Dutta Obstetrics

• A Abdominal examination, 91 Abnormal menopause, 57 • Abdominal pain, cyclical, 509 differential diagnosis, 520 in ectopic pregnancy, 507 in PID, 118 post-operative, 532 Abortion, recurrent spontaneous, 41 anatomical factors, 39 Abscess, - pelvic, 165 tubo-ovarian, see Tubo-ovarian abscess, 120 Acanthosis nigricans, 422 Acetowhite changes, cervix, 303 Acne, 502 Acquired immune deficiency syndrome (AIDS),l44 Actinomycosis, 135 Activins, 61, 84 Acyclovir, 143 • Adenoacanthoma endometrial, 330 Adenocarcinoma, cervix, 316 clear cell (adeno) carcinoma, 315 endometrial, 330 ovary, 343 vulva, 314 Adenocarcinoma-in-situ (AIS), vulva (Paget's disease), 298 Adenogenital syndrome, 404 Adenoma malignum, cervix, 317 Adenoma pituitary, 426 Adenomyosis, 293, 603 Adenosis,vaginal,500 Adenylate cyclase, 63 Adenomyosis, 293 • Adhesions, chlamydial infections, 120 Adolescence, 499 Adrenal cortex, 69 androgen, 69 • androgen-secreting tumours, 356 • • • 1 • Adrenal hyperplasia, congenital 404, late onset, 427 Adrenarche, 71 Adrenocortical hormones, 69,492 Adrenocorticotrophic hormone (ACTH), 64 Adrenogenital syndrome, 404 Age, Gynaecologic problems, 55, 495-499 AIDS, 144 Albright's syndrome, 48 Alkylating agents, 471 Allis tissue forceps, 573 Alopecia, 472 Alzheimer's disease, 55 Amenorrhoea, 412-434 exercise-related,426 hyperprolactinaemic, 426, 526 hypothalamic,426. in hypothalamic pituitary disorders, 419, 420 lactational,412 management, 415-418,431-432 in ovary failure, 425 pathological,413 physiological,412 post-pill, 428, 449 primary, 413-421 definition, 413 secondary, 419-432 weight related, 426 • anorexia nervosa, 426 causes,413,419 classification, 412 investigations, 417, 418, 429 American Fertility Society Classification for Endometriosis, Revised, 289 Aminoglutethimide, 432 Amnion vaginoplasty, 419 Amoebiasis vulva, 244 Amputation cervix, 540 Anal canal, 16 Anaemia, cytotoxic drug therapy, 472 Analgesia, patient-controlled (PCA), 532 • postoperative, 532 Analgesics, in cancer, 327 Analogues GnRH, 480 • •,• , • • -. • . ' • , x Intravenous urogram (IVU), 369 Intravesical pressu re, 368 Invasive mole, 334 Inversion uterus, 209,549 In-vitro fertilization, 235 Doppler ultrasound, 108 1U1,234 K Kallmann's syndrome, 426 Kartagener syndrome, 213 Karyotype, 467 Karyotyping, 213,219,371,407 Kelly sutures, 371 Ketoconazole, in hirsutism, 492 17-Ketosteroid,524 Klinefelter's syndrome, 407 Kobelt's tubule, 44 Kocher's artery forceps, 576 Koilocytosi8, 103 Krukenberg's tumour, 345, 596 KTP (potassium titanylphosphate) laser, 113 L Labia majo ra, 1 La'oial fusion, 404, 496 Lactational amenorrhoea, 412 Lamivudine, 146 Laparoscopic hysterectomy (LH), 561 Laparoscopy, 111 contraindications, 560 complications, 561 diagn ostic, 112 instruments, 557 operative, 559 procedures, 457,559 sterilisation, 457 therapeutic, 559 trocar and cannula, 557, 584 Large loop excision (TLLETZ), 306 Lasers, 113 common laser systems, 113 controlled area (LCA), 114 uses, 113 Hazards, 114 Physics, 113 Laurence-Moon-Biedl syndrome, 416 • • , TEXT BOOK OF GYNAECOLOGY LAVH, 561 Lazko method of repair, 390 LeFort's operation, 207 Leiomyoma, 253 Leiomyomatosis intravenous, 340 peritonealis disseminata, 340 Leiomyosarcoma, 340 Leuprorelin, 480 Leucorrhoea, 503 Levator ani muscle, 17 Levonorgestrel, 440, 452 Leydig cells, 213 Libido, 56, 449 Lichen sclerosus, 242, 244 Ligament, broad,20 cardinal, 22 ovarian, 22 round,22 triangular, 19 uterosacral, 22 Lipshutz ulcer, 245 Lump, abdomino-pelvic, 520 Luteal phase, inadequate, 222, 232, 489 Luteal-placental shift, 80 Luteinizing hormone, 63 Luteinizing hormone-releasing hormone, 60 • Luteinized unruptured follicle (LUF) ,s yndrome, 222, 232 Lymphadenectomy laparoscopic,324 pelvic lymphadenectomy, 324 vulval cancer, 554 Lymphatic drainage, 27-30 bladder, urethra, 29 cervix, 28 corp us, 28 ovarian, 28 vaginal,29 vulval,29 Lymphogranuloma venerum, 142 Lynch I and II syndrome, 343 M , , Mackenrodt's ligament, 22 , Macrophage colony-stimulating factor (M-CSF), 472 Macrophages, peritoneal, in endometri<?sls, 286 - • , - • INDEX Madlener's technique, 456 Magnetic resonance imaging (MRI), 109 Maldevelopment of genital organs, 39-45 