Abdominal Pregnancy, 81 Abortion Epidemiology, 121 Legal/Social

Cambridge University Press 978-0-521-86248-6 - Operative Obstetrics, Second Edition Edited by John P. O’Grady and Martin L. Gimovsky Index More information

Index

abdominal pregnancy, 81 vs. curettage, 129 abortion Laminaria insertion/removal, 129–131 epidemiology, 121 misoprostol technique, 131 legal/social issues, 141. See also abortion, legal operative procedure, 131–132 considerations/decisions. postoperative procedures/treatment, 132 abortion, complications preoperative medications, 131 continued pregnancy, 140 with ultrasound, 129 hematometrium, 139 hysterotomy/hysterectomy, 133 hemorrhage, 138–139 instillation methods, 132–133 infection, 137 menstrual extraction psychological distress, 139–140 arguments against, 129 retained uterine products, 137–138 operative procedure, 128–129 uterine perforation, 135–137 preoperative evaluation abortion, legal considerations/decisions gestational age assessment, 121 Harris v. McRae, 867 medical/surgical history, 121–122 informed consent, 187–188 patient counseling, 121, 122–123 Maher v. Roe, 867 vacuum curettage Martinez v. Long Island Jewish Hillside Medical cervical clamping, 126 Center, 187–188 dilation, 124, 126–127 patient rights, 186 instrument/equipment review, 123 Perez v. Park Madison Professional Laboratories, instrument sterilization procedures, 124 Inc., 187–188 interpersonal skills of practitioner, 123 Planned Parenthood v. Casey, 867–868 local anesthesia, 124 primary considerations, 188 operative procedure, 127 Roe v. Wade, 866–867 paracervical blockade, 124 Sheppard-Mobley v. King, 187 pelvic examination, 123 Stenberg. v. Carhart, 868 postoperative procedures/treatment, 127–128 wrongful pregnancy, 186–187 pretreatment medications, 123–124 abortion, medical methods sedation during, 124–126 ancient/botanical techniques, 133 abruptio placentae. See placental abruption. methotrexate compound, 135 acardiac twins, 332 mifepristone (RU 486), 133–134 ACNM (American College of Nurse-Midwives), postcoital contraception, 140–141 788 prostaglandin compounds, 134–135 acute dermal gangrene. See necrotizing fasciitis (NF). abortion, surgical procedures AFE. See amniotic ﬂuid embolism (AFE). dilation and evacuation (D & E), AFI. See amniotic ﬂuid index (AFI).

889

© Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-86248-6 - Operative Obstetrics, Second Edition Edited by John P. O’Grady and Martin L. Gimovsky Index More information

890 INDEX

alcohol abuse, 201. See also illicit drugs/alcohol. appendicitis. See under surgery in pregnancy, surgical alfentanil, 195–196 complications. alloimmune thrombocytopenia (ATTP). See APS. See antiphospholipid syndrome (APS). thrombocytopenia (TTP). aspirin, low-dose, 200 American College of Nurse-Midwives (ACNM), assisted reproductive technology (ART), 322 788 asynclitism, 486 amniocentesis ATP (autoimmune thrombocytopenia purpura). complications See thrombocytopenia (TTP). accidental fetal needling, 28–29 atracurium, 198 amniotic fluid discoloration, 28 ATTP (alloimmune thrombocytopenia), 532–533. See also blood-tinged amniotic fluid, 27 thrombocytopenia (TTP). gestational age, 26 autoimmune thrombocytopenia purpura (ATP). MSAFP elevation, 27 See thrombocytopenia (TTP). maternal age, 26 maternal infection, 28 B-hCG measurement, 74–75 neonate orthopedic disorder risk, 29 B-Lynch suture (Brace suture), 278 neonate respiratory risk, 29 Baudelocque, Jean Louis, 258 study design/evaluation, 26 Benedetti, T. J., 274–275 vaginal leakage/spotting, 28 benign cystic teratomas, 438. . See also ovarian tumors. vs. CVS safety, 32–33 Bernhardt-Roth syndrome (meralgia paresthetica), early procedures, 32 770–771 laboratory problems, 35–36 biophysical profile (BPP) in multiple gestation, 34 in intrapartum period, 51 transabdominal procedure predictive parameters, 50–51 fluid sample collection, 25 score interpretation, 51 needle gauge/length, 25 uses of, 50 patient instructions, 25–26 birth injuries preparation for, 25 development disorders and adult disease, 767–768 successful/unsuccessful attempts, 26 etiology of, 725–726 ultrasonography benefits, 28 grief and mourning, perinatal, 769 amniotic fluid embolism (AFE) trauma, blunt abdominal causes of death, 737 fetal risks, 768 clinical symptoms, acute, 737–738 incidence of, 768 diagnosis, 738–739 maternal/fetal assessment, 769 etiology, 736 maternal resuscitation, 768 incidence of, 736–737 motor vehicle accidents/safety, 768–769 morbidity/mortality, 736, 738 birth injuries, fetal pathophysiology, 736 castration, accidental, 754 treatment, 738, 739 cephalohematoma, 745–746 amniotic fluid index (AFI) environmental risks/exposures, 765–767 AFI/MVP accuracy comparison, 49 eye injuries, 749–750 obtainment method, 49 facial nerve palsy, 753–754 oligohydramnios thresholds, 49–50 fetal infection, 758–759 polyhydramnios thresholds, 50 fractures, long bones volume as assessment tool, 48–49 in breech/cephalic presentations, 750 volume/perinatal outcome relationship, 49 clavicle fracture, 751 amphetamines, 201 congenital abnormalities, 750 Amsterdam Surgeon’s Guild, 13–14 diagnosis, 750 anesthesia, obstetric. See obstetric anesthesia. elective fracture, 750 anticholinergics, 199 family counseling, 750–751 antiphospholipid syndrome (APS), 875. See also venous incidence/etiology, 750 thrombosis (VT). treatment/therapy, 750 aortic stenosis head and neck injuries, 743 future role, 655 intracranial hemorrhages morbidity/mortality, 654–655 clinical associations, 759, 761 pathophysiology, 654 clinical indicators, 760–761 in restrictive atrial septum, 655 incidence of, 759 in utero aortic valvuloplasty, 655 intracranial bleeding, types of, 759

Index 891

periventricular hemorrhage, 759 incidence of, 751–752 subarachnoid bleeding, 759–760 treatment, 752–753 treatment, 761 subgaleal/subaponeurotic hemorrhage nerve injury diagnosis, 747 femoral neuropathy, 771–773 incidence of, 747 iatrogenic surgical risk factors, 769 morbidity/mortality, 748 incidence of, 769 pathology, 746–747 isolated, 754 prevention of, 747 lumbosacral palsy, 773–774 treatment, 747–748 meralgia paresthetica, 770–771 visceral injuries postoperative/postpartum paralysis (POP), in instrumental delivery, 754 769–770 intra-abdominal organs, 758 upper extremities, 774 subcutaneous fat neurosis, 758 overview, 743 birth injuries, in clinical settings perineal injuries, 754 cesarean delivery 727. See also cesarean delivery terms.. permanent neurologic injury dystocia/macrosomia, 727–728. See also cerebral circulation vulnerability, 763 macrosomia; shoulder dystocia terms. cerebral palsy, 762 fetal monitoring, 729–730. See also fetal monitoring clinical indicators, 762–763 terms. EFM, role of, 763–765 instrumental delivery, 728–729. See also instrumental etiology, 761 delivery terms. hypoxic ischemic encephalopathy, 762 overview, 725–726 incidence of, 762 birth injuries, maternal. mental retardation, 762 See also episiotomy/extensions neonatal encephalopathy, 761–762 amniotic fluid embolism (AFE). pathology, 763 causes of death, 737 terminology, 761 clinical symptoms, acute, 737–738 treatment/therapies, 763 diagnosis, 738–739 retinal hemorrhage, 754–755 etiology, 736 scalp injuries, minor, 743–745 incidence of, 736–737 shoulder dystocia. See also macrosomia; shoulder morbidity/mortality, 736, 738 dystocia terms; shoulder impaction. pathophysiology, 736 brachial plexus injuries, 756 treatment, 738, 739 cesarean delivery, 758 coccygodynia clinical observations of, 755 coccyx anatomy, 741 fetal macrosomia, 757 diagnosis, 741–742 fetopelvic relationship, 758 etiology/symptoms, 741 incidence of, 755 treatment, 742 morbidity/mortality, 755–756 infection, 733 prediction of, 757 medical errors pseudo-Erb palsy, 756 crew resource management, 743 recovery, 756–757 medication errors, 743 treatment/management, 756, 757 patient/surgical site identification, 742–743 Weigart palsy, 350, 756 study findings, 742 skull/facial fractures pelvic relaxation syndrome cranial plasticity, 748 anatomy of, 739–740 dental defects, 749 chronic pelvic joint pain, 740 depressed fractures, 748 diagnosis, 740 diagnosis, 748–749 etiology, 739 identification of, 748 osteomyelitis, 741 leptomeningeal cysts, 749 symphysis rupture/division, 740–741 nasal injuries, 749 symptoms, 740 occipital osteodiastasis, 749 treatment, 740 treatment/management, 749 urinary tract infection (UTI), 733–734 spinal cord injuries uterine atony/inversion, 735–736. See also uterine cranial hyperextension, 752 atony; uterine inversion. . uterine infection, 734. diagnosis, 751 uterine rupture, 734–735. vaginal/cervical experimental/simulation findings, 752 lacerations, 732–733

