Essential obstetrics and gynaecology pdf


 

This is the fifth edition of a popular, highly readable primer in obstetrics and gynaecology. It has been thoroughly updated and reconfigured to key into the new. Request PDF on ResearchGate | Essential Obstetrics & Gynaecology | Essential Obstetrics & Gynaecology is a textbook written to suit the new UK. This book is aimed at students of medicine, midwifery and nursing, and covers all the topics likely to be needed at this level in appropriate depth. The book is.

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Essential Obstetrics And Gynaecology Pdf

Affairs, Department of Obstetrics and Gynecology, Albert Einstein Medical Center/ Thomas. Jefferson . The primary goal of this book is to provide the basic in-. Ian M Symonds; Sabaratnam Arulkumaran; E M Symonds Essential obstetrics and medical-site.info - Free ebook download as PDF File .pdf), Text File .txt) or . American College of Obstetrics and Gynecology (ACOG) with. Charles R. B. . The primary goal of this book is to provide the basic in- formation about obstetrics .

This is the fifth edition of a popular, highly readable primer in obstetrics and gynaecology. New to this edition: New editor: Professor Sabaratnam Arulkumaran. Now a multi-authored text written by eminent experts from across the specialty. Book entirely restructured to reflect the national undergraduate curriculum in obstetrics and gynaecology. Over self-assessment MCQs at the end of the book. Key features: Essential information points at the end of chapters.

The clitoris plays an important role in sexual stimulation and function. The vestibule consists of a shallow depression lying between the labia minora. The external urethral orifice opens into the vestibule anteriorly and the vaginal orifice posteriorly.

The ducts from the two Bartholins glands drain into the vestibule at the posterior margin of the vaginal introitus and the secretions from these glands have Labium Clitoris an important lubricating role during sexual intercourse. Although they have some Urethral Labium lubricating function, it is minor compared to the function orifice majus of Bartholins glands.

The bulb of the vestibule consists of two erectile bodies that lie on either side of the vaginal orifice and are in contact with the surface of the urogenital diaphragm. The bulb of the vestibule is covered by a thin layer of muscle known as the bulbocavernosus muscle. The external urethral orifice lies 1. In addition to Skenes ducts, there are often a number of paraurethral glands without associated ducts and these Fig.

The vaginal orifice opens into the lower part of the ves- tibule and, prior to the onset of sexual activity, is partly The labia majora consist of two longitudinal cutaneous covered by the hymenal membrane. The hymen is a thin folds that extend downwards and posteriorly from the fold of skin attached around the circumference of the mons pubis anteriorly to the perineum posteriorly.

The vaginal orifice. There are various types of opening within labia are composed of an outer surface covered by hair and the hymen and the membrane varies in consistency. Once sweat glands and an inner smooth layer containing seba- the hymen has been penetrated, the remnants are repre- ceous follicles.

The labia majora enclose the pudendal cleft sented by the carunculae myrtiformes, which are nodules into which the urethra and vagina open.

Ian M Symonds; Sabaratnam Arulkumaran; E M Symonds Essential obstetrics and gynaecology.pdf

The ducts are approximately 2 cm in 4 Anatomy of the female pelvis Chapter 1 length and open between the labia minora and the vaginal the lower part of the vagina is separated from the anal orifice.

Their function is to secrete mucus during sexual canal by the perineal body. In the middle third, it lies in arousal. Cyst formation is relatively common but is the apposition to the ampulla of the rectum and in the upper result of occlusion of the duct, with fluid accumulation in segment it is covered by the peritoneum of the rectovagi- the duct and not in the gland.

Although it does not strictly lie within the description The uterine cervix protrudes into the vaginal vault. Four of the vulva, the perineum as described in relation to zones are described in the vaginal vault: the anterior obstetric function is defined as the area that lies between fornix; the posterior fornix; and the two lateral fornices. The pH of the vagina in the sexually mature non- pregnant female is between 4. This has an important antibacterial function that reduces the risk of pelvic infection.

