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Tarascon OB/GynPocketbookTamara L. Callahan, MD, MPPAsst. Professor, OB/GYNVanderbilt University Medical CenterNashville, TNxxxxx FM i-xvi.indd i8/27/14 6:32 PM

World HeadquartersJones & Bartlett Learning5 Wall StreetBurlington, MA .comJones & Bartlett Learning books and products are available through most bookstores and online booksellers.To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website,www.jblearning.com.Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available tocorporations, professional associations, and other qualified organizations. For details and specificdiscount information, contact the special sales department at Jones & Bartlett Learning via the abovecontact information or send an email to specialsales@jblearning.com.Copyright 2016 by Jones & Bartlett Learning, LLC, an Ascend Learning CompanyAll rights reserved. No part of the material protected by this copyright may be reproduced or utilized inany form, electronic or mechanical, including photocopying, recording, or by any information storage andretrieval system, without written permission from the copyright owner.The content, statements, views, and opinions herein are the sole expression of the respective authorsand not that of Jones & Bartlett Learning, LLC. Reference herein to any specific commercial product,process, or service by trade name, trademark, manufacturer, or otherwise does not constitute or implyits endorsement or recommendation by Jones & Bartlett Learning, LLC and such reference shall not beused for advertising or product endorsement purposes. All trademarks displayed are the trademarksof the parties noted herein. Tarascon OB/Gyn Pocketbook is an independent publication and has notbeen authorized, sponsored, or otherwise approved by the owners of the trademarks or service marksreferenced in this product.The authors, editor, and publisher have made every effort to provide accurate information. However, theyare not responsible for errors, omissions, or for any outcomes related to the use of the contents of thisbook and take no responsibility for the use of the products and procedures described. Treatments andside effects described in this book may not be applicable to all people; likewise, some people may requirea dose or experience a side effect that is not described herein. Drugs and medical devices are discussedthat may have limited availability controlled by the Food and Drug Administration (FDA) for use only ina research study or clinical trial. Research, clinical practice, and government regulations often changethe accepted standard in this field. When consideration is being given to use of any drug in the clinicalsetting, the health care provider or reader is responsible for determining FDA status of the drug, readingthe package insert, and reviewing prescribing information for the most up-to-date recommendations ondose, precautions, and contraindications, and determining the appropriate usage for the product. This isespecially important in the case of drugs that are new or seldom used.Production CreditsExecutive Acquisitions Editor: Nancy Anastasi DuffyProduction Assistant: Alex SchabManufacturing and Inventory Control Supervisor:Amy BacusComposition: CAE Solutions Corp.Cover Design: Kristin E. ParkerManager of Photo Research, Rights & Permissions:Lauren MillerCover Image: Courtesy of National Library of MedicinePrinting and Binding: CenveoCover Printing: CenveoTo order this product, use ISBN:978-0-7637-8425-66048Printed in the United States of America18 17 16 15 14 10 9 8 7 6 5 4 3 2 1xxxxx FM i-xvi.indd ii8/27/14 6:32 PM

For Connor and Jaela. You make it all worthwhile.-TLCxxxxx FM i-xvi.indd iii8/27/14 6:32 PM

