You are on page 1of 33

Jeffcoate’s Principles of

GYNAECOLOGY

Prelims New.indd 1 09-Apr-18 3:10:04 PM


Prelims New.indd 2 09-Apr-18 3:10:04 PM
Jeffcoate’s Principles of
GYNAECOLOGY
NINTH INTERNATIONAL EDITION
Revised and updated from the Eighth Edition by
Narendra Malhotra
MD FICOG FRCOG (Honoris Causa) FICS FMAS
Professor, Dubrovnik International University, Croatia
Past President, FOGSI
Managing Director, Global Rainbow Healthcare
Agra, Uttar Pradesh, India

Jaideep Malhotra
MD FICOG FICS FRCOG FRCPI
Professor, Dubrovnik International University, Croatia
President, FOGSI
Past President, The Asia Pacific Initiative on Reproduction (ASPIRE)
Managing Director, ART Rainbow-IVF
Agra, Uttar Pradesh, India

Richa Saxena
MBBS MD (Obstetrics & Gynaecology)
PG Diploma in Clinical Research
Obstetrician and Gynaecologist
New Delhi, India

Neharika Malhotra Bora


MD (Gold Medalist) DRM (Germany)
FMAS FICMCH ICOG (Reproductive Medicine)
Infertility Consultant, Rainbow-IVF, Agra
Assistant Professor, Department of Obstetrics and Gynaecology
Bharati Vidyapeeth Medical College, Pune, Maharashtra, India
Consultant, ART Rainbow-IVF
Agra, Uttar Pradesh, India

The Health Sciences Publisher


New Delhi | London | Panama

Prelims New.indd 3 09-Apr-18 3:10:04 PM


Jaypee Brothers Medical Publishers (P) Ltd
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: jaypee@jaypeebrothers.com

Overseas Offices
J.P. Medical Ltd Jaypee-Highlights Medical Publishers Inc
83 Victoria Street, London City of Knowledge, Bld. 235, 2nd Floor, Clayton
SW1H 0HW (UK) Panama City, Panama
Phone: +44-20 317 08910 Phone: +1 507-301-0496
Fax: +44 (0)20 3008 6180 Fax: +1 507-301-0499
Email: info@jpmedpub.com Email: cservice@jphmedical.com
Jaypee Brothers Medical Publishers (P) Ltd Jaypee Brothers Medical Publishers (P) Ltd
17/1-B Babar Road, Block-B, Shyamoli Bhotahity, Kathmandu, Nepal
Mohammadpur, Dhaka-1207 Phone: +977-9741283608
Bangladesh Email: Kathmandu@jaypeebrothers.com
Mobile: +08801912003485
Email: jaypeedhaka@gmail.com

Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com

© 2019, Jaypee Brothers Medical Publishers


The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent
those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their
respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the
subject matter in question. However, readers are advised to check the most current information available on procedures included and
check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and
duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety
precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property
arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or
services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any
have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/
DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Jeffcoate’s Principles of Gynaecology
First Edition: 1957
Fifth Edition: 1987
Sixth Edition: 2001
Seventh Edition: 2008
Eighth Edition: 2014
Ninth Edition: 2019

ISBN 978-93-5270-477-4

Printed at

Prelims New.indd 4 09-Apr-18 3:10:04 PM


CONTRIBUTORS

Acharya Neema  MBBS DGO DNB DFP FICOG Bahadur Anupama  MBBS MD (Obstetrics and
Gynaecology)
Professor
Department of Obstetrics and Gynaecology Sub-Dean (Academics)
Datta Meghe Institute of Medical Sciences Additional Professor
(Deemed University) Department of Obstetrics and Gynaecology
Wardha, Maharashtra, India All India Institute of Medical Sciences
Rishikesh, Uttarakhand, India
Agrawal Kavita  MBBS MD (Obstetrics and
Gynaecology)
Banerjee Dipanwita  MBBS MS (Obstetrics and
Assistant Professor Gynaecology) DPMIACA
Lady Hardinge Medical College Department of Gynaecological Oncology
New Delhi, India Chittaranjan National Cancer Institute
Kolkata, West Bengal, India
Agrawal Mohit  MBBS MD (Obstetrics and
Gynaecology)
Assistant Professor Bansal Kanthi  MD DGO FICOG
Department of Obstetrics and Gynaecology Director
Wardha, Maharashtra, India Safal Fertility Foundation
Ahmedabad, Gujarat, India
Agrawal Ragini  MBBS MS (Obstetrics and
Gynaecology) MS FICOG FICMCH
Director Bansal Shemi  MBBS DIPGO
W Pratiksha Hospital and IVF Centre Consultant, Rainbow Hospital
Gurugram, Haryana, India Agra, Uttar Pradesh, India

Ahuja Maninder  MBBS MD (Obstetrics and


Gynaecology)
Honorary Professor, Indian Medical Baxi Dhaval  MBBS DGO DNBn MCh
Association Resident
Director, Ahuja Hospital and Infertility Centre Department of Reproductive Medicine and
Faridabad, Haryana, India Surgery
Sri Aurobindo Medical College and
Ali Hina  MBBS MS (Obstetrics and
Gynaecology) Fellowship in Reproductive Medicine Postgraduate Institute
Indore, Madhya Pradesh, India
Consultant, Rainbow-IVF
Agra, Uttar Pradesh, India

Anand Anupama  DGO FICOG Bindra Vimee  MBBS MS (Obstetrics and


Gynaecology) MHA
Consultant
Department of Obstetrics and Gynaecology Consultant Gynaecologist and Obstetrician
Nelson Mother and Child Hospital Apollo Hospitals
Nagpur, Maharashtra, India Hyderabad, Telangana, India

