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Early Pregnancy Care

Introduction Early pregnancy complications are a significant cause of maternal morbidity and mortality and a common cause for women to present to acute gynaecology services. These include miscarriage and ectopic pregnancy, and account for over 50,000 hospital admissions in the United Kingdom every year. Miscarriage Miscarriage is the most common early pregnancy complication, occurring in as many as 15% to 20% of all clinically recognised pregnancies.…

Subfertility

Introduction Subfertility is a condition that affects approximately one in six couples. The cause may be related to a problem with the man, woman or both. In view of the intimate nature of the problem, subfertility is often associated with personal distress and embarrassment; effective treatment is available to help an increasing proportion of these couples. Definitions Subfertility is formally recognized as a disease by the…

Menstruation and Amenorrhoea

The Menstrual Cycle Overview of the cycle The endometrial cycle results from the growth and shedding of the uterine lining – the endometrium. This cycle, the average duration of which is 28 days, is controlled by the hormones from the ovary and consists of a follicular phase, ovulation, and a post-ovulatory (or luteal) phase. During the follicular phase, the endometrium thickens (proliferative phase of the endometrium).…

Paediatric Gynaecology and Differences in Sex Development

Introduction Puberty should transform a girl into a fertile woman. Its social importance is so great that any deviation from normality may be the cause of considerable embarrassment and anxiety. This chapter describes normal puberty and outlines the management of both precocious and delayed puberty. It will also cover some of the gynaecological conditions which may affect pre- and post-pubertal girls. Normal Puberty Pathophysiology of normal…

History and Examination

Introduction In general, history and examination cannot be divided neatly into different specialties, and questions relating to obstetrics and gynaecology should form part of the assessment of any woman presenting to any specialty. There may be embarrassment and recrimination, for example, when a suspected appendicitis turns out to be a pelvic infection secondary to an unsus­pected intrauterine contraceptive device (IUCD). Similarly, not all problems presenting to…

Clinical Pelvic Anatomy

Introduction A thorough understanding of pelvic anatomy is essential for clinical practice. Not only does it facilitate an understanding of the process of labour, it also allows an appreciation of the mechanisms of sexual function and reproduction, and establishes a background to the understanding of gynaecological pathology. Congenital abnormalities are discussed in Chapters 3, 25, and 40. Obstetric Anatomy The bony pelvis The girdle of bones…

Harmonization of Data and Biobanks for Preeclampsia Research

Editor's comment : This new chapter is included in recognition of the increasing power of informatics and data analysis that have become evident in the 21 st century. We are no longer constrained to examining tiny “slices of disease” or attempting to satisfy the Ockham's razor approach to simplifying findings to the most parsimonious explanation. Rather, we now have the power to begin to examine interactions…

Animal Models Used for Investigating Pathophysiology of Preeclampsia and Identifying Therapeutic Targets

Funding sources This work was supported by the American Association under grant number 18POST33990293 (BAB) and the National Institutes of Health under grant numbers P01HL051971 (BAB, JPG), P20GM104357 (BAB, JPG), R01HL136684 (JPG), R01HL137791 (EMG), R01HL123527 (EMG), T32HL105324 (JPG), and U54GM115428 (JPG). Editors’ comment: Animal models were not mentioned in Chesley’s initial edition, and it is not clear that he acknowledged that they could be useful to…

Long-Term Effects of Preeclampsia on Mothers and Offspring

Editors' comment: The short-term maternal and offspring effects of preeclampsia are presented in Chapter 2. This is a new chapter to the fifth edition of Chesley's Hypertensive Disorders in Pregnancy, focusing on long-term health. The topic of remote maternal health has been previously addressed in Chesley editions, including part of the prior chapter named “Epidemiology of Pregnancy-Related Hypertension” by Janet W. Rich-Edwards, Roberta B. Ness, and…

Prediction and Prevention of Preeclampsia

Editors’ comment: When Dr. Chesley published his original textbook in 1978, tests to predict preeclampsia had hardly been studied. Nevertheless, the concepts of prediction and prevention were never far from his mind. For example, his proposal to use urate clearance as a predictor of disease risk was a pioneering example of such thinking. Suggestions are offered in this chapter to incorporate specific biomarkers in conjunction with classical…

Clinical Management and Antihypertensive Treatment of Hypertensive Disorders of Pregnancy

