Fluent Essays

Topic: Puberty and Disorders of Pubertal Development (25-30 slides). Powerpoint Presentation.  The Topic is on Chapter 32 of the attached pdf https://t.me/MedicalBooksStore HP Stamp Hacker & Moore’s E S S E N T I A L S O F OBSTETRICS & GYNECOLOGY https://t.me/MedicalBooksStore Hacker & Moore’s E S S E N T I A L S O F OBSTETRICS & GYNECOLOGY Sixth Edition Neville F. Hacker, MD Professor of Gynaecologic Oncology Conjoint, University of New South Wales Director, Gynaecological Cancer Centre Royal Hospital for Women Sydney, Australia Joseph C. Gambone, DO, MPH, Executive Editor Professor Emeritus of Obstetrics and Gynecology David Geffen School of Medicine at UCLA Attending Physician, Ronald Reagan UCLA Medical Center Clinical Professor of Obstetrics and Gynecology Western University of Health Sciences College of Osteopathic Medicine of the Pacific Private Infertility and Reproductive Endocrinology Practice, Durango, Colorado Calvin J. Hobel, MD Miriam Jacobs Chair in Maternal-Fetal Medicine Cedars-Sinai Medical Center Professor of Obstetrics and Gynecology Professor of Pediatrics David Geffen School of Medicine at UCLA Los Angeles, California 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 HACKER & MOORE’S ESSENTIALS OF OBSTETRICS & GYNECOLOGY, SIXTH EDITION ISBN: 978-1-4557-7558-3 INTERNATIONAL EDITION ISBN: 978-0-323-34053-3 Copyright © 2016 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2010, 2004, 1998, 1992, and 1986. Library of Congress Cataloging-in-Publication Data Hacker & Moore’s essentials of obstetrics & gynecology / [edited by] Neville F. Hacker, Joseph C. Gambone, Calvin J. Hobel.—6th edition. p. ; cm. Hacker and Moore’s essentials of obstetrics and gynecology Essentials of obstetrics and gynecology Preceded by Hacker and Moore’s essentials of obstetrics and gynecology / [edited by] Neville F. Hacker, Joseph C. Gambone, Calvin J. Hobel. Includes bibliographical references and index. ISBN 978-1-4557-7558-3 (pbk. : alk. paper)–ISBN 978-0-323-34053-3 (international edition) I. Hacker, Neville F., editor. II. Gambone, Joseph C., editor. III. Hobel, Calvin J., editor. IV. Title: Hacker and Moore’s essentials of obstetrics and gynecology. V. Title: Essentials of obstetrics and gynecology. [DNLM: 1. Obstetrics–methods. 2. Genital Diseases, Female. 3. Pregnancy Complications. WQ 100] RG101 618—dc23 2015035364 Acquisitions Editor: James Merritt Developmental Editor: Julia Rose Roberts Publishing Services Manager: Catherine Jackson Project Manager: Rhoda Howell Design Manager: Renee Duenow Illustrations Manager: Nichole Beard Marketing Manager: Melissa Darling Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 http://www.elsevier.com/permissions This edition is dedicated to our wives, Estelle Hacker, Marge (Morris) Gambone, and Marsha Lynn Hobel. Their understanding and support for the time and effort required to complete this project was essential. https://t.me/MedicalBooksStore vii Contributors Carolyn J. Alexander, MD Southern California Reproductive Center Beverly Hills, California; Clinical Associate Professor David Geffen School of Medicine at UCLA University of California, Los Angeles Los Angeles, California Jonathan S. Berek, MD, MMS Laurie Kraus Lacob Professor Chair, Department of Obstetrics and Gynecology Stanford University School of Medicine Director, Stanford Women’s Cancer Center Director, Stanford Health Care Communication Program Stanford, California Lony C. Castro, MD, FACOG Specialist, Maternal-Fetal Medicine Professor and Chair, Department of Obstetrics and Gynecology COMP/Western University of Health Sciences Pomona, California Sara Churchill, MD Resident Physician Department of Obstetrics and Gynecology Cedars Sinai Medical Center Los Angeles, California Daniel A. Dumesic, MD Professor, Department of Obstetrics and Gynecology Division Chief, Reproductive Endocrinology and Infertility David Geffen School of Medicine at UCLA University of California, Los Angeles Los Angeles, California Michael L. Friedlander, PhD, FRACP Conjoint Professor of Medicine Prince of Wales Clinical School University of New South Wales Sydney, Australia Brian J. Koos, MD, DPhil Professor, Department of Obstetrics and Gynecology