Prelims New.indd 5 09-Apr-18 3:10:05 PM


vi Jeffcoate’s Principles of Gynaecology

Bora Neharika M  MD (Gold Medalist) DRM Gupta Shally  DGO DNB


(Germany) FMAS FICMCH ICOG (Reproductive Medicine) Consultant
Infertility Consultant, Rainbow-IVF, Agra Rainbow-IVF
Assistant Professor, Department of Obstetrics Agra, Uttar Pradesh, India
and Gynaecology
Bharati Vidyapeeth Medical College Pune,
Maharashtra, India Gupta Sushma  MBBS MD (Obstetrics and
Consultant, ART Rainbow-IVF Gynaecology)
Agra, Uttar Pradesh, India Consultant
Aakanksha Test Tube Baby Centre
Bora Rishabh MBBS MD (Radiology) Dr Kusum Gupta Nursing Home
Rainbow Hospital Agra, Uttar Pradesh, India
Agra, Uttar Pradesh, India
Hafizur  MBBS DGO DNB MNAMS FMAS FICOG Dip. MAS
(Germany)
Professor
Dutta Indranil  MBBS MS (Obstetrics and Department of Obstetrics and Gynaecology
Gynaecology) FIAOG FAGE Sikkim Manipal Institute of Medical Sciences
Associate Professor Gangtok, Sikkim, India
IQ City and NH Medical College
Durgapur, West Bengal, India Hinduja Ritu  MBBS MD MRM (UK) DRM (Germany)
Consultant
Ganapule Chaitanya  MBBS MD (Obstetrics and Department of Reproductive Medicine
Gynaecology) Nova IVI Fertility
Director Mumbai, Maharashtra, India
Pearl Women’s Hospital and Yash IVF
Pune, Maharashtra, India Hokabaj Shaheen  MBBS DNB FIRM FAGE
Gynae Endoscopy and Infertility Specialist
Ganesh Deepa  MBBS MS FMAS DMAS FICRS FIMA Sneh Infertility Centre
Dip MIS (Germany) Dip ALS (France) Dip ACG (USA) FIMSA
Ahmedabad, Gujarat, India
Director
DG Laser and Cosmetic Gynecology Clinic
Chennai, Tamil Nadu, India Indersen Amitha  MBBS MD (Obstetrics and
Gynaecology)
Garg Ruchika  MBBS MD MRCOG 1 CIMP MAMS Consultant and Head
FAMS FICMCH
Department of Fetal Medicine
Associate Professor Apollo Cradle Hospitals
Department of Obstetrics and Gynaecology Hyderabad, Telangana, India
SN Medical College
Agra, Uttar Pradesh, India Joshi Prasanna  MBBS DNB (Gynae) DGO MNAMS
DGL (Germany) FICOG DIP ART (Germany)
Ghosh Chiranjit  MBBS MD (Obstetrics and Director
Gynaecology) DGO
Ganesh Hopital
RG Kar Medical College and Hospital
Amalner, Jalgaon, Maharashtra, India
Kolkata, West Bengal, India

Kale Ashish  MBBS MD DNB MNAMS FICS DEPS


Goswami Diksha  MBBS MD DNB MRCOG FNB MICOG
(Reproductive Medicine)
IVF Consultant and Founder Director
Consultant Ashakiran Group of Hospitals and
Rainbow-IVF Asha IVF Centre
Agra, Uttar Pradesh, India Pune, Maharashtra, India

Prelims New.indd 6 09-Apr-18 3:10:05 PM


Contributors vii

Kale Ashwani  MBBS DGO DNB (Obstetrics and Malik Jyoti  MBBS DGO DNB MNAMS FICS
Gynaecology) J J Institute of Medical Sciences
IVF Consultant and Embryologist Bahadurgarh, Haryana, India
Ashakiran Hospital and Asha IVF Centre
Pune, Maharashtra, India
Malik Sonia  MBBS MD DGO
Kashyap Vivek  MBBS MD (Radiology) Director and Head
Chairman and Consultant Southend Fertility and IVF
Dr Kashyap’s Diagnostics New Delhi, India
New Delhi, India
Mehta Manjeet  PhD (Human Genetics)
KD Reubina  MBBS MS (Obstetrics and Gynaecology) Director, Neogenetics, New Delhi
Director Director-Technical
Grace IVF Centre DNA Diagnostics Center, Gurugram
Chandigarh, India Director-Partner, Genetic World Mumbai,
Maharashtra, India

Mishra Sakshi  MBBS MS (Obstetrics and


Kharas Percy  MBBS DGO MD Gynaecology)
CEO, Gynaecology and Infertility Specialist Senior Resident
Excellent IVF and ICSI Centre Department of Obstetrics and Gynaecology
Valsad, Surat, Gujarat, India NSCB Medical College
Jabalpur, Madhya Pradesh, India

Malhotra Hemant  MBBS MD FRCP (London) Mittal Bhawana  MBBS MS (Obstetrics and
FACP (USA) MNAMS FICP FUICC FIMSA Gynaecology)
Senior Professor Director, Shivam IVF Centre, Delhi
RK Birla Cancer Center Consultant, Max IVF
SMS Medical College and Hospital Ghaziabad, Uttar Pradesh, India
Jaipur, Rajasthan, India
Mukherjee Basab  MBBS MD FRCOG FICOG
Malhotra Jaideep  MD FICOG FICS FRCOG FRCPI Consultant Gynaecologist
Professor Kolkata, West Bengal, India
Dubrovnik International University, Croatia
President, FOGSI
Past President The Asia Pacific Initiative on
Reproduction (ASPIRE) Naik Bijouy  MBBS MS (Obstetrics and Gynaecology)
Managing Director, ART Rainbow-IVF Senior Consultant
Agra, Uttar Pradesh, India Manipal Hospital
New Delhi, India
Malhotra Narendra  MD FICOG FRCOG (Honoris
Causa) FICS FMAS
Professor Panchal Sonal MBBS MD (Obstetrics and
Dubrovnik International University, Croatia Gynecology)
Past President, FOGSI Consultant
Managing Director Dr Nagori’s Institute for
Global Rainbow Healthcare Infertility and IVF
Agra, Uttar Pradesh, India Ahmedabad, Gujarat, India

Prelims New.indd 7 09-Apr-18 3:10:06 PM


viii Jeffcoate’s Principles of Gynaecology

Pandey Jyotsana MBBS Raj Mala  MBBS MD


Resident Managing Director
Department of Obstetrics and Gynaecology Firm Hospital
Institute of Medical Sciences, Banaras Hindu Chennai, Tamil Nadu, India
University
Varanasi, Uttar Pradesh, India
Ray Chandrima  MBBS DGO DNB (OBGYN) FMAS
Senior Resident, Department of
Pandey Seema  MBBS MD FICOG FRM Gynaec-Oncology
Director Chittaranjan National Cancer Institute
Chief, IVF and Reproductive Medicine Kolkata, West Bengal, India
Consultant
Seema Hospital and Eva Fertility Clinic and Ray Rajat  MBBS MD FICOG
IVF Centre Associate Professor
Sanjeevani Nursing Home Hi-Tech Medical College
Azamgarh, Uttar Pradesh, India Rourkela, Odisha, India
Pandey Uma  MBBS MD FRCOG FICOG FIAOG
Associate Professor Roy Priyankur  MBBS MS FIRM FAGE
Department of Obstetrics and Gynaecology
Senior Resident
Institute of Medical Sciences, Banaras Hindu
North Bengal Medical College
University
Siliguri, West Bengal, India
Varanasi, Uttar Pradesh, India

Pathak Jayshree  MBBS MD (Obstetrics and


Gynaecology) Reddy Appoorva Pallam  MBBS MS
(Obstetrics and Gynaecology) DNB
Rainbow-IVF
New Delhi, India Apollo Cradle
Bengaluru, Karnataka, India