892 INDEX

bladder injury/management breech presentation, labor and delivery management bladder injuries, 622 anesthesia support, 313 bladder repair, 622–623 cesarean delivery, elective, 312 vesicocervical/vesicouterine fistula repair, 624 current practice, 313–314 vesicovaginal fistula repair, 623–624 delivery room equipment, 313 BPP. See biophysical profile (BPP). pediatric support, 313 Brace suture (B-Lynch suture), 278 personnel requirements, 313 brachial plexus trial of labor (TOL) anatomy of, 350 dilation/descent, 309–310 injury classifications fetal acidosis, 309 Erb’s palsy, 350 fetal outcome, 312 Horner’s syndrome, 350 imminent delivery, 310–311 Klumpke palsy, 350 low-birthweight fetus, 312 Weigart palsy, 350, 756 maternal evaluation, 309 injury occurrence, 350–351, 355–356 progression of labor, 309 brachial plexus injuries, 314–315. See also shoulder umbilicus appearance, 312 impaction. vaginal delivery, 311–312 brachial plexus palsy, 349–351, 356–357. . See also breech presentation, outcomes shoulder dystocia terms; shoulder impaction. preterm infants Bracht maneuver, 303. . See also breech presentation, cesarean vs. vaginal delivery, 316 delivery techniques. delivery risk factors, 315 Brandt-Andrews maneuver, 218, 260–261 external cephalic version, 315–316 breech presentation VLBW/low-birthweight infants, 316 adverse outcomes, 297 term infants cesarean indications, 297–299 bony injury/nerve damage, 315 cesarean vs. vaginal delivery, 317 brachial plexus injuries, 314–315 definitions/types of, 300 cerebral palsy, 314 fetal/maternal risk balance, 299 cesarean delivery, 315 incidence of, 297 congenital abnormalities, 314 labor, mechanisms of, 300–301 ECV-related injuries, 315 low-birth weight fetuses, 299 resuscitation at delivery, 315 operative delivery rate, 299 traumatic injury, 314 patient counseling, 316–317 worldwide study results, 315 residency education, 317 bupivacaine, 195, 198 risk factors, 297, 298 fentanyl combination therapy, 204 trial of labor, 299–300 in postoperative pain management, 218 vaginal delivery, pre-modern, 297 butorphanol, 196, 212 breech presentation, delivery techniques aftercoming head delivery Caesar, Gaius Julius, 3 Kristellar maneuver, 303 castration, accidental, 754 Mauriceau-Smellie-Viet (MSV) maneuver, 303 CCAMs (congenital cystic adenomatotic malformations), Naujok’s maneuver, 303 648–650 Prague maneuver, 303–304 CDH. See congenital diaphragmatic hernia (CDH). Wigand-Martin-Winkle maneuver, 303 cephalohematoma, 745–746 approaches, type of, 301 cephalopelvic disproportion (CPD), 245, 246, 463–464 assisted breech delivery cerclage. See cervical cerclage; cervical insufficiency; Bracht maneuver, 303 cervicoisthmic cerclage (TACIC). fetal position, 301 cerebral palsy (CP), 314, 323–324, 762 Loveset maneuver, 301–303 cervical cerclage. . See also cervical insufficiency; breech extraction cervicoisthmic cerclage (TACIC). partial breech extraction, 304–305 efficacy of, 92–93 total breech extraction, 304 epidemiology, 92–93 cesarean delivery, 306 cervical incompetence. See cervical insufficiency. external cephalic version, 307, 312–313 cervical insufficiency forceps in, 305 acquired cervical lesions internal podalic version, 306–307 conization, 91 selective trial of labor, 308 lacerations, 91 spontaneous breech delivery, 305–306 cerclage operations

Index 893

incidence of, 92 transabdominal approach, 105–107 indications, 111 transvaginal approach, 107 intraoperative complications, 95–96 cesarean delivery intrauterine infections, 95–96, 102 delivery rate membrane rupture, 96, 102–103 international comparisons, 510–511 postoperative complications, 95, 96 vaginal delivery effects on, 512–513 postoperative treatment, 96–97 documentation, 564 surgical technique, 108–111 epidural anesthesia. See obstetric anesthesia. congenital factors, 91 morbidity reduction, 567–568 diagnosis cesarean delivery, and VBAC trial obstetric history, 93 epidural analgesia/anesthesia, use of, 537 sonography, 94–95 fetal macrosomia, 537 techniques for, 93–94 issues of concern, summarized, 533 epidemiology, 92 management, 537 historical observations/procedures, 90 morbidity/mortality, 533 nonsurgical treatment, 111 multiple prior cesareans, 536–537 pathophysiology, 90–91 twins and breech position, 537 pessary insertion, 111 uterine exploration, 536 preterm delivery risk, 89–90 uterine scar separation sonography clinical consequence, 535 endovaginal, 94 clinical risk, 535 significance of, 94–95 dehiscence vs. rupture, 533–534 transperineal/transvaginal, 94 literature review/data interpretation, 534 Valsava maneuver, 94 maternal morbidity, 535 surgical procedures oxytocin stimulation, 534–535 cervicoisthmic cerclage (TACIC), 104–107 patient counseling, 535 classifications of, 97 repeat rupture, 535 elective cerclage, 97, 99 uterine rupture, 535–536 emergency cerclage, 98–99, 100–101 cesarean delivery, associated risk factors McDonald cerclage, 101–102, 103–104 breech presentation, 512 Shirodkar cerclage, 101–102, 103 demographic factors and tocolytic therapy, 102 maternal age, 512 Trendelenburg’s positioning, 102 medicolegal environment, 512 urgent cerclage, 97 socioeconomic factors, 512 transcervical cerclage dystocia, 511. See also shoulder dystocia terms. Lash operation, 107 electronic fetal monitoring, 511–512 Mann cerclage, 107 repeat procedures, 511 Page “wrapping” technique, 107 cesarean delivery, complications trachelorrhaphy, 107 fetal injury, 566–567 Wurm technique, 107–108 general/frequent complications, 564 cervical intraepithelial neoplasia (CIN) management of, 564–565 biopsy, 425 wound disruption, 565–566 colposcopy, 424–425 cesarean delivery, elective procedures cytopathology, 424 controversy of, 539, 540 risk factors, 424 indications for, 538–539 treatment, 425 morbidity/mortality, 540 cervical length assessment. See ultrasound, cervical obstetrician opinion survey results, 539–540 length assessment. operative delivery rates, 538, 539 cervical malignancy timing of, 537–538 classification/staging, 426–427 cesarean delivery, fetal indications. diagnosis, 425–426 See also thrombocytopenia (TTP). epidemiology, 425 abnormal presentation, 522 management, 427–428 fetal anomalies, 522–523 pathology, 426 fetal compromise, suspicion of, 522–523 prognosis, 428 fetal macrosomia, 530–531 cervical pregnancy, 83 hepatitis C virus (HCV) cervicoisthmic cerclage (TACIC) chronicity, 529 laparoscopic approach, 107 incidence/seroprevalence, 528–529

894 INDEX

cesarean delivery (Contd.) cranial delivery difficulty, 553 indications, 528 fetal monitoring, 545–546 interferon/ribavirin therapy, 529–530 general preparation, 545 obstetric management, 529 incision perinatal transmission, 529 abdominal wall entry, 547–548 spontaneous cure rates, 529 in breech presentation, 551–552 types, 528 fascia exposure/separation, 548 herpes simplex virus (HSV) gutter packing, 549 and AIDS/HIV, 525 for morbidly obese patients, 547 asymptomatic carriers, 525 myometrial incision, 551 diagnosis, 525 peritoneal entry, 549 fetal infection, 524–525 rectus muscle division, 548–549 incidence of, 524 retractors, use of, 549 management, 525 severed uterine arteries, 553 STD screening, 525 in transverse lie, 552–553 human immunodeficiency virus (HIV) transverse vs. vertical incisions, 546–547 antiretroviral therapy, 526–527 uterine entry, 549–551 management/treatment, 527–528 vesicouterine reflection identification, 549 pathology, 526 myometrial wound closure, 555–556 perinatal transmission, 527 peritoneal closure prevalence, 526 adhesion formation, 561–562, 563–564 multiple gestation, 530 adhesion prevention, 562 cesarean delivery, history of, 509 closure/nonclosure debate, 560–561, 564 cesarean delivery, maternal indications. patient outcomes, 563 See also thrombocytopenia (TTP). physiology, 561–562 birth canal obstruction, 517–518 study findings/limitations, 562–563, 564 cerebral aneurysm/arteriovenous placental delivery, 555 malformation, 519 skin preparation, 546 cervical cancer, 518–519 uterine closure, 556–557 combined indications, 522 cesarean delivery, perimortem connective tissue disorders ethical issues, 544 Ehlers-Danlos syndrome (EDS), 520–521 fetal outcome/survival, 541 Marfan’s syndrome, 519–520 gestational age assessment, 542–543 hypertension, 521 history of, 541 informed consent, 522 legal issues, 544 pelvic malformations, 521 maternal resuscitation, 541, 543 placenta accreta/increta/percreta, 516 surgical procedures, 543–544 placenta previa, 513–516 cesareanhysterectomy. See also hemorrhage, operations for. vaginal surgery, prior, 519 history of, 9–10 vasa previa, 517 indications, 568–569 cesarean delivery, operative procedure. procedure See also symphysiotomy. cervix removal, 570, 571 abdominal-pelvic exploration closure, 571–572 abdominal wall closure, 558–559 complications, 572 adnexal examination, 557–558 hemorrhage control, 569, 570–571 appendix delivery, 558 hysterectomy technique, 569–570 Camper’s fascia closure, 560 incision, 569 drains/drainage, 558 cesarean, term derivation fascia closure, 559 Caesar myth, 3 lavage/irrigation, 558 current usage, 4 myometrial wound closure, 558 Latin roots, 3 skin closure, 560 from legal responses, 3 subcutaneous tissue closure, 560 in medical literature, 3 vesicouterine fold closure, 558 “section” linkage, 3–4 additional procedures. See tubal ligation. Chamberlen forceps, 12–14, 15 alternative technique, 567 chloroprocaine, 198 anesthesia, 544–545. See also obstetric anesthesia. choriocarcinoma, 439. . See also gestational trophoblastic auto stapler, 557 disease; ovarian tumors .