Male, , contraception, 453, 461 infertility, 212, 217, 227 Mammography,517 Manchester, operation for prolapse, 203 technique of irradiation, 325 Marshall-Marchetti-Kranz operation, 372 Marsupialization, Bartholin's cyst, 152 Martius graft, 390 Mastalgia, 88, 17~ Mc Cune-Albright syndrome, 48 Medroxyprogesterone acetate, 333, 451 / Mefenamic acid, 169, 181 Meig's syndrome, 277 Melanoma .' vaginal,315 vulval,311 Melphalan, 471 Menarche, 46 Menopause, 51 endocrinology, 52 definition, 51 delayed,57 premature, 57, 425 surgic;lI,53 symptoms, 53 treatment, 54 Menorrhagia, 175 Menstruation, anatomic aspect, 74 anovular, 87 cervical cycle, 88 definition, 74 endometrial cycle, 81 hormone in relation, 84 . mechanism of bleeding, 83 • ovarian cycle, 76 postponement, 87, 489 total blood loss, 74 vaginal cycle, 88 6-Mercaptopurine (6MP), 471 Mesna,472 Mesosalpinx, 20 Meso-ovarium,20 • , • • I • xi Metal catheter, female, 568 Methotrexate, 471, 474 Metritis, 158 Metropathia haemorrhagica, 178 • Metrorr~agia, 176 Metronidazole, 143 Metroplasty,44 . abdominal (Tompkin's), 44 hysteroscopic, 44 MESA,234 Micro-surgery, 232 Micturition continence of urination, 365 incontinence of urine, ."166 physiology, 363 • Mifepristone, see RU486, 490 ~ . . • • (' .. .-. Minimally invasive surgery, 557 • Mittelschmerz, 172 - Mixed mesodermal tumour, 340 Molluscum c<;lntagiosum, 147 Monilial vaginitis, 154 Monoclonal antibodies, radiolabelled, 473 Morning after pill, 452 Mucinous cystadenoma, ovary, 272 Mucocolpos, 497 Mullerian duct, 33 Mullerian-inhibiting factor (MIF), 36, 403 Mullerian tubercle, 33 Myelosl'ppression, cytotoxic, 472 (table 29.4) Myolysis, laparoscopic, 263 Myoma (see fibroid), 253 Myoma screw, 575 Myomectomy, 551 hysteroscopic,263 laparoscopic,263 results, 262 Myometrium, 8 • I / • N , / Nabothian cyst (follicle), 250 Nafarelil1, 480 (table 30.1) Naproxen, 169, 181 • Needlestick injuries, 146 Neisseria gonorrhoea (gonococcus), 138 • Neovagina, methods of creation, 419 Nestorone, 461 Neurotransmitters, 61 x•u• • Nickerson's medium, 155 Nipples, discharge, 518 (table 32.12) Nocturia, 373 Non-steroidal anti-inflammatory agents, 169, 182 Ndrethisterone, 451, 488 • Norgestrel, 466, 488 Norplant, 451 Nystatin, 155 o Obesity, adolescent, 416, 424, 502, 523 Oestrogen{s), 56, 64, 484, 485 Oligomenorrhoea, 176 Oligospermia, 218 Omentectomy, 351 Oncogenes, 477 Oocyte, 74 Oocytedonation, 238 Oophoritis, 164 Opioids in cancer, 327 endogenous, 61 Or~1 contrafeptives • combined (COC), 446 Orchidometer, 217 Osteitis pubis, 372, 555 Osteoporosis, 53 Ovarian agenesis, 406 • Ovarian cysts - nonneoplastic, 270 Ovarian failure (POF), 425 Ovarian follicles, 76 • Ovarian hyperstimulation syndrome (OHSS), 482 Ovarian tumours, 271 -283 epithelial ' benign, 272 borderline, 282 malignant, 343 feminising, 595 germ cell, 352 masculinising, 595 sex cord stromal, 355 solid,595 Ovariotomy, 282, 547 Ova rio lysis, 559 Ovary, 11 drilling, laparoscopic, 549 endometriomas, 288 Ovarian cysteu.tomy, 282, 546 • • TEXT BOOK-eF GYNAECOLOGY Ovarian fossa, 13 Ovarian, pedicle, 279 (table 19.2) cycle, 76 ovarian remnant syndrome, 511 residUal syndrome, 511 torsion, 279 Ovarian tumour (Benign), 271 adolescence, in, 500 borderline, 282 Brenner, 272 childhood, in 497 classification, 272 clinical features, 276 complications, 279 cystic, 272 diagnosis, of 278 malignant, 343 management, of 281 Overflow incontinence, 366 Ovotestes, 407 Ovulation, 84 failure of, 214 incessant, 343 induction of, 229 tests for, 220 Oxybutynin, 374 p Paclitaxel (Taxol), 351,471 (table 29.7) Pad tests, 368 Paget's diseases, vulva, 298 Palliative care, 327 Panhysterectomy, 540 Papanicolaou grading, 104 (table 8.'2) Papanicolaou stain, 102 Papillary serous carcinoma, 344 Paralytic ileus, 544 I Parametrium, 21 Parametritis, 164 I Paroophoron, 44 Parovarian cyst, 282 Pediculosis pubis, 147 Pelvic abscess, 165 Pelvic congestion syndrome, 172,510 Pelvic cellular tissue, 21 Pelvic diaphragm, 17 Pelvic fascia, 21 • '. INDEX Pelvic floor, 17 Pelvic floor repair, 203 Pelvic inflammatory disease (PID), 118 Pelvic pain, 507-509 Perihepatitis, chlamydia I, 141 Perineal body, 19 Perineoplasty, 539 Perineorrhaphy, 200 Peritonei, pseudomyxoma, 