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Obstetric Haemorrhage

Introduction Obstetric haemorrhage is one of the leading causes of maternal mortality. Worldwide, approximately 300,000 women die during pregnancy and childbirth each year, and a quarter of these are caused by haemorrhage. Whilst most deaths occur in low-resource settings (primarily Sub-Saharan Africa and Southern Asia), deaths still occur in areas with low rates of maternal mortality, where around 8% of deaths are attributed to haemorrhage. Haemorrhage…

Fetal Medicine

Introduction Fetal medicine is a constantly evolving specialty. With improved understanding of scientific basis and development in technologies, numerous advances have been made in the past decade to provide more holistic and personalised perinatal care. Congenital anomalies are defined as being present at birth and include structural, chromosomal, and genetic anomalies. Fetal medicine involves the assessment of the unborn fetus mainly by ultrasound to allow monitoring…

Maternal Medicine

Introduction Medical disorders are relatively common in pregnancy and often have no implications for the mother or her baby. However, the alteration in maternal physiology which occurs during pregnancy may affect the medical condition, or the medical condition itself may affect the pregnancy and the baby. Treatment options for the mother may be limited by concerns for fetal welfare. Therefore, there is the potential for difficult…

Antenatal and Postnatal Care

The Aim of Antenatal Care The aim of antenatal care is to maximise the chance of a positive outcome from a pregnancy: a healthy mother and a healthy baby or babies. This will involve regular contact between a pregnant woman and health care professionals. The aims of antenatal care are to: Optimise maternal and fetal health Offer women maternal and fetal screening Make medical and social…

Ethical Issues

Introduction Ethics ( Box 22.1 ) is the philosophical study of human conduct. It is not what we do or what we can do, it is what we ‘should’ do and, therefore, what we ‘should not’ do. In the subset of medical ethics that is clinical ethics, attention is focussed on the individual patient, such that resolution is case and patient specific ( Fig. 22.1 ).…

Contraception

Introduction A rights-based approach to sexual and reproductive health supports women to choose if and when they wish to have children, and if so, how many. This is central to women’s empowerment, reducing poverty and achieving the United Nation’s Sustainable Development Goals. The growing use of contraception worldwide has led to a reduction in maternal and neonatal mortality and improvements in socioeconomic conditions. Currently, the World Health…

Abortion

Introduction Induced abortion or termination of pregnancy has been carried out for thousands of years. The provision of abortion in a legal, medically supervised, and safe framework remains one of the most contentious issues in modern-day medicine. Many people have strongly held and often divergent opinions about abortion. Those who are pro-abortion maintain that they are ‘pro-choice’ and support the right of individuals to make their…

Sexual Problems

Introduction It is important for any doctor to be able to take a sexual history and to have some idea of how sexual problems are managed. Understanding the physiology of the normal sexual response will allow the doctor to better understand many of the uncomplicated sexual problems. This chapter is divided in its discussion into issues affecting anatomical males and anatomical females. People with gender incongruence…

Sexually Transmitted Infections

Introduction Sexually transmitted infections (STIs) – including syphilis, gonorrhoea, genital herpes, genital warts, chlamydia, trichomoniasis and Mycoplasma genitalium – are transmitted via the moist mucous membranes of the vulva, vagina, cervix, anus, rectum and oropharynx during sexual activity. Untreated STIs in women can lead to chronic pain or infertility and may lead to genital cancers, including cervical, vulval and anal carcinoma. Ulcerative STIs increase the risk…

Gynaecological Surgery

Introduction Surgery has a central aim of helping people to live a longer or better life. Translated into medical terminology, this means improved survival and enhanced quality of life (QOL). QOL is a subjective measure, reported by the patient, and multiple factors affect how QOL would be rated at any point in time. An operation is in the middle of a much longer process of selecting…