Index 895

chorionic villus sampling (CVS) cranial deflection correction, 485–486 vs. amniocentesis, 30–31, 32–33 Crede´ method, 261 complications CSE. See combined spinal/epidural (CSE analgesia). general, 31 CVS. See chorionic villus sampling (CVS). limb anomalies, 31, 32 oromandibular-limb hypogenesis, 32 death. See perinatal loss. transverse limb reduction defects (TLRD), 32 deep vein thrombosis (DVT). See under surgery in contraindications, 30 pregnancy, systemic complications. efficacy of, 30 DeLee, Joseph Bolivar, 17–18 gestational restrictions to, 30 DES (diethylstilbestrol), 91 laboratory problems, 35–36 desflurane, 197 maternal cell contamination (MCC), 30–31 diazepam, 195 mosaicism, 30–31 dichorionic-diamniotic placenta, 325. . See also multiple specimen assessment, 30 gestation, physiology of. study design/evaluation, 31 diethylstilbestrol (DES), 91 transabdominal biopsy (TA-CVS) Doppler, Christian, 51. . See also ultrasound, Doppler. single-needle technique, 30 DVT (deep vein thrombosis). See under surgery in two-needle technique, 29–30 pregnancy, systemic complications. transcervical biopsy (TC-CVS) dysgerminoma, 438–439. . See also ovarian tumors. procedure, 29 ultrasonic assessment, 29 eclampsia. See preeclampsia/eclampsia. chromosomal aneuploidy, 33–34 ectopic pregnancy cimetidine, 195, 200 diagnosis CIN. See cervical intraepithelial neoplasia (CIN). differential, 76 clinical pelvimetry empiric treatment, 77 as controversial technique, 241–242 hormonal assays, 74–75 limitations, 242–243 surgical, 76–77 measurement techniques, 242 symptoms, 74 use/utility of, 242, 243 epidemiology, 69–70 clonidine, 196 future detection/management directions, 84 coagulopathy, in neuraxial procedures, 211 future fertility, 78–80 cocaine, 200–201. . See also illicit drugs/alcohol maternal mortality, 70 coccygodynia vs. normal pregnancy, 69 coccyx anatomy, 741 pathophysiology diagnosis, 741–742 extrauterine, 73 etiology/symptoms, 741 tubal, 70–71 treatment, 742 Rh prophylaxis, 83–84 combined spinal/epidural (CSE) analgesia risk factors duration, 214 age, 73 vs. epidural anesthesia, 214 contraception, 72 vs. general anesthesia, 214 ectopic pregnancy, prior, 72, 77 in labor pain management, 210–211 infertility/infertility treatment, 73, 77 sequential CSE, 214–215 maternal DES exposure, 73 computed tomography (CT) scan, in labor, 243 pelvic inflammatory disease (PID), 71–72 congenital cystic adenomatotic malformations smoking, 73 (CCAMs), 648–650 surgical sterilization, 72 congenital diaphragmatic hernia (CDH) tubal surgery, prior, 72–73 clinical outcomes, 652–653 surgical diagnosis EXIT-to-ECMO intervention, 653 approaches, 76 morbidity/mortality, 652 frozen section analysis, 76 open diaphragmatic repair, 652 laparoscopy, 77 tracheal occlusion, 652, 653 pipelle biopsy, 76–77 continuous quality improvement (CQI), 220–221 surgical management Coombs’ test, 28 prophylactic methotrexate, 78 corticosteroids, antenatal, 337 salpingectomy, 78 Couvelaire uterus, 170 salpingostomy, 77–78 CP (cerebral palsy), 314, 323–324, 762 transvaginal ultrasound CPD (cephalopelvic disproportion), 245, 246, 463–464 B-hCG levels, 75, 76

896 INDEX

ectopic pregnancy (Contd.) rectal dysfunction/incontinence issues, diagnostic accuracy, 75–76 repair techniques, 730–731 gestational sac observation, 75 supporting studies/claims, 270–272 vs. transabdominal approach, 75 timing of, 271 treatment episiotomy repair, 265, 266–268. . See also abdominal pregnancy, 81 perineal/periurethral injuries. cervical pregnancy, 83 epithelial cell tumors, 438. See also ovarian tumors. expectant management, 81 Erb’s palsy, 350 heterotopic pregnancy, 81 ergometrine, 263–264 interstitial (cornual) pregnancy, 83 ergot derivatives, 264 medical management, 80–81 ethical issues ovarian pregnancy, 81 fetal viability, 811 surgical management, 77–80 general agreements/maxims, 810–811, 817–818 uncommon types legalistic solutions, avoidance of, 817 abdominal, 81 physician–patient relationship, 814, 817 cervical, 83 prenatal testing, 814. See also prenatal genetic testing. heterotopic, 81 social/racial inequality, 811 interstitial (cornual), 83 ethical issues, elective termination ovarian, 81 characteristic selection, 813–814 ECV. See external cephalic version (ECV). congenital abnormalities in, 811–813 education/certification. See medical simulations. maternal/fetal interests, 813 EFM (electronic fetal heart rate monitoring), 683–684. See selective reduction, 814 also fetal monitoring terms. ethical issues, second/third trimesters Ehlers-Danlos syndrome (EDS), 520–521 ethical parallels, 817 Elliot, George T., 17 fetal status, uncertainty of, 816–817 embryonal carcinomas, 439. See also ovarian tumors. informed consent, 816 Emergency Medical Treatment and Labor Act (EMTALA) physician obligations rules. See under legal principles. in detrimental maternal behavior, 815–816 endoanal examination, 62 in experimental procedures, 815 endodermal sinus tumors, 439. See also ovarian tumors. in maternal/fetal conflict, 814–815 endometrial carcinoma risk assessment, 814 epidemiology, 431 etomidate, 197 management, 431–432 EXIT (ex utero intrapartum treatment) procedure, pathology, 431 646–648, 653 prognosis, 432 external cephalic version (ECV), 299–300, 307, 312–313. endometriosis, 734 See also breech presentation. enflurane, 197, 200 ephedrine, 198, 199, 201 facial nerve palsy, 753–754 epidural analgesic technique. failure to progress (FTP), 245 See also labor pain management; obstetric anesthesia. fallopian tube disease catheter dislodgment/malposition, 206 diagnosis, 440 catheter placement, 205 incidence, 440 delivery management, 207–208 management, 440–441 dosing pathology, 440 loading, 205 staging, 440 maintenance, 205–206, 207 fentanyl subdural erosion, 206 bupivacaine combination therapy, 204 subdural injection, 205–206 for hypoxia/apnea, 195 epinephrine, 198, 201, 204 in postoperative pain management, 218 episiotomy/extensions in systemic analgesia, 195, 212 adverse effects, 731 fetal birth injuries. See birth injuries, fetal. complications, long-term, 731 fetal fibronectin (FFN) test, 249 elective perineal incision, 731 fetal monitoring historic advocacy/acceptance, 269–270 electronic fetal heart rate monitoring (EFM), injury reduction claims, 730 683–684 injury risks, 730 intrapartum surveillance techniques, 683 lacerations, occurrence of, 270 pulse oximetry, 713 perineal lacerations, 271 standard maneuvers, 713–714

Index 897

fetal monitoring, deceleration recovery fetal occiput position baseline rate/variability, return to, 701 digital examination for, 57–58 contraction frequency control, 702 identifying landmarks, 58 deceleration severity classification, 701 as labor management tool, 56–57 EFM tracing, reading of, 701–702 malposition/malrotation, 58 fetal distress transvaginal examination, 58 agonal pattern, 702–703 fetal position assessment. See ultrasound, fetal pattern of injury, 702 position assessment. fetal monitoring, heart rate patterns fetal status assessment. See ultrasound, fetal status fetal deterioration from hypoxia assessment late decelerations, 697–699 fetal surgery pattern of decelerations, 693–697 fetal ethics. recurrent decelerations, 701 See also ethical issues terms. variable/prolonged decelerations, 699–701 informed consent, 639–640 fetal deterioration without hypoxia, 692–693 maternal-fetal conflicts, 638–639 fetal well-being estimation, 693–697 maternal safety, 639, 640 long-term neurologic outcome, 709–710 preoperative diagnosis, 640–641 neuroradiological studies, 710 fetal surgery, established applications fetal monitoring, intervention timing airway obstruction pattern assessment, 715 causes/diagnosis, 646 pattern progression, 714 EXIT procedure, 646–648 prevention vs. rescue role, 714–715 bladder outlet obstruction fetal monitoring, neurologic injury diagnosis diagnosis, 651 FHR patterns, use of, 710 indications, 651–652 hypoxic/ischemic episode, 711–713 procedures, 652 injury severity, 710–711 sacrococcygeal teratomas (SCT), 650–651 fetal monitoring, physiological principles thoracic anomalies baseline heart rate, 687 congenital cystic adenomatotic malformations FHR pattern influences, 686 (CCAMs), 648–650 tachycardia/bradycardia hydrothoraces, 648 basal vs. baseline rates, 687 twin-reversed arterial perfusion (TRAP) sequence, 646 baseline variability measurement, 689 twin-twin transfusion syndrome (TTTS) contributing factors, 687 alternative interventions, 645–646 development speed of, 687–688 amnioreduction, 645 diagnosis, 690 fetoscopic laser ablation, 645 irregular fluctuations, 688–689 mortality/morbidity, 645 saltatory/jumping patterns, 690–691 pathophysiology, 645 servocontrol mechanisms, 689 fetal surgery, experimental applications. See aortic stenosis; variability, causes of, 689–690 congenital diaphragmatic hernia (CDH); fetal monitoring, second stage of labor myelomeningocele (MMC). complications/risks, 705 fetal surgery, general operative approaches decelerations, frequency of, 703 challenging factors, 641 excessive uterine activity, 704–705 fetoscopic surgery fetal blood sampling advantages/disadvantages of, 644 technique, 708–709 development of, 643 tissue pH maintenance, 708 preoperative preparation, 643 maternal pushing strategies, 703–704 specialist roles, 643 nomenclature issues, 705–706 surgical procedures, 643 tracing abnormalities, 706–708 open fetal surgery fetal monitoring, surveillance methods postoperative activity, 642–643 vs. adult coronary care systems, 686 preoperative preparation, 641 contraction effects specialist roles, 641 fetal stimulation, 686 surgical procedure, 641–642 on uterine blood flow (UBF), 685–686 percutaneous approaches, 644–645 EFM functions fetoscopy, 159 heart rate measurements, 685 fetus papyraceus, 330–331 uterine contraction measurements, 685 FFN (fetal fibronectin) test, 249 intermittent auscultations (IA), 684–685 fibroids. See leiomyomata.