280 Perforation uterus, 516 Perineal tear, 395 Pessary HodgeSmith, 190,584 ring, 198,585 test, 190,585 Pineal gland, 48 Pituitary hormones; 63 Pituitary gland, 63, 64 Pituitary gonadotrophin, 482 Placental site trophoblastic tumour, 334 Pneumoperitoneum, laparoscopy, 560 Podophyllotoxin, 147 Polycystic ovarian.stisease, 421, 431, 523, 549, 558 Polymenorrhoea, i75 Polyps, 265 cervical, 267 endometrial, 267 fibroid, 267 malignant, 268 placental, 268 Pomeroy's technique, 455 POMS/ ACE regimen, 354 , Post coital1:esb, 106 , Postmen<lpausal bleeding, 511 , Postpartum necrosis (Sheehan syndrome), 420, 427 Postoperative cpre, 531 , , Postoperative complications, '545 Post-pill amenorrhoea, 449 Pouch of Douglas, 20 Power density (PO), 113 Premalignant disease, 297-309 Premenstrual syndrome, 172 Preoperative preparations, 529 Presacral neurectomy, 17l • Primary peritoneal adenocarcinoma, 356 Procidentia, 194 Progesterone, 68, 487 • Prognostie factors cervical cancer, 318 endometrial cancer, 334 ovarian cancer, 352 in trophoblastic disease, 335 Prolactin, 64, 426, 432, 526 Prolactinoma, 426, 432, 526 Prolapse, 190-209 aetiology, 192 diagnosis, 195 preventive, 197 supports of uterus, 190 symptoms, 195 treatment, 197 types, 192 vault, 207 Prostaglandins dysmenorrhoea, 169 endometriosis, 287 in menorrhagia, 182 in menstruation, 84 \ Prostaglandin synthetase inhibitors, 182 Protein kinase, 62 Protein kinase C, 63 Pruritus vulvae, 505 Psammoma bodies, 274 Pseudo-Meig's syndrome, 277 Psoas hitch procedure, 393 Puberty, 46-51 delayed, 50 endocrinology, 46 menorrhagia, 50 precocious, 48 pubic hair, development, 47 somatic changes, 47 Pulmonary embolism, 545 Pulmonary oedema, hysteroscopy, 564 Punch biopsy, 537 Purandare's operation, 208 Pyometra, 159 Pyridoxine, in PMS, 173 Pyosalpinx, 162 Pyouria, 380 R Radiotherapy, 464 Radioisotopes, 465 Radium, 465 • • • X1U , • XI• V Rape, forensic considerations, 399 Rectocele, 193 "- Recto-vaginal fistula, 393 Rectovaginal septum, endometriosis, 285 Rectum, 16 Red degeneration, fibroid, 256 Relaxin, 69 Relaxed perineum, 193 Resistant ovary syndrome, 425, 432 Retention urine, 377 Retractors, abdominal, 577 Retroflexion, uterine, 187 Retroversion, uterine, 187 Rifampicin, 134, 448 • Rokitansky-Kuster-Mayer syndrome, 416 (table 27.1) Rollerball endometrial ablation, 183 RU486 (mifepristone), 490 s Sacral colpopexy, 207 Sacrospinous colpopexy, 207 Safe period, 438 Salpingectomy, 549 Salpingitis, 159-163 Salpingolysis, 232, 559 Salpingography ulfrasound, 109,224 hysterosalpingography, 536, 591, 599-602 Salpingoscopy, 224 Salpingitis isthmica nodosa, 130, 163 Salpingo-oophorectomy, 547 Salpingo-oophoritis, 164 Salpingostomy, 232 Salvage procedure, 373 Sarcoma, botryoides, 342 uterine, 340 Scabies, 147 Schiller's test, 320 Scissors, laparoscopic, 558, 582 Screening breast cancer, 516 cervical cancer, 322 endometrial cancer, 332 ovarian cancer, 350 Sebaceous cysts, vulva, 245 Semen, analysis, 217 Seminiferou" lubules, 406 TEXT BOOK OF GYNAECOLOGY , Senile endometritis, 158 SERMS,54 Serous cyst adenoma, ovary, 273 Serotonin, 61 in gonadotrophin release, 61 in PMS, 172 Serous adenocarcinoma ovary, 344 Sertoli cell-only syndrome, 219 Sertoli cells, 213 Sertoli Leydig cell tumours, 356 Sex cord stromal tumours, 355 Sex differentiation, 32 Sex-determining region of Y (SRY) gene, 36 Sex hormone-binding globulin (SHBG), 423 Sexually transmitted diseases, 137- 148 Sheehan's syndrome, 427 Shock bacteraemic endotoxic, 124 TSS,156 Short stature, 405 Sims' position, 94 Sims' speculum, 566 Sim's triad, 390 Sinovaginal bulbs, 34 Sling operation, 208 Sling procedures, suburethral, 373 , Smear dyskaryotic - mild, moderate, severe, 103 Soft sore, 141 Sonography, 108 Sonohysterosalpingography,109 Sound, uterine, 570 Specimens, 587 Sperm antibodies, 214, 225, 228 Sperm count, 217 Sperm-cervical mucus contact test (SCMC), 224 Spinnbarkeit, 106 SRY gene, 36, 403 Stamey procedure, 373 Stein-Leventhal syndrome, 421, 558 Ster.Hization, 453 vasectomy, 453 laparoscopic,457 minilaparotomy,456 tubectomy, 455 Steroid hormones, 64, 484 Strassman's procedure, 44 Stress, amenorrhoea related to, 426 Stress ineontinence, urinary, 366 , , INDEX xv --------------~--------------~------------------~~~~~~=============---.