Patolia Hetal  MBBS MD (Obstetrics and


Gynaecology) Reddy Yasodhara Pallam  MBBS MD
(Obstetrics and Gynaecology)
Columbia Asia Hospital
Ahmedabad, Gujarat, India Consultant, Department of High Risk
Pregnancy
Clinical Director, Sri Durga Hospital and IVF
Centre
Priyadarshini Neha  MBBS MD (Obstetrics and
Gynaecology) Nellore, Andhra Pradesh, India
Consultant Saxena Richa  MBBS MD (Obstetrics and
SATVIK IVF Gynaecology) PG Diploma in Clinical Research
Dhanbad, Jharkhand, India Obstetrician and Gynaecologist
New Delhi, India
Priya Selva  MBBS MD (Obstetrics and Gynaecology)
Clinical Director
Shah Rupal  MBBS MD (Obstetrics and Gynaecology)
NDJH GIFT Department of Fertility and Fetal
Medicine Chief Consultant
Dr Jeyasekharan Hospital Rupal Hospital for Women
Kanyakumari, Tamil Nadu, India Surat, Gujarat, India

Prelims New.indd 8 09-Apr-18 3:10:06 PM


Contributors ix

Sharma Esha  MBBS MS DNB Singh Kuldeep  MBBS MS (Obstetrics and


Gynaecology)
Consultant
Ramkrishna IVF Centre Dr Kuldeep Ultrasound and Color Doppler
Siliguri, West Bengal, India Clinic
New Delhi, India

Sharma Manpreet  MBBS MS (Obstetrics and Singh Rakhi  MBBS DGO FICOG FIAOG DRM ARCOG
Gynaecology) Director
Consultant Abalone Clinic and IVF Center
Department of Obstetrics and Gynaecology Noida, Uttar Pradesh, India
Rainbow Hospital
Agra, Uttar Pradesh, India
Vats Garima  MBBS MS (Obstetrics and Gynaecology)
Shinde Prerna  MBBS MD DGO DICOG
Assistant Professor
Director Jaipur National University and Medical
Shinde Hospital and Test Tube Baby Center College
Ahmednagar, Maharashtra, India Jaipur, Rajasthan, India

Yadav Himanshu  MBBS MS (General Surgery)


Singh Amreen  MBBS MD (Obstetrics and MCh (Surgical Gastroenterology)
Gynaecology)
Associate Professor
Aspire Fellow SN Medical College
Rainbow Hospital Agra, Uttar Pradesh, India
Agra, Uttar Pradesh, India
Yadav Nisha  MBBS MD DNB DESA
Singh Ankan  MBBS MS (Obstetrics and
Gynaecology) Consultant
Department of Anaesthesiology and Critical
Fellow in Reproductive Medicine
Care
Rainbow Hospital
Global Rainbow Healthcare
Agra, Uttar Pradesh, India
Agra, Uttar Pradesh, India
Singh Kavita  MS PhD (Gyn. Oncology) FICOG
FICMCH
Professor and Head
Department of Obstetrics and Gynaecology
NSCB Government Medical College
Jabalpur, Madhya Pradesh, India

Prelims New.indd 9 09-Apr-18 3:10:07 PM


Prelims New.indd 10 09-Apr-18 3:10:07 PM
PREFACE TO THE
NINTH INTERNATIONAL EDITION

It is an honour yet again to update this “Bible of Gynaecology”, Prof Sir Norman Jeffcoate had written this book
on the basis of what he saw in those days. His style of describing gynaecology as a story telling is still appreciated.
However, from the years of Prof Jeffcoate the practice of medicine, especially in the field of gynaecology, has
changed a lot as there is an incorporation of transvaginal sonography, colposcopy and office hysteroscopy in the
clinic and this has simplified and quickened the diagnosis and treatment. Leaps of advances have occurred in
diagnosis, management, procedures and drugs.
In this revised edition, new chapters, pictures, photographs and discussions have been incorporated keeping
in mind the recent guidelines and updates in this field. New topics like genetics in gynaecology, precocious and
delayed puberty, pregnancy of unknown location, female genital mutilation, adenomyosis, assisted reproductive
technology, urinary tract infection, contraception, and single incision laparoendoscopic surgery, etc. have been
introduced.
We have tried to update all the chapters to include the latest evidences and preserving Prof Norman Jeffcoate
narrative style. This issue has been updated with the efforts of multiple authors and experts. We hope this updated
Bible of Gynaecology will be useful to all students, teachers and practitioners.
Happy Reading!
Narendra Malhotra
Jaideep Malhotra
Richa Saxena
Neharika Malhotra Bora

Prelims New.indd 11 09-Apr-18 3:10:07 PM


Prelims New.indd 12 09-Apr-18 3:10:07 PM
PREFACE TO THE FIFTH EDITION

It was inevitable that following Professor Sir Norman Jeffcoate’s retirement, there would be pressure to continue to
publish the Principles of Gynaecology.
In the last revision in 1974, Sir Norman emphasised that he had endeavoured to preserve his personal approach,
bearing in mind the objectives and principles outlined in the preface to the First Edition. In addition, some of Sir
Norman’s comments in the preface to his Fourth Edition are included to emphasise the guidelines the present
author has taken in an attempt to maintain the format of the Principles of Gynaecology.
Much of the material presented is retained from the last edition, since it also reflects the gynaecological training
of the author under Professor Jeffcoate in Liverpool. The views expressed are therefore personal ones from a pupil
of Sir Norman Jeffcoate against the background of all the information available. Once given, the views expressed
mean that references are excluded for the special reasons given in the preface to the First Edition.
In the process of being taught Obstetrics and Gynaecology by Sir Norman, one was encouraged to consider all
the facts about a case, to come to a conclusion and to be able to justify it. Even though a critical approach to each
case was expected, we were never allowed to forget that we were dealing with a woman, mother or child with a
personal problem. Indeed, Professor Jeffcoate’s personal approach was such that in a clinic with many students
and postgraduates present, it was obvious that as far as the patient was concerned Sir Norman was the only person
there. I have never been able to achieve the same effect, but I hope that my efforts in revising this book will be
acceptable to an outstanding teacher, guide and friend. If so, then I am sure it will benefit all those who read it.