The internal genitalia include the vagina, the uterus, the Fallopian tubes and the ovaries. Situated in the pelvic The uterus cavity, these structures lie in close proximity to the urethra The uterus is a hollow, muscular, pear-shaped organ situ- and urinary bladder anteriorly and the rectum, anal canal ated in the pelvic cavity between the bladder anteriorly and pelvic colon posteriorly Fig.

The size of the uterus depends on the hormonal status of the female. In the sexually mature female, the uterus is approx- The vagina imately 7. The vagina is a muscular tube some It is lined by non-cornified squamous epi- that the uterine fundus is anterior to the uterine cervix. In cross-section, the vagina is H-shaped and it roversion in the pouch of Douglas.

The uterus may also be is capable of considerable distension, particularly during curved anteriorly in its longitudinal axis, a feature that is parturition when it adapts to accommodate the passage of described as anteflexion, or posteriorly, when it is described the fetal head.

Anteriorly, it is intimately related to the as retroflexion. Posteriorly, It consists of a body or corpus, an isthmus and a cervix. The corpus uteri consists of a mass of smooth muscle cells, the myometrium, arranged in three layers. The external Sacrum layers contain smooth muscle cells that pass transversely Tube across the uterine fundus into the lateral angles of the uterus, where their fibres merge with the outer layers of Ovary Cervix the smooth muscle of the Fallopian tubes and the ovarian and round ligaments.

The muscle fibres in the middle layer Uterus Coccyx are arranged in a circular manner and the inner layer con- tains a mixture of longitudinal, circular and oblique Bladder The cavity of the uterus is triangular in shape and is Symphysis flattened anteroposteriorly so that the total volume of the cavity in the non-pregnant state is approximately 2 mL. It Clitoris is lined by endometrium that consists on the surface of mucus-secreting columnar epithelium.

The nature of the Labium maj. Rectum endometrium depends on the phase of the menstrual Labium min. External anal cycle.

Essential Obstetrics and Gynaecology

Following menstruation, the endometrium in the sphincter proliferative phase is only 12 mm thick. By the second Urethra Anus half secretory phase of the cycle the endometrium has Vagina Internal anal grown to a thickness of up to 1 cm. The internal os posterior surface of the broad ligament. Like the anterior opens into the uterine cavity through the isthmus of the ligaments, the broad ligaments play only a weak support- uterus.

In non-parous women the external os is round or ive role for the uterus. In the lum is passed, for example, when taking a Pap smear.

The They arise from the anterolateral surface of the uterus just transition between this epithelium and the stratified squa- below the entrance of the tubes and extend diagonally and mous epithelium of the vaginal ectocervix forms the squa- laterally for cm to the lateral pelvic walls, where mocolumnar junction.

The exact site of this junction is they enter the abdominal inguinal canal, and blend into related to the hormonal status of the woman. Some of the the upper part of the labia majora. These ligaments have cervical glands in the endocervical lining are extensively a weak supporting role for the uterus but do play a role in branched and mucus-secreting.

If the opening to these maintaining its anteverted position. In pregnancy, they glands becomes obstructed, small cysts may form, known become much thickened and strengthened, and during as nabothian follicles.

The outer longitu- direction of entry of the presenting part into the pelvic dinal layer merges with the muscle layer of the vagina. The isthmus of the uterus joins the cervix to the corpus The cardinal ligaments transverse cervical ligaments uteri and in the non-pregnant uterus is a narrow, rather form the strongest supports for the uterus and vaginal poorly defined, area some 23 mm in length.

In preg- vault and are dense fascial thickenings that extend from nancy, it enlarges and contributes to the formation of the the cervix to the fascia over the obturator fossa on each lower segment of the uterus, which is the normal site for pelvic side wall.

Essential Obstetrics and Gynaecology

Medially, they merge with the mass of the incision of caesarean section. In labour it becomes a fibrous tissue and smooth muscle that encloses the cervix part of the birth canal but does not contribute significantly and the vaginal vault and is known as the parametrium. The to the expulsion of the fetus. Close to the cervix, the parametrium contains the uterine arter- Supports and ligaments ies, nerve plexuses and the ureter passing through the ureteric canal to reach the urinary bladder.

