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American College of Obstetricians and Gynecologists with LEAD AUTHORS Robert Casanova, MD, MHPE, FACOG Adjunct Professor, Department of Medical Education, Assistant Dean for Clinical Sciences Curriculum, Assistant Vice Dean Medical Education Covenant Branch Campus, Texas Tech University Health Sciences Center, Lubbock, Texas Alice Chuang, MD, MEd, FACOG Professor, Department of Obstetrics and Gynecology, Clerkship Director, University of North Carolina School of Medicine, Chapel Hill, North Carolina Alice R Goepfert, MD, FACOG Professor, Department of Obstetrics and Gynecology, Associate Dean for Graduate Medical Education and Designated Institutional Official, University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama Nancy A Hueppchen, MD, MSc, FACOG Associate Professor, Department of Gynecology and Obstetrics, Associate Dean for Undergraduate Medical Education, Johns Hopkins University School of Medicine, Baltimore, Maryland Patrice M Weiss, MD, FACOG Professor, Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Executive Vice President and Chief Medical Officer, Carilion Clinic, Roanoke, Virginia ORIGINAL AUTHORS Charles R B Beckmann, MD, MHPE, FACOG Former Professor of Obstetrics and Gynecology, Thomas Jefferson University College of Medicine, Former Director, Offices of Ambulatory Care and of OB-GYN Academic Affairs, Department of Obstetrics and Gynecology, Albert Einstein Medical Center, Philadelphia, Pennsylvania Frank W Ling, MD, FACOG Clinical Professor, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine and Meharry Medical College, Nashville, Tennessee; Partner, Women’s Health Specialists, PLLC, Germantown, Tennessee William N.P Herbert, MD, FACOG Former William Norman Thornton Professor and Chair, Professor Emeritus, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia Douglas W Laube, MD, MEd, FACOG Professor and former Chair, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Past President (2006–2007), American College of Obstetricians and Gynecologists Roger P Smith, MD, FACOG The Robert A Munsick Professor of Clinical Obstetrics and Gynecology, Director, Medical Student Education, Director, Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana Acquisitions Editor: Matt Hauber Development Editor: Laura Horowitz/Andrea Vosburgh Editorial Coordinator: Laura Horowitz/Annette Ferran Editorial Assistant: Brooks Phelps Marketing Manager: Mike McMahon Production Project Manager: Bridgett Dougherty Design Coordinator: Steve Druding Manufacturing Coordinator: Margie Orzech Prepress Vendor: Newgen Knowledge Works Pvt Ltd., Chennai, India 8th edition Copyright © 2019 Wolters Kluwer Copyright © 2014, 2010, 2006, 2002, 1998, 1995, 1992 by Lippincott Williams & Wilkins, a Wolters Kluwer business All rights reserved This book is protected by copyright No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via our website at lww.com (products and services) 987654321 Printed in China 9781496353092 Library of Congress Cataloging-in-Publication Data available upon request This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient The publisher does not provide medical advice or guidance and this work is merely a reference tool Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work LWW.com The new lead authors would like to dedicate the eighth edition to the original authors who paved the way with the first six editions and invited us to collaborate on the seventh We hope to continue the long tradition with this edition In addition, we would like to dedicate this edition to the medical students who have inspired us and to the women who, as patients, have entrusted us with their care Finally, we want to thank our families who supported us through the