On the occasion of the symposium on Hypertension in Postmenopausal Women (Monte Carlo, January 19-22, 1994), international scientists and clinicians discussed the various aspects of high blood pressure in older women. This volume presents an overview of this important aspect of both cardiology and gynecology. Special emphasis is given to the different approaches to antihypertension treatment.

With mesh surgery for prolapse sometimes proving problematic, there has been a resurgence of professional medical interest in more traditional methods for the management of prolapse and of stress urinary incontinence. This concise guide to the practical aspects of pessary use will be of interest to all gynecologists involved in the clinical management of the patient with these problems. Contents: Historical review * Pessaries for pelvic organ prolapse * Incontinence pessaries * Pessary fitting * Pessary care * Outcomes of pessary use * Current clinical studies on vaginal pessaries Cover image of vaginal pessaries (c) 2019 Rick Hicaro, Jr., Chicago, IL 60647, USA

In Manufacturing Babies and Public Consent, Jose Van Dyck sketches a map of the public debate on new reproductive technologies as it has evolved in the USA and Britain since 1978. Many people have participated in heated discussions on test-tube babies and in vitro fertilization, particularly medical researchers and feminists. The new technologies have been both embraced as the cure to infertility and condemned as the exploitation of women's bodies. Reconstructing this debate, Van Dyck juxtaposes a variety of textual material, from scientific articles to newspaper articles and works of fiction.

Here, the author clearly guides you through the necessary steps to controlling your gestational diabetes and reducing the risks for both you and your child.

Since the first edition went to press in 1989, there have been many important developments concerning different aspects of maternity care. To take account of these, much needs to be added to this history. Late 1989 saw the publication of the double volume set of studies, Effective Care in Pregnancy and Childbirth, in which all the then existing evidence on all the associated procedures was considered and evaluated by well-informed and impartial authors representing many countries. This informative collection has since been followed by a flow of single reports of new research findings about specific subjects within the field. To incorporate the new material has involved, in particular, a consider able enlargement and rearrangement of the text and reference lists for Chapters 3 and 4, which deal with antenatal and intranatal care. Then in 1990-1 the House of Commons Health Committee, under its chairman Nicholas Winterton, undertook a further enquiry into the maternity services in Britain. A wide range of people concerned as pro viders or users of the service, as well as researchers concerned to find out how well the service was meeting needs, chose to submit testi monies, written and oral. These testimonies were all later published in six volumes which offered a most valuable depiction of the maternity service from many points of view."

Offering an authoritative collection of chapters from clinicians and researchers in the United States, Canada, and Europe, this reference comprehensively covers the latest understanding in the etiology, pathophysiology, diagnosis, and treatment of sexual dysfunction.

The examination for Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) remains one of the most internationally recognised postgraduate examinations in the specialty. Over the years, the examination has evolved in keeping with changes in medical education; the Part 2 examination now consists of two papers made up of Single Best Answer (SBA) questions and Extended Matching Questions (EMQ). This invaluable resource consists of 400 SBA questions (200 in Obstetrics and 200 in Gynaecology), followed by 400 EMQs (200 in Obstetrics and 200 in Gynaecology), grouped into papers, to provide enough material to guide preparations and to give some practice experience of the examination formats. All the questions have answers with explanations and sources of evidence. In preparing for the examination, candidates should make repeated references to these sources of evidence. There is also general advice on how to prepare for the examination and discussion of the reasons why trainees fail the examination.

The task of updating the classification was given to the Classification and Nomenclature Committee of the International Society of Gynecological Pathologists and its four subcommittees. This classification reflects the present state of knowledge and modifications are almost certain to be needed as experience accumulates. Since many of the tumours and tumour-like conditions in the classification occur in several sites in the female genital tract, cross-referencing from one site to another has been done in illustrating these lesions.

The main focus of this new edition remains the practical assessment and management of people presenting with psychiatric symptoms in late life. The core of the book describes the common presentations of depression, confusion, somatic preoccupation, hallucinations and delusions. Case vignettes are used to illustrate the approach to clinical problems. There is special emphasis on the complex interaction of social, psychological and medical factors and the need for close multi-disciplinary teamwork. The new edition has been revised to: update the clinical approach, update patient management under new policies, provide a precise diagnostic system and structure the book in keeping with today's practice.;This book should be of interest to postgraduate students in psychiatry or geriatrics; medical students; clinical psychologists; and nurses and other health professionals.