David Geffen School of Medicine at UCLA University of California, Los Angeles Los Angeles, California Amy R. Lamb, PhD, CNM Nurse-Midwife and Researcher Obstetrics and Gynecology Cedars-Sinai Medical Center Los Angeles, California Anita L. Nelson, MD Professor, Department of Obstetrics and Gynecology David Geffen School of Medicine at UCLA University of California, Los Angeles Los Angeles, California; Medical Director, Research Division California Family Health Council Los Angeles, California William H. Parker, MD Health Sciences Clinical Professor Department of Obstetrics and Gynecology UCLA School of Medicine Santa Monica, California Andrea J. Rapkin, MD Professor of Obstetrics and Gynecology David Geffen School of Medicine at UCLA University of California, Los Angeles Los Angeles, California Bassam H. Rimawi, MD, FACOG Department of Gynecology and Obstetrics Division of Reproductive Infectious Diseases and Maternal Fetal Medicine Emory University School of Medicine Atlanta, Georgia viiiviii C O N T R I B U T O R S Ingrid A. Rodi, MD Health Sciences Clinical Professor Director, Fertility Services UCLA Medical Center Santa Monica, California Amy E. Rosenman, MD, FACOG, FPMRS Health Sciences Clinical Professor of Obstetrics and Gynecology David Geffen School of Medicine at UCLA University of California, Los Angeles Los Angeles, California David E. Soper, MD J. Marion Sims Professor Department of Obstetrics and Gynecology Medical University of South Carolina Charleston, South Carolina John Williams III, MD Clinical Professor Department of Obstetrics and Gynecology David Geffen School of Medicine at UCLA University of California, Los Angeles Director of Reproductive Genetics Department of Obstetrics and Gynecology Cedars-Sinai Medical Center Los Angeles, California Mark Zakowski, MD Associate Professor of Anesthesiology Adjunct, Charles Drew University of Medicine and Science Chief, Obstetric Anesthesiology, Cedars-Sinai Medical Center Los Angeles, California ix Preface It has been thirty years since the first edition of Essen- tials of Obstetrics and Gynecology was published. As stated in the Preface to the First Edition, there was then, and continues to be today, a need for a textbook that covers the essential aspects of the specialty of Obstetrics and Gynecology, which is written primarily for the student and resident physician training in the field. The text has become known as ”Hacker and Moore” over the years, as a tribute to the pioneering work of the original editors. The late J. George “Jerry” Moore was the Professor and Chairman of Obstetrics and Gynecology at the University of California at Los Angeles (UCLA), and the concept for the book was his. Neville Hacker was then an Assistant Professor in the Department and was in charge of the Student Clerk- ship. He was co-opted by Jerry to co-edit the book, after the entire UCLA faculty had agreed to participate in its writing. The first edition of any textbook contains the vision and forms the foundation of the intent of the work, as outlined in the original preface. The editors have always felt that a new edition should be published only when there was significant new clinical information to report. Based on that standard, we believe it is now time for the sixth and latest edition of “Hacker and Moore” to be published. Medical education is continuously evolving, and has changed significantly since the first edition of this text- book was published in 1986. The internet with its world-wide web and other technologies have made information instantly available to students and resi- dents on a mobile phone or tablet during a clinical meeting. They are being taught to be life-long learners and information seekers. The classroom dynamics have been flipped in the past decade, in the sense that information transfer and gathering occurs before a seminar, with classroom time now increasingly devoted to discussions and problem solving by teams of stu- dents supported by diverse faculty mentors. This is appropriate, because health care is increasingly being delivered by multidisciplinary teams of professionals rather than by individual practitioners. With the ever- increasing complexity of medical and surgical