--- Stromal endometriosis, 295 Struma ovarii, 272, 595 Subzonal insemination (SU2I), 234 Superovulation for assisted conceptio'1, 236 Supports of genital organs, 190 - . Surface area, body, 603 Suture materials, 585 Swim-up test, 234 Synechiae uterine, 602 Syphilis,'140 , T Tall girls, 499 Tamoxifen, 487 Tanner staging, 47 Taxol, see Paclitaxel, 471 Teletherapy, see Radiotherapy, -165 Temperature basal body (B8T), 221 Teratoma immature, 354 Teratoma, solid, 354, 595 Tcratozoospermia, 218 TerminC\1 carc, 327 . Testicular-determining factor (TUF), 3R Testicular failure, 21 ') • Testis, biopsy, 219 Testicular feminisation, 406 Testosterone (T), 522 an tagonists, 525 Theca cells, 76 Theca cell tumours, 356 . Theca externa and interna, 78 Threadworm infestations, 506 Three swab test, 387 Thromboembolism, 545 Thrombophlebitis, 545 Thyroid hormones, 69,493 Thyroid-stimulating hormone (TSH), 64 . Thyrotrophin-releasing hormone (TRH), 60 TNM staging, breast cancer, 518 Toluidine blue test, 297 Toxic shock syndrome, 156 Tranexamic acid, 181 • Transformation zone, cervix, 299 Transforming growth factor (TGF), 254 Tran, sva'ginal sonography, 108 Treponema pallidum, 140 Trichomon.as vaginitis, 153 , Trigone, bladder, 14,32 Trocars, 558, 584 Trophoblastic tumour, 334 True hermaphrodite, 407 Tubal insufflation, 535 Tubal ligation, 455 Tubal surgery laparoscopic,559 microsurgical,232 Tuberculosis, genital, 128-135 Tubo-ovarian abscess, cyst, 120 Tumour markers, 350, 477 Tumour necrosis factor-Ct, 286 Tumour suppressor genes, 476 Tunica albuginea, 13 Turner's syndrome, 405, 409, 415, table 27.1 and 27.2 Two-cell, two-gonadotrophin theory, 65, 66 u Uchida technique, 456 Ulcer, Vulva, 245 • Ultraso\Jnd ill gymt~wlogy, lOR Unicornuate uterus, 601 Uniplant, 461 Ureter(s), ana tomical relations, 15 fistulae, 391 surgical injury, 391 Urethra anatomy, 13 caruncle, 382 prolapse, 382 C[ethral sphincter incompetence, 366 Urethral syndome, 379 Urethrocele, 193 Urethrovaginal fistulae, 391 Urinary fistula, 385 Urge incontinence, 373 Urgency of micturition, 375 (tablc ~3.6) Urinary diary, 368 Urinary diversion, 375 • Urinary retention, 377 Urinary tract infec;tions (UTI), 378 Urine examination, 100 Urodynamic investigations, 368 • Uroflowmetry, 368 • Urogenital sinus, 34 • • Uterosacral ligaments, 22 · • 'Uterus, 7, 41 Ut~rine bleeding, abnormal (DUB), 177, 511 UterinJ malformations, 41 \ ' . Utriculoplasty, 44, 601 v Ya:S:Cme, contraceptive, 462' '5imen, 475-(table 29.7) V an.atomY;-4 agenesis, 40. adenosis, 315, 50.0. cyst, 246 development, 34 • c{lrcir\oma, 314 coital injur~ 399 cytology, 1~, 565 flora, 6 Vaginal creams, oestrogen-conta_ining, 485 Vaginal intraepithel-ia neoplasia (VAIN), 298 Vaginal discharge, S 3 Vaginal ring, (LNG), 461 Vaginectomy radical, 315 Vaginismus, 518 Vaginitis, 152 . ~onococcal, 138 \ monilial, 154 , ,n311-speci fio, 156 senile, 155 trichomonas, 153 I ~Vaginopla s ty, 419 ~ Vaginosis, bacterial (anaerobic), 1421 Var,i cosities, Vulva, 245 Vascular endothelial growth factor (VEGF), 483 Vasectomy, 453 no scalpel, 154 I Vault prolapse, 20.7 Vault suspension, 20.7 y entro suspension, 190, 550. Vesicq-vaginal fistula, 386 Vestibuhtis, vulval, 247 Verres needle, 557, 583 IA,3D? Videocystourethrograp hy (Ve U), 369 - Viri lisld, 522 VIN,2,97 Violin striJ;'g adhesion, 120. • , T(EXT BOOK OF G -v' oiding difficulties, 377 Vulsellum, 569 Vulva, anatomy, 1 burning, 247 Vulva, Squamous cell hyperplasia, 243 Vulvtwhite lesions, 245 Vulval ulcer, 245 Vulval pain, 247 . Vulvectomy radical, 554, 599 complications, 555 separate groin incisions, 554 simple, 553 Vulvitis, 149 Vulvodynia, 247 Vulva-vaginitis, 497 w Ward-Mayo's operation, 20.5, 546 \ Warfarin,545 -- / Wedge resection, ovary, 549 Weight, imenorrhoea, weight loss-related, 426 in hirsutis~, 523 ' Wertheim' ~ (radical) hysterectomy, 55? Witch's milk, 496 Wolffian duct, remnants, 44 Womostone, 256 . Wound dehiscel}ce, 583 x X-chromosome, 38 X-rays, 599-60.2 XX gonadal dysgenesis, 40.6 • XXY (Klinefelter's) svndr<fIle" 40.7 . I XY females, 38 / y Y-€~omosQme,36,38,4D3 Yolk sac tumour of the ovary, 354 Young's syndrome, 214 'z