Epigenetics is the study of how certain genes are activated without modification at the DNA sequence level, resulting in genetically similar individuals having different clinical outcomes. As contemporary medicine increasingly aims to personalize the medical approach to a patient's genetic profile, the factors that can affect which genes are expressed also increase in importance and relevance to the clinician. This text from experts will give the clinician in Reproductive Medicine a reliable grounding in current thinking and research on this fast-moving topic, with many clinical implications.

Management Options in Breast Cancer is the only comprehensive resource devoted to exploring the systematic approach to breast cancer diagnosis, surgery, and postoperative care. This guide is an ideal tool for oncologists, pathologists, radiologists, and gynecologists seeking alternative management options for breast cancer. In addition, trainees will find this text a valuable reference for learning the basic principles and clinical guidelines of the field. Key features in this stand-alone text: an international review of the management options in the field of breast cancer clinical practice case-based examples designed to aid in optimal clinician decision-making two chapters devoted to rarely-explored topics: male breast cancer and geriatric breast cancer

This work attempts to sketch a coherent picture of the amniotic fluid com partment, its borders, and the interactions occurring between fetus and amniotic fluid, for it is this compartment which for 10 months provides the habitat in which the fetus and its functions develop. As a matter of course, our mor phological studies had to be limited to the situation prevailing at the full term of pregnancy. This portrayal purposely neglects the placenta, which is already the subject of an extraordinary profusion of literature. The other aspects of the embryonic sac have been overshadowed to date by the preeminent role 2 of the placenta, although they represent around 1200cm of contact surface in the maternal compartment. From our point of view, the fetal membranes not only act as a seal or simply a diffusion barrier, but actively participate in the exchange processes between compartments. The author also took pains to compile (albeit incompletely) the widely scattered findings reported in clinical journals in order to present them as a well-rounded summary of the mor phological picture and the functional happenings involved in fetal develop ment. The author's own studies of a specifically histomorphological nature provided the groundwork for this synopsis. A special branch of embryology, embryonal physiology, is treated only incidentally in today's embryology textbooks. This work offers several encounters with this field, which should help make it the focus of greater interest. 2 Definition of Terms Fig. 1.

This book was prepared to present an integrated review of selected topics in Human Embryology. It is designed specifically for students who completed stan dard courses in the various anatomical disciplines and who wish to review the developmental history of the major organ systems. This book will provide medical students with a highly suitable review for Step 1 of the United States Medical Licensing Exam (USMLE, Step 1). R. E. Coalson J. J. Tomasek Acknowledgments We wish to acknowledge the invaluable assistance provided by our colleagues at the University of Oklahoma Health Sciences Center during preparation of this review. In particular, we would like to thank Ms. Nancy Halliday for proofread ing, Mr. Shawn Schlinke for preparation of the illustrations, Mr. Melville Vaughan for assistance with mounting the illustrations, and Ms. Trenda Tanner for assis tance with the typing. Contents Preface to the Oklahoma Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii 1. Gametogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. Female Reproductive Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 3. Fertilization and Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 4. Implantation and Formation of the Deciduae . . . . . . . . . . . . . . . . . . . . 15 5. Formation of the Placenta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 6. Fetal Membranes and Umbilical Cord . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 7. Early Development of the Conceptus 26 8. Development of General Body Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 9. Nervous System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 10. Musculoskeletal System . . . . . . . . . . .: . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 11. Integumentary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 12. Oral Cavity and Development of the Branchial Apparatus . . . . . . . . 62 13. Differentiation of the Branchial Apparatus . . . . . . . . . . . . . . . . . . . . . . . 66 14. Face and Palate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 15. Digestive System and Mesenteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 16. Diaphragm and Body Cavities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 17. Respiratory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ."