care, this trend is expected to continue. Textbooks have the recognized disadvantage of not always containing the latest information on a topic and of having a limited “shelf life.” But just as newspapers and periodicals (printed or electronic) provide a “first and early draft” of human history and require frequent correction over time, medical texts should contain and document the time-tested facts of a discipline, along with newer information viewed through the prism of evidence-based and safe practice. It is our belief that textbooks will continue to provide the reliable essen- tials of all clinical practice, including the practice of obstetrics and gynecology. All of the 42 chapters in this edition have been updated. Some chapters have been completely rewrit- ten. Others have been modified due to changes in clini- cal practice. As was the case in previous editions of this text, we have worked to include only the “essentials” of obstetrics and gynecology, making difficult choices about the breadth and depth of the material presented. Every attempt has been made to include material con- sistent with the learning objectives and goals proposed by the Association of Professors in Gynecology and Obstetrics (APGO), available on their website at www. apgo.org. In addition to the authors and editors of this current edition, we wish to acknowledge and thank those who have contributed to all previous editions.* Their knowl- edge and wisdom contained in their words, some of *Contributors from all previous editions: Juan J. Arce, Carol L. Archie, Ricardo Azziz, Martha J. Baird, Richard A. Bashore, A. David Barnes, Michael J. Bennett, Narender N. Bhatia, Jennifer Blake, Clifford Bochner, J. Robert Bragonier, Charles R. Brinkman III, Michael S. Broder, Philip G. Brooks, John E. Buster, Maria Bustillo, Richard P. Buyalos, Mary E. Carsten (deceased), Anita Bachus Chang, R. Jeffrey Chang, George Chapman, Ramen H. Chmait, Gautam Chaudhuri, Kenneth A. Conklin, Irvin M. Cushner (deceased), Alan H. DeCherney, Cath- erine Marin DeUgarte, William J. Dignam (deceased), John A. Eden, Bruce B. Ettinger, Ozlem Equils, Robin Farias-Eisner, Larry C. Ford (deceased), Michelle Fox, Janice I. French, Ann Garber, Anne D.M. Graham, Paul A. Gluck, William A. Growdon, John Gunning (deceased), Lewis A. Hamilton, Hunter A. Hammill, George S. Harris, Robert H. Hayashi, James M. Heaps, Howard L. Judd (deceased), Continued http://www.apgo.org http://www.apgo.org xx P R E FA C E which remain in this edition, form the foundation of this work and will continue to enlighten future stu- dents of obstetrics and gynecology. We greatly appreciate, and wish to acknowledge, the support and professionalism of James Merritt and his excellent production staff, particularly Rhoda Howell, Rachel McMullen, Amy Meros, and Julia Roberts at Elsevier. We hope that the knowledge acquired from this book will encourage many to pursue a more in depth study of the specialty. Joseph C. Gambone (Executive Editor) Neville F. Hacker Calvin J. Hobel Daniel A. Kahn, Samir Khalife, Ali Khraibi, Matthew Kim, Oscar A. Kletzky (deceased), Grace Elizabeth Kong, Larry R. Laufer, Thomas B. Lebherz (deceased), Joel B. Lench, Ronald S. Leuchter, John K.H. Lu, Michael C. Lu, Donald E. Marsden, John Marshall, Ruchi Mathur, James A. McGregor, Arnold L. Medearis deceased) David R. Meldrum, Robert Monoson, J. George Moore (deceased), Thomas R. Moore, John Morris (deceased), Suha H.N. Murad, Sathima Natarajan, Lauren Nathan, John Newnham, Tuan Nguyen, Bahij S. Nuwayhid, Gary Oakes, Dotun Ogunyemi, Aldo Palmieri, Groesbeck P. Parham, Ketan S. Patel, Margareta D. Pisarska, Gladys A. Ramos, Anthony E. Reading, Robert C. Reiter, Jean M. Ricci (Goodman), Michael G. Ross, Edward W. Savage, William D. Schlaff, Mousa Shamonki, James R. Shields, Klaus J. Staisch (deceased), Eric Surrey, Khalil Tabsh, Christopher M. Tarnay, Maryam Tarsa, Nancy Theroux, Paul J. Toot, Maclyn E. Wade (deceased), Nathan Wasserstrum, Barry G. Wren, and Linda Yielding. 2 1 CHAPTE R CALVIN J. HOBEL • JOSEPH C. GAMBONE A Life-Course Perspective for Women’s Health Care Safe, Ethical, Value-Based Practice with a Focus on Prevention ■  Clinical  practice  in  obstetrics  and  gynecology,  based  upon the principles of safe, ethical and value-based care,  is  facilitated  by  viewing  wellness  and  sickness  in  the  context  of  a  life-course perspective.  