Victor Tindall

Prelims New.indd 13 09-Apr-18 3:10:07 PM


Prelims New.indd 14 09-Apr-18 3:10:07 PM
EXTRACTS FROM
THE PREFACE TO THE FIRST EDITION

The book is meant to add to rather than replace clinical and tutorial instruction, so those matters which can best
be taught beside the patient, or which are easy for any student to learn and understand from other sources, receive
little attention. In planning the text, I recalled those subjects which I myself found (and still do find) difficult to
master, or on which I had to search far and long for information, and gave them disproportionate emphasis. This
and other considerations resulted in a disregard for the relative importance, as judged by their clinical frequency, of
different conditions. Indeed, the reader will find that quite rare conditions are mentioned, illustrated or described
at length; and that all manner of asides—even some with an obstetrical flavour—creep in. This is partly because
they are of special interest to me but mainly because they appeared to offer scope for presenting an attitude of
mind; for discouraging loose thinking and empiricism; for inculcating a scientifically and ethically honest outlook;
for emphasising the art as well as the science of gynaecology.
I have not played safe by stating only generally accepted views, nor have I played fair by giving the differing
views of various authorities. Instead, after weighing the evidence, I have attempted to reach a conclusion which
satisfies me as being as rational as present knowledge allows. Without intended disrespect, mention by name of
authors and workers has been avoided as a rule; references clutter up the text, destroy continuity and are hardly
ever used properly. On the other hand, I have not hesitated to give my own views and have, at times, been more
dogmatic than clinical experience ever really justifies. I have even gone so far as to enunciate ideas which in many
respects are conjectural, if not fanciful. I do not expect these all to be accepted; if they are I shall be disappointed
because their object is to provoke trains of thought and discussion.
In offering this book to fellow students, I remember with affection and gratitude William Blair-Bell, one of the
great gynaecologists of this century. He not only taught me gynaecology and a particular approach to it, he taught
me to think and to write. He, more than anyone else, provided me with the stimulus and the opportunity to obtain
the experience which has led to this work.

Norman Jeffcoate

Prelims New.indd 15 09-Apr-18 3:10:07 PM


Prelims New.indd 16 09-Apr-18 3:10:07 PM
ACKNOWLEDGEMENTS

To edit a book written by a legend Professor Jeffcoate is a mammoth task. I and Dr Jaideep Malhotra did a lot of
researches and asked all our students to suggest what more they wanted in the ninth edition. Dr Neharika Malhotra
Bora and Dr Richa Saxena have helped immensely in adding a lot of material to the chapters and updating many
of them.
We are thankful to all the contributors (names mentioned in the contributor list), for their valuable inputs and
contributions to update all the chapters.
We are grateful to all those who have helped us to do this mammoth job. Special appreciations and thanks to
Shri Jitendar P Vij (Group Chairman) and Mr Ankit Vij (Managing Director) of M/s Jaypee Brothers Medical
Publishers (P) Ltd, New Delhi, India. Simultaneously we would like to acknowledge the help of various doctors,
editors and content strategists (Dr Arun Bhatia, Kanav Midha, Mampi Debnath, Priyanka Diwan, Dr Sudha Chamoli
and Shallu Mann), who helped in editing of the manuscript within a short span of time.
We are thankful to our families for bearing with us and sharing family time for work like this.
We thank Dr Prabha Malhotra, Dr Deepali, Dr Deepika, Dr RM Malhotra, Dr Rishab Bora and Dr Kehsav.
We hope the students of gynaecology will like what we have produced in the ninth edition.
We have tried to retain Professor Jeffcoate’s style and some of the valuable photographs from the first edition.

Narendra Malhotra
Jaideep Malhotra
Richa Saxena
Neharika Malhotra Bora

Prelims New.indd 17 09-Apr-18 3:10:07 PM


Prelims New.indd 18 09-Apr-18 3:10:07 PM
CONTENTS

Chapter 1: A Clinical Approach to Gynaecology 1


‰‰ Psychosomatic and Sociological Aspects of Gynaecology  2
‰‰ Clinical Methods  2
‰‰ Physical Examination  6
‰‰ Special Tests and Accessory Aids to Diagnosis  12
‰‰ Endometrial Sampling Procedures  12
‰‰ Transvaginal Sonography  14
‰‰ Transrectal Sonography  14
‰‰ Colour Doppler  14
‰‰ Endoscopy 16
‰‰ Laparoscopy 16
‰‰ Hysteroscopy 18
‰‰ Computed Tomography  19
‰‰ Magnetic Resonance Imaging  20
‰‰ PET Scan  21

Chapter 2: Anatomy 23
‰‰ Vulva 23
‰‰ Vagina 27
‰‰ Uterus 32
‰‰ Fallopian Tubes  36
‰‰ Ovary 38
‰‰ Urethra and Bladder  39
‰‰ Ureter 43
‰‰ Sigmoid Colon  43
‰‰ Rectum and Anus  44
‰‰ Pelvic Peritoneum and Ligaments  45
‰‰ Pelvic Musculature  46
‰‰ Pelvic Fascia and Cellular Tissue  47
‰‰ The Supports of the Genital Organs 47
‰‰ Blood Vessels of the Pelvis 48
‰‰ Lymphatic Drainage 52
‰‰ Innervation of Pelvic Organs 54

Chapter 3: Ovarian Functions 58


‰‰ Production of Ova  59
‰‰ Ovarian Hormones  71
‰‰ Pituitary Hormones  77
‰‰ Pituitary-Hypothalamic Relations  78
‰‰ Pituitary-Ovarian Relations (Control of Ovulation)  80
‰‰ Hormone Levels and Assays  81

Prelims New.indd 19 09-Apr-18 3:10:07 PM


xx Jeffcoate’s Principles of Gynaecology

Chapter 4: Menstruation and Other Cyclical Phenomena 83


‰‰ Normal Menstrual Cycle  83
‰‰ Endometrial Cycle  83
‰‰ Correlation of Endometrial and Ovarian Cycle  88
‰‰ Uterine Bleeding  90
‰‰ The Myometrial Cycle  94
‰‰ Cyclical Changes in the Tube  94
‰‰ The Cervical Cycle  94
‰‰ The Vaginal Cycle  95
‰‰ Cyclical, Metabolic, Vascular and Psychological Changes  95

Chapter 5: Clinical Aspects of Menstruation and Ovulation 97


‰‰ Menstruation 97
‰‰ The Menopause and the Climacteric  100
‰‰ Abnormal Menopause  108
‰‰ Ovulation 109

Chapter 6: Puberty and Adolescent Gynaecology 119


‰‰ Puberty and Adolescence  119
‰‰ Abnormalities of Puberty and Adolescence  123
‰‰ Prolactin 130
‰‰ Puberty Menorrhagia  132

Chapter 7: Conception 134


‰‰ Process 134
‰‰ Early Development of the Ovum  136
‰‰ Formation of Foetus and Membranes  137
‰‰ Hormonal Control of Early Pregnancy  141

Chapter 8: Spontaneous Abortions (Including Recurrent Loss) 143


‰‰ Spontaneous Abortions  143
‰‰ Pathology of Spontaneous Abortions  143
‰‰ Causes of Spontaneous Abortion  144
‰‰ Clinical Varieties of Spontaneous Abortions  148
‰‰ Recurrent Early Pregnancy Loss  150
‰‰ Risk Factors for Reccurent Miscarriage  151
‰‰ Investigations 154
‰‰ Management 154