Biochemical monitoring of the fetus has been in the back of every perinatologist's mind. Technological advancements have been made in the last ten years but not to the expected level. A continued interest in the subject can only be maintained by symposiums of this nature where perinatologists from different countries can share their experience. Laserspectroscopy of the fetus is a valuable addition to this volume. The future of biochemical monitoring of the intrapartum fetus depends on the continued collection of scientific data and further technological advances. This successful symposium was held in October, 1990, in Albuquerque, New Mexico, USA. I would like to thank Hewlett Packard for their generous support without which this publication would not have been possible. My sincere thanks goes to my secretary, Nancy Whalen, who has done a tremendous job with the word processing, organization, and layout of the chapters. Molly S. Chatterjee, M. D. Associate Professor University of New Mexico Department of Obstetrics & Gynecology CLINICAL IMPORTANCE OF BIOCHEMICAL MONITORING OF THE FETUS DURING LABOR WITH DEMONSTRATION OF TYPICAL CASES E. SALING, J. BARTNICKI Institute of Perinatal Medicine, Free University of Berlin, Berlin, Germany The biochemical monitoring of the fetus during labor is historically the oldest part of prenatal medicine. The very first direct approach to the human fetus took place on June 21, 1960 when the first blood samples were taken from the fetal scalp in our labor room (3).

This text draws together the principal issues related to the identification of language difficulties in pre-school children. Factors closely associated with the development of language such as cognitive skills, play, behaviour and hearing are discussed. The basic principles underlying early identification, the role of the parent and the issue of early identification within the context of public health are also included.;To reflect the range of related professionals involved with language impaired children, there are chapters written by a health visitor, a psychiatric social worker and speech and language therapists specializing in hearing loss. This book should be a useful reference for all those professionals working with children in the health and education setting.;This book should be of interest to practising and student speech therapists, nurses, health visitors, paediatric nurses, nursery leaders, play group leaders, clinical medical officers, educational and clinical psychologists.

In the USA, severe psychiatric illness after childbirth strikes one woman for every 1000 births, or about 3500 women each year. An unrecorded number of new mothers experience lesser degrees of postpartum illness, and two distinct forms of severe illness can be distinguished. One form, called postpartum psychosis, is an agitated, very changeable condition, often characterized by confusion, hallucinations, delusions and sometimes episodes of violent behaviour. The other condition, major postpartum depression, begins two or three weeks after childbirth, and is characterized by confusion, depression of mood, and often with exhaustion, headache and digestive upset. Mixtures of the two severe disorders occur frequently. This volume contains a number of essays which support the position that postpartum disorders are primarily organic and are mainly disorders of hormonal deficit. They develop as the endocrine system falls back from the hyperactivity of pregnancy toward or beyond the levels of the prior non-pregnant state. Tremendous therapeutic opportunities exist or are imminent for both the organic and the psychological components of postpartum mental illness.

Gynecologists cannot fulfill the commitments of their profession without being psychosomatically oriented. Nevertheless, this field needs methodology and scientific thinking just as does any other subspeciality in clinical medicine. Although practiced by all gyne cologists, creative work is needed in order to develop the various aspects properly and to establish postgraduate training on a firm and sound basis. For this purpuse the European Symposia have been planned by several European Researchers on Psychosomatic Obstetrics and Gynecology in order to stimulate and integrate clinical scientific data and therapeutic skills in the bio-psycho-social field of obstetrics and gynecology. The first European Symposium in Leuven 1985 concentrated on the psychosomatic aspects of infertility and high risk pregnancies. This second European Symposium in Bad Sackingen centered around disturbed body perception, disturbances of the menstrual cycle, climacteric syndrome, and senium. These topics were elaborated in main lectures and workshops held by outstanding researchers in this rapidly expanding field. The second European Symposium on Psychosomatic Obstetrics and Gynecology was organized by the German Society of Psycho somatic Obstetrics and Gynecology, supported by the University Hospital Freiburg/Br., the University Hospital Basel, and the Women's District Hospital in Bad Sackingen."

It is vital that healthcare practitioners understand the psychological impact of childbirth when caring for women. This accessible guide is designed to improve the care that women receive and, as a result, public health outcomes related to maternal and infant wellbeing. This book outlines how clinicians can offer practical support to women after birth. It: discusses what we know about how women adapt to motherhood and develop a post-childbirth identity; outlines some of the causes and manifestations of post-traumatic stress following childbirth; provides practical guidance for setting up postnatal pathways for women traumatised by birth and how to communicate effectively; equips practitioners with the knowledge and skills to support pregnant women with a fear of birth; incorporates narratives from women to demonstrate how their births and related events were perceived and processed, before discussing how women's views can be used to inform future practice; highlights the importance of restorative supervision for healthcare professionals working in this area to promote staff resilience and sustainability. Drawing together theoretical knowledge, evidence, practical skills and women's narratives to help clinicians understand the psychology of childbirth and support women, it is of significant value to all healthcare practitioners engaged in maternity services.