898 INDEX

fibroleiomyomas. See leiomyomata. hemolytic streptococcal gangrene. See necrotizing fibromyomas. See leiomyomata. fasciitis (NF). fluorescent in situ hybridization (FISH), 25–37 hemorrhage. See hemorrhage, operations for; intracranial forceps, historic hemorrhages; massive hemorrhage; postpartum axis-traction, 17 hemorrhage (PPH); subgaleal/subaponeurotic Chamberlen, 12–14 hemorrhage. destructive vs. atraumatic instruments, 11–12 hemorrhage, operations for development/modifications, 11, 15, 18 angiographic embolization Elliot’s, 17 advantages/disadvantages of, 581 Palfyn instrument, 14–15 complications, 581 prophylactic forceps operation, 17–18 indications, 580–581 rotational maneuvers, 17 procedure, 581 Simpson’s, 17 balloon tamponade, 581–582 solid-bladed, 17 hypogastric vessel ligation term derivation, 11 complications, 579–580 van Roonhuysian instrument(s), 13–14 indications, 579, 580 Fournier gangrene. See necrotizing fasciitis (NF). pelvic circulation effects, 580 Freud, Sigmund, 821 problems following, 580 FTP (failure to progress), 245 procedure, 579 incidence/risk factors, 572–573 Gainey, H. L., 270–271 initial management, 572 gallbladder disease. See under surgery in pregnancy, maternal resuscitation, 573 surgical complications. principal surgical procedures, 573 gas gangrene, 289. See also necrotizing fasciitis (NF). uterine artery ligation (O’Leary technique) genetic disease advantages of, 575 clinician/obstetrician role, 23 B-Lynch sutures, 576–577 financial/social impacts, 22–23 complications, 574–575 identification advances, 23 compression techniques, 575 medical importance, 22 drains/drainage, 578 genital herpes. See herpes simplex virus (HSV). extent of bleeding, judgment of, 577–578 germ cell tumors, 438. See also ovarian tumors. oversewing techniques, 577 gestational thrombocytopenia (GTP), 532 packing techniques, 575–576 gestational trophoblastic disease postoperative management, 578–579 classification/staging, 418–419 procedure, 573–574 diagnosis, 417–418 heparin, 402–403, 404–405 epidemiology, 416 hepatitis C virus (HCV) historic recognition of, 416 chronicity, 529 management incidence/seroprevalence, 528–529 follow-up, 422 indications, 528 high-risk metastatic tumors, 421–422 interferon/ribavirin therapy, 529–530 nonmetastatic/low-risk metastatic disease, 419–421 obstetric management, 529 morbidity/mortality, 416–417 perinatal transmission, 529 pathology, 416–417 spontaneous cure rates, 529 gestational trophoblastic neoplasia. See gestational types, 528 trophoblastic disease. herpes simplex virus (HSV) glycopyrrolate, 195 and AIDS/HIV, 525 gonadal stromal tumors, 439–440. See also ovarian tumors. asymptomatic carriers, 525 granulosa cell tumors, 439–440. See also ovarian tumors. diagnosis, 525 Greenfield filter, 405 fetal infection, 524–525 grief. See perinatal loss. incidence of, 524 GTP (gestational thrombocytopenia), 532. See also management, 525 thrombocytopenia (TTP). STD screening, 525 Guillemeau, Jacques, 4 heterokaryotypia, 332 Haas maneuver, 490 heterotopic pregnancy, 81 Hale forceps, 471 HIE (hypoxic ischemic encephalopathy), 762 halothane, 197, 199, 200, 201 high-order multiple gestation (HOM), 340 Haultain operation, 283 history. See obstetric history. HCV. See hepatitis C virus (HCV). HIV. See human immunodeficiency virus (HIV).

Index 899

HOM (high-order multiple gestation), 340 digital examination errors, 465–466 Horner’s syndrome, 350 documentation, 467 hospital gangrene. See necrotizing fasciitis (NF). pelvic adequacy evaluation HSV. See herpes simplex virus (HSV). abdominal examination, 464 human immunodeficiency virus (HIV) cephalopelvic disproportion, 463–464 antiretroviral therapy, 526–527 fetal malpositioning, 463 management/treatment, 527–528 intervention indications, 463 pathology, 526 Leopold’s maneuvers, 464 perinatal transmission, 527 oxytocin stimulation, 465 prevalence, 526 prolongation/arrest disorders, 463 Huntington procedure, 283 ultrasound, 464–465 hydatidiform mole. See gestational trophoblastic disease; sequential instrument use, 466 gestational trophoblastic disease. training deficiencies, 467–468 hydralazine, 200 instrumental delivery, conduct of hydrostatic uterine replacement, 282 analgesia/anesthesia use, 472 hyperhomocystinemia syndrome (HHCS), . See also choice of instrument, 477–478 venous thrombosis (VT). descent, 474 hypotension treatment, 198 febrile morbidity, 472 hypoxic ischemic encephalopathy (HIE), 762 forceps application, 474–476 hysterectomy. See cesarean hysterectomy. forceps motion, 473 prerequisites, 471–472 IA (intermittent auscultations), 684–685 traction, 472–473 idiopathic thrombocytopenia purpura (ITP). use of force, 476–477 See thrombocytopenia (TTP). vacuum extractor, 473–474, 476 ileocecal cystoplasty bladder augmentation, 629 instrumental delivery, fetal injuries illicit drugs/alcohol from forceps, 494 alcohol abuse complications/therapies, 201 intracranial hemorrhages, 495 drug interactions scalp bruising/lacerations, 495 amphetamines, 201 subgaleal/subaponeurotic hemorrhage, 494–495 cocaine, 200–201 from vacuum extraction, 494 marijuana, 201 instrumental delivery, forceps/vacuum extractor narcotic abuse complications/therapies, 201 comparison indomethacin, 199 analgesia/anesthesia use, 469 infection, 287. See also necrotizing fasciitis (NF); maternal/fetal injuries, 468, 469 surgery in pregnancy, wound infection. in midpelvic procedures, 469 instrumental delivery surgeon/practitioner experience level, 468–469 contraindications, 470 vacuum extractor advantages/application, 469–470 equipment, types of instrumental delivery, instrument application forceps, 459–460 in breech presentations, 491 specialized instruments, 461 fetal station, 482–483 vacuum extractors, 459–460, 461 forceps operation procedure, 478–480 follow-up study findings, 499–500 manual rotation, 483 intervention indications in rotation of 45 degrees or less elective shortening of second stage, 457 forceps operation, 481–482 fetal compromise, suspicion of, 458–459 vacuum extractor technique, 481–482 prolonged second stage, 457 in rotation of 45 degrees or more mandatory prerequisites, 456 forceps rotation, 482 procedure coding transverse arrest, 482 forceps deliveries, 461–462 transverse arrest vacuum extraction operations, 462. risks. See also Barton forceps, 484 instrumental delivery, fetal injuries blade introduction, 483 from episiotomy, 493–494 Kielland forceps, 483–484 in fetal macrosomia, 492 Tucker-McLean forceps, 483 maternal/fetal injuries, 491–492 vacuum extraction procedure, 480–481 role of, 442 instrumental delivery, maternal injuries station system scoring, 456 perineal lacerations, 495 trial vs. failed procedures, 496–499 risk factors, 495–496 instrumental delivery, clinical issues stress urinary and anal incontinence, 496

900 INDEX

instrumental delivery, occiput posterior (OP) positions Kielland rotation, 490–491 associated conditions/complications, 486–487 Kleihauer-Betke test, 155 incidence of, 486 Klumpke palsy, 350 management Kristellar maneuver, 303. See also breech presentation, antepartum repositioning, 487 delivery techniques. Haas maneuver, 490 Kubler-Ross,¨ Elisabeth, 821 instrument/procedure selection, 488–489 Kustner procedure, 283 Kielland rotation, 490–491 manual rotation, 487–488 labetalol, 200, 201 procedure failure rates, 488 labor, abnormal conduct Puddicombe’s maneuver, 487 dystocia reverse Scanzoni maneuver, 489–490 causes, 245 Scanzoni rotation, 489 disproportion, 245–246 vaginal vs. cesarean delivery, 488 “pelvic/passenger/powers” issues, 245 morbidity/mortality, 486 malpresentation/disproportion diagnosis risk factors, 487 CPD, 246 instrumental delivery, special applications cranial molding estimation, 246–247 cranial extraction, 470–471 etiology establishment, 246 multiple gestation, 471 Muller-Hillis¨ maneuver, 246 upward extractor procedure, 471 oxytocin stimulation, 246 instrumental delivery, special issues palpation techniques, 246 asynclitism, 486 ultrasound, real time, 247 cranial deflection correction, 485–486 management of wandering, 485 latent phase treatment, 247 intermittent auscultations (IA), 684–685 oxytocin stimulation/augmentation, internal podalic version (IPV), 306–307. See also breech 247–248 presentation; breech presentation, delivery labor, active management of techniques. American/Canadian experience, 252 interstitial (cornual) pregnancy, 83 Dublin group system, 252 intracranial hemorrhages labor induction/augmentation clinical associations, 759, 761 contraindications/criteria, 249 clinical indicators, 760–761 fetal fibronectin (FFN) test, 249 incidence of, 759 indications, 248–249 and instrument delivery, 495 mechanical methods intracranial bleeding, types of, 759 amniotomy, 250 periventricular hemorrhage, 759 cervical dilators, 250 subarachnoid bleeding, 759–760 cervical ripening, 249 treatment, 761 Foley catheter, 250 intrauterine growth restriction (IUGR), 289, 298, 314 membrane sweeping, 249–250 intravenous patient-controlled analgesia (IV-PCA), 212, oxytocin, 251–252 218 pelvic examination, 249 intravenous pyelography (IVP) use, 626 prostaglandins, 250–251 invasive mole. See gestational trophoblastic disease. timing of, 252 IPV (internal podalic version), 306–307. See also breech labor, normal conduct, 252. See also labor pain presentation, delivery techniques. management; labor pain management, epidural isoflurane, 197 blockade; obstetric anesthesia. ITP (idiopathic thrombocytopenia purpura). See analgesia, 234 thrombocytopenia (TTP) clinical pelvimetry IUGR (intrauterine growth restriction), 289, 298, 314 as controversial technique, 241–242 IV-PCA (intravenous patient-controlled analgesia), 212, limitations, 242–243 218 measurement techniques, 242 IVP (intravenous pyelography) use, 626 use/utility of, 242, 243 clinician/obstetrician role, 232 Jonas, Richard, 3, 4 computed tomography (CT) scan, 243 cranial flexion evaluation, 244 ketamine, 196–197, 199, 201 diagnosis of labor, 233–234 ketorolac, 196, 201 epidural anesthesia, 244–245 Kielland forceps, 305 fetal position/presentation, 240

