Fully revised for this fourth edition, the Oxford Handbook of Obstetrics and Gynaecology fully reflects new developments in the field. Featuring new sections on the outcomes of the MBRRACE report, abnormally adherent and invasive placenta, pregnancies in mothers of advanced age, assisted reproduction, and ovarian cancer screening, it provides a contemporary overview of this complex and important specialty. Written and reviewed by a team of highly experienced clinicians, academics, and trainees, this Handbook is a perfect starting point for preparation for postgraduate exams. Practical advice is presented with key evidence-based guidelines, supported by visual algorithms and top clinical tips. The previous edition was Highly Commended in the Obstetrics and Gynaecology category of the BMA Book Awards. The indispensable, concise, and practical guide to all aspects of obstetric and gynaecological medical care, diagnosis, and management, this fourth edition continues to be the must-have resource for all specialist trainees, junior doctors, and students, as well as a valuable aide memoire for experienced clinicians.

This concise 1993 volume proposes a standardized approach to the investigation of infertility. The volume provides clear guidelines and a logical sequence of steps which will quickly lead the clinician or physician to an accurate diagnosis of the underlying cause of infertility. This standardized approach to the management of infertility will lead to more efficient, systematic and economic care for the infertile couple. The diagnostic charts, which may be photocopied, provide an unambiguous route to diagnosis of the underlying cause of infertility, whilst the text fully explains and describes the essential clinical tests. The volume summarizes the results gained from the study of more than 10,000 infertile couples, who were investigated as part of the WHO's programme to counter the widespread personal distress caused by infertility. It is hoped that the standardized approach presented here will go some way towards countering this major problem.

One of modern healthcare's most controversial areas, reproductive medicine is an emerging discipline that fosters hugely divergent opinions on topics such as laboratory techniques, clinical management and ethical considerations. Highlighting over 50 contentious topics in reproductive medicine, this book presents expertly argued opinions are presented for and against, often with diametrically opposing views about management. Debates such as these are being increasingly used as learning tools, helping participants develop their critical thinking skills and showing that context is vital when making decisions. Issues discussed include limits on IVF provision, ethical queries about sex selection, embryology, and ovarian stimulation. Authors are authorities in their field, combining years of experience with fresh and innovative ideas to structure their arguments. Readers will gain an insight into topical controversies, critically evaluating the different sides to enhance their own clinical practice.

Male infertility is a clinician-orientied book aimed at the clinician dealing with the infertile couple because rational, effective management is only possible if the couple are considered together. The aim of the work is to provide advice to the clinician and to give reference to the underlying science. This will not only enable clinicians to understand the underlying science but will also give scientists an insight to clinical work. This blend of science and clinical work is reflected in the contributors who are experts drawn from both fields.

Many health problems are unique to, more common in, or more severe in women than men. This book examines the underpinnings of these gender differences. Sections deal with biological (hormonal, anatomic, immunologic, and pregnancy-related), social, behavioural/psychological, and lifestyle influences. Chapters are heavily referenced, packed full with data, and they provide methodological insights that will guide future women's health research.

Despite France and Belgium sharing and interacting constantly with similar culinary tastes, music and pop culture, access to Assisted Reproductive Technologies are strikingly different. Discrimination written into French law acutely contrasts with non-discriminatory access to ART in Belgium. The contributors of this volume are social scientists from France, Belgium, England and the United States, representing different disciplines: law, political science, philosophy, sociology and anthropology. Each author has attempted, through the prism of their specialties, to demonstrate and analyse how and why this striking difference in access to ART exists.

Fibrin sealant is used for numerous indications in gynecology, especially for the McIndoe Operation and Cohn biopsy, the Marshall-Marchetti-Krantz-Hirsch-Stoll-Operation, urethrocysopexy, or in vitro fertilization for embryo transfer. The use of fibrin sealant in urology has also been extended, especially in operations of the spermatic cord, reconstruction of the urethra and closing of nephrotomies.

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.

This open access edited book brings together new research on the mechanisms by which maternal and reproductive health policies are formed and implemented in diverse locales around the world, from global policy spaces to sites of practice. The authors - both internationally respected anthropologists and new voices - demonstrate the value of ethnography and the utility of reproduction as a lens through which to generate rich insights into professionals' and lay people's intimate encounters with policy. Authors look closely at core policy debates in the history of global maternal health across six different continents, including: Women's use of misoprostol for abortion in Burkina Faso The place of traditional birth attendants in global maternal health Donor-driven maternal health programs in Tanzania Efforts to integrate qualitative evidence in WHO maternal and child health policy-making Anthropologies of Global Maternal and Reproductive Health will engage readers interested in critical conversations about global health policy today. The broad range of foci makes it a valuable resource for teaching in medical anthropology, anthropology of reproduction, and interdisciplinary global health programs. The book will also find readership amongst critical public health scholars, health policy and systems researchers, and global public health practitioners.