Gynecology is principally an operative specialty and the range of gynecologic procedures managed is constantly expanding due to improved instrumentation and minimally invasive techniques. Covering the entire spectrum of gynecologic surgery through a case-based, digestible format, procedures such as vaginal, transvaginal, hysteroscopic, laparoscopic, robotic, and abdominal procedures are included, as well as common surgical challenges and complications. For each case, a clinical vignette outlines the situation and the clinical context of the patient, followed by a comprehensive discussion of the evidence-based management approach and key teaching points. The decision to operate, contraindications, alternatives to surgery and preoperative counseling is discussed in detail along with the level of care needed for each case. Readers will improve their knowledge base of gynecologic surgery and gain multiple tools to overcome common surgical obstacles.

Part of a new series on reproductive medicine, this book is a complete guide to the diagnosis and management of infertility. Beginning with an overview of infertility in both women and men, the next chapters discuss assessment and ultrasound. The following chapters cover numerous causes of infertility, and their diagnosis and treatment, examining both medical and lifestyle issues. The book presents the latest advances in the field and each chapter includes key points and references for further reading. Clinical photographs, diagrams and tables further enhance the comprehensive text. Other titles in the series include: Practical Guide in Reproductive Surgery, Practical Guide in Assisted Reproductive Technology and Practical Guide in Andrology and Embryology. Key points Comprehensive guide to diagnosis and management of infertility Part of new series on reproductive medicine Covers numerous causes of infertility, and their diagnosis and treatment Chapters include key points and detailed references for further reading

Endorphins and other endogenous opioids appear to be the connecting link between reproductive functions and stress adaption of the human organism. This book contains the con- tributions of an international group of biologists, bioche- mists, and endocrinologists on the opioidergic control me- chanisms in reproduction and stress physiology. Main topics covered are: endogeneous opioids and the pituitary-gonadal system; ovarian endorphinsecretion; pregnancy-associated changes of plasma endorphin; and opioid control of the hypo- thalamo-pituitary-adrenal axis. Although all chapters give an excellent review on various studies in basic opioid re- search, there are numerous clinical implications mentioned in this book.

The number of diabetics in the elderly population is increasing rapidly, not merely because of the increasing size of the elderly population itself. In elderly people diabetes is often poorly diagnosed and occurs as a consequence of, or in addition to, some other condition. Although diabetes may manifest itself less dramatically in the elderly there is evidence to suggest that diabetes-related complications do arise more rapidly in this group. It is therefore extremely important that doctors and health professionals can spot the symptoms of diabetes at an early stage. This book provides a concise description of diabetes in the elderly as well as discussing related complications and should be useful to all health workers dealing with elderly people.;This book should be of interest to all health professionals working with elderly people.

During the past 20 years, endometrial carcinoma has continued to increase in frequency and it is quite possible that this carcinoma will become the major gynecologic malignancy in the future. For many years, endometrial carcinoma was considered less malignant than other gynecologic malignancies, simple hysterectomy and bil ateral salpingo-oophorectomy or surgery combined with radiation being effective in certain circumstances. It is unfortunate to note that the global 5-year survival rate for patients with advanced or recurrent endometrial carcinoma has improved only slightly. Therefore any complacency regarding this 'benign malignancy' should be reconsidered. There is a growing awareness of the nature of end ometrial carcinoma, with advances in our knowledge ranging from its etiology through its epidemiology to its clinical findings. This volume has been designed to fill a hiatus in the literature in China. To achieve this aim, we have attempted to review the world-wide advances on endometrial carcinoma and summarize systematically and comprehensively this common gynecologic malig nancy, including the clinical experiences gathered at the Cancer Institute (Hospital) of the Chinese Academy of Medical Sciences since 1958 as well as a brief description of the psychological problems in patients with gyneco logic cancers."