Chapter 9: Ectopic Pregnancy and Pregnancy of Unknown Location 157


‰‰ Frequency of Ectopic Pregnancy  157
‰‰ Sites of Ectopic Pregnancy  157
‰‰ Aetiology of Ectopic Pregnancy   158
‰‰ Ectopic Pregnancy in Fallopian Tubes  159
‰‰ Management and Treatment Options of Ectopic Pregnancy  170
‰‰ Expectant Management  170
‰‰ Medical Management  171

Prelims New.indd 20 09-Apr-18 3:10:07 PM


Contents xxi

‰‰ Surgical Management  172


‰‰ Complications of Ectopic Pregnanccy  177
‰‰ Ovarian Pregnancy  177
‰‰ Cornual Pregnancy  178
‰‰ Cervical Pregnancy  178
‰‰ Abdominal Pregnancy  179
‰‰ Interstitial Pregnancy  180
‰‰ Intraligamentary Pregnancy  181
Pregnancy of Unknown Location  182
‰‰ Outcome of Ectopic Pregnancy  182
‰‰ Diagnosis 183
‰‰ Management of Pregnancy of Unknown Location  183

Chapter 10: Gestational Trophoblastic Disease 188


‰‰ Epidemiology 188
‰‰ Types of Tumours  188
‰‰ Aetiology 189
‰‰ Hydatidiform Mole  189
‰‰ Persistent Gestational Trophoblastic Tumour  196

Chapter 11: Breast Function and its Disorders 204


‰‰ Breast Development  204
‰‰ Developmental Anomalies of Breast  206
‰‰ Breast Feeding and Lactation  209
‰‰ Endocrine Disorders (Galactorrhoea and Breast Atrophy)  211
‰‰ Benign Breast Condition  214
‰‰ Screening for Breast Diseases  216
‰‰ Benign Breast Disease  217
‰‰ Breast Cancer  221
‰‰ Epidemiology 221

Chapter 12: Development of the Urogenital System 227


‰‰ The Gonad  227
‰‰ Wolffian System  228
‰‰ Müllerian Ducts  231
‰‰ Mesenteries and Ligaments  231
‰‰ Development of the Vagina, Bladder and Urethra  232
‰‰ Development of the Vulva  234

Chapter 13: Malformations and Maldevelopments of the Genital Tract 235


‰‰ Causes of Malformations  235
‰‰ Cytogenetics 237
‰‰ Uterine Anomalies  239
‰‰ Ovary 252
‰‰ Fallopian Tube  253
‰‰ Uterus 253
‰‰ Conical Cervix and Pinhole Ostium  255
‰‰ Vagina 255

Prelims New.indd 21 09-Apr-18 3:10:07 PM


xxii Jeffcoate’s Principles of Gynaecology

‰‰ Vulva 258
‰‰ Errors Arising in Connection with the Cloaca  260
‰‰ Malformations of the Urinary Tract  261

Chapter 14: Disorders of Sexual Development, Asexuality and Intersexuality 263


‰‰ Determinants of Sexual Development in Humans  277
‰‰ Aetiology 279
‰‰ Clinical Presentation  282
‰‰ Investigations 283
‰‰ Management 284
‰‰ Intersex Developing After Birth  287
‰‰ Feminism 287
‰‰ Virilism 288
‰‰ Ambiguous Genitalia  293

Chapter 15: Injuries 296


‰‰ Foreign Bodies in the Genital Tract  296
‰‰ Vaginal Burns  298
‰‰ Direct Trauma to Vulva and Vagina  299
‰‰ Defective or Deficient Perineum  301
‰‰ Complete Perineal Tear  301
‰‰ Laceration of the Cervix  303
‰‰ Rupture and Perforation of the Uterus  306
‰‰ Broad Ligament Haematoma  307
‰‰ Genital Tract Fistulas  308
‰‰ Acquired Atresia and Stenosis of the Genital Tract  315

Chapter 16: Female Genital Mutilation 320


‰‰ Indications 321
‰‰ Diagnosis 322
‰‰ Management in the UK Practice  322
‰‰ Complications 324

Chapter 17: Pelvic Organ Prolapse 327


‰‰ Uterine and Vaginal Prolapse  327
‰‰ Prolapse of the Ovaries  346

Chapter 18: Other Displacements of the Uterus 348


‰‰ Upward Displacement of the Uterus  348
‰‰ Lateral Displacement of the Uterus  348
‰‰ Forward Displacement of the Uterus  349
‰‰ Backward Displacement of the Uterus  349
‰‰ Retroverted Gravid Uterus  354
‰‰ Inversion of the Uterus  355
‰‰ Chronic Inversion  356

Prelims New.indd 22 09-Apr-18 3:10:07 PM


Contents xxiii

Chapter 19: Torsion of Pelvic Organs 359


‰‰ Torsion of the Normal Organs  359
‰‰ Torsion of Abnormal Organs  359
‰‰ Aetiology 361
‰‰ Differential Diagnosis  363
‰‰ Treatment 363

Chapter 20: Infections Including Sexually Transmitted Diseases 365


‰‰ The Natural Defences of the Genital Tract  365
‰‰ Sexually Transmitted Diseases  367
‰‰ Other Sexually Transmitted Infections  367
‰‰ Genital Tuberculosis  381
‰‰ Sarcoidosis 389
‰‰ Actinomycosis 390
‰‰ Schistosomiasis (Bilharzia)  390
‰‰ Amoebiasis 390

Chapter 21: Infections as they Affect Individual Organs 392


‰‰ Vulvitis 392
‰‰ Bartholinitis 396
‰‰ Vaginitis 397
‰‰ Cervicitis 405
‰‰ Endometritis 407
‰‰ Metritis 407
‰‰ Salpingo-oophoritis 408
‰‰ Oophoritis 413
‰‰ Pelvic Peritonitis  414
‰‰ Pelvic Cellulitis  414
‰‰ Chronic Cellulitis  416
‰‰ Pelvic Inflammatory Disease  416
‰‰ Suppurative Thrombophlebitis of the Pelvic Veins  418

Chapter 22: Genital Tuberculosis 420


‰‰ Clinical Profile  421
‰‰ Classification 421
‰‰ Diagnosis 421
‰‰ Pathology of Pelvic Organs  431

Chapter 23: Endometriosis and Chronic Pelvic Pain 432


Endometriosis and Allied States  432
‰‰ Endometriosis and Adenomyosis  432
‰‰ Adenomyosis  451
‰‰ Endosalpingiosis  452
‰‰ Cervical Endometriosis  452
Low Backache and Chronic Pelvic Pain  453
‰‰ General Considerations  453
‰‰ Causes in the Genital Tract  453
‰‰ Extragenital Causes  455

