编辑推荐
正版原版,原汁原味,留学生与双语教学用。
内容简介
本书系统地介绍了妇产科学的基本知识,包括妇产科的解剖、生理、孕产期保健、产科常见并发症和合并症及各种妇科疾病的诊断与治疗等。内容简明易懂,图文并茂,适合作为临床医学专业本科生中英文双语教学、留学生英文教学、硕士研究生和博士研究生教学的妇产科学教材。本书也可以作为其他医学相关专业学生和青年医生学习妇产科学的参考教材。
作者简介
薛凤霞,天津医科大学总医院妇产科行政主任,教授,博导。中华医学会妇产科分会常委,中华妇产科杂志编委,从事国际学院、7年制教学多年。国家十一五教材《妇产科学》编委,全国高等医药院校教材《妇产科学》五年制、七年制编委。主持国家自然基金等科研项目10余项。获得天津市科技进步奖等多项奖项。
内页插图
目录
Section One Basic Sciences in Obstetrics and Gynecology
1 Anatomy… ……………………………………………………………………………………………………… 3
2 Reproductive Physiology………………………………………………………………………………………… 33
3 Conception, Fertilization and Implantation… …………………………………………………………………… 51
4 Fetal Growth, Placenta and Umbilical Cord……………………………………………………………………… 62
5 Embryology… …………………………………………………………………………………………………… 78
Section Two Gynecology
6 Gynecological History and Clinical Examination………………………………………………………………… 91
7 Pediatric and Adolescent Gynecology… ………………………………………………………………………… 96
8 Gynecological Infection and STD………………………………………………………………………………… 105
9 Amenorrhea… …………………………………………………………………………………………………… 139
10 Abnormal Uterine Bleeding… ………………………………………………………………………………… 148
11 Infertility………………………………………………………………………………………………………… 158
12 Polycystic Ovarian Syndrome (PCOS)… ……………………………………………………………………… 174
13 Hirsutism………………………………………………………………………………………………………… 180
14 Menopause……………………………………………………………………………………………………… 184
15 Benign Lesions of the Vulva and Vagina………………………………………………………………………… 192
16 Benign Disorders of the Uterine Cervix………………………………………………………………………… 202
17 Benign Disorders of Uterine Corpus (Fibroids, Adenomyosis and Endometrial Polyp) ………………………… 206
18 Benign Adnexal Masses… ……………………………………………………………………………………… 222
19 Premalignant and Malignant Disorders of the Vulva and Vagina… …………………………………………… 234
20 Premalignant and Malignant Disorders of the Uterine Cervix… ……………………………………………… 244
21 Premalignant and Malignant Disorders of the Uterine Corpus… ……………………………………………… 267
22 Premalignant and Malignant Disorders of Ovaries and Fallopian Tubes………………………………………… 278
23 Gestational Trophoblastic Diseases……………………………………………………………………………… 291
24 Endometriosis…………………………………………………………………………………………………… 299
25 Pelvic Organ Prolapse (POP)…………………………………………………………………………………… 309
26 Urinary Incontinence…………………………………………………………………………………………… 321
27 Genital