Index 901

fetopelvic relationship labor pattern analysis, 236–237 fetal size estimation, 241 reporting systems, 234–236 pelvic types/architecture, 240–241 terminology, 234 maternal posture effects, 239–240 uterine activity measurement medical/surgical intervention, 240 manual palpation, 239 patient history/examination, 232–233 Montevideo units, 239 physiology of, 248 tocodynamometry, 239 premature rupture of membranes (PROM), 233 labor, third/fourth stage radiographic (x-ray) pelvimetry, 243 active management ultrasound, real-time, 243–244 basic components of, 263 labor pain cord blood drainage/collection, 265 characteristics of, 202 cord clamping, 264–265 complications from, 202 ergot derivatives, 264 natural childbirth beliefs, 202 oxytocin, 263–264 patient expectations, 202 prostaglandins, 264 prenatal childbirth training (PCT) effectiveness, 202 study findings, 263 labor pain management.See also obstetric anesthesia uterotonic agents, 263–264. combined spinal/epidural (CSE) analgesia, 210–211 complications. See postpartum hemorrhage; uterine contraindications to neuraxial procedures, 211 inversion. paracervical block (PCB), 212 history parturient-controlled epidural analgesia (PCEA), 209 Bard, John, 258 pudendal block/perineal infiltration, 212–213 Baudelocque, Jean Louis, 258 spinal analgesia, 209–210 British monarchy, 258–259 systemic analgesia, 211–212 Dewees, William P., 258 labor pain management, epidural blockade. Mauriçeau, François, 257–258 See also epidural analgesic technique. Smellie, William, 258 analgesic regimen Taj Mahal, 258 vs. anesthesia, 202–203 normal physiology delivery management, 207–208 placental separation, 259 initiation, 205–206 uterine involution, 259–260 maintenance, 206–207 placenta delivery neuropharmacology of pain, 204 Brandt-Andrews maneuver, 260–261 technique, 204–205 cord traction/tension, 260–261 timing of, 208–209 Credi method, 261 contraindications, 211 episiotomy/laceration repair, 261 hazards, anesthesia-related kneading/massage techniques, 261 aortocaval compression, 207 retained placenta, 261–262 oral intake, 207 separation confirmation, 260 local anesthetics, negative effects, 203–204 twisting/lifting methods, 261 maternal benefits, 206–207 post-delivery placenta examination in second-stage management, 209 drainage/injection practices, 263 terminology usage, 202 gross examination, 262–263 labor, progress of lacerations, birth canal evaluation methods, 252 cervical, 286 influencing factors, 252 uterine, 286 intervention judgment, 253 vaginal, 286–287 oxytocin stimulation, 252–253 Lash operation, 107. See also cervical cerclage. labor, stages of legal considerations, antepartum partogram, 237–238 cervical insufficiency prolonged labor diagnosis/evaluation of, 189–190 and epidural anesthesia, 239 primary considerations, 190–191 fetal monitoring, 238–239 ectopic pregnancy medical/surgical intervention, 239 communication errors, 181–182 protocol development, 238 medicolegal issues, 180 two-hour rule, 238, 239 misdiagnosis, risk of, 181 ultrasound examination, 238 primary considerations, 182–183 station genetic testing cervical dilation, 236 Howard v. Lecher, 179

902 INDEX

legal considerations (Contd.) legal considerations, intra- and postpartum physician liability theories, 177–178 breech presentation primary considerations, 179–180 cesarean indications, 383 Schirmer v. Mt. Auburn Obstetrics and Gynecologic complications, 383–384 Assoc., 177–178 Draper v. Jasionowski, 384–385 standard of care/causation, 179 informed consent, 384 legal/ethical landscape, 176–177 obstetrician considerations, 385–386 placental abnormalities, 189 safe conduct of breech delivery, 384 therapeutic abortion vaginal delivery, 384–385 informed consent, 187–188 cesarean delivery Martinez v. Long Island Jewish Hillside Medical cesarean on demand controversy, 672, 673 Center, 187–188 Meador v. Stahler and Gheridian, 674 patient rights, 186 Schreiber v. Physicians Insurance, 672 Perez v. Park Madison Professional Laboratories, damages/jury awards Inc., 187–188 economic/non-economic, 370–371 primary considerations, 188 Gourley v. Nebraska Methodist Health System, Sheppard-Mobley v. King, 187 371 wrongful pregnancy, 186–187 insurer payments, 372 ultrasound Wareing v. United States, 371–372 personnel expertise, 183–185 instrumental delivery primary considerations, 185–186 fetal/maternal injury, standard of care issues, 185 midforceps operation controversy, legal considerations, birth injuries obstetrician considerations, causation, 831–832, 851–852 malpractice claim reduction, 373 education/training, 837–838 multiple gestation electronic fetal monitoring congenital abnormalities, 387 Baglio v. St. John’s Queens Hospital, 833–834 diagnosis failure, 386 in clinical decision making, 833 gestational age assessment, 386 errors in judgment vs. malpractice, 834 Mundell v. La Pata, 386–387 in intrapartum assessment, 833 obstetrician considerations, medical record review/analysis, 834 387–388 morbidity/mortality, 833 tocolytic agents, 387 obstetrician considerations, 834–835 vaginal vs. operative delivery, 387 genetic science/counseling, 832. genetic testing. See obstetric anesthesia under legal considerations, antepartum. acts or omission, 374 indemnity payouts, 831 Denton v. LaCroix, 374–375 intrauterine assessment, 832 Lanzet v. Greenberg, 374 neurological assessments/abnormalities, 832–833 maternal mortality, 373 nurse midwives. nonmortal injuries, 373–374 See also midwives/midwifery. Oberzan v. Smith, 374 “direct entry” midwives, 838 obstetrician/anesthesiologist responsibility, history, in United States, 838 374 independent vs. collaborative practice, 839 obstetrician considerations, 375–376 vs. physician outcomes, 838–839 policy/protocol standardization, 374 practitioner considerations, 839–840 shoulder dystocia regulation of, 838 litigation rebuttal, 389–390 placental pathology management controversy, 388 expert opinions, battle of, 836–837 obstetrician considerations, 390–391 explanation of neonatal outcomes, 835–836 res ipsa doctrine, 389 plaintiff’s burden, 832 tort reform, 370, 372 legal considerations, fetal surgery legal considerations, maternal-fetal conflict Adams v. Arthur, 679–680 contradictory outcomes efficacy of, 678 criminal prosecution, 666 experimental vs. standard medical therapy, Ferguson v. City of Charleston, 666 678–679 illicit drug use, 666 indications for, 678 fetal-rights advocacy informed consent, 679 Jefferson v. Griffin Spalding County Hospital, obstetrician considerations, 680 664–665

Index 903

Pemberton v. Tallahassee Memorial Regional Marshall v. East Carroll Parish Hospital, 862 Hospital, 665 patient “dumping”, 862 Planned Parenthood v. Casey, 664 patient transfer, 863–864, 865 informed consent, 666–675 requirement of, 862, 865 maternal behaviors, 663–664 screening examination, 862, 863 maternal-rights advocacy Urban v. King, 864 Matter of Angela C., 665 U.S. v. Rush Foundation Hospital, 862–863 McFall v. Shrimp, 664 expert witness religious convictions, 665–666 jury consideration of, 857–858 Roe v. Wade, 664 Lake v. Clark, 859 legal considerations, surgery in pregnancy qualifications of, 858 clinical evaluation difficulties, 667–668 Sheely v. Leslie, 858–859 common nonobstetric procedures, 667 informed consent complications/liability relationship, 668 Canterbury v. Spence, 855–856 incidence of, 667 customary practice standard, 855 nondelegable duties, 668–669 Dingle v. Belin, 855 obstetrician considerations, 669 Harrison v. United States, 856–857 risk assessment, 668 materiality standard, 856 legal considerations, surgical complications medical/expert testimony, 857 improper surgical recommendation, 441 loss-of-chance doctrine improper treatment of complications, 442 vs. “all-or-nothing” rule, 852–853 surgical technique, 441–442 compensable injury, 854 legal considerations, third stage of labor probabilities vs. possibilities, 853–854 Gabaldoni v. Board of Physicians, 672–677 as reduced standard of causation, 852 maternal care, 669–672 substantial factor test, 854–855 obstetrician considerations, 680 medical malpractice, 843–844 placental examination, 669 new technology, standard of care, 865–866 postpartum complications, 677–680 physician as Good Samaritan postpartum hemorrhage (PPH), 680 Good Samaritan legislation, 848–849 legal considerations, urologic complications Hurley v. Eddingfield, 848 delayed diagnosis risks, 677 vs. layperson, 848 maternal/fetal injuries, 675–676 reasonable care, 848 negligence allegations, 676 United States v. DeVane, 848 principles for practice, 677–678 Velazquez vs. Jiminez, 849–850 Seats v. Lowery, 676–677 standard of care issues, 850–851 legal principles supervision of resident physicians abortion, legal decisions in Maxwell v. Cole, 846 Harris v. McRae, 867 McCullough v. Hutzel Hospital, 847 Maher v. Roe, 867 Moeller v. Hauser, 846–847 Planned Parenthood v. Casey, 867–868 Mozingo v. Pitt City Memorial Hospital, 847–848 Roe v. Wade, 866–867 wrongful life/wrongful birth Stenberg. v Carhart, 868 Becker v. Schwartz, 868–869 authoritative sources/learned treatises Gallagher v. Duke University Hospital, 870 in evidence introduction, 861, 862 genetic technology, 868–870 Federal rule regarding, 859–860 injury, nature of, 869 Gridley v. Johnson, 860 physician negligence, 868 Jacober v. St. Peters Medical Center, 860–861 Reed v. Campagnolo, 869 Kilpatrick v. Wolfond, 861–862 Roe v. Wade, 868–869, 870 Swank v. Halivopoulos, 860 Siemieniec v. Lutheran General Hospital, 869–870 causation, 851–852 leiomyofibromas. See leiomyomata. duty (doctor–patient relationship) leiomyomata consultation between professionals, 844–845, 846 diagnosis, 430 de minimis contact, 844 epidemiology, 429 Gilinsky v. Indelicato, 845–846 management, 430 implied contract, 844 pathology, 429–430 Wheeler v. Yettie Kersting Memorial Hospital, 845 prognosis, 430–431 EMTALA rules levobupivacaine, 198 Burditt v. United States, 864–865 lidocaine, 198, 200