Effective  clinical  care  of  mother  and  child  must  begin  early,  even  before  conception, and continue throughout life. ■  Adaptive developmental plasticity and epigenetic modi- fication of genes during and after pregnancy can have a  significant impact on chronic diseases later in life. ■  Clinicians  should  incorporate  the  major  ethical  princi- ples  of  nonmaleficence,  beneficence,  autonomy,  and  justice  into  their  practices,  along  with  the  duties   and  ideals  of  confidentiality  and  multidisciplinary  collaboration. ■  Regulatory, economic, and public pressure make assess- ment  and  improvement  of  safety  and  value  essential   in  the  delivery  of  women’s  health  care.  Optimal  health  outcomes  can  only  be  achieved  when  principles  from  continuous quality assessment and high reliability orga- nizations are combined with the systematic approach of  safety science and evidence-based medicine. ■  The  promising  area  of  clinical  preventive  services  in  obstetrics  and  gynecology,  as  in  all  heath  care,  is  trans- forming the practice of medicine in a very positive way. CLINICAL KEYS FOR THIS CHAPTER This chapter of Essentials of Obstetrics and Gynecology  is being revised at a time when the health and wellness  of the population of the United States and some other  developed  countries  of  the  world  are  being  evaluated  and  questioned.  A  recent  study  by  the  Harvard  Busi- ness  School  conducted  by  Professor  Michael  Porter  and his team ranked the United States only 70th in the  world in terms of overall health and wellness. Despite the fact that the United States spends far more on health care  (nearly  18\%  of  gross  domestic  product  or  GDP) than any other nation, it continues to be ranked only about 37th out of 191 nations for health status and health system performance.  Further,  the  United  States  is  ranked  only  46th  for  average  life-expectancy  and  42nd  for  infant  mortality  by  the  World  Health  Organization  (WHO).  Clearly,  the  United  States  must  strive to improve its standing on these and other mea- sures of performance. This is especially important at a  time  when  the  health  care  delivery  system  enters  the  era  of  the  Affordable  Care  Act  (ACA),  and  efforts  to  provide  care  to  all  citizens  at  a  reasonable  cost  are  underway. Obstetrics  and  gynecology  is  one  of  the  most   exciting  and  challenging  areas  of  health  care,  with  a  number  of  significant  opportunities  for  improvement  such  as  infant  and  maternal  mortality.  The  specialty  provides  students  and  young  physicians  in  training  with  the  knowledge  and  skills  necessary  to  improve   the  health  of  women  and  their  children  very  early  in  their lives. In this first chapter of the book, some basic  principles and guidelines for improving health care are  provided, and several important factors that are influ- encing  the  health  of  women  and  their  children  are  suggested. Principles of Practice There are four basic principles for practicing and improving health care. First, the safety of our patients must always be paramount.  In  recent  years  we  have  made  major  improvements  in  patient  safety,  in  large  part  by  emphasizing  teamwork  and  implementing  practices proven to be effective in the airline industry.  Second, we must be true to our personal pledge made when taking the Hippocratic Oath—to adhere to ethical practices. Third, we must transform to a value- based system of health care delivery.  Because  medi- cine  has  become  very  complex,  we  must  be  open  to  a  C H A P T E R 1 A Life-Course Perspective for Women’s Health Care 3 structure  include  altered  DNA  methylation  by  both  histone acetylation and methylation. Since the last edition of this text, investigators have  determined  that  alterations  in  the  in  utero  environ- ment during pregnancy may result in modifications to  the chromatin structure. These modifications may lead  to  persistent  changes  in  postnatal  gene  expression  which  may  render  the  child  more  susceptible  to   early onset adult disease. The conditions during preg- nancy that account for these epigenetic changes are preeclampsia, preterm birth, intrauterine growth restriction (IUGR), obesity, diabetes, poor nutrition, smoking, and some cancers.  