Zidovudine, 146 Zona pellucid, , 78, 238 Zygote intra fallopian transfer, 234 , .. • • • 11 Androblastoma, 356 Androgen(s), 68, 491, 522, table 32.15 therapy, 491 • OVarian in polycystic ovarian syndrome, 423 hirsutism / virilization, 521 Androgen insensitivity syndrome, 406 3a-Androstenediol-glucuronide (3a AG), 523 Andr(jstenedione, 522 Aneuploidy, 334 Anorexia nervosa, 426 Anosmia, 426 Anovular menstrua tion, 87 Anterior colporrhaphy, 198 Anteflexion of uterus, 7, 187 Anteversion of u terus, 187 Anti-androgens, 491 in hirsutism, 525 . Antibiotics, in bacterial vaginosis, 143 ' in chlamydial infection, 122 in gonococcal infections, 122 in PID, 122 prophylactic preoperative use, 530 in syphilis, 140 . in urinary tract infections, 380 - Anticholinergic drugs, in incontinence, 374 Anticoagulants, postoperative therapy, 545 Antiemetic therapy, 472 Anti-glucocorticoids, 432 Anti-gonadotrophin, 483 Anti-mullerian hormone (AMH), 36, 403 Anti-oestrogens, 486 Anti-progesterone (RU 486), 490 Antisperm antibodies, 218, 225 in cervical mucus tests, 225 management, 233 Antituberculous chemotherapy, 133 Apareunia, 519 Arcuate arteries, 25 Argon laser, 113 Artificial insemination, 234 Artificial urinary sphincter, 373 Ascites, ovarian tumours, 277, 347 Assisted reproduction, 234 Asherman's syndrome, 421, 432, 602 Assisted reproductive techniques (ART), 234 TEXT BOOK OF GYNAECOLOGY Asthenozoospermia, 218 Asymptomatic bacteriuria, 379 Autoimmunity, in endometriosis, 286 ovarian failure, 425 Auvard's speculum, 567 Azithromycin, 141 Azoospermia, 218 AZT (zidovudine), 146 B Bacterial vaginosis, 142 Backache,512 Barr body, 405 Bartholinitis, 151 Bartholin's gland abscess, 151 anatomy, 2 cyst, 152 carcinoma, 314 lymphatic drainage, 29 Basal body temperature, 221 Basal cell carcinoma, vulva, 311 Behcet's disease, 245 Bethesda classification, 104, 299 Bicornuate uterus, 601 • Bimanual examination (palpation), 97 Biodegradable, contraceptives, 461 Biopsy, cervix, 536 Bladder, urinary, 14 Bladder injury, repair, 568 . Blood supply, pelvic organs, 24 Boari flap procedure, 393 Body image, altered, 555 Body mass index (BMI), 502, 604 obesity; weight, 432, 604 Body surface area, 603 Bonney's myomectomy hood/clamp, 551, 575 Bonni!y's hood opn, 551 Botryoides sarcoma, 342 Brachytherapy, 465 afterloading system, 465 interstitial, 465 in vaginal cancer, 315 in vulval cancer, 313 intracavitary, 465 in cervical cancer, 324, 466, 468 in endometrial cancer, 333 • • • • • INDEX BRCA1 gene, 343, 517 BRCA2 gene( 343, 517 Breakthrough bleeding (BTB), 448 Breasts, 513 • • abnormalities of development, 514 accessory, 515 anatomy, 513 asymmetry, 515 biopsy, 516 at puberty, 47 in menopause, 53 examination, 91 fibroadenoma, 516 fibrocystic disease, 515 hypertrophy / 497 nipple discharge, 518 risk factor for breast carcinoma, 517 self examination, 516 Breast cancer, 516 aetiology f risk factors,517 familial genetics, 517 screening women at risk, 516 risk after HRT, 56 staging, 518 Breastfeeding, contraceptive effects, 450 in HIV infection, 146 Brenner tumourS, 276, 277 Bromocriptine, 432 • Burch colposuspension, 372 Burning vulva syndrome, 247 Burns, electrosurgery causing, 561 B~ Iltsdomen, 583 , Buserelin, 480 (table 30.1) in endometriosis, 291 for uterine fibroid, 262 • Borderline epithelial tumours, ovary, 282 Broad ligament, anatomy, 20 cyst, 278 . fibroid, 254 • Bromocriptine, 432 Brunschwig's operation, 324 • • c CA125, serum, 350,.477 Cabergoline, 432 Caesium, 465 Caffeine consumption, 173 Calcitonin,54 Calcium (Ca2), 54, 63 Caloric restriction, 525 Call Exner's body, 356 Canal of Nuck, cysts of, 245 Cancer, gene therapy, 476 Candida albicans, 101, 150, 154 Carbon dioxide, in laparoscopy, 560 Carbon dioxide laser, 113 Carboplatin,471 (table 29.6) Carcinoid tumour, ovary, 272 Carcinoma, cervix, 316, 597 endometrium, 329, 598 fallopian tube, 342, 592 ovary, 344,595 stump, 328 vagina, 314 vulva, 310, 599 Carcinosarcoma, uterine, 341 Cardinal ligaments, 22 Caruncle, urethral, 382 Carunculae myrtiformes, 2 CD4 lymphocytes, HIV infection, 144 Cell cycle, 470 Cellular tissues, in pelvis, 21 Centchroman, 461 Cervical hostility, 224 Cervicitis, 156, 157 Cervicopexy (sling), 208 Cervical carcinoma, 316 screening, 322 staging, 318 treatment, 322 microinvasive disease, 325 . Cervical cytology, 102,565 I Cervi val intraepithelial neoplaSia (CIN), 298 Cervical mucus, 106 Cervicography, 304 ••• III .