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

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.

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.

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.

From a renowned specialist at the Cleveland Clinic and medical and surgical experts in this growing field comes an up-to-date, multidisciplinary resource on transgender health care and surgery. Comprehensive Care of the Transgender Patient, by Dr. Cecile Unger, covers all aspects of transgender health care, beginning with epidemiology and history and progressing to an in-depth review of the complex transition for patients, including mental health services, endocrine and hormone therapy treatment, and surgical options. Incorporates all of the latest guidelines for providers and patients, written by experts from a wide variety of disciplines involved in transgender patient care. Contains outstanding surgical chapters contributed by prominent surgeons who regularly perform these procedures, providing clear guidance on male-to-female and female-to-male surgical options. Features high-quality, full-color illustrations throughout. Covers key topics in every area of transgender health care, including Mental Health Care for the Adult and for the Child and Adolescent Transgender Patient; Hormone Treatment for the Adult and Adolescent Transgender Patient; Facial Surgery for Transgender Patients; Breast and Genital Surgeries for Transgender Patients; and Primary, Preventive, and Gynecologic Care. Expert ConsultT eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, Q&As, and references from the book on a variety of devices.

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 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.

This book provides those studying for the MRCOG Part 2 examination with welcome practice in answering Extended Matching Questions (EMQs). Updated throughout to map onto the MRCOG syllabus from September 2016, the book is designed to test the candidate's theoretical and practical knowledge of obstetrics and gynaecology. An introductory section on exam techniques is followed by a collection of 41 EMQ themes, split into obsterics and gynaecology. The questions are based on common clinical scenarios and cover a variety of topics. Answers are included after each topic, and these include explanatory material and useful references.

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 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ."

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."

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.

Doppler ultrasound is a hot topic at the present time. This is because studies of the uteroplacental and fetal circulation give fundamental information as to the physiology or pathology of placental function and the response of the fetal circulation to hypoxaemia. Dr. Arabin's clinical studies which are described in this book are an important contribution to knowledge in this field and will be of enormous interest not only to researches but also to clini cians interested in learning how this latest technology can be integrated into their clinical practice. London STUART CAMPBELL Foreword Although only three decades old, the field of perinatal medicine is marked by continuous new advances. Ultrasound diagnostic techniques comprise an important element of this new field. Dr. Arabin has taken the initiative to investigate the functional-diagnostic aspects of ultrasound. Among other things, she has further developed and refined the concept of "oxygen-con serving adaptation of fetal circulation" which originated in the Department of Obstetrics and Gynecology at the Neukolln Hospital Center in 1966. She thus has been able to show that the most reliable Doppler blood flow meas urement predictors of a high risk to the fetus are (1) a decrease in the flow volume of the descending thoracic aorta and the umbilical artery and (2) an increase in the flow volume of the common carotid arteries."

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."

This book explores theologically the practice of hospital chaplains seeking to meet the spiritual needs of parents bereaved by baby death in-utero. The lived experience of bereaved parents, gathered through a series of in-depth interviews, informs such an exploration. Parents describe the trauma of late miscarriage and stillbirth as still being shrouded by silence, myth and misunderstanding in contemporary society. Up-to-date theoretical understandings of grief are also re-examined in light of parents' stories of living with baby death. This book offers suggestions as to how the actual spiritual needs of parents may be met and their grief sensitively facilitated through the sharing of rituals co-constructed by parents and chaplain which seek to have theological integrity yet be relevant in our postomodern age. In our prevalent culture of caring, where increasingly ongoing professional and personal development are regarded as normative, recommendations are made which may aid reflection on current, or shape future, practice for chaplains, pastors, students and various healthcare professionals.