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Obstetrics and Gynecology A. N. Rybalka, V. A. Zabolotnov, I. K. Kamilova, A. N. Sulima, S. S. Anikin, V. V. Litvinov, I. M. Shlapak, S. E. Regushevsky, D. A. Beglitce, Z. S. Rumyanceva, I. A. Khomulenko, N. S. Demidova, O. P. Miklin, G. N. Bagrova OBSTETRICS AND GYNECOLOGY Textbook in 2 volumes Edited by Professor A. N. Rybalka Volume 2 GYNECOLOGY Simferopol 2018 1 2 N. Rybalka, V. A. Zabolotnov, I. K. Kamilova, A. N. Sulima, S. S. Anikin, V. V. Litvinov, I. M. Shlapak, S. E. Regushevsky, D. A. Beglitce, Z. S. Rumyanceva, I. A. Khomulenko, N. S. Demidova, O. P. Miklin, G. N. Bagrova OBSTETRICS AND GYNECOLOGY Textbook in 2 volumes Edited by Professor A. N. Rybalka Simferopol 2018 3 УДК 618.2/7 ББК R 98 Rybalka A. N., Zabolotnov V. A., Kamilova I. K. at al. R 98 Obstetrics and gynecology. Textbook - in 2 vol. Vol. 2 Gynecology. – Simferopol, 2018. – 704 p., 134 pic., 20 +ав. ISBN 978-966-2913-33-0 Annotation The manual on obstetrics and gynecology is designated for English-speaking students of the 5-6 courses of medical higher schools. Short lectures on the main topics of obstetrics and gynecology are presented in the manual. The book acquaints the reader with up-todate notions in etiology, pathogenesis, diagnosis and treatment of gynecological diseases. The book is intended as a handbook on obstetrics and gynecology for the English-speaking students. © A. N. Rybalka, V. A. Zabolotnov, I. K. Kamilova, A. N. Sulima, S. S. Anikin, V. V. Litvinov, I. M. Shlapak, S. E. Regushevsky, D. A. Beglitce, Z. S. Rumyanceva, I. A. Khomulenko, N. S. Demidova, O. P. Miklin, G. N. Bagrova, 2018 4 Volume 2 GYNECOLOGY Recommended by the Scientific Council of the Midical Academy named after S. I. Georfievsky V. I. Vernadsky Crimean Federal University as “Obstetrics and gynecology” textbook in 2 volumes in English for students, internus and doctors of higher medical schools, who study the academic discipline in English 27. 12. 2016 (Protocol №14) 5 Authors: A. N. Rybalka – DM, Professor, Academician, Head of the Department of Obstetrics, Gynecology and Perinatology. V. A. Zabolotnov – DM, Professor, Head of the Department of Obstetrics and Gynecology. I. K. Kamilova – PhD, Associate Professor of the Department of Obstetrics and Gynecology. A. N. Sulima – DM, Professor of the Department of Obstetrics, Gynecology and Perinatology. S. S. Anikin – PhD, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology. V. V. Litvinov – PhD, Chief Physician of the Human Reproduction Clinic “Altra Vita” (LLC “ECO Center”), Moscow. I. M. Shlapak – DM, Professor of the Department of Obstetrics, Gynecology and Perinatology, Chief Physician of the Crimean Republican Clinical Perinatal Center. S. E. Regushevsky – PhD, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology, Chief Obstetrician and Gynecologist of the Ministry of Health of the Crimea, Deputy Chief Republican of Crimean Republication Clinical Perinatal Center. D. A. Beglitce – PhD, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology, Chief Physician of Clinical Maternity №1. Z. S. Rumyanceva – PhD, Associate Professor of the Department of Obstetrics and Gynecology №1. I. A. Khomulenko – PhD, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology. N. S. Demidova – PhD, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology. O. P. Miklin – PhD, Associate Professor of the Department of Obstetrics and Gynecology №1. G. N. Bagrova – PhD, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology. 6 CONVENTS INTRODUCTION. ....................................................................................................... 7 Gynecology as a science. Historical Perspective. Deontological ethic in gynecological practice .............................................................................................. 7 CHAPTER 1. Anatomical and Physiological changes in women in different periods of the life. Puberty ......................................................................................... 11 Puberty stages in girls. ............................................................................................. 15 Menstruation ............................................................................................................. 19 Menopause. ............................................................................................................... 20 CHAPTER 2. Examination of Gynecological Patients ............................................... 23 Clinical breast examination. ..................................................................................... 31 Inspection of external genitalia. ............................................................................... 