•. , • I• V Cervix amputation, 540 anatomy, 8 biopsy, 536 carcinoma, 316 , complications, 321 diagnosis, 318 differential diagnosis, 321 histology, 316 incidence, 316 in-situ, 299 spread,317 stages, 318 stump, 328 cauterisation, 538 conisation, 537 dilatation, 533 dysplasia, 299 ectropion, 250 elongation, 251 erosion, 248 fibroid, 264 mucous, 106 tear, 250 tuberculosis, 135 Carboplatin,471 Chancroid,141 Chemotherapy, 469 single agent, 470 multiple agent, 470 toxicity,472 Chlorambucil, 471, table 29.6 Chocolate cysts, ovarian, 288 Chorioadenoma destruens, 336 Choriocarcinoma, 336, 591 \ \ Chorion gonadotrophins, 230, 477, 482 Chlamydia, 120, 141, 155 Cisplatin, 351 CIN, 104, 298 Clear cell adenocarcinoma, 315 Climacteric, 52 Clitoris,1 Cloaca,32 C-lomiphene,4&) Cloquet's lymph node, 29 Clue cells, 143 • • • TEXT BOOK OF GYNAECOLOGY Coitus, injury, 399 interruptus, 438 vulval/vaginal trauma, 399 Colles' fractures, 54 Collimation, 113 Colorectal cancer, 448 hereditary non-polyposis (HNPCC), 343 Colour Doppler ultrasound, 108 Colpocleisis, 207 Colpomicrohysteroscope, 112 Colpopexy, 207 Colposcopy, 107 cervix, 303 method,107 terminology, 108,303 vagina, 298 vulva, 297 Colposuspension, 372 Colpotomy, posterior, 166 Complete perfueal tear, 395 Computed tomography (CT), 109, 604 Condylomata accuminata, 146 Congenital anomalies, genital organs, 39-45 Cone biopsy, 537 knife, 537 laser, 537 Congenital adrenal hyperplasia (CAH), 404, 427 Consent, informed, 530 Continence, 365 stress, mechanism of, 366 Contraception, 435 Contraceptives, barrier methods, 435 centchroman, 461 Condom, male 438; female 438 Copper T, 439 Diaphragm, 437 eQ1.ergency contraception, 452 implanon, 452 injectable steroids, 451 LNG-IUS, 440 Norplant, 451 minipill, 450 morning after pill, 452 multi load, 440 natural, 438 - - • • . INDEX Contraceptives contd. nestorone, 461 progestin only pm, 450 post-coital, 452 prescription, 460 progestasert, 440 saheli,461 sponge (Today), 437 sterilisa tion, 453 tubectomy, 455 laparoscopic, 457 vasectomy, 453 steroidal,445 triphasic, 450 unip!::mt, 461 Cornification index, 105 Corona radiata, 78 • Coronary artery disease, 55,425 Corpus albicans, 80 Corpus cancer syndrome, 329 Corpus luteum, 79 Corticosteroid therapy, 408, 432, 492 Coprticotrophin-releasing hormone (CRH), 60 Counselling, 146,453,460,530 Craniopharyngioma, 420 Crohn's disease, 245 Cryotherapy, 538 Cryptomenorrhoea, 40, 413 Cryptorchidism, 213, 228 CTscan, 109 Cryo surgery, 538 Culdocentesis, 111 Curettage, uterine, 533 Culdoscopy, 113 Cusco's bivalve speculum, 566 Cushing's syndrome/disease, 427 Cyclophosphamide, 471, table 29.4, table 29.6 Cyproterone acetate (CPA), 491, 525 Cystic glandular hyperplasia, 178 Cystitis, 379 Cystocele, 192, 195, 196, 198 • Cystoscopy, 112 Cytobrush, 565 .,/Cysts (see also individual organs) atretic, 80 cervical, 250 chocolate, 288 dermoid, 274 follicular, 270 • • • Cysts contd. lutein,271 Nabothian, 250 ovarian, 271 parovarian, 282, 597 vaginal, 246 vulva, 245 Cystometry, 368 Cytology, cervical, vaginal, 102 Cytotoxic drugs (chemotherapy), 469 D Danazol, 291, 483 Day case surgery, 531 DDAVP (desmopressin), 374 Decubitus ulcer, 274 . • • Deep inguinal lymph node, 29 Dehydroepiandrosterone (DHA), 522 Dehydroepiandrosterone sulphate (DHAS), 522 • Dementia, 54 Depo-provera (depot medroxyprogesterone acetate),451 Depression, 54, 555 Delayed puberty, 50 Dermoid cyst, 274, 593 Desogestrel, 446 Detrusor, hyperreflexia, 373 innervation, 362 instability,373 , drug therapy, 374 investigations, 374 Development, • • female genital organs, 32 • • • Dexamethasone suppression test, 428 Diabetes insipidus, 432 Diaphragm, pelvic, 17 Diathermy, 558 bipolar, 558 monopolar, 558 Diagnostic procedures, 100 Diethylstilboestrol (DES), 42, 500 Dydrogesterone, 488 Dihydrotestosterone (DHT), 522 Dilatation and curettage, 533 Dilators, cervical, 568 • , • • • • • • VI Discharge, vaginal, 503- abnormal, 505 normal,503 Discus proligerus, 78 Docetaxel (Taxotere), 