Disorders of the Vulva

Introduction The vulva consists of the mons pubis, labia majora (singular: labium majus), labia minora (singular: labium minus), clitoris, and the vestibule (see Fig. 2.1 ). It is covered with keratinizing squamous epithelium, unlike the vaginal mucosa, which is covered with non-keratinizing squamous epithelium. The labia majora are hair-bearing and contain sweat and sebaceous glands: from an embryological viewpoint, they are analogous to the scrotum. Bartholin…

Gestational Trophoblastic Disease

Introduction Gestational trophoblastic disease (GTD) comprises a group of diagnoses, each characterised by the abnormal proliferation of trophoblast cells with constitutive human chorionic gonadotropin (hCG) production. GTD can be divided into premalignant and malignant forms, with the premalignant diagnoses of complete and partial molar pregnancies and the malignant forms including invasive moles, choriocarcinoma, placental site trophoblastic tumour (PSTT), and epithelioid trophoblastic tumour (ETT; Table 15.1 ).…

Cervical Neoplasms

Introduction Approximately 1 in 10 female cancers diagnosed worldwide are cancers of the cervix; in countries without effective screening programmes, little is changing. Cervical cancer remains the most common cancer among women in many countries without accessible effective screening programmes, with over 450,000 cases each year worldwide. In the United Kingdom, there are 3100 cases of cervical cancer diagnosed each year and 1300 women die from…

Uterine Neoplasms

Introduction The uterus consists of both the cervix and the body (or ‘corpus’) of the uterus. For many reasons, including their causative factors and their treatment, tumours arising from the corpus and the cervix are usually regarded as originating from two separate organs. This chapter will consider cancers arising from the uterine body; cancers arising from the cervix are discussed in Chapter 14. The majority of…

Ovarian Neoplasms

Introduction Ovarian neoplasms, or tumours, encompass a wide range of conditions: benign, malignant and indeterminate lesions, known as borderline. Pathologically, these are distinct, as shown in Fig. 12.1 . They pose challenges for both early detection and correct diagnosis. Ovarian cancer is the second most common gynaecological malignancy in high-income countries (endometrial cancer being the most common). There are many histological subtypes of ovarian cancer; epithelial…

Urinary Incontinence

Introduction Urinary incontinence (UI) is defined as any involuntary loss of urine, which is a social or hygienic problem. UI is common – it is reported by 46% of women attending primary care clinics in the United Kingdom but is often underdiagnosed and undertreated. The incidence of UI increases with age. Overactive bladder (OAB) symptoms are present in up to half of elderly women in care…

Pelvic Organ Prolapse

Introduction Pelvic organ prolapse (POP) is described as the descent of one or more of the pelvic organs into the vagina. It can affect any of the compartments of the vagina: anterior (bladder), posterior (bowel) or apical (uterus/cervix or vault if the woman has previously had a hysterectomy). Although prolapse in a single compartment can happen, typically more than one compartment will be involved (e.g., bladder…

Menopause and Hormone Replacement Therapy

Introduction ‘Menopause’ is derived from the Greek term for cessation of the last monthly period. The definition is 12 months of absent periods in a woman with a uterus who is not pregnant or not taking hormones that might affect the menstrual cycle. Due to the increase in life expectancy in the last century, menopause has now become merely a midlife point for many women. This…

Pelvic Pain and Endometriosis

Pelvic Pain Physiological pelvic pain with menstruation or childbirth is almost universal, but many women have pelvic pain for other reasons. Pelvic pain can be acute (associated with miscarriage, ectopic pregnancy, or appendicitis) or it can be chronic, lasting for many months or years. With acute pain, there is usually a well-defined pathological cause that either resolves spontaneously or can be effectively treated. It is important…

Heavy Menstrual Bleeding, Dysmenorrhoea and Pre-Menstrual Syndrome

Heavy Menstrual Bleeding Heavy menstrual bleeding (HMB) is defined, for clinical purposes, as bleeding that has an adverse impact on the quality of life of a woman. It may occur alone or with other symptoms. Menstrual blood loss can be measured, but this is usually performed only for research purposes. HMB was often called ‘menorrhagia’ in the past, but this term is better avoided as it…