Unlike other areas of medicine where statistics are meticulously kept by governments and global organizations, there are no accurate data to describe the number of the world's inhabitants who are overweight, obese, or morbidly obese. Despite this knowledge deficit, it should come as no surprise to readers that the medical community is facing an epidemic. Obesity is present in many of the developed countries and can also be observed in some urban areas of developing nations. The cause of this epidemic, simply stated, is overeating, but the overriding concern is more complex. Social factors, such as growing affluence since the 1950s, increasing reliance on pre-prepared meals, and the popularity of fast foods and sweetened drinks, have all contributed to the problem. Without doubt, the obesity epidemic has had adverse effects on both men and women, but in the case of women, some of its worse complications occur with those who are severely obese and pregnant. Obviously, this combination has been seen in the past, but it has increased so dramatically in its frequency that research has yet to catch up. Studies may discuss one or another aspect of caring for the obese pregnant patient, but until now, there has been no attempt to draw all such material together to try and present a comprehensive appraisal of the problem. Written by international experts, this practical guide draws on evidence-based material and is an invaluable resource for healthcare professionals dealing with obese pregnant women on a day-to-day basis.

Care of the older patient is characterized by increasing incidence of chronic and acute diseases, with many patients suffering from several conditions simultaneously. The susceptibility to disease increases not only because of physiological factors relating to the aging process, but also due to changes in lifestyle, such as decreased mobility. Issues relating to polypharmacy are exacerbated by concerns about compliance, for example in patients experiencing cognitive decline. Decisions about appropriate medical care are complicated by the fact that many of the normal values that can be relied upon as a guide in younger individuals, do not apply in the older patient. These factors are particularly true for women, who tend to live longer and who undergo more dramatic physiologic changes, such as those associated with the menopause. This book is designed to educate gynecologists about these issues. It draws upon the experience of specialists in a variety of clinical and non-clinical specialties, reviews current knowledge of the problems encountered in caring for the elderly female patient, and suggests guidelines for best practice.

In Memoriam xiii Preface xvii Chapter 1 Development, Mechanisms of Action and Evaluation of IUD Performance 2 Chapter 2 IUD Insertion 28 Chapter 3 Uterine Perforation 54 Chapter 4 Pelvic Inflammatory Disease 92 Chapter 5 Bleeding 138 Chapter 6 Cervical and Uterine Pathology 158 Chapter 7 Intrauterine Pregnancy 172 Chapter 8 Ectopic Pregnancy 194 Chapter 9 Return to Fertility after IUD Discontinuation 222 Chapter 10 IUD Complications in Perspective 232 Appendices 243 Index 253 Foreword Ever since Hippocrates observed that foreign bodies placed in the uterus would help to prevent pregnan cy, periodic interest in this information and its use has resulted in attempts to control unwanted fertil ity. Prior to the 1900s, this interest was somewhat episodic. Because of anxiety about infection, early attempts flourished only briefly and then were no more. In the twentieth century, however, as a result of renewed interest in intrauterine contraception, particularly in the developing countries, a number of individuals throughout the world began experiment ing with a variety of new intrauterine devices. Since then, a great number of these devices have been studied; a few have survived careful scrutiny, and IUDs now represent the second most commonly used form of medical contraception. It is estimated that approximately 15 million devices are in use at the present time, 3 to 4 million of them in the United States."

Lois Keith was thirty-five, with a successful career, two daughters, and a partner of many years, when she was hit by a car and paralyzed from the waist down. Over the next few years, she discovered both a community of disabled people and a paucity of literature and public understanding about their lives. In response, she began soliciting the manuscripts that make up "What Happened to You?", a candid, powerful, and often hilarious collection of fiction, essays, and poetry by women with disabilities. Coming from a wide range of backgrounds and ages, impairments and experiences, the thirty-six women included in the book write on everything from access to abuse, equality to equanimity, in what may well be the definitive volume on living with a disability. At the same time, this anthology tells a universal story about dealing with pain and illness, about overcoming prejudice and unjust legislation, and about the importance, regardless of an individual's fortitude, of creating a community.