edits and rewrites About the Authors Drs Beckmann and Ling embarked on the project that would become this textbook as a response to the conventional wisdom of the day that medical students should “know all of Williams.” They decided that this was unreasonable and opted to write a “core” textbook based on the APGO Learning Objectives instead The rules were simple: fully address the objectives but only with essential information, not all that the author knows (i.e., the task was to decide what NOT to include, a much more difficult task than writing all you know) They also noted a lot of "here at we do…" kind of text, also useless, and agreed not to that In addition, they noted that many of the figures and some tables really added nothing, hence the rule that a figure or table must be able to "stand alone" and teach If it could not pass that test, it was not worthy of the book The first two editions were well received, but it was only when they added information they knew students were being asked on rounds (despite the first two rules) that the book gained its present popularity Thus, from the earliest planning meetings for the first edition of Obstetrics and Gynecology, the authors have remained focused on the needs of the primary audience, medical students rotating through their clerkship in this specialty Having medical education as a primary focus of their respective academic careers has made this team of authors uniquely positioned to create an effective learning tool In this eighth edition, the “second generation” of leading ob/gyn clinician– educators took over as lead authors for each chapter They, too, have dedicated their careers to enhancing the quality of women’s health through medical education As evidence of their collective involvement and success in ob/gyn education, the author team features the following current and past achievements: University Educational and Administrative Appointments Department Chair Department Vice-Chairs Fellowship Directors Residency Directors Student Clerkship Directors 11 Assistant/Associate Deans Department Director of Undergraduate Medical Education President Academy of Educators Designated Institution Official Chief Medical Officer National Organizations American College of Obstetricians and Gynecologists (College) President Committee Chair District Chair SASGOG Board Association of Professors of Gynecology and Obstetrics (APGO) President Council Member Undergraduate Medical Education Committee Chair Undergraduate Medical Education Committee Member Academic Scholars and Leaders, Scholar Academic Scholars and Leaders, Faculty Academic Scholars and Leaders, Advisors American Board of Obstetrics and Gynecology (ABOG) President Vice President Board Examiner Chairman of the Board Council on Resident Education in Obstetrics and Gynecology (CREOG) Chairman Vice Chair Education Committee Chair Council Member Program Chair InTraining Exam Other National Educational Activities and Honor National Test Committee Member National Test Committee Reviewer Peer-Reviewed Educational Research Publications 214 Medical Student Teaching Award 57 Resident Teaching Award 12 Resident Review Committee Member District IV Mentor Award The authors remain committed to not only including the most up-todate evidence-based information but also presenting it in a fashion that meets the needs of the ever-evolving adult learner This eighth edition of Beckmann and Ling’s Obstetrics and Gynecology is the latest step in our collective journey in the field of women’s health education 10 human immunodeficiency virus, 18 risk factors for, 18t screening recommendations for, 210t syphilis, 18–19 Sexually transmitted infections (STIs), 250, 260–261 Chlamydia trachomatis (Chlamydia), 252–254 general diagnostic principles, 