Even  the  mothers  with  these  pregnancy  conditions  are  themselves  at  greater  risk for cardiovascular disease, hypertension, and dia- betes later in life. The onset for these conditions occurs  earlier  in  life  compared  to  those  women  who  have  normal pregnancies. Thus having a normal pregnancy may be protective of disease later in life. It is now thought that the effect of harmful behav- iors and our environment on the expression of our genes may account for up to 40\% of all premature deaths in the United States. Two of the top behavioral  factors related to this premature death rate are obesity  (and  its  usual  physical  inactivity)  and  smoking.  Envi- ronmental  exposures  to  metals,  solvents,  pesticides,  endocrine disruptors, and other reproductive toxicants  are also major concerns. Second, in human biology, a phenomenon called adaptive developmental plasticity plays a very impor- tant role in helping to adjust behavior to meet any environmental challenge.  In  order  to  understand  human  development  over  time  (a life-course perspec- tive),  one  must  first  understand  what  is  normal  and  what  adverse  circumstances  may  challenge  and  then  change  normal  development  of  the  fetus.  These pro- tective modifications of growth and development which are programmed in utero to prevent fetal death, may become permanent.  The  price  the  fetus  may pay for short-term survival is later vulnerability to  conditions such as obesity, hypertension, insulin resis- tance, atherosclerosis, and even diabetes. In relation to individual X and individual Y with the  same genomic makeup but different in utero environ- mental influences, metabolic changes that may be ini- tiated  in  utero  in  response  to  inadequate  nutritional  supplies (Figure 1-1) can lead to insulin resistance and  eventually  the  development  of  type  2  diabetes.  These  adaptive changes can even result in a reduced number  of nephrons in the kidneys as a stressed fetus conserves  limited nutritional resources for more important organ  systems in utero. This can then lead to a greater risk of  hypertension later in life. This series of initially protective but eventually harmful developmental changes was first described in humans by David Barker, a British epidemiologist, who carefully assessed birth records of individuals more cost-effective multidisciplinary approach to both  diagnostic  and  therapeutic  practice.  Performance  improvement efforts, practice management skills, and  effective communication are all necessary to efficiently  optimize  clinical  outcomes  and  value.  Fourth,  and  perhaps most importantly, we must focus on the pre- vention and early mitigation of disease, in addition to  our  continued  focus  on  its  treatment.  This  should  occur  in  a  patient-centered  manner,  meeting  their  needs and expectations. For this reason, we emphasize an approach called a  life-course perspective for clinical practice, beginning  with  preconception  health,  continuing  throughout  pregnancy,  the  postpartum  period  (interconception  health),  and  then  giving  children  and  their  mothers  a  health perspective  for  adopting  and  maintaining  healthy living. Before delving more deeply into these principles of  practice  (safety,  ethics,  value,  and  prevention),  some  newer concepts about the origins of disease are impor- tant to mention. LIFE-COURSE PERSPECTIVE When does disease begin and lead to pathology and illness during the course of life? First, although genetics is beginning to provide a much better understanding of the etiology of poor health, it probably accounts for only about one-third of the direct causes.  Imprinted  genes  from  both  the  mother and the father play an important role in passing  on  characteristics  to  the  offspring.  …