Prelims New.indd 23 09-Apr-18 3:10:07 PM


xxiv Jeffcoate’s Principles of Gynaecology

‰‰ Management and Treatment  455


‰‰ Chronic Pelvic Pain  456
‰‰ General Considerations  457
‰‰ Step-wise Evaluation of Chronic Pelvic Pain  457
‰‰ Examination  457
‰‰ Diagnostic Investigations  457
‰‰ Management  458

Chapter 24: Polycystic Ovary Syndrome 460


‰‰ Puberty and Polycystic Ovarian Syndrome  466
‰‰ Menstrual Irregularities  467
‰‰ Infertility 468
‰‰ Weight Loss  469
‰‰ Clomiphene Citrate  469
‰‰ Metformin 469
‰‰ Laparoscopic Ovarian Drilling  470
‰‰ Gonadotrophin Therapy  470
‰‰ Long-Term Monitoring  471

Chapter 25: Hirsutism 473


‰‰ Virilisation and Masculinisation  473
‰‰ Diagnosis of Hyperandrogenism  477
‰‰ Late Onset Adrenal Hyperplasia  480

Chapter 26: Epithelial Abnormalities of the Genital Tract 481


‰‰ Pathology 481
‰‰ Aetiology 483
‰‰ Symptoms 484
‰‰ Diagnosis 484
‰‰ Treatment 484
‰‰ Vulvar and Oral Epithelial Abnormalities  485
‰‰ Vulvar Intraepithelial Neoplasia  486
‰‰ Vagina 489
‰‰ Cervix 490
‰‰ Uterine Corpus  501
‰‰ Fallopian Tube  505

Chapter 27: Genital Cancers 514


‰‰ Importance of Genital Cancer  514
‰‰ Treatment and Results  514
‰‰ Prevention of Pelvic Cancer  516
‰‰ Early Diagnosis  516
‰‰ General Management of the Cancer Patient  520
‰‰ Management of Advanced Pelvic Cancer  521

Chapter 28: Tumours of the Vulva 527


‰‰ Swellings of the Vulva  527
‰‰ Varicose Veins  528

Prelims New.indd 24 09-Apr-18 3:10:07 PM


Contents xxv

‰‰ Oedema 528
‰‰ Retention Cysts  528
‰‰ Benign Neoplasms  529
‰‰ Malignant Neoplasms of Vulva  531
‰‰ Histology 531
‰‰ Tumours of Bartholin’s Gland  538
‰‰ Urethral Tumours  539
‰‰ Tumours of the Inguinal Canal  542

Chapter 29: Tumours of the Vagina 544


‰‰ Swellings of the Vagina  544
‰‰ Vaginal Cysts  544
‰‰ Benign Neoplasms  545
‰‰ Malignant Neoplasms  547
‰‰ Squamous Cell Carcinoma  549
‰‰ Adenocarcinoma 550
‰‰ Melanoma 551
‰‰ Sarcoma 551

Chapter 30: Tumours of the Cervix Uteri 553


‰‰ Benign Neoplasms of Cervix  553
‰‰ Benign Tumours of Cervix  553
‰‰ Carcinoma of Cervix  555
‰‰ Screening for Cervical Cancer  558
‰‰ Other Malignant Tumours of the Cervix  572

Chapter 31: Tumours of the Corpus Uteri 573


‰‰ Enlargement of Uterus  573
‰‰ Polyps 574
‰‰ Benign Neoplasms  574
‰‰ Malignant Neoplasms  595

Chapter 32: Adenomyosis 608


‰‰ Aetiology 608
‰‰ Diagnosis 609
‰‰ Differential Diagnosis  610
‰‰ Management 610
‰‰ Medical Therapy  610
‰‰ Surgical Management  611
‰‰ Complications 611

Chapter 33: Tumours of the Fallopian Tubes 613


‰‰ Benign Neoplasms  613
‰‰ Primary Malignant Neoplasms  613
‰‰ Secondary Malignant Neoplasms  618
‰‰ Prevention of Fallopian Tube Cancer  618
‰‰ Recurrent Disease  618
‰‰ Coping with Disease  618

Prelims New.indd 25 09-Apr-18 3:10:08 PM


xxvi Jeffcoate’s Principles of Gynaecology

Chapter 34: Tumours of the Pelvic Ligaments 619


‰‰ Cysts of the Broad Ligament and Associated Structures  619
‰‰ Neoplasms of the Pelvic Ligaments and Connective Tissues  621
‰‰ Neoplasms of the Peritoneum  621

Chapter 35: Tumours of the Ovary 623


‰‰ Ovarian Enlargements  623
‰‰ Distension or Retention Cysts  623
‰‰ Types 623
‰‰ Ovarian Neoplasms  626
‰‰ Features Suggestive of Malignancy  650
‰‰ Screening 651
‰‰ Borderline Tumours  651
‰‰ Complications 652
‰‰ Staging of Ovarian Cancer  653
‰‰ Treatment 654
‰‰ Metastatic (Secondary) Ovarian Tumours  660
‰‰ Ovarian and Parovarian Tumours and Pregnancy  662

Chapter 36: Chemotherapy in Gynaecological Malignancies 665


‰‰ Clinical Use of Chemotherapy  666
‰‰ Assessment of Response to Chemotherapy  666
‰‰ Chemotherapy and the Cell Cycle  666
‰‰ Stem Cell Theory  666
‰‰ Cell-Kill Hypothesis  667
‰‰ Therapeutic Agents Used in the Treatment of Gynaecological Cancer  668
‰‰ Chemotherapy Resistance of Cancer Cells  669
‰‰ Poor Host Defences  669
‰‰ Protected Tumour Sanctuaries  670
‰‰ Route of Administration  670

Chapter 37: Radiotherapy in Gynaecological Malignancies 671


‰‰ The Biological Basis of Radiotherapy Treatment  671
‰‰ Radiation Dosage  671
‰‰ The Therapeutic Ratio  672
‰‰ Radiotherapy Machines  672
‰‰ Brachytherapy 672
‰‰ Radiotherapy in Endometrial Cancer  672
‰‰ Aggressive Histological Variants  673
‰‰ Radiotherapy in Carcinoma Cervix  673
‰‰ Brachytherapy in Carcinoma Cervix  674
‰‰ External Radiation Therapy Techniques  674
‰‰ Chemoradiation in Locally Advanced Carcinoma Cervix  674

Chapter 38: Immunotherapy in Obstetrics and Gynaecology 676


‰‰ Definition 676
‰‰ Basics of Immunotherapy  676
‰‰ Causes of Failure of Immunosurveillance  676

Prelims New.indd 26 09-Apr-18 3:10:08 PM


Contents xxvii

‰‰ Tumour-associated Antigens  677


‰‰ Types of Immunotherapy  680
‰‰ Monoclonal Antibodies as Therapeutic Agents  682
‰‰ Other Areas of Application of Immunotherapy in Obstetrics and Gynaecology  683
‰‰ Case Studies  685