351, 471, table 29.7 Doderlein's bacillus, 7 Donor insemination, 235 Donovan bodies, 142 Dopamine, agonists, 432 antagonists, 427 Doppler ultrasound, 108 Douglas, pouch of, 20 Doxorubicin (Adriamycin), 471 (table 29.6) Drugs, hirsutism-inducing, 523 (table 32.14) hyperprolactinaemia due to, 427 male infertility due to, 213 masculinization of female fetus by, 405 voiding disorders caused by, 377 Dysfunctional uterine bleeding, 177 Dysgerminoma, 352 Dyskaryosis, 103 Dysmenorrhoea, 168 - 174 aetiology, 168 congestive, 171 ovarian, 171 primary (spasmodic), 168 treatment, 169 unilateral, 171 Dyspareunia, 519 Dysplasia, cervical, 299 Dystrrml-' 'ulval,242 Dysuria, E Ectopy, cervical, 248 Ectropion, cervix, 250 Ejaculation, premature, 213 retrograde, 213 Electrocautery, cervix, 538 Electrocardiography, preoperative, 529 Electrolysis, 526 Elongation, cervix, 251 EMA/CO regimen, 339 Embolism, carbon dioxide, 562, 564 .Embolization, postoperative, 545 • • TEXT BOOK OF GYNAECOLOGY Einbryo, cryopreservation, 237 dona tion, 238 transfer, 236 Embryoma, 353 Encephalitis, 48 Endodermal sinus tumour, 354 Endo' CIA stapling devices, 558 Endometrial ablation, 183, complications, 564 endometrial p reparation for, 564 in dications, 183 rollerball technique, 183 thermal balloon, 184 microwave, 184 Endometrial biopsy, 110 Endometrial carcinoma, aetiology, 329 diagnosis/investigation, 331 familial,329 management, 332 surgery, 332 tamoxifen therapy and, 333 • Endometrial carcinoma, prognostic index for, 334 Endometriosis, 284-296 . aetiology, 285 clinical features, 287 definition, 284 pathology, 286 treatment, 290 Endometritis, 158 acute, 158 chronic, 158 senile, 158 Endometrium carcinoma, 329 cyclic changes, 81 hyperplasia, 178, 307 polyp, 267 stromal sarcoma, 340 Endomet•r ial sampling, 110 Endopelvic fascia, 21 Endorphins, 61 Endoscopy, in gynaecology, 557- 564 Enterocele, 193, 200, 203, 207 Epidermal growth fac tor (ECF), 254 Epidermidization of cervix, 301 Epimenorrhoea, 175 • INDEX Epoophoron, 34 Erosion cervix, 248 Erythromycin, in pelvic infections, 122, 140, 141 Ethinyl oestradiol, 484 in emergency contraception, 452 in oral contraceptives, 446 Etoposide, 474 (table 29.6) Examination of patient, 90-114 abdominal, 91 anaesthesia, under, 113 bimanual,97 clinical, 91 digital,97 rectal,98 rectovaginal, 99 speculum, 95 Examination under anaesthesia, 113 cervical cancer, 317 fistulae, 387 Exenteration, pelvic, 324 External genitalia, 1 F fa lope ring, 457 Fallopian tubes anatomy, 10 cancer, 342 carcinoma, 342 insufflation, 535 infection, 129, 159 ligation, 455 Falloposcopy, 224 • Familial breast/ ovarian cancer genetics, 343, 476, 517 Family planning natural,438 Fascia endopelvic, 21 pubocervical, 22 Fe<:Undity,212 • Feminising tumours of the ovary, 355, 595 Fenton's operation, 539 Fern test, 106 Fertility, immunologic control, 462 Fertilization, in vitro, 235 Fimbrial cyst, 44 / Fimbriolysis, 232 • • Fibroid (fibromyoma, myoma), 253-269 broad ligament, 250 capsule, 255 cervical, 255, 264, 5si 589 complications, 257 clinical features, 257 degenerations, 256 diagnosis, 259, 603 histology, 256 incidence, 253 myomectomy, 551 treatment, 261 types, 254 FICO staging cervical cancer, 318 endometrial cancer, 330, 334 gestational trophoblastic tumour, 338 ovarian cancer, 346 vaginal cancer, 315 vulval cancer, 313 Filshie clip, 457 Finasteride, in hirsutism, 526 Pme-needle 3tiplratlon cytology (fNAC),517 Fistulas classifica tion, 385 recto-vaginal, 393 surgical repair, 388, 391, 393, 394 urethro-vaginal,391 uretero-vaginal, 391 vesico-vaginal,386 Fitz-Hugh-Curtis syndrome, 141 Flora of vagina, 6 Fluconazole, 155 5-Fluorouracil, 471 (table 29.6) Flutamide, in hirsutism, 526 Follicles, ovarian atresia, 80 growth,75 ovulation, 78 recruitment, 76 • selection and dominance, 77 Follicle-stimulating hormone (FSH), 63, 229 purified preparation, 229 • recombinant human, 229 Follicular atresia, 80 • Follicular cyst, 270 • • Vll • • • VIII Foreign bodies vagina, 401 uterus, 401 Forceps ovum, 572 sponge holding, 572 uterine dressing, 572 dissecting, 581 Fothergill's operation, 203 complications, 209, tab1e 14.3 Fourchette, 1 Frankenhauser's plexus, 31 Frequency of micturition, 