Lower down, of the uterus the muscular activity of the pelvic floor muscles and the The uterus and the pelvic organs are supported by a integrity of the perineal body play a vital role in preventing number of ligaments and fascial thickenings of varying the development of uterine prolapse see Chapter The pelvic organs also depend for support on the integrity of the pelvic floor: a particular The Fallopian tubes feature in the human female is that, an upright posture having been adopted, the pelvic floor has to contain the The Fallopian tubes or uterine tubes are the oviducts.

In cross-section, the vagina is H-shaped and it roversion in the pouch of Douglas. The uterus may also be is capable of considerable distension, particularly during curved anteriorly in its longitudinal axis, a feature that is parturition when it adapts to accommodate the passage of described as anteflexion, or posteriorly, when it is described the fetal head.

Anteriorly, it is intimately related to the as retroflexion. Posteriorly, It consists of a body or corpus, an isthmus and a cervix. The corpus uteri consists of a mass of smooth muscle cells, the myometrium, arranged in three layers. The external Sacrum layers contain smooth muscle cells that pass transversely Tube across the uterine fundus into the lateral angles of the uterus, where their fibres merge with the outer layers of Ovary Cervix the smooth muscle of the Fallopian tubes and the ovarian and round ligaments.

The muscle fibres in the middle layer Uterus Coccyx are arranged in a circular manner and the inner layer con- tains a mixture of longitudinal, circular and oblique Bladder The cavity of the uterus is triangular in shape and is Symphysis flattened anteroposteriorly so that the total volume of the cavity in the non-pregnant state is approximately 2 mL.

It Clitoris is lined by endometrium that consists on the surface of mucus-secreting columnar epithelium.

The nature of the Labium maj. Rectum endometrium depends on the phase of the menstrual Labium min. External anal cycle. Following menstruation, the endometrium in the sphincter proliferative phase is only 12 mm thick. By the second Urethra Anus half secretory phase of the cycle the endometrium has Vagina Internal anal grown to a thickness of up to 1 cm. The internal os posterior surface of the broad ligament. Like the anterior opens into the uterine cavity through the isthmus of the ligaments, the broad ligaments play only a weak support- uterus.

In non-parous women the external os is round or ive role for the uterus. In the lum is passed, for example, when taking a Pap smear. The They arise from the anterolateral surface of the uterus just transition between this epithelium and the stratified squa- below the entrance of the tubes and extend diagonally and mous epithelium of the vaginal ectocervix forms the squa- laterally for cm to the lateral pelvic walls, where mocolumnar junction.

The exact site of this junction is they enter the abdominal inguinal canal, and blend into related to the hormonal status of the woman. Some of the the upper part of the labia majora. These ligaments have cervical glands in the endocervical lining are extensively a weak supporting role for the uterus but do play a role in branched and mucus-secreting.

If the opening to these maintaining its anteverted position. In pregnancy, they glands becomes obstructed, small cysts may form, known become much thickened and strengthened, and during as nabothian follicles. The outer longitu- direction of entry of the presenting part into the pelvic dinal layer merges with the muscle layer of the vagina.

The isthmus of the uterus joins the cervix to the corpus The cardinal ligaments transverse cervical ligaments uteri and in the non-pregnant uterus is a narrow, rather form the strongest supports for the uterus and vaginal poorly defined, area some 23 mm in length. In preg- vault and are dense fascial thickenings that extend from nancy, it enlarges and contributes to the formation of the the cervix to the fascia over the obturator fossa on each lower segment of the uterus, which is the normal site for pelvic side wall.

Medially, they merge with the mass of the incision of caesarean section. In labour it becomes a fibrous tissue and smooth muscle that encloses the cervix part of the birth canal but does not contribute significantly and the vaginal vault and is known as the parametrium. The to the expulsion of the fetus. Close to the cervix, the parametrium contains the uterine arter- Supports and ligaments ies, nerve plexuses and the ureter passing through the ureteric canal to reach the urinary bladder.