Chapter 39: Amenorrhoea, Hypomenorrhoea, and Oligomenorrhoea 687


‰‰ Amenorrhoea 687
‰‰ Aetiology 687
‰‰ Treatment 703
‰‰ Hypomenorrhoea 706
‰‰ Oligomenorrhoea 709

Chapter 40: Abnormal and Excessive Uterine Bleeding 711


‰‰ The Term Dysfunctional Uterine Bleeding is Obsolete Now and No Longer in Use  711
‰‰ Causes pf AUB-PALM COEIN 712
‰‰ Subserous Fibroid   714
‰‰ Intramural Fibroid  714
‰‰ Lasmaar Classification  714
‰‰ Submucous (SM2) Myoma by Lasmaar Classification  714
‰‰ Special Clinical Types of Bleeding  719

Chapter 41: Dysmenorrhoea 723


‰‰ Primary Dysmenorrhoea  723
‰‰ Secondary Dysmenorrhoea  727
‰‰ Membranous Dysmenorrhoea  730
‰‰ Other Conditions Simulating Dysmenorrhoea  730

Chapter 42: Premenstrual Syndrome and Other Menstrual Phenomena 732


‰‰ Premenstrual Syndrome  732
‰‰ Menstrual Migraine  735
‰‰ Premenstrual Mastalgia  736
‰‰ Recurrent (Cyclical) Buccal and Vulvar Ulceration  736
‰‰ Pelvic Allergy  738
‰‰ Vicarious Menstruation  738
‰‰ Cyclical Haemothorax and Pneumothorax  739
‰‰ Menstrual Epilepsy  740

Chapter 43: Hormone Therapy in Gynaecology 742


‰‰ Oestrogens 742
‰‰ Anti-oestrogens 748
‰‰ Progestogens 749
‰‰ Antiprogestogens 752
‰‰ Androgens 752
‰‰ Antiandrogens 754
‰‰ Types of Gonadotrophins  755
‰‰ Antigonadotrophins 756
‰‰ Hypothalamic Hormones  758

Prelims New.indd 27 09-Apr-18 3:10:08 PM


xxviii Jeffcoate’s Principles of Gynaecology

Chapter 44: Vaginal Discharge 761


‰‰ General Considerations  761
‰‰ Causes of Physiological Discharge  761
‰‰ Prognosis 765
‰‰ Risk Factors  765
‰‰ Diagnosis 765
‰‰ Management 767
‰‰ Therapy 767
‰‰ Prevention 769

Chapter 45: Pruritus Vulvae and Vulvodynia 770


‰‰ Definition and Incidence  770
‰‰ Pathophysiology 770
‰‰ Natural Defence Mechanisms  770
‰‰ Aetiological Classification of Pruritus Vulvae  771
‰‰ Causes of Pruritus According to Age Groups  771
‰‰ Evaluation of Patient with Pruritus  771
‰‰ Investigations 772
‰‰ General Measures for Women with Pruritus  772
‰‰ Differential Diagnosis of Pruritus  772
‰‰ Treatment 777
‰‰ Results 777
‰‰ Vulvodynia 778
‰‰ Management 779

Chapter 46: Problems of Sex and Marriage 782


‰‰ Physical Sex—Coitus  783
‰‰ Masturbation 785
‰‰ Apareunia and Dyspareunia  786
‰‰ Female Frigidity  790
‰‰ Nymphomania 793
‰‰ Coital Difficulties in the Male  793
‰‰ Homosexuality 797
‰‰ Transvestism and Transsexuality  797
‰‰ Premarital Chastity and Faithfulness in Marriage  798

Chapter 47: Male and Female Infertility Overview 800


‰‰ Infertility 800
‰‰ Frequency 800
‰‰ Concept of Fertility  800
‰‰ Causes of Infertility  801
‰‰ The Investigation of Infertility  806
‰‰ Treatment 817

Chapter 48: Assisted Reproductive Technology 828


‰‰ In Vitro Fertilisation and Embryo Transfer  828
‰‰ Controlled Ovarian Hyperstimulation  829
‰‰ Oocyte Retrieval  829

Prelims New.indd 28 09-Apr-18 3:10:08 PM


Contents xxix

‰‰ Insemination 829
‰‰ Embryo Transfer  831
‰‰ Outcome 832
‰‰ Cryopreservation 832
‰‰ Oocyte Donation  833
‰‰ Embryo Donation  834
‰‰ Surrogacy 834
‰‰ Intrauterine Insemination  834
‰‰ Donor Insemination  836
‰‰ Other ART Methods  836
‰‰ Results of Treating Infertility  838
‰‰ Dangers of Investigating and Treating Infertility  838
‰‰ Complications of ART 839
‰‰ Adoption 840

Chapter 49: Instruments in Gynaecological Procedures 842


‰‰ Instruments 842
‰‰ Gynaecological Procedures  849

Chapter 50: Ultrasonography in Gynaecology 852


‰‰ Indications for Gynaecology  852
‰‰ Techniques 852
‰‰ Normal Female Pelvic Anatomy  852
‰‰ Uterus 854
‰‰ Adenomyosis 860
‰‰ Endometrium 863
‰‰ Cervix 865
‰‰ Ovarian Anatomy  866
‰‰ Polycystic Ovary  872
‰‰ Ovarian Malignant Lesions  872
‰‰ Fallopian Tubes  877

Chapter 51: Ultrasound in Infertility 880


‰‰ Method 880
‰‰ Uterine Abnormalities  881
‰‰ Cycle Assessment Consists of Baseline Scan, Preovulatory Scan and Secretory Scan  899

Chapter 52: Ultrasound in Menopause 908


‰‰ Normal Uterus in Menopause  909
‰‰ Post-menopausal Bleeding  909
‰‰ Normal Atrophic Ovary  911
‰‰ Fluid in Pouch of Douglas  912
‰‰ Ovary and Ovarian Cancer Screening  912

Chapter 53: Robotics Surgery 914


‰‰ Features of Robotic Surgery  914
‰‰ Overview 916
‰‰ Advantages of Robotic Surgery  918

Prelims New.indd 29 09-Apr-18 3:10:08 PM


xxx Jeffcoate’s Principles of Gynaecology

‰‰ Risks of Robotic Surgery  919


‰‰ Innovations Used in Robotic Surgery  919
‰‰ Indications for Use of Robotic Surgery in Gynaecology  921
‰‰ Endometriosis 921
‰‰ Myomectomy 923
‰‰ Criticism and Controversies  923
‰‰ Experience in Last Decade  925