373 treatment, 374 Frequency / volume chart, 368 • Furunculosis, 149 G • '. • Gamete intrafallopian transfer (GIFT), 237 Galactorrhoea, 426, 432, 526 Gamma-aminobutyric acid, 172 Gardnerella vagina lis, 142 Gartner's duct cyst of, 48, 196, 246 GAX collagen injections, periurethral, 370 Gene therapy, 476 Genetics, cancer, 476 Genital crisis, 496 Genital organs, defence, 116 Genital prolapse, 190 - 209 • Genitalia, external devefopment, 32 ambiguous, 403, 495 Genital tubercle, 33 Germ cells, 35, 75 Germ cell tumour, ovary, 272, 353 Gestational trophoblastic neoplasia (GTN), 334 Gestrinone, 484 Gilliam's operation, 190, 550 GnRH analogues, 480 antagonists, 231, 262 Gonad, development, 35 Gonadal dysgenesis, 405 Gonadoblastoma, 354 Gonadotrophins, 63, 230 Gonadotrophin-releasing hormone (GnRH), 60 Gonorrhoea, 138 Goserelin, 480 • TEXT BOOK OF GYNAECOLOGY Gossipol, 461 Graafian follicle, 77 Granuloma inguinale, 142 Granulosa cells, 78 Granulosa cell tumour, 355 Granulosa lutein cyst, 271 Grape like sarcoma, 342 Grays (Gy) , 466 Growth factors uterine fibroids, 245 Growth hormone (GH), 230, 499 Gynand roblastoma, 356 H Haematocolpos, 39, 413 Haematuria, 369 Haematoma, vulva, 400 Haematometra, 39, 413 Haemato-salpinx, 413, 592 Haematuria, 369 Haemophilus vaginalis, 142 Haemorrhage, post operativ~ primary, 208, 545, secondary, 208,545 Hair growth, 523 genetic/ethnic influences, 523 hormonal influences, 523 pubic, development, 47 Haultain's operation, 549 • Heparin thromboembolism prophylaxis, 545 Hepatitis B virus (HBV) screening, 529 HER-2/neu, in ovarian cancer, 350, 477 Hernia, incisional, 546 Hermaphrodite, 404 Hernia, inguino labial, 245 Herpes genitalis, 143 Herpes zoster, 150 Hilar celt tumour, 356 Hirsu tism, 521-526 History, in gynaecology, 90 preoperative, 529 HIV,144 Hormone therapy, in gynaecology, 479 Hormone replacement therapy (HRT), 56 • • INDEX Hormones, in gynaecology; 479 mechanisms of action, 63, 66 steroid,66 Hot flushes, 53 HPV, see Human papilloma viruses, 302, 304 H-Y antigen, 36, 403 Hydatidiform mole, 335, 590 Hydrocolpos, 497 . Hydrosalpinx, 161,591 11-Hydroxylase deficiency, 404, 427 21-Hydroxylase deficiency, 404, 427 Hymen, 2 Hyperandrogenism, 523 (table 32.14) Hyperinsulinaemia, 425 in hyperandrogenism, 523 in polycystic ovarian syndrome, 421 Hyperprolactinaemia, 426, 526 Hyperthyroidism, menorrhagia, 175 Hypertrichosis, 522 Hypogonadism hypergonadotrophic, 50, 414 hypogonadotrophic causes, 50, 413 Hypomenorrhoea,l77 Hyponatraemia,405 Hypothalamo-pituitary-ovarian axis, 70 (Fig. 6.6) Hypothalamic hormones, 60, 480 Hypothalamus, 59 HypothyrOidism itmpnnrrhOPit / nlignmpnnrrhnpit in, 17S, 417 Hysterectomy, abdominal, 541 complications, 208, 545 indications, 544 (table 33.3) laparoscopic,561 laparoscopic assisted vaginal, 561 subtotal, 541 total,541 vaginal, 205 Wertheim's (radical), 552 Hysterosalpingography, 536, 599-602 Hysteroscopy, 112,562 Complications, 564 I Identification of, trichomonas vagina lis, 153 monilia, 101, 154 Ifosfamide, 471 (table 29.6) • Imipramine, in. incontinence, 374 Immotile cilia syndrome (Kartagener), 213 Implanon, 452 Immunotherapy, 473 Impotency, 214, 228 Implant, biodegradable, 461 Imaging in gynaecology, 108 Incontinence of, faeces, 393 urine, 366 Index, body mass, 604 Induction of ovulation, 229, 492 Infections, genital organs, 117, 126 organisms concerned, 117 postabortal and puerperal, 123 sexually traOfmitted, 137-148 tubercular, 128-135 Infertility, 212-240 causes, 212 female factors, 214 (Scheme - 3) investigations, 216 LUF, 222, 232 . luteal phase defect, 222, 232 male factors, 212 (table 15.1) prognosis, 239 secondary, 212 unexplained, 225, 234 treatment, 225 Infundibulo pelvic ligament, 20 Inhibins, 69 Injury, bladder, 568 ureter, 391 Innervation of genital organs, 30 Insemination intrauterine (ruI), 234 subzonal (SUZT), 234 Insulin-Eke grow~ factor 1 (IGF-1), 84, 423 Irving method, 456 Insufflation cannula, 577 Integrins, 286 • Interception, 453 Interleukin, 286 Intermenstrual bleeding, 176 (table 13.5) • Intersexuality, 403 Internal genital organs, 3 Intertigo, vulva, 150 Intracytoplasmic sperm injection (ICSI), 238 Intrauterine contraceptive devices (lUCD), 439, 462 I•X •