Editors' comment: This is a new chapter in the fifth edition of Chesley's Hypertensive Disorders in Pregnancy . The present chapter includes a revision of the previous chapter named “Antihypertensive Treatment” of the fourth edition ( Chapter 19 ), by Jason G. Umans, Edgardo J. Abalos, and F. Gary Cunningham. Jason Umans remains as an important contributor to this extended chapter, which now has added three…

Platelets, Coagulation, and the Liver

Editors' comment: Following the retirement of Dr. Gary Cunningham from our editorial team after the fourth edition of Chesley's textbook, we have taken the opportunity to update this important chapter on platelet function, coagulation, and hepatic pathophysiology in pregnancy and preeclampsia. The complex relationships among these systems contribute to many of the clinical biochemistry analytes that we rely upon to diagnose and monitor the course of…

Salt, Aldosterone, and the Renin–Angiotensin System in Pregnancy

Editors' comment : The role of the renin–angiotensin–aldosterone system (RAAS) in preeclampsia has intrigued investigators for decades. Chesley had a chapter devoted to this topic in his first edition, and he would have been delighted by some of the novel twists that have occurred in this important area, such as the discovery of agonistic autoantibodies (AT1-AA) and that Angiotensin (Ang)1-7 has potent vasodilatory activity. In the…

The Kidney in Normal Pregnancy and Preeclampsia

Editor's Comment : The Editors gratefully acknowledge the invaluable contributions of Marshall D. Lindheimer, recently retired, who served as Editor and coauthor of this chapter in the second–fourth editions. The revision of the chapter for the current edition (previously Chapter 16 in the fourth edition) includes the welcome addition of a new first author, Kate Wiles, a Nephrologist and Consultant in Obstetrics with expertise in the…

Cerebrovascular Pathophysiology in Preeclampsia and Eclampsia

Editors' comment : A complete chapter focusing on the brain in normal pregnancy and preeclampsia appeared in Chelsley's third edition, and this is its second revision. The important contributions of previous authors of this chapter, Gerda G. Zeeman and F. Gary Cunningham, are greatly appreciated. Hemorrhagic and ischemic strokes are in addition to eclamptic fits important and feared causes of maternal morbidity and mortality in women…

Cardiometabolic Antecedents of Preeclampsia

Editors' comment: In the chapter entitled “Metabolic syndrome and preeclampsia” of the previous (fourth) edition of this textbook, we advanced the concept that components of metabolic syndrome interact with placental factors to promote inflammation, endothelial cell dysfunction, and the maternal preeclampsia syndrome. We also summarized evidence suggesting that the same underlying factors that contribute to preeclampsia also increase a woman's risk of developing cardiovascular disease (CVD)…

Cardiovascular Alterations in Normal and Preeclamptic Pregnancy

Editors' comment: We welcome the addition of a new coauthor to this chapter, Alisse Hauspurg MD, who brings expertise in Maternal Fetal Medicine with a focus on hypertensive disorders of pregnancy. The chapter has been revised and updated to include the new literature that emerged on the topic since the previous version in the fourth edition. Introduction There are striking physiologic cardiovascular changes during pregnancy that…

Vascular Endothelial Cell Dysfunction in Preeclampsia

Editors' comment : It was not until the early 1980s that physicians and scientists gained an appreciation of the physiological importance of the endothelium, the simple unicellular layer lining the luminal surface of blood vessels. Indeed, in Chesley's first, single-authored edition of this text, the reference to this term was as it related to the “endotheliosis” lesion of the renal glomerulus. We now recognize that endothelial…

Angiogenesis and Preeclampsia

Editors' comment: When Chesley wrote his original monograph, he, like most of the scientific community, was unfamiliar with the concept of angiogenesis. Even in the multiauthored second edition, in which the endothelial cell hypothesis of preeclampsia was first proposed, the subject “angiogenesis” was not elaborated. This millennium has witnessed a very different story. Starting with preliminary observations of the roles of angiogenic proteins in normal and…

Trophoblast Extracellular Vesicles in Preeclampsia

Acknowledgments MV is grateful to Drs. William Cooke, Sofia Cerdeira, and Neva Kandzija for their helpful contributions to this chapter. CR acknowledges the major contributions from Ian Sargent, who developed the STBEV story in Oxford. Editors' comment: This is a new chapter for the fifth edition of Chesley's Hypertensive Disorders in Pregnancy, focusing on trophoblast extracellular vesicles. In the fourth edition of this book, there was…