hospital London, UK London, UK Sarah Winfield BSc, MBBS, MRCOG Peter Stewart MA (Oxon), BMBCH (Oxon), FRCOG Consultant Obstetrician Royal Hallamshire Hospital Leeds Teaching Hospitals NHS Trust Sheffield, UK Leeds, UK
R. William Stones MD, FRCOG The Puribai Kanji Jamal Professor and Chair Department of Obstetrics and Gynaecology Aga Khan University Nairobi, Kenya Professor Sir John Dewhurst
Professor Sir John Dewhurst died on 1 December 2006. of the Royal College of Obstetricians and Gynaecologists, Jack, as he was known to all his colleagues, was a doyen a post he held for 3 years, for which he was subsequently amongst obstetricians and gynaecologists of the twenti- knighted. He retired in 1986 after a long and distinguished eth century. His reputation was internationally renowned career, but his legacy lives on and he will be remembered and he became a worldwide expert in paediatric and ado- with great affection and professional respect by all who lescent gynaecology, for which he received due accolade. knew him. He was also an outstanding teacher of obstetrics and gynaecology, and, as such, this textbook, which he began Keith Edmonds in the 1970s, is testament to his dedication to the passing December 2011 on of knowledge to others. In 1976 he became President
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