47 Vaginal smears ......................................................................................................... 56 Tests for evaluation of vaginal ecology ............................................................ 56 Tests for evaluation of endocrine status ............................................................ 61 Tests for evaluation of abnormal (precancerous and cancerous) conditions .... 70 Invasive methods of examination sounding of the uterus ...................................................................................................................... 172 Histological investigations. Cervical biopsy. ......................................................... 174 CHAPTER 3. Congenital anomalies and displacements of the female genitalia .... 186 CHAPTER 4. Inflammaory diseases of the female genitalia ......................................................................................................... 203 Sexually transmitted pelvic inflammatory diseases. .............................................. 236 CHAPTER 5. Neurohumoral control of the menstrual cycle .......................................................................................................... 253 CHAPTER 6. Menstrual disorders ............................................................................ 270 CHAPTER 7. Neuroendocrinal syndromes in gynecology ............................................................................................................... 299 7 CHAPTER 8. The infertile couple ............................................................................ 322 CHAPTER 9. Contraception ..................................................................................... 332 CHAPTER 10. Typical operations in gynecology .................................................... 354 CHAPTER 11. Acute abdomen in gynecologic practice .......................................... 435 CHAPTER 12. Injuries of the female genital tract.................................................... 452 CHAPTER 13. Myoma of the uterus. Endometriosis. Sarcoma of the uterus .......... 470 CHAPTER 14. Breast diseases .................................................................................. 500 CHAPTER 15. Premalignant diseases of the vulva and vagina. Cancer and sarcoma of the vulva and vagina .............................................................................. 519 CHAPTER 16. Background processen and premalignant lesions of cervix. Cervical cancer ......................................................................................................... 545 CHAPTER 17. Premalignant diseases of the endometrium. Cancer of the uterus. Sarcoma of the uterus ................................................................................................ 573 CHAPTER 18. Cysts of the ovary. Ovarian tumors ................................................. 589 CHAPTER 19. Cancer of the fallopian tubes ........................................................... 605 CHAPTER 20. Trophoblastic diseases .................................................................... 609 CHAPTER 21. Gynecological diseases in childhood and adolescence .................... 617 CHAPTER 22. Female dispensary – prophylactic medical examination of gynecological patients .............................................................................................. 635 CHAPTER 23. Hygienic regimen in female ............................................................. 640 CHAPTER 24. Urinary tract diseases in female ....................................................... 647 CHAPTER 25. Appendices ....................................................................................... 681 Appendix 1. Tests 1. ............................................................................................... 681 8 PART II. GYNAECOLOGY INTRODUCTION Gynecology as a science. Historical Perspective Gynaecology (British) or gynecology (North American) literally means 'the science of women', - “the science of womankind” (Oxford Dictionary);“the medical specialty concerned with diseases of the female genital tract as well as endocrinology and reproductive physiology of the female”(Stedman Dictionary). Almost all modern gynecologists are also obstetricians. Gynecology is a typically consultant specialty. In most countries, women must see a general practitioner first. If their condition requires knowledge or equipment unavailable to the general practitioner, they are referred to a gynecologist. However, in many countries law and many health insurance plans allow gynecologists to provide primary care and some women select that option. Clinical history and examination generally accepted in medicine are the main tools of diagnosis
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