CONTENTSPART 1: OBSTETRICS1 Preconception andPrenatal CarePrenatal Testing GuidelinesScreening for SpecialPopulations andCircumstancesGenetic Counseling andScreeningMaternal Adaptations toPregnancyFetal CirculationNutrition in PregnancyDrugs, Medications, andEnvironmental Exposuresin PregnancyAntepartum Fetal SurveillanceOB Ultrasound andDiagnostic Imaging2 Obstetric Complicationsof PregnancyCervical Insufficiency andShortened CervixPremature Rupture ofMembranes (PPROMand PROM)Antepartum HemorrhagePreterm Labor and DeliveryPostterm PregnancyMultiple GestationPregnanciesIntrauterine FetalDemise (IUFD)3 Fetal and PlacentalComplications ofPregnancyFetal MacrosomiaIntrauterine GrowthRestriction (IUGR)Congenital AnomaliesDisorders of AmnioticFluid VolumePolyhydramniosNon-immune Fetal Hydropsand Isoimmunization14 Pregnancy-InducedMedical ComplicationsNausea and Vomiting inPregnancyGestational DiabetesMellitus (GDM)Preeclampsia andPregnancy-RelatedHypertensive DiseaseAcute Fatty Liver ofPregnancy (AFLP)Intrahepatic Cholestasis inPregnancy (ICP)Maternal Thrombocytopeniaand Neonatal AlloimmuneThrombocytopeniaDermatologic Disorders inPregnancy5 Coexistent MedicalDisorders DuringPregnancyCardiovascular DiseaseCollagen Vascular DisordersDermatologic DisordersHematologic DisordersHepatic DisordersInfectious DiseasesNeurologic DisordersPulmonary DisordersRenal and Urinary TractDisorders in PregnancyThyroid Disorders inPregnancy6 Intrapartum ManagementNormal Labor andVaginal DeliveryInduction and Augmentationof LaborIntrapartum ElectronicFetal MonitoringGroup B Strep Infection (GBS)ChorioamnionitisFetal MalpresentationObstetrical AnesthesiaOperative Vaginal DeliveryCesarean 145145152156164166169175179182ivxxxxx FM i-xvi.indd iv8/27/14 6:32 PM

ContentsVaginal Birth After CesareanDelivery (VBAC)Obstetric Emergencies7 Postpartum IssuesNormal Postpartum ChangesLactation and BreastfeedingThe Postpartum VisitPostpartum ContraceptionPostpartum ThyroiditisPostpartum Depression andPsychosisPostpartum HemorrhagePostpartum Infections186189197197198200202203204207212PART 2: GYNECOLOGY2218 General Gynecology223Preventative HealthScreening for Women223Vaginitis andVaginal Discharge231Permanent ContraceptionMethods (Sterilization)255Emergency Contraception258Abnormal Uterine Bleeding262Dysfunctional UterineBleeding (DUB)267Postmenopausal Bleeding269Dysmenorrhea270Premenstrual Syndrome(PMS) and PremenstrualDysmorphic Disorder(PMDD)273Benign Vulva, Conditionsof the Vagina, Cervix276Uterine Fibroids(Leiomyomas)279Adenomyosis280Endometrial Polyps281Endometriosis282Ovarian Cysts286Common Breast Complaints 289Sexual Assault292Domestic Violence2949 Reproductive Endocrinologyand Fertility299Primary Amenorrhea299Secondary Amenorrhea302Diagnosis andManagement of Infertility 318Ectopic Pregnancy331Menopausal and HormoneReplacement Therapy336xxxxx FM i-xvi.indd v10 UrogynecologyUrethral Caruncle andProlapseUrinary Tract Infection UTIInterstitial Cystitis (IC)Pelvic Organ Prolapse (POP)11 Gynecologic OncologyVulvar IntraepithelialNeoplasia (VIN) andVulvar CancerVulvar CancerVaginal IntraepithelialNeoplasia (VAIN)Vaginal CancerCervical IntraepithelialNeoplasia (CIN) andPap Smear Screeningand ManagementCervical CancerEndometrial HyperplasiaEndometrial CancerOvarian CancerGestational TrophoblasticDiseaseBreast CancerGynecologic GeneticCancer 693703723823873893944024104224294478/27/14 6:32 PM

viAcronymACRONYMSPELLED dvanced ageAmerican Academy of Pediatricsantibodyarterial blood gasantibiotic therapyabdominal circumferenceangiotensin converting enzymeAdvisory Committee on Immunization Practicesanticardiolipin antibodyAdvanced Cardiac Life SupportThe American College of Obstetricians and GynecologistsAmerican Cancer SocietyAmerican Diabetes Associationattention deficit hyperactivity disorderantiepileptic drugamniotic fluid embolismamniotic fluid indexacute fatty liver of pregnancyalpha-fetoproteinamniotic fluid volumeatypical glandular cellsantigensacquired immune deficiency syndromeanal intraepithelial neoplasiaadenocarcinoma in situaxillary lymph node dissectionalanine transaminaseadvanced maternal ageAnti-Müllerian hormoneantinuclear antibodyanteroposteriorantiphospholipid antibodyantiphospholipid antibody syndromeacute respiratory distress syndromeassisted rupture of membranesassisted reproductive technologiesaortic stenosisaspirinasymptomatic bacteriuriaatypical squamous cells- cannot exclude high grade squamous intraepithelial lesionatypical squamous cells-undetermined significanceaspartate transferaseacute tubular necrosisASC-UASTATNxxxxx FM i-xvi.indd vi8/27/14 6:32 PM