904 INDEX

Loveset maneuver, 301–303 ultrasound scanning/procedures, 803–804 lower urinary tract injuries and trauma. vaginal breech delivery, 804 See also bladder injury/management; ureteral future applications, 808 injury/management; urethral injury/management. in graduate medical education, 801 accidental trauma, 620 patient safety/outcomes, 806–807 intrapartum injuries, 620–621 rationale for, 799–800 surgical injuries, 621–622 simulation products, 798–799 lumbosacral palsy (LSP), 773–774 team drills, 807–808 as training tool, 798 macrosomia in undergraduate medical education, 800–801 diagnosis Meigs, Charles, 193 fetal weight assessment, 352 Melaney’s ulcer, 289. See also necrotizing fasciitis (NF). ultrasound reliability, 352 membranous twin, 330–331 labor abnormalities, 353–354 meperidine, 195, 212 management/injury profile, 361–362 meralgia paresthetica (MP), 770–771 related risks methamphetamine, 201 maternal diabetes, 353 methergonovine maleate, 264 maternal factors, 353 methotrexate therapy maternal weight, 352 contraindications, 80 post-term pregnancy, 352 future fertility, 81 prior macrosomic infant, 352–353 side effects, 80–81 magnesium sulfate, 199 single/multidose therapies, 80 magnetic resonance imaging (MRI), 158–159 uses of, 80 Malmstrom¨ extractor, 18–19 metoclopramide, 195 Mann cerclage, 107. See also cervical cerclage MFM (maternal-fetal medicine) specialists, 335–336 Marfan’s syndrome, 519–520 midazolam, 195 marijuana, 201 midwives/midwifery MSAFP (maternal serum alpha fetoprotein), circumcision, newborn, 794 27 core competencies, 789–790 massive hemorrhage, obstetric first assisting, 792–793 anesthetic management, 216–217 intervention, role of, 795–796 causes/treatment, 216 procedures performed by, 787, 789 childbirth vs. surgery misperception, 217 technology, appropriate role of, 795 maternal cell contamination (MCC), 30–31 training/credentialing maternal-fetal medicine (MFM) specialists, 335–336 American College of Nurse-Midwives (ACNM), 788 maternal serum alpha fetoprotein (MSAFP) clinical privileging, 791 elevation, 27 liability concerns, 791–792 Mauriçeau, François, 5–7, 13, 257–258 of physician assistants (PAs), 788–789 Mauriçeau-Smellie-Viet (MSV) maneuver, 303,.See also state laws/regulations, importance of, 791 breech presentation, delivery techniques. trends/future maximum vertical pocket (MVP), 49 at-risk evaluation, 794 MCC (maternal cell contamination), 30–31 cesarean delivery rates, 795 McDonald cerclage, 101–102, 103–104. See also cervical hospitalist movement, 794–795 cerclage. laborists, role of, 794–795 McGill Pain Questionnaire, 202 medical education, 795 medical simulations vacuum-assisted birth, 793–794 continuing education, role in, 806 mifepristone (RU 486), 133–134 development of, 797–798 Misgav-Ladach (ML) cesarean technique, 567 example simulations misoprostol bad-news communication, 805 in labor induction/augmentation, 250–251 circumcision, 804 in third/fourth stage labor, 264 documentation training, 804–805 mixed germ cell tumors, 439. See also ovarian tumors. eclampsia, 803 MMC. See myelomeningocele (MMC) operative vaginal delivery, 803, 805–806 monochorionic-diamniotic placenta, 325. See also multiple postpartum hemorrhage, 802–803 gestation, physiology of. professionalism scenarios, 805 monochorionic-monoamniotic placenta, 325. See also shoulder dystocia, 801–802 multiple gestation, physiology of. surgical skill assessment, 806 Montevideo units, 239

Index 905

morphine, 195, 218 multiple gestation, preterm labor management mosaicism, 30–31 delivery timing, 338 MP (meralgia paresthetica), 770–771 fetal lung maturity, 338 MRI (magnetic resonance imaging), 158–159 preterm rupture of membranes (PROM), 337 Muller-Hillis¨ maneuver, 246 tocolytic therapy, 337 Mullerian¨ anomalies, 91 Murless forceps, 471 multiple gestation. MVP (maximum vertical pocket), 49 See also twin-twin transfusion syndrome. myelomeningocele (MMC) acardiac twins, 332 incidence of, 653 antenatal corticosteroids, in triplet gestations, 337 MMC repair approaches, 654 assisted reproductive technology (ART) effects, standard of care, 653 322 study/data interpretation, 654 cerebral palsy, incidence of, 323–324 in utero repair rationale, 653–654 congenital anomalies, 331–332 myomas. See leiomyomata. diagnosis, 326–327 myonecrosis, 289. See also necrotizing fasciitis (NF). epidemiology, 322, 324 fetal complications, 329 nalbuphine, 196, 212, 218 growth restriction in, 330 naloxone, 201 high-order multiple gestation (HOM), 340 Naujok’s maneuver, 303. See also breech presentation, intrauterine death, 330–331 delivery techniques. medicolegal issues, 341–342 necrotizing fasciitis (NF) monoamniotic twins, 335 causative organism, 288 perinatal mortality, 322–323 diagnosis, 288 placental/cord complications, 335 forms/alternate names, 287–288 preterm birth prevention, 337 gas gangrene, 289 preterm labor/delivery laboratory ﬁndings, 288 incidence of, 329 medical management, 289 predictive factors, 329 myonecrosis, 289 psychosocial issues, 341 surgical treatment, 288–289 selective fetocide, 332 symptoms/disease progression, 288 selective reduction, 340–341 wound infection, 399–400 “vanishing twin” syndrome, 329–330 neoplastic diseases. See cervical intraepithelial neoplasia multiple gestation, antepartum care (CIN); cervical malignancy; endometrial maternal-fetal medicine (MFM) specialists, role carcinoma; fallopian tube disease; gestational of, 335–336 trophoblastic disease; leiomyomata; ovarian prenatal screening, 336–337 tumors; vaginal malignancy; vulvar malignancy. prenatal visits/nutrition, 336 neostigmine, 196 ultrasound evaluation, 336 neuraxial analgesia, 218 multiple gestation, intrapartum management neuraxial procedures, contraindications to, 211 interval between deliveries, 338 NF. See necrotizing fasciitis (NF). nonvertex/any presentations, 339–340 nifedipine, 199 vertex/nonvertex presentations, 339 nitroglycerin vertex/vertex presentations, 338 in PIH, 200 multiple gestation, maternal physiologic changes urgent uterine relaxation, 215–216 complications, 328–329 in uterine relaxation, 282 hypertensive disorders, 328 nitroprusside, 200 organ system adaptations, 327–328 nitrous oxide, 197 weight gain, 328 multiple gestation, physiology of obstetric anesthesia. dizygotic twinning, 324 See also labor pain; labor pain management. monozygotic twinning, 324–325 vs. analgesia, 213 placentation drug interactions chorionicity determination, 325–326 illicit drugs, 200–201 complications, 326 obstetric pain management, 201–202 dichorionic-diamniotic placenta, 325 PIH therapy, 200 monochorionic-diamniotic placenta, 325 tocolytic agents, 199 monochorionic-monoamniotic placenta, 325 uterotonic agents, 199 superfecundation/superfetation, 324 epidural anesthesia

906 INDEX

obstetric anesthesia (Contd.) self/traumatic delivery, 2 catheter position, 213–214 support for, 7 for cesarean delivery, 213 surgical innovations, 9, 10–11 vs. general anesthesia, 214 vs. symphysiotomy, 7–8 pain during, 213 uterine sutures/suturing, 8–9 general anesthesia cesarean hysterectomy, 9–10 antacid prophylaxis, 215 instrumental delivery practice standards, 215 advances in, 17 safety, 215 axis-traction forceps, 17 uses of, 215 Chamberlen forceps, 12–14 for massive hemorrhage, 216–217 conservative obstetric management, 15 pharmacology destructive vs. atraumatic instruments, 11–12 analgesics, 195–196 Elliot’s midwifery forceps, 17 circulation support agents, 197–198 incidence of procedures, 16–17 general anesthesia, induction agents, 196–197 instrument development/modifications, 11, 15, 18 general anesthesia, volatile agents, 197 intervention error example, 15 local anesthetics, 198 maternal mortality, 17 neuromuscular blocking agents, 198 Palfyn instrument, 14–15 premedicants, 195 popularization of, 15 tranquilizers, 195 Princess Charlotte debacle, 15 postoperative pain management, 218 procedural alternatives, 11 spinal/CSE anesthesia prophylactic forceps operation, 17–18 duration, 214 rotational maneuvers, 17 vs. epidural anesthesia, 214 Simpson’s forceps, 17 vs. general anesthesia, 214 solid-bladed forceps, 17 sequential CSE, 214–215 usage guidelines, 15 surgery during pregnancy van Roonhuysian instrument(s), 13–14 fetal monitoring, 217–218 labor, third/fourth stage fetal risks/outcome, 217 Bard, John, 258 general precepts, 217 Baudelocque, Jean Louis, 258 maternal/fetal survival, 218 British monarchy, 258–259 vs. surgical anesthesia, 193, 194–195 Dewees, William P., 258 urgent uterine relaxation, 215–216 Mauriçeau, François, 257–258 obstetric anesthesia service Smellie, William, 258 communication/coordination Taj Mahal, 258 characteristics of, 219 prenatal genetic testing informed consent, 220 amniocentesis, 23–24 outpatient anesthesiology clinic, 219–220 chorionic villous biopsy (CVS), 24–25 management of, 218 technologic advances, 25 quality assurance ultrasonography, 24–25 continuous quality improvement, 220–221 vacuum extractors traditional approaches, 220 cupping, 18 staffing/equipment, 218–219 Malmstrom¨ extractor, 18–19 obstetric history. See also forceps, historic. Simpson extractor, 18 abortion occiput posterior (OP) positions. See instrumental in ancient/classical texts, 119 delivery, occiput posterior (OP) positions. controversy in medical practice, 119 O’Leary technique, 278, 573–574 Hippocrates’ injunction, 119–120 oromandibular-limb hypogenesis, 32 legality of, 120 ovarian pregnancy, 81 religious doctrines, 120 ovarian tumors cesarean delivery classification/staging, 434–435 advice against, 5–7 diagnosis, 433–434 in classic theater, 2 epidemiology, 432 documented operations, 4–5, 7 management in myths/legends, 1–2 benign cystic teratomas, 438 Porro operation, 9–10 choriocarcinomas, 439 propriety controversy, 5 dysgerminoma, 438–439 safety preclusions, 8 embryonal carcinomas, 439