"A remarkable collection of scholarly essays, philosophical discussions, and ethical arguments concerning reproductive choices."
--"Choice"

It seems as if every week there is a new case involving reproductive technologies that raises provocative, often painful questions: What policies should be followed by centers that preserve human embryos? Are such innovations as Norplant improvements over established methods of contraception? Should R.U. 486 be available in the U.S.? Is prenatal diagnosis an ethically acceptable step to limiting the number of disabled people?

These are just some of the vital questions explored in this timely work which offers incisive analysis of the plethora of issues raised by advances in reproductive medicine. The book's major section cover abortion, contraception, cryopreservation of gametes and embryos, surrogate motherhood, and psychosocial issues of in-vitro fertilization.

In each section, introductory essays by recognized authorities such as Elizabeth Bartholet and Andrea L. Bonnicksen are followed by critical articles by professionals in such fields as women's health, medicine, biology, sociology, politics, and philosophy. In assessing a technology, the authors present well-argued analyses of problems created by that technology, including views from advocates and practitioners that raise attendant ethical and practical issues.

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.

1. 1 Historical Perspective In the nineteenth century, knowledge of the events leading to ovulation, fertilization, and implantation was very limited, so much so that Seiler (1832), in his book The Uterus and the Human Egg, wrote: ." . . in the left ovary the first signs of fertilization, namely a Graaf vesicle could be seen. The right ovary shows proof of a second successful copulation: a fresh scar from the ovulated egg and the beginning of a corpus luteum. " In fact all nineteenth century authors strictly divide the female cycle into two phases: the menstrual period and the intermenstruum (ct. Hitschmann and Adler 1908). The generally accepted histology of the endometrium in those days was that of the late proliferative phase. Deviations from this were considered to be pathological (Von Ebner 1902). As Gebhard (1899) expressly put it: "As a rule, it can be said that in the mature woman the endometrial glands run straight; an irregular course of the glands is to be regarded as pathological. " The same author describes the changes occurring during the secretory phase of the cycle as "endometritis glandularis" which he believed to arise from a local nutritional disturbance. The uterine stroma was believed to be lymphoid (Toldt 1877), and the uterine glands were compared to the crypts of Lieberkiihn (Von Ebner 1902).

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.

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."

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."

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 Project on Reproductive Laws for the 1990s began in 1985 with the realization that reports of scientific developments and new technologies were stimulating debates and discussions among bioethicists and policymakers, and that women had little part in those discussions either as participants or as a group with interests to be considered. With the help of a planning grant from the Rutgers University Institute for Research on Women, the Women's Rights Litigation Clinic at Rutgers University Law School-Newark held a planning meeting that June attended by approximately 20 theorists and activists in the area of reproductive rights. Project purposes, methods, and general shape took form at the meeting. Two goals have characterized the Project's work since then: first, to generate discussion, debate, and, where possible, consensus among those committed to reproductive autonomy and gender equality as to how best to respond to the questions raised by re ported advances in reproductive and neonatal technology and new modes of reproduction; and second, to ensure that those shaping reproductive law and policy appreciate the ramifications of these developments for gender equality. In meeting this twofold agenda, the Project focused on six areas: time limits on abortion; prenatal screening; fetus as patient; reproductive hazards in the workplace; interference with reproductive choice; and alternative modes of reproduction. The Project identified individuals to take respon sibility for drafting model legislation and position papers in the six areas (for the drafters, see the Appendix)."

Although impotence may be the most widely recognized manifestation of male sexual dysfunction, many other forms of sexual disorders do not involve the erectile mechanism, from deficiencies of desire to disturbances in ejaculatory function to the failure of detumescence. With such a myriad-and often co-existing-number of disorders, the successful treatment of male sexual dysfunction requires not only a thorough understanding of the underlying physiology and pathophysiology, but also the coordinated efforts of multiple specialties, including endocrinology, andrology, urology, radiology, sex therapy, and even sometimes psychiatry, cardiology, or oncology. Male Sexual Dysfunction: Pathophysiology and Treatment presents the collective expertise of more than 60 international authorities in a single landmark text. From foundations in the anatomy of the male genital tract to the latest neuroimaging data, readers will appreciate the comprehensive information detailing the tremendous advances made in the delineation of sexual function and its disorders as well as the expert descriptions of practical and cost-effective medical, surgical, and psychological strategies for the treatment of all forms of male sexual dysfunction.