250 genital herpes, 256–257 HIV and AIDS, 260–261 human papillomavirus (HPV), 257–258 Neisseria gonorrhoeae (Gonorrhea), 254–256 prevention, 252 screening, 250–252 syphilis, 258–260 Shoulder dystocia, 103, 105, 106f, 163, 164, 180 Shoulders, delivery of anterior and posterior shoulders, 96f Sickle cell anemia, 203 Sickle cell disorders, 202, 203 Sickle cell trait, 203 Sigmoid diverticular disease, 415 Signet-ring cell type, 424 Simple fibroadenomas, 291 Simple hyperplasia, 406 Single-channel urodynamic testing, 267 Single-gene (Mendelian) disorders, 77 Sinusoidal pattern, 108t Skin, 50–51 Skin nevi, 51 Sleep disturbances, menopause and, 347–348 Small for gestational age (SGA), 140 Smoking, and menopause, 350 Sniffing position, 117 Sojourn time interval, 16 Somatic cells, 73 Spastic quadriplegia, 106 Spectral karyotyping (SKY), 83 Speculum examination, 9–11 Speculum insertion, 10, 11f Spermatogenesis, 359 Spermicides, 236 1128 Spider angiomata, 50 Spinal anesthesia, 92 Spironolactone derivative, 232 Spongiotic pattern, 382 Spontaneous abortion, 173 recurrent pregnancy loss, 174 first-trimester pregnancy loss, 174 second-trimester pregnancy loss, 174 and stillbirth, 178 types of, 173–174 Squamocolumnar junction (SCJ), 37, 389 Squamous cell cancer (SCC) of the vulva, 381 SRY (sex-determining region on Y), 29 Step-care therapeutic approach, 200 Sterilization, 239 decision for, 244 of men, 239–240 as a method of contraception, 239 reversal of tubal ligation, 243–244 of women, 240 hysteroscopy, 242 laparoscopy, 240–241 minilaparotomy, 241–242 noncontraceptive benefits, 243 side effects and complications, 242–243 Stress urinary incontinence, 48, 266–267 Striae gravidarum, 50, 121 Stromal cell tumors, 417, 420 Sublethal injury, repair of, 371 Submucous leiomyoma, 402, 403 Subserosal leiomyoma, 402 Substance abuse, 70 Subtotal hysterectomy, 301 Succenturiate, 131 Successful conception, steps in, 354f Sulfonamides, 68t Supine exercises, 64 Supine hypotensive syndrome, 90 Suppressive therapy, 257 Supracervical hysterectomy, 301 1129 Surgical conditions, 189–190 adnexal masses in pregnancy, 189–190 appendicitis in pregnancy, 189 cholelithiasis in pregnancy, 189 pregnant patients, considerations for, 189 Surgical errors, reducing the likelihood of, 26 Surgical management, 171 Surrogate decision maker, 24 Survival, 158 Sweeping the membranes, 165 Symphysis–fundal height, measurement of, 145 Symphysis pubis, 33 Syncope, 44 Synergistic, 371 Synthetic progesterones, 409 Syphilis, 18–19, 215, 258–260 Systemic corticosteroids, 200 Systolic blood pressure, 195 Tachycardia, 107, 128 Tachypnea, 128 “Talk before you touch,” Tamoxifen, 289, 409 Teletherapy, 373 Telogen (resting) phase, 51 Telophase, 73 Tension headaches, 219 Teratogenicity, 68t fear of, 186 Teratogens, 66 alcohol, 69–70 herbal remedies, 67–69 ionizing radiation, 67 medications,–67 methyl mercury, 67 substance abuse, 70 tobacco use,–70 Terminal deletion, 76 Term premature rupture of membranes, 158, 160 Testis-determining factor, 29 1130 Test of cure, 254 Testosterone, 337 and anabolic steroids, 68t Testosterone receptors, 338 Tetanus–diphtheria–acellular pertussis vaccine, 122 Tetracyclines, 68t, 215 Thalassemias, 202, 203 Theca lutein cysts, 375, 376, 417 Thecomas, 424 Thelarche, 327 Third spacing, 193 Third stage of labor, 87 Third-trimester bleeding, 152 history and physical examination, 152–153 placental abruption, 155 complications, 156 diagnosis and management, 155–156 risk factors, 155 placenta previa, 153 complications, 154–155 diagnosis, etiology, and risk factors, 153–154 management, 154 uterine rupture, 156 vasa previa, 156 tests, 156 Third-trimester screening, 62 Thorax, maternal, 44 Threatened abortion, 173 Thromboembolism, 46 Thrombophilias, 173 Thyroid-binding globulin (TBG), 182 Thyroid disease, 20, 182 laboratory screening, 182 management of existing thyroid disease in pregnancy, 182–183 management of thyroid disease diagnosed during and after pregnancy, 183 biochemical hyperthyroidism, 183 postpartum thyroiditis, 183 pathophysiology, 182 Thyroid disorders, 380 1131 Thyroid function, 49–50 Thyroid gland, 54 Thyroid-stimulating hormone (TSH), 182 Thyroid storm, 182 symptoms of, 183b Thyrotoxicosis, 182 Tobacco use,–70 Tocodynamometer, 98, 99f, 149 Tocolytics, 148, 150 contraindications, 151 Tocometry, 190 Topoisomerase inhibitors, 370 Topotecan, 372t Total hysterectomy, 301 Total thyroxine (T4), 182 Toxoplasmosis, 216–217 Transabdominal ultrasonography, 33 Transcription, 72 Transdermal contraceptive patch, 234 Transformation zone (TZ), 37, 391 Transitional care, 114–115 Translation, 72 Transvaginal sonogram, 154 Transvaginal ultrasound, 59, 149, 153–154, 169, 408 for cervical length screening, 138 Transverse diameter, 36 Trauma, in pregnancy, 190 fetal–maternal hemorrhage, 190 management, 190 Travel, 66 Treponemal-specific tests, 215 Treponema pallidum, 215, 259 Tretinoin, 69t Trials of labor after cesarean (TOLAC), 97 Trichomoniasis, 245, 248 Triglycerides, 20 Triple and quadruple screening tests, 81 Triple screen, 81 Trisomy 13, 61 Trisomy 16, 74 1132 Trisomy 18 (Edward syndrome), 61, 74 Trisomy 21 (Down syndrome), 74 Trisomy 13 (Patau syndrome), 74 True labor, 86 T-score, 19 Tubal abortion, 167 Tubal ectopic pregnancy, 167 clinical findings, 168 diagnostic procedures, 169 culdocentesis, 170 endometrial curettage, 170 laparoscopy, 170 serum human chorionic gonadotropin levels, 169 serum progesterone level, 169–170 transvaginal ultrasonography, 169 differential diagnosis, 168–169 management, 170–171 pathophysiology and risk factors, 167 symptoms, 167–168 Tubal ligation, 167 Tubal rupture, 167 Tubal sterilization, 167 Tubo-ovarian abscesses (TOAs), 255 Tumor debulking, 426 Tumors of low malignant potential, 421 Tumor vaccines, 373 Tunica albuginea, 30 Turner syndrome, 61 Turtle sign, 105 Twin pregnancy, 137 chorionicity in, 135f delivery of second twin, 139f Twin–twin transfusion syndrome (TTTS), 136–138 Typical use failure rate, 226 Ultrasonography, 61, 138, 159, 275, 288, 295–296 dating, 165 of umbilical artery blood flow velocity, 62 Ultrasound, 59, 61, 80–81, 149, 155, 206 Umbilical artery blood gases, 117 1133 Umbilical artery Doppler velocimetry, 144f Umbilical cord blood banking, 117–118 Umbilical cord blood gases, 117 Umbilical cord care, 114 Umbilical cord compression, 164 Unbalanced translocation, 76 Uncomplicated urinary tract infection, 188 Uncorrected tetralogy of Fallot, 198 Undifferentiated endometrial sarcoma, 413 Upper urinary tract infection, 269 Ureter and uterine artery, relative locations of, 39f Ureterovaginal fistula, 267 Urethritis, 250, 254 diseases characterized by, 253t Urethrocele, 262 Urethrovaginal fistula, 267 Urinary calculi, 188 Urinary frequency, 48 Urinary incontinence, 264, 266 characteristics of, 266t evaluation, 267 treatment, 267–269 types, 266–267 Urinary tract disorders, 188–189 asymptomatic bacteriuria and uncomplicated urinary tract infection, 188 nephrolithiasis and urinary calculi, 188 preexisting renal disease, 189 pyelonephritis, 188 treatment, 188 Urinary tract infections (UTIs), 48, 188, 269, 415 clinical history, 269 laboratory evaluation, 269–270 risk factors for, 269t treatment, 270 Urine culture, 188 Urine LH kits, 355 Urodynamic testing, 267 Urogenital diaphragm, 36, 37f Urogenital folds, 33 Urogenital ridges, 29 1134 Urogenital system, early development of, 30f Urogynecology procedure, 302 Urorectal septum, 33 Uterine and vaginal anomalies, 40f Uterine artery, 37 Uterine atony, 128, 129 management of, 129–130 Uterine contractions, 86, 98 Uterine corpus, cancer of, 406 endometrial cancer, 410 diagnosis, 411 hormone therapy after treatment for endometrial carcinoma, 413 pathogenesis and risk factors, 411 prognostic factors, 411–412 recurrent endometrial carcinoma, 413 treatment, 412–413 endometrial hyperplasia, 406 atypical hyperplasia and endometrioid intraepithelial neoplasia, 406 evaluation, 407–409 hyperplasia without atypia, 406 management, 409 pathophysiology and risk factors, 406–407 patient history, 407 risk factors for, 408t World Health Organization’s classification of, 407t endometrial polyps, 409–410 uterine sarcoma, 413–414, 413f Uterine dehiscence, 132, 156 Uterine inversion, 132 Uterine leiomyoma and neoplasia, 173, 402 diagnosis, 403–404 effect of leiomyomata in pregnancy, 405 symptoms, 402–403 treatment, 404 Uterine malignancy, 402 Uterine palpation, 60 Uterine rupture, 132–133, 156 Uterine sarcoma, 413–414, 413f Uterine surgery, 154 Uterine tubes, 39 1135 Uteroplacental insufficiency, 106, 141, 164 Uteroplacental unit, 106 Uterosacral ligament, 37 Uterus, 37 bimanual examination of, 12 involution of, 120 and pelvic support, 37–39 positions of, within the pelvis, 39f Uterus and adnexa, bimanual examination of, 12f Uterus didelphys, 40 Vaccinations for women, 15t Vacuum extraction, 103–104 Vacuum extractor, 104f Vagina, 36–37 Vaginal artery, 37 Vaginal biopsy, 298 Vaginal birth, 33 Vaginal birth after cesarean (VBAC), 97 Vaginal bleeding, 152, 155, 167 Vaginal breech delivery, 104–105 Vaginal cancer, 388 Vaginal delivery, 111, 164 assisted by modified Ritgen maneuver, 95f low operative, 103 midpelvis operative, 103 outlet operative, 103 Vaginal discharge, 71 Vaginal dryness and genital tract atrophy, menopause and, 348 Vaginal examination, 87–88 Vaginal hemorrhage, 153 Vaginal hysterectomy, 301 Vaginal intraepithelial neoplasia (VAIN), 387–388 Vaginal plate, 32 Vaginal speculum, 10f Vaginitis, Valacyclovir, 257 Valproic acid and carbamazepine, 68t Valsalva maneuver, 93 Vanishing twin syndrome, 137 1136 Variable deceleration, 108t Variable expressivity, 77 Variable FHR decelerations, 109 Varicella, 217 Varicose veins and hemorrhoids, 71 Vasa previa, 156 Vascular and lymphatic dissemination, 271 Vascular spiders, 50 Vasectomy, 240f Vaso-occlusive crisis, 202, 203 Velamentous insertion, 156 Vertex presentation, various positions in, 88f Vesicouterine, 267 Vesicovaginal fistula, 267, 267f Vibroacoustic stimulation, 109 Vincristine, 372t, 377 Virilization, 337 Virtue-based approach, 24 Vital signs, Vitamin A, 69t Vitamin K, 54 Vitamin K1 oxide, 115 Von Willebrand disease, 152 Vulva, 36 biopsy, 297–298 and perineum, 36 Vulvar and vaginal disease and neoplasia, 379 benign vulvar disease, 379 dermatitis, 382 lichen planus, 381 lichen sclerosus, 379–381 lichen simplex chronicus, 381 localized vulvodynia, 382–383 psoriasis, 381–382 vulvar lesions, 383–384 Paget disease, 385–386 vaginal disease, 387 benign vaginal masses, 387 vaginal cancer, 388 vaginal intraepithelial neoplasia (VAIN), 387–388 1137 vulvar cancer, 386–387 vulvar intraepithelial neoplasia (VIN), 384 high-grade squamous intraepithelial lesions of the vulva (vul-var HSIL), 384–385 low-grade squamous intraepithelial lesion of the vulva (vulvar LSIL), 384 Vulvar dermatitis, 382 Vulvar dermatoses, clinical characteristics of, 383t Vulvar intraepithelial lesions, grading systems for, 384t Vulvovaginal ecosystem, normal, 245–246 Vulvovaginitis, 245 atrophic vaginitis, 249 bacterial vaginosis (BV), 246–247 clue cells, 247f diagnosis and treatment, 246t trichomonal vulvovaginitis, 248–249 vulvovaginal candidiasis, 247–248 Waning fertility, Warfarin, 68t Warming, 114 Weak D antigen, 204 Weight, maternal, 59 Weight loss, 124 Well newborn, initial care of, 112 delivery room assessment of the newborn, 112 Apgar scoring system, 112–114, 114t Ballard scoring system, 112 jaundice, 115 routine care, 114 practices to promote breastfeeding, 114 transitional care, 114–115 umbilical cord care, 114 vital signs, 114 warming, 114 Western blot test, 213 White’s classification of diabetes, in pregnancy, 178 WHO Surgical Safety Checklist, 27f Withdrawal bleed, 234 WNT4 gene, 29 1138 X-linked inheritance, 77–78 Yuzpe method, 237 Zavanelli maneuver, 105 Zero station, 86 Zidovudine, 213 Zika virus, 218 Zona basalis, 131 Zona spongiosa, 131 Z-score, 19 1139 目录 Half Title Title Page Copyright Page Dedication About the Authors Foreword Preface Acknowledgments Contents SECTION I General Obstetrics and Gynecology Women’s Health Examination and Women’s Health Care Management The Obstetrician–Gynecologist’s Role in Screening and Preventive Care Ethics, Liability, and Patient Safety in Obstetrics and Gynecology Embryology and Anatomy SECTION II Obstetrics 11 13 16 17 20 20 52 70 85 114 Maternal–Fetal Physiology Preconception and Antepartum Care Genetics and Genetic Disorders in Obstetrics and Gynecology Intrapartum Care Abnormal Labor and Intrapartum Fetal Surveillance 10 Immediate Care of the Newborn 11 Postpartum Care 12 Postpartum Hemorrhage 13 Multifetal Gestation 14 Fetal Growth Abnormalities: Intrauterine Growth Restriction and Macrosomia 15 Preterm Labor 1140 114 142 183 216 245 281 299 317 335 350 366 16 Third-Trimester Bleeding 17 Premature Rupture of Membranes 18 Post-term Pregnancy 19 Ectopic Pregnancy and Abortion 378 391 403 412 SECTION III Medical and Surgical Disorders in Pregnancy 437 20 Endocrine Disorders 21 Gastrointestinal, Renal, and Surgical Complications 22 Cardiovascular and Respiratory Disorders 23 Hematologic and Immunologic Complications 24 Infectious Diseases 25 Neurologic and Psychiatric Disorders 437 455 472 497 518 544 SECTION IV Gynecology 557 26 Contraception 27 Sterilization 28 Vulvovaginitis 29 Sexually Transmitted Infections 30 Pelvic Support Defects, Urinary Incontinence, and Urinary Tract Infection 31 Endometriosis 32 Dysmenorrhea and Chronic Pelvic Pain 33 Disorders of the Breast 34 Gynecologic Procedures 35 Human Sexuality 36 Sexual Assault and Domestic Violence SECTION V Reproductive Endocrinology and Infertility 37 Reproductive Cycles 38 Puberty 39 Amenorrhea and Abnormal Uterine Bleeding 40 Hirsutism and Virilization 41 Menopause 42 Infertility 43 Premenstrual Syndrome and Premenstrual Dysphoric 1141 557 594 606 618 649 672 688 703 725 746 763 781 781 794 808 821 838 858 Disorder 883 SECTION VI Gynecologic Oncology and Uterine Leiomyoma 44 Cell Biology and Principles of Cancer Therapy 45 Gestational Trophoblastic Neoplasia 46 Vulvar and Vaginal Disease and Neoplasia 47 Cervical Neoplasia and Carcinoma 48 Uterine Leiomyoma and Neoplasia 49 Cancer of the Uterine Corpus 50 Ovarian and Adnexal Disease Appendices 896 896 909 920 944 973 983 1004 1033 A The American College of Obstetricians and Gynecologists Well-Woman Recommendations by Age Group B The American College of Obstetricians and Gynecologists Antepartum Record and Postpartum Form C Edinburgh Postnatal Depression Scale (EPDS) Index 1033 1043 1059 1063 1142 ... The Robert A Munsick Professor of Clinical Obstetrics and Gynecology, Director, Medical Student Education, Director, Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, ... about obstetrics and gynecology that all medical students need to successfully complete an obstetrics and gynecology clerkship, to pass national standardized examinations in this content area and. .. restructured and helpfully divided into six units: I General Obstetrics and Gynecology, II Obstetrics, III Medical and Surgical Problems in Pregnancy, IV Gynecology, V Reproductive Endocrinology and Infertility,