Index 907

endodermal sinus tumors, 439 perinatal loss epithelial cell tumors, 438 clinician response to, 821 germ cell tumors, 438 death, as taboo subject, 820–821 gonadal stromal tumors, 439–440 as family trauma, 820 granulosa cell tumors, 439–440 grief, stages of mixed germ cell tumors, 439 Freud, Sigmond, 821 ovarian cancer, 435–438 Kubler-Ross,¨ Elisabeth, 821 ovarian immature teratomas, 439 texts on, 821–823 Sertoli-Leydig cell tumors, 439–440 grieving father, 825 pathology, 432 grieving mother prognosis, 438 miscarriage, 823 oxytocin stimulation.See also hemorrhage, operations for. multiple gestation, 824–825 active labor, 263–264 overview, 823–824, 827 drug interactions, 199 stillbirth, 824–826 labor, abnormal conduct, 247–248 hospital staff practices labor induction/augmentation, 251–252 bereavement protocol, 826 labor physiology, 248 cultural considerations, 823 labor progression, 252–253 personnel roles, 823–825 malpresentation/disproportion diagnosis, 246 talking to grieving families, 826–827 pelvic adequacy evaluation, 465 patient resources retained placenta treatment, 284 books, 828 shoulder dystocia, 354 Internet, 828–829 in third-fourth-stage labor, 263–264 support groups, 827–828 third-fourth-stage labor, 263–264 video, 828 uterine scar separation, 534–535 terminology, 821 perineal infiltration, 212–213 Page “wrapping” technique, 107. See also cervical cerclage. perineal/periurethral injuries Palfyn instrument, 15 avoidance of, 266 Palfyn, Johannes, 14–15 common injuries, 265–266 pancuronium, 198 surgical repairs paracervical block (PCB), 212. See also labor pain episiotomy repair, 265, 266–268 management. internal/external sphincter lacerations, 268–269 Pare,´ Ambroise, 4, 5–7, 14 rectal mucosa tear, 268 parturient-controlled epidural analgesia (PCEA), 209 suture material, 269 PAs (physician assistants), 788–789 vaginal lacerations, 266 patient-controlled analgesia (PCA), 212, 218 phenylephrine, 198, 199, 201 PCA (patient-controlled analgesia), 218 phenytoin, 200 in hypotension, 199 physician assistants (PAs), 788–789 PCB (paracervical block), 212. See also labor pain physiologic pelvic girdle relaxation. See pelvic relaxation management. syndrome. PCEA (parturient-controlled epidural analgesia), . See also PID (pelvic inflammatory disease), 71–72 labor pain management. PIH. See pregnancy-induced hypertension (PIH) therapy. PCR (polymerase chain reaction), 25 Pinard maneuver, 304 (PCR) polymerase chain reaction, 36–37 Pipelle biopsy, 76–77 PCT (prenatal childbirth training) effectiveness, 202 Piper forceps, 305 pelvic girdle relaxation. See pelvic relaxation syndrome. placenta.See also ultrasound, placental. pelvic inflammatory disease (PID), 71–72 development/physiology, 145–147 pelvic relaxation syndrome pathology anatomy of, 739–740 description at delivery, 160 chronic pelvic joint pain, 740 maternal floor infarction, 161 diagnosis, 740 maturation disorders, 160–161 etiology, 739 weight aberrations/variations, 160 osteomyelitis, 741 perinatal evaluation, role of, 145 symphysis rupture/division, 740–741 placenta accreta/increta/percreta.See also placental symptoms, 740 abnormalities terms. treatment, 740 associations/risk factors, 284 percutaneous umbilical blood sampling (PUBS), diagnosis, 284, 285 60–61 etiology, 152, 284–285

908 INDEX

placenta accreta/increta/percreta (Contd.) hemorrhagic shock, hemorrhage risk, 284 in newborns, infant mortality, 285 organ damage, management of, 166–167 respiratory failure/distress, pathophysiology, 55–56, 150, 285 Rh isoimmunization, treatment placental abnormalities, diagnosis conservative management, 285 fetoscopy, 159 surgical procedures, 285 magnetic resonance imaging (MRI), 158–159 vaginal vault/pelvic packing, 286 patient history, 154 ultrasound diagnosis, 156–157 physical examination, 154–155 placenta delivery. See under labor, third/fourth stage. placental migration, 156 placenta increta. See placenta accreta/increta/percreta. ultrasound scanning placenta percreta. See placenta accreta/increta/percreta. placenta accreta, 156–157 placenta previa placenta previa, 155–156 etiology/incidence, 55 placental abruption, 157–158 management uses of, 155 activity restriction, 164 placental abnormalities, management of. antenatal corticosteroids, 166 See also placental abruption. artery/vessel ligation, 163–164 placenta accreta, 166–167 bleeding, assessment of, 162–163, 164–165 placenta previa blood transfusion, 165 activity restriction, 164 cervical cerclage, 166 antenatal corticosteroids, 166 home-care vs. hospitalization, 165 artery/vessel ligation, 163–164 hysterectomy, 164 bleeding, assessment of, 162–163, 164–165 incision locations, 163 blood transfusion, 165 intraoperative/postpartum hemorrhage, 163 cervical cerclage, 166 pre-surgery planning, 163, 165 home-care vs. hospitalization, 165 tocolytics, 165–166 hysterectomy, 164 pathology, 149 incision locations, 163 prevalence, 150–152 intraoperative/postpartum hemorrhage, 163 ultrasound diagnosis presurgery planning, 163, 165 transabdominal ultrasound (TAS), 155 tocolytics, 165–166 transperineal sonography (TPS), 156 previable pregnancy transvaginal ultrasound (TVS), 155–156 bleeding, 161–162 placental abnormalities chorioangioma, 161 abnormal trophoblastic invasion, 148–149 maternal well-being, 161–162 epidemiology viable gestation, 162 marginal placental separation, 150 placental abruption placenta accreta, 152 bleeding/blood replacement, 169–170 placenta previa, 150–152 Couvelaire uterus, 170 placental abruption, 152–154 evaluation of, 167–168 vaginal bleeding, 150 fetal monitoring, 169 fetal heart rate monitor, 160–169 mild/minimally symptomatic cases, 167–168 implantation disruption, 148 moderate/severe cases, 168–169 intrinsic abnormalities mortality/morbidity, 152–154 amniotic band syndrome, 147 pathophysiology, 149 chorioangioma, 147 ultrasound diagnosis, 54–55, 157–158 circumvallate placenta, 147 placental examination single umbilical arteries (SUA), 148 beneﬁts of, 289 velamentous insertion, of cord, 147–148 in obstetric management review, 289 patient/family communication, 170 study/storage recommendations, 289–290 placenta accreta, 150 placental separation, 259 placenta previa, 149 placental site trophoblastic tumor. See gestational placental abruption, 149 trophoblastic disease. preeclampsia/fetal growth restriction, Planned Parenthood v. Casey 148–149 abortion, legal decisions in, 867–868 placental abnormalities, complications fetal-rights advocacy, 664 coagulation disorders, polymerase chain reaction (PCR), 25–37

Index 909

Porro, Eduardo, 9–10 prenatal genetic program trends postoperative/postpartum paralysis (POP), quality assurance, 36 769–770 service organization development, 36 postpartum hemorrhage (PPH). technological advances, 25–37 See also hemorrhage, operations for; retained placenta; prenatal genetic testing.See also amniocentesis; chorionic uterine atony; uterine inversion. villus sampling (CVS); genetic disease. causes/signs, 272, 273 prenatal genetic testing, multiple gestations diagnosis accuracy/sampling error, 35 blood/arterial pressure, 274 identification approach, 34 blood loss, 273–274 laboratory problems, 35–36 four-stage classification scheme, 274–275 risks laboratory tests, 275 chromosomal aneuploidy, 33–34 urinary output, 274 miscarriage, 34–35 incidence of, 272 vs. singleton gestations, 34 management selective pregnancy termination, 35 compression sutures, 278 single/dual puncture methods, 34 embolization, 278 PROM (premature rupture of membranes), 233, 337 fluid resuscitation, 275 propofol, 197 gauze packing, 276–277 propranolol, 200 hematoma identification, 277–278 Prosser, William L., 848, 851–852 hysterectomy, 279 prostaglandin 15-methyl-F2␣ (PGF2), initial/supportive therapy, 275 PUBS (percutaneous umbilical blood sampling), O’Leary technique, 278 60–61 physician assistance, 279 Puddicombe’s maneuver, 487 placental examination, 277 pudendal block, 212–213 subinvolution, 279 surgical control, 278 ranitidine, 200 uterine compression, 277 remifentanil, 196, 212 uterotonic agents, 275 retained placenta, 261–262. See also placenta vessel ligation, 278–279 accreta/increta/percreta. management of, 272 clinical associations, 283–284 maternal mortality, 272 diagnosis, 284 risk factors, 272–273 treatment Power, R. M. H., 271 manual removal, 284 Prague maneuver, 303–304. See also breech presentation, oxytocin, 284 delivery techniques. retinal hemorrhage, 754–755 preeclampsia/eclampsia Rh prophylaxis, 83–84 abnormal trophoblastic invasion, 148–149 Rh sensitization, 27–28 Doppler flow measurement, 52 ritodrine, 199 drug interactions, 199, 208–209, 210–211 rocuronium, 198 health care education, 680 Roe v. Wade in hypertensive disorders, 328 abortion, legal decisions in, 866–867 IUGR, 146 and genetic testing, 177–178 in maternal mortality, 676–680 maternal-rights advocacy, 664 and PPH, 272–273 wrongful life/wrongful birth, 868–869, 870 and thrombocytopenia, 211 ropivacaine, 198 pregnancy-induced hypertension (PIH) therapy, drug Rosslin,¨ Eucharius, 3, 4 interactions Rousset, François, 5 aspirin, low-dose, 200 RU 486 (mifepristone), 133–134 cimetidine, 200 hydralazine, 200 sacrococcygeal teratomas (SCT), 650–651 labetalol, 200 Sanger,¨ Max, 9–10 nitroglycerin, 200 Scanzoni, Friedrich Wilhelm, 17 nitroprusside, 200 Scanzoni rotation/reverse maneuver, 489–490 verapamil, 200 SCT (sacrococcygeal teratomas), 650–651 pregnancy termination. See abortion terms. selective feticide, 328, 332, 335, 341–342 premature rupture of membranes (PROM), 233, 337 selective pregnancy termination, 35 prenatal childbirth training (PCT) effectiveness, 202 selective reduction, 35, 340–341, 814

910 INDEX

selective trial of labor subgaleal/subaponeurotic hemorrhage in breech presentation, 308 diagnosis, 747 CT pelvimetry, 309 morbidity/mortality, 748 X-ray pelvimetry, 308–309 prevention of, 747 Sertoli-Leydig cell tumors, . 439–440. See also ovarian treatment, 747–748 tumors. succinylcholine, 198 sevoflurane, 197 sufentanil, 195–196 Shirodkar cerclage, 101–102, 103. See also superficial perineal infection, 287 cervical cerclage. suppurative fasciitis. See necrotizing fasciitis (NF). shoulder dystocia. surgery in pregnancy.See also legal considerations, surgical See also macrosomia; shoulder impaction. complications; neoplastic diseases. clinical issues diagnosis morbidity/mortality, 349 history/physical examination, 393–394 neonatal injury, 349–351 laboratory data, 395 prevalence, 349 location/progression of pain, 394 clinician/obstetrician role, 348 radiography, 395 intrapartum factors traumatic injury, 394 episiotomy, 354 surgical technique labor abnormalities, 353–354 drains, 397–398 oxytocin/anesthesia incidence, 354 hemostasis, 396 management/injury profile knot tying, 397 disimpaction maneuver study findings, 361 operative incisions, 395–396 routine cesarean, 361 skin closure, 397 medical record, 363 skin preparation, 396 occurrence analysis, 349 suture materials, 396–397 prediction/prevention, 360 wound closure, 396 risk factors, predictive value of, 348–349, 354 wound complications shoulder dystocia, disimpaction maneuvers dehiscence/evisceration, 398–399 clavicle fracture, 360 incisional hernia, 398 posterior arm extraction, 359 integrity, risks to, 398 rotation maneuvers wound infection fundal pressure in, 359 clinical signs/symptoms, 399 Rubin’s maneuver, 359 etiology, 399 Woods “cork-screw” maneuver, 358–359 necrotizing fasciitis (NF), 399–400 simple maneuvers preventive measures, 399 historical surveys, 357–358 treatment, 399 McRoberts maneuver, 358, 361 surgery in pregnancy, fetal heart rate monitoring suprapubic pressure application, 358 appropriate use of, 880–881 Walcher position, 358 gestation age, role of, 881 Zavanelli maneuver, 360 labor effects, 881–882 shoulder dystocia, emergency management plan and potential viability, 882–883 anticipation of, 362 protocols, 883 assistance, 362 surgical management, 883–885 episiotomy, 362–363 tocolytic administration, 882 obstetric intervention techniques, 363 surgery in pregnancy, iatrogenic injuries optimal delivery route determination, 362 avoidance, 406 shoulder dystocia, medicolegal issues fetal injuries, 410 prevention strategies, 365–366 gastrointestinal injuries reasonable conduct, 363–364 intestinal tract/bowel lacerations, standard of care issues, 364–365 406–407 shoulder impaction thermal bowel injuries, 407–408 forces operating in, 355–356 neurologic injuries, 409–410 pathophysiology, 354–355, 356 reporting, 406 Simpson forceps, 305, 471 reproductive tract injuries, 410 Simpson, James Young, 17, 18, 193, 194 urinary tract injuries, 408–409 single umbilical arteries (SUA), 148 surgery in pregnancy, surgical complications spinal analgesia, 209–210 appendicitis Spinelli operation, 283 diagnosis, 413–414