A cutting-edge analysis of the global issues surrounding modern reproductive technologies Advances in assisted reproductive technologies have sparked global policy debates since the birth of the first so-called "test tube baby" in 1978. Today, mitochondrial replacement therapies represent the most recent advancement in assisted reproductive technologies, allowing some women with mitochondrial diseases to birth babies without those diseases. In the past decade, mitochondrial replacement therapies have captured public sentiment, reigniting debates around social views of reproductive rights and the appropriate legal and political response. Reproduction Reborn guides readers through the history and science of mitochondrial replacement therapies and the various attempts to control them. Leading experts from medicine, genetics, ethics, law, and policy explore the influence of public debate on the evolving shape of these technologies and their subsequent regulation. They highlight case studies from both developed and developing countries across the globe, including recent legislation in Australia and China. They further identify the ethical, legal, and societal norms that need to be addressed by policymakers and communities as more and more people seek to gain access to these treatments. Given the importance of reproduction in family life and cultural identity, clinicians and policymakers must understand how regulatory regimes around mitochondrial replacement therapies have evolved to illuminate the processes and challenges of governing reproduction in a fast-moving world. Informative and global in scope, Reproduction Reborn explores how advancements in assisted reproductive technologies challenge core values surrounding the rights and responsibilities of modern-day family units.

Everyone involved in obstetric practice at the present time will be well aware oft he complexities of drug interactions in the mother and fetus, and newborn infant. Perhaps the most spectacular manifestations of these drug interactions are those that result in teratogenic effects, but the implications of drug therapy generally in pregnancy range far wider than the hazards of inducing fetal malformation. It must also be realised that there are hazards in withholding some therapeutic agents from pregnant women, and these hazards have to be weighed against the dangers of indiscriminate drug therapy. It is often very difficult to obtain relevant information about any given compound in relation to its use in pregnancy, and it is therefore appropriate to provide a handbook which brings together information about a wide variety of drugs in a form which allows ready access for the practising clinician. Rodney Ledward first discussed this project with me some years ago, and it seemed to me at the time that with his background as both a pharmaceutical chemist and an obstetrician that his talents were particularly well suited to this task. In conjunction with Professor Hawkins, he has produced a concise reference book for use in clinical practice, which I feel confident will prove to be invaluable to all those practising obstetrics at all levels of seniority. The book covers the use of drugs during pregnancy, but it also includes sections on the transfer of drugs into breast milk.

Human Assisted Reproductive Technology: Future Trends in Laboratory and Clinical Practice offers a collection of concise, practical review articles on cutting-edge topics within reproductive medicine. Each article presents a balanced view of clinically relevant information and looks ahead to how practice will change over the next five years. The clinical section discusses advances in reproductive surgery and current use of robotic surgery for tubal reversal and removal of fibroids. It looks into the refinement of surgical procedures for fertility preservation purposes. Chapters also discuss non-invasive diagnosis of endometriosis with proteomics technology, new concepts in ovarian stimulation and in the management of polycystic ovary syndrome, and evidence-based ART. The embryology section discusses issues ranging from three-dimensional in-vitro ovarian follicle culture, and morphometric and proteomics analysis of embryos, to oocyte and embryo cyropreservation. This forward-looking volume of review articles is key reading for reproductive medicine physicians, gynecologists, reproductive endocrinologists, urologists and andrologists.

Women most fully experience the consequences of human reproductive technologies. Men who convene to evaluate such technologies discuss Itthem ": the women who must accept, avoid, or even resist these technologies; the women who consume technologies they did not devise; the women who are the objects of policies made by of women is neither sought nor listened to. The men. So often the input and perspectives that women bring to the privileged insights consideration of technologies in human reproduction are the subject of these volumes, which constitute the revised and edited record of a Workshop on "Ethical Issues in Human Reproduction Technology: Analysis by W omen" (EIR TAW), held in June, 1979, at Hampshire College in Amherst, Massachusetts. Some 80 members of the workshop, 90 percent of them women (from 24 states), represented diverse occupations and personal histories, different races and classes, varied political commitments. They included doctors, nurses, and scientists, lay midwives, consumer advocates, historians, and sociologists, lawyers, policy analysts, and ethicists. Each session, however, made plain that ethics is an everyday concern for women in general, as well as an academic profession for some.

Women most fully experience the consequences of human reproductive technologies. Men who convene to evaluate such technologies discuss "them": the women who must accept, avoid, or even resist these technologies; the women who consume technologies they did not devise; the women who are the objects of policies made by men. So often the input of women is neither sought nor listened to. The privileged insights and perspectives that women bring to the consideration of technologies in human reproduction are the subject of these volumes, which constitute the revised and edited record of a Workshop on "Ethical Issues in Human Reproduction Technology: Analysis by Women" (EIRTAW), held in June, 1979, at Hampshire College in Amherst, Massachusetts. Some 80 members of the workshop, 90 percent of them women (from 24 states), represented diverse occupations and personal histories, different races and classes, varied political commitments. They included doctors, nurses, and scientists, lay midwives, consumer advocates, historians, and sociologists, lawyers, policy analysts, and ethicists. Each session, however, made plain that ethics is an everyday concern for women in general, as well as an academic profession for some.