Lower down, of the uterus the muscular activity of the pelvic floor muscles and the The uterus and the pelvic organs are supported by a integrity of the perineal body play a vital role in preventing number of ligaments and fascial thickenings of varying the development of uterine prolapse see Chapter The pelvic organs also depend for support on the integrity of the pelvic floor: a particular The Fallopian tubes feature in the human female is that, an upright posture having been adopted, the pelvic floor has to contain the The Fallopian tubes or uterine tubes are the oviducts.

They downward pressure of the viscera and the pelvic organs. The tubes are approx- from the anterior aspect of the cervix across the superior imately cm long and lie on the posterior surface of surface of the bladder to the peritoneal peritoneum of the the broad ligament, extending laterally in a convoluted anterior abdominal wall.

It has a weak supporting role. These liga- The tubes are enclosed in a mesosalpinx, a superior fold ments and their peritoneal covering form the lateral of the broad ligament, and this peritoneal fold, apart from boundaries of the rectouterine pouch of Douglas. The the tube, also contains the blood vessels and nerve supply ligaments contain a considerable amount of fibrous tissue to the tubes and the ovaries.

It also houses various embry- and non-striped muscle and extend from the cervix onto ological remnants such as the epoophoron, the paroopho- the anterior surface of the sacrum.

These Laterally, the broad ligaments are reflected folds of peri- embryological remnants are significant in that they may toneum that extend from the lateral margins of the uterus form para-ovarian cysts, which are difficult to differentiate to the lateral pelvic walls. They cover the Fallopian tubes from true ovarian cysts.

They are generally benign. Beneath this layer extending from the emergence of the interstitial lies the cortex of the ovary, formed by stromal tissue and portion until it widens into the next section. The collections of epithelial cells that form the Graafian folli- lumen of the tube is narrow and the longitudinal cles at different stages of maturation and degeneration.

These follicles can also be found in the highly vascular, The ampulla is a widened section of the tube and the central portion of the ovary: the medulla. The blood vessels muscle coat is much thinner. The widened cavity is and nerve supply enter the ovary through the medulla. The infundibulum of the tube is the outermost part of the ampulla. The tubes are richly innervated and The major part of the blood supply to the pelvic organs is have an inherent rhythmicity that varies according to the derived from the internal iliac arteries sometimes known stage of the menstrual cycle and whether or not the woman as the hypogastric arteries , which originate from the is pregnant.

The ovaries The internal iliac artery arises at the level of the lum- bosacral articulation and passes over the pelvic brim, con- The ovaries are paired almond-shaped organs that have tinuing downward on the posterolateral wall of the cavity both reproductive and endocrine functions.

It then reaches 3. Each ovary lies on the posterior surface of the broad ligaments in a shallow depression known as the ovarian fossa in close proximity to the external iliac Superior vesical artery vessels and the ureter on the lateral pelvic walls.

Each has Urinary a medial and a lateral surface, an anterior border, a poste- bladder rior border that lies free in the peritoneal cavity, an upper or tubal pole and a lower or uterine pole. Round ligament The anterior border of the ovary is attached to the poste- rior layer of the broad ligament by a fold in the peritoneum External known as the mesovarium.

This fold contains the blood iliac artery vessels and nerves supplying the ovary. The tubal pole of the ovary is attached to the pelvic brim by the suspensory liga- ment infundibulopelvic fold of the ovary.

Procedures in Obstetrics and Gynaecology - - PDF

The lower pole is attached to the lateral border of the uterus by a musculofi- brous condensation known as the ovarian ligament.

Anterior The surface of the ovary is covered by a cuboidal or low branch columnar type of germinal epithelium.

This surface opens of internal directly into the peritoneal cavity. The disease is silent and artery and often asymptomatic and thus presents late. As a result of these characteristics, the prognosis is generally rectum Ovarian Fallopian Common iliac Ureter poor unless the disease is diagnosed when it has not artery tube artery extended beyond the substance of the ovary. They descend behind the peritoneum at the upper margin of the greater sciatic notch, it divides on the surface of the corresponding psoas muscle until into anterior and posterior divisions.

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