Index 911

epidemiology, 412–413 transperineal sonography (TPS), 156 management, 414–415 transvaginal ultrasound (TVS), 155–156 gallbladder disease transverse arrest, see under instrumental delivery, diagnosis, 411 instrument application. epidemiology, 410–411 transverse limb reduction defects (TLRD), 32 management, 411–412 TRAP (twin-reversed arterial perfusion) sequence, 332, surgery in pregnancy, systemic complications 646 deep vein thrombosis (DVT) trauma, blunt abdominal antiphospholipid syndrome (APS), fetal risks, 768 diagnosis, 403–404 incidence of, 768 Greenfield filter, 405 maternal/fetal assessment, 769 heparin therapy, 402–403, 404–405 maternal resuscitation, 768 incidence of, 401–402 motor vehicle accidents/safety, 768–769 inherited thrombophilia, 402, 405–406 Trautmann, Jeremias, 5 mechanical intervention, 403 Trendelenburg’s positioning, 102. See also cervical pulmonary embolism, 402 cerclage. risk factors, 402 TTP. See thrombocytopenia (TTP). therapy, 404 TTTS. See twin-twin transfusion syndrome (TTTS). warfarin therapy, 405 tubal ligation febrile morbidity in cesarean delivery, 583 abdominal abscess, 401 complications, 588–589 differential diagnosis, 400–401 counseling/consent, 584–585 infection, 401 incision, 585 treatment, 401 surgical operations symphysiotomy, 7–8, 582–583 fimbriectomy, 587–588 symptom-giving pelvic girdle relaxation. See pelvic Irving technique, 586–587 relaxation syndrome. Kroener technique, 587–588 synergistic necrotizing cellulitis. See necrotizing Madlener technique, 585–586 fasciitis (NF). Pomeroy technique, 586 syntometrine, 263–264 Uchida technique, 587–588 systemic analgesia, 211–212 in vaginal delivery, 584 TVS (transvaginal ultrasound), 155–156 TA-CVS (transabdominal biopsy). See under chorionic twin-reversed arterial perfusion (TRAP) sequence, 332, villus sampling (CVS). 646 tachycardia/bradycardia. See under fetal monitoring, twin-twin transfusion syndrome (TTTS). physiologic principles. See also multiple gestation terms. TACIC. See cervicoisthmic cerclage (TACIC) alternative interventions, 645–646 TAS (transabdominal ultrasound), 155 amnioreduction, 645 TC-CVS (transcervical biopsy). See under chorionic villus diagnosis, 333 sampling (CVS). donor risks, 332 terbutaline, 199 fetoscopic laser ablation, 645 termination, of pregnancy. See abortion terms. management thiopental, 196–197 laser photocoagulation, 334–335 thrombocytopenia (TTP) selective fetocide, 335 alloimmune thrombocytopenia (ATTP), 532–533 septostomy, 335 gestational thrombocytopenia (GTP), 532 serial amnioreduction, 334 immune thrombocytopenia, 532 mortality/morbidity, 645 incidence, 531–532 pathophysiology, 332–333, 645 obstetric intervention recommendations, 533 staging, 334 physiology, 531 thrombophilias. See venous thrombosis (VT). UBF (uterine blood flow), 685–686 TLRD (transverse limb reduction defects), 32 ultrasound tocolytic agents, drug interactions expanded use of, 44 ␤2-agonists, fetal weight assessment, 54 calcium ion antagonists, 199 gestational age assessment, 53–54 magnesium sulfate, 199 importance of, 62–63 TPS (transperineal sonography), 156 transvaginal approach, 75–76 transabdominal ultrasound (TAS), 155 twin gestation, 58–59

912 INDEX

ultrasound, cervical length assessment ureteral injury/management accuracy importance, 44–45 in cesarean delivery, 625 with digital examination, 46–47 in cesarean hysterectomy, 625 effacement process, 46–47 crush/suture ligation injuries, 626 endocervical length, 46 incision/needle puncture injuries, 626 funneled cervix criteria, 47 intravenous pyelography (IVP) use, 626 labor outcome prediction, 48 in pregnancy termination, 625–626 measurement procedure, 46 ureteral injuries, 625 normal lengths, 47 ureteral transections, 626–628 preterm delivery prediction, 47–48 ureteroneocystostomy, 626–628 transabdominal approach, 45 urethral injury/management transperineal/translabial approach, 46 urethral injuries, 624 transvaginal approach, 45–46 urethral repair, 624 ultrasound, Doppler urethrovaginal fistula repair, 624–625 cerebroplacental ratio, 53 urinary calculi fetal arterial assessment, 51–52, 53 diagnosis, 614–616 in intrapartum period, 52–53 epidemiology, 613–614 perinatal mortality rates, 52 etiology, 614 properties of, 51 management, expectant, 616 vascular impedance measurement, 52 management, operative ultrasound, fetal position assessment lithotripsy, 616–617 fetal occiput position timing of, 618 identifying landmarks, 58 ureteral stents, 617 as labor management tool, 56–57 ureteroscopy, 617–618 malposition/malrotation, 58 management, pharmacologic, 618 ultrasound vs. digital examination, 57–58 urinary tract infection (UTI), 733–734 fetal presentation, 56 urolithiasis. See urinary calculi. ultrasound, fetal status assessment urologic disorders, during pregnancy. See also lower amniotic fluid index (AFI) urinary tract injuries and trauma; urinary calculi. AFI/MVP accuracy comparison, 49 anatomic changes, 608–610 obtainment method, 49 common urinary complaints oligohydramnios thresholds, 49–50 stress urinary incontinence, 611–613 polyhydramnios thresholds, 50 urinary frequency/nocturia, 610–611 volume as assessment tool, 48–49 urinary tract infection, 613 volume/perinatal outcome relationship, 49 urinary urgency/urge incontinence, 611 biophysical profile (BPP) voiding difficulties, 611 in intrapartum period, 51 genitourinary malignancy predictive parameters, 50–51 diagnosis, 632 score interpretation, 51 epidemiology, 631–632 uses of, 50 etiology, 632 fetal occiput position, 58 management, 632–633 maximum vertical pocket (MVP), 49 lower urinary tract obstruction ultrasound, placental impacted/incarcerated uterus, 619 diagnosis of abnormalities, 155 ureteral compression/obstruction, placenta accreta, 55–56 618–619 placenta previa, 55, 155–156 urinary retention in labor, 619 placental abruption, 54–55 physiologic changes, 610 ultrasound, procedure guidance previous urologic surgery endoanal examination, 62 anti-incontinence procedures, 630 percutaneous umbilical blood sampling (PUBS), artificial urethral sphincters, 629–630 60–61 enterocystoplasty, 629 prenatal diagnosis general recommendations, 629 amniocentesis, 59 ureteral reimplantation, 631 CVS, 59–60 urinary diversion, 630–631 as invasive procedure adjunct, 59 urethral diverticulum needle visualization, 60 diagnosis, 628 retained uterine products, 61–62 etiology, 628 3D/4D techniques, 61 management, 628

Index 913

uterine atony epidemiology, 423 clinical associations, 279 management, 424 treatment, 279–280 pathology, 423 uterine blood flow (UBF), 685–686 prognosis, 424 uterine inversion Valsalva maneuver, 94 causes/risk factors, 281 van Roonhuysian instrument(s), 13–14 diagnosis, 280–281 “vanishing twin” syndrome, 329–330 maternal mortality, 281 VBAC (vaginal birth after cesarean), 511. See also cesarean types of, 280 delivery and VBAC trial. uterine inversion, surgical treatment vecuronium, 198 abdominal approaches venous thromboembolism (VTE), 874–875 Haultain operation, 283 venous thrombosis (VT) Huntington procedure, 283 diagnosis, 875 hydrostatic uterine replacement, 282 incidence, 874 shock, incidence of, 282 pathophysiology, 874–875 uterine relaxation, 282 treatment vaginal approaches alternative treatments, 876 Kustner procedure, 283 antepartum concerns, 876 Spinelli operation, 283 embolism, prior history of, 877 vaginal replacement, 281–282 pharmacology, 876, 877 uterine involution, 259–260 postsurgical care, 876 uterine relaxation, 215–216, 282 pregnancy loss, prior history of, 877 uterotonic agents thrombophilia, lack of, 877 oxytocin verapamil, 199, 200 drug interactions, 199 very-low-birthweight (VLBW) infants, 316, in labor physiology, 248 322–323 prostaglandins vulvar malignancy drug interactions, 199 classification/staging, 423 in labor physiology, 248 diagnosis, 423 epidemiology, 422 vacuum extractors. See also obstetric history, management, 423 vacuum extractors. pathology, 422–423 experimental devices, 19 plastic/disposable devices, 19 wandering, 485 practitioner education, 19–20 warfarin, 405 vaginal birth after cesarean (VBAC), 511. See also Weigart palsy, 350, 756. See birth injuries, fetal. cesarean delivery and VBAC trial. Wigand-Martin-Winkle maneuver, 303. See also breech vaginal malignancy presentation, delivery techniques. classification/staging, 424 Williams, J. Whitridge, 355 diagnosis, 423 Wurm technique, 107–108. See also cervical cerclage.