xxx FM i-xvi.indd viiviiabnormal uterine bleedingzidovudineBacillus Calmette-Guérinbreast-conserving therapybeta human chorionic gonadotrophinbody mass indexblood pressurebiparietal diameterbeats per minutebiophysical profileblood per vaginabody surface areabreast self-exambilateral salpingo-oophorectomyblood urea nitrogenCirculation–Airway–Breathingcoronary artery diseasecongenital adrenal hyperplasiacommunity-acquired pneumoniacomplete blood countcalcium channel blockersclomiphene citrate challenge testCenters for Disease Control and Preventioncarcinoembryonic antigenconjugated equine estrogencongestive heart failurecervical insufficiencycervical intraepithelial neoplasiacarcinoma in situcomprehensive metabolic panelcervical motion tendernesscytomegaloviruscore needle biopsycentral nervous systemchronic obstructive pulmonary diseasecephalopelvic disproportioncreatininecrown–rump lengthcontraction stress testcomputed tomographycarpal tunnel syndromecardiac transplantationcardiovascularcerebrovascular accidentcostovertebral angle tendernesscardiovascular diseasecardiovascular risk factors8/27/14 6:32 PM

FHRFHxxxxxx FM i-xvi.indd viiichorionic villus samplingchest x-raydischargedilation and curettagedrug abuseductal carcinoma in situdevelopmental disabilitydifferential diagnosisdiethylstilbestroldual-energy x-ray osterone sulfatedihydrotestosteronedisseminated intravascular coagulopathydiabetic ketoacidosisdiabetes mellitusdepot medroxyprogesterone acetatedimethyl sulfoxidedeoxyribonucleic aciddeep tendon reflexesdysfunctional uterine bleedingdeep vein thrombosisemergency contraceptionexternal cephalic versionestimated date of deliveryend diastolic flowelectronic fetal monitoringestimated fetal weightendometrial intraepithelial neoplasiaelectrocardiogramenzyme-linked immunosorbent assayendometrialendometrial biopsyexpedited partner therapyestrogen receptorsestrogen replacement therapyethyl alcoholexamination under anesthesiafeverfibrocystic breast diseaseUnited States Food and Drug Administrationforced expiratory volumefetal fibronectinfresh frozen plasmafetal growth restrictionfetal heart ratefamily history8/27/14 6:32 PM

Acronym xxx FM i-xvi.indd ixInternational Federation of Gynecology andObstetricsfecal immunochemical testfemur lengthfetal lung maturityfine-needle aspirationFracture Risk Assessment Toolfetal scalp electrodesfollicle-stimulating hormonefibrin split productsfluorescent treponemal antibody absorptionglucose-6-phosphate dehydrogenasegallbladdergroup B streptococcusGonorrheagestational diabetes mellitusgastroesophageal reflux diseaseglomerular filtration rategastrointestinalglucose loading testgonadotropin-releasing hormonegestational trophoblastic diseasesglucose tolerance highly active antiretroviralhepatitis B immune globulinhead circumferencehuman chorionic gonadotropinhemocrithigh-density lipoproteinhyperemesis gravidarumHepatitishemoglobinhigh-grade squamous intraepithelial lesionhypoxic ischemic encephalopathyhuman immunodeficiency virushigh power fieldhereditary non polyposis colon cancerhuman papilloma virushigh-riskhormone replacement s simplex virus8/27/14 6:32 PM