Chapter 54: Endoscopic Surgery in Gynaecology 927


Laparoscopic Surgery  927
‰‰ Surgical Equipment  928
‰‰ Indications 934
‰‰ Contraindications to Laparoscopy   938
‰‰ Preoperative Preparation  938
‰‰ Surgical Steps  939
‰‰ Postoperative Care  942
‰‰ Advantages 942
‰‰ Disadvantages 942
‰‰ Complications 942
Hysteroscopic Surgery  944
‰‰ Surgical Equipment  944
‰‰ Indications 948
‰‰ Preoperative Preparation  951
‰‰ Surgical Steps  952
‰‰ Postoperative Care  954
‰‰ Advantages 955
‰‰ Disadvantages 955
‰‰ Complications 955
Laparo-endoscopic Single-Site Surgery  958
‰‰ Surgical Equipment  958
‰‰ Indications 959
‰‰ Laparo-endoscopic Single-Site Surgical Techniques  959
‰‰ Advantages 961
‰‰ Complications 962

Chapter 55: Contraception 965


‰‰ General Consideration  965
‰‰ Epidemiology 965
‰‰ Impact of Contraception Throughout the World  966
‰‰ Efficacy of Contraception  966
‰‰ Indications for Contraception  967
‰‰ Criteria for the Use of Various Contraceptive Methods  967
‰‰ Contraceptive Methods  967
‰‰ Natural Family Planning Method  967
‰‰ Barrier Methods  971
‰‰ Intrauterine Contraceptive Devices  978
‰‰ Hormonal Contraception Methods  994
‰‰ Progestogen-Only Contraception  1006
‰‰ Emergency Postcoital Contraception (Morning After Pills)  1014

Prelims New.indd 30 09-Apr-18 3:10:08 PM


Contents xxxi

‰‰ Other Methods of Contraception  1017


‰‰ Choice of Methods  1022
‰‰ Contraception Choice for Older Women  1022
‰‰ Contraception and Litigation  1023

Chapter 56: Sterilisation and Termination of Pregnancy 1026


‰‰ Sterilisation 1026
‰‰ Female Sterilisation  1027
‰‰ Male Sterilisation  1030
‰‰ Compulsory Sterilisation  1031
‰‰ Termination of Pregnancy  1031
‰‰ Abortion as a Means of Contraception  1039

Chapter 57: Urinary Incontinence 1040


‰‰ Bladder Dysfunction  1040
‰‰ Urethral Sphincter Dysfunction  1043
‰‰ Investigation of Urinary Problems  1045
‰‰ Treatment of Urinary Problems  1047
‰‰ Incontinence of Urine  1048
‰‰ Management 1052
‰‰ Overview of Surgical Management  1053
‰‰ Enuresis 1060
‰‰ Urinary Retention and Difficulty in Micturition  1061

Chapter 58: Urinary Tract Infection 1066


‰‰ Aetiology 1067
‰‰ Diagnosis 1067
‰‰ Investigations 1068
‰‰ Management 1069
‰‰ Treatment 1069
‰‰ Complications 1071
‰‰ Clinical Pearls  1072
‰‰ Evidence-Based Medicine  1072

Chapter 59: Menopause 1074


‰‰ History 1074
‰‰ Definitions and Staging of Menopause  1074
‰‰ Physiology of Menopause  1076
‰‰ Problems Associated with Menopause  1078
‰‰ Effect of Oestrogen Deficiency  1079
‰‰ Menstrual Problems  1087
‰‰ Management of Menopause  1089
‰‰ Various Types of Hormonal and Non-hormonal Pharmacological Agents Available  1090
‰‰ Use of Progesterone for HRT 1092
‰‰ Hormone Therapy in Special Circumstances  1092
‰‰ Androgens in Menopause  1094
‰‰ Symptoms of Menopause  1094

Prelims New.indd 31 09-Apr-18 3:10:08 PM


xxxii Jeffcoate’s Principles of Gynaecology

Chapter 60: Hysterectomy and its Aftermath 1095


‰‰ History 1095
‰‰ Operative Steps  1095
‰‰ Vaginal Hysterectomy  1098
‰‰ Total Laparoscopic Hysterectomy  1100
‰‰ Depression Following Hysterectomy and the Influencing Factors  1102
‰‰ Hysterectomy and Sexual Functioning  1102

Chapter 61: Conditions of the Lower Intestinal Tract 1103


‰‰ Rectal Prolapse  1103
‰‰ Incontinence of Faeces and Flatus  1106
‰‰ Diarrhoea 1107
‰‰ Difficult Evacuation  1107
‰‰ Irritable Bowel Syndrome  1108
‰‰ Pruritus Ani  1109
‰‰ Rectal and Anal Pain  1110

Chapter 62: Preoperative and Postoperative Management: Postoperative Complications 1113


‰‰ Fluid and Electrolytes  1113
‰‰ Preoperative Management  1114
‰‰ Postoperative Management  1117
‰‰ Fast-Track Protocol  1121
‰‰ Postoperative Examination  1122
‰‰ Postoperative Complications  1123

Chapter 63: Nutrition and Exercise in Women 1138


Nutrition in Women from Adolescence to Menopause  1138
‰‰ Nutrition Basics  1138
‰‰ Proteins 1139
‰‰ Fats 1139
‰‰ Carbohydrates 1141
‰‰ Energy 1143
‰‰ Adolescents Nutrition  1144
Exercise and Physiotherapy in Gynaecology  1152
‰‰ Active Muscle Exercises  1152
‰‰ Electrical Stimulation of Pelvic Muscles  1154
‰‰ Short-Wave Therapy  1154
‰‰ Infrared Radiation  1154
‰‰ Transcutaneous Electric Nerve Stimulation  1154
‰‰ Ultrasound 1155

Chapter 64: Applications of Laser in Gynaecology 1157


‰‰ Types of Lasers  1157
‰‰ Mechanism of Action  1157
‰‰ Laser Surgery for Cervix  1159
‰‰ Laser Surgery of the Vulva  1160
‰‰ Laser Surgery of the Vagina  1160
‰‰ Intra-abdominal Laser Surgery  1160

Prelims New.indd 32 09-Apr-18 3:10:08 PM


Contents xxxiii

‰‰ Gynaecologic Laser Laparoscopy  1160


‰‰ Hysteroscopic Laser Surgery  1161

Chapter 65: Genetics in Gynaecology 1162


‰‰ Genetics of Gynaecological Cancers  1163
‰‰ Family History of Gynaecological Cancers  1163
‰‰ Human Papillomavirus Integration and its Role in Cervical Malignant Progression  1163
‰‰ Hereditary Breast and Ovarian Cancer Syndrome  1163
‰‰ Genetic and Functional Analyses of Polymorphisms in the Human FSH Receptor Gene  1164
‰‰ Congenital Adrenal Hyperplasia  1164
‰‰ Genetics of Human Hypogonadotrophic Hypogonadism  1164
‰‰ Variation in the Timing of Puberty: Clinical Spectrum and Genetic Investigation  1165
‰‰ Genetic Counselling  1165

Index 1167

Prelims New.indd 33 09-Apr-18 3:10:08 PM

You might also like