By Jeremy J N Oats MBBS DM FRCOG FRANZCOG, Suzanne Abraham MSc PhD(Med) MAPS
Comprehensive insurance of the scientific necessities of either obstetrics and gynaecology in a single cheap quantity. a brand new workforce of authors offers the newest advances within the administration of being pregnant and the remedy of gynaecological problems in a well-written, easy-to-read kind. Shorter chapters, up-to-date terminology, clearer scans, and extra line drawings are only many of the clean, new adjustments that carry this renowned reference up to date and make it proper to state-of-the-art practice
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Extra resources for Llewellyn-Jones Fundamentals of Obstetrics and Gynaecology, 9e
Sample text
History At this first visit the doctor should take a history in the manner described earlier. The information includes more than that described for gynaecological examination. The history of previous pregnancies should be detailed and include information about: • Spontaneous and induced abortions • Complications during pregnancy • The gestation period at delivery • The method of delivery (spontaneous vaginal birth, forceps, ventouse delivery, caesarean section) • Complications in the puerperium • Birthweight of the baby, neonatal complications and long-term outcome • Maternal physical and mental health during and after each pregnancy • Breastfeeding history.
The calculation has to be altered if the woman’s menstrual cycle is prolonged, or if she was taking oral contraceptives during the cycle before she became pregnant, as ovulation may have been delayed and conception may have occurred up to 14 days later than expected. In these two circumstances the EDC will be later than calculated, and to obtain greater accuracy of prediction an ultrasound examination at the 18th to 20th week of pregnancy may be needed. Many obstetricians have an ultrasound of the fetus performed routinely at the time of the first visit, to accurately establish the gestation and fetal viability.
2I). On reaching the uterine cavity the zona pellucida becomes distended and thin. It soon disappears, leaving the surface cells of the blastocyst in contact with the endometrial stroma. About 50% of blastocysts adhere to the endometrium. The surface trophoblastic cells of the adhering blastocyst differentiate into an inner cellular layer, the cytotrophoblast, and an outer syncytiotrophoblast. Knobs of trophoblast rapidly form and invade the endometrial stroma in a controlled manner (Fig. 3). By the 10th day after fertilization the knobs of trophoblastic tissue have developed a mesodermal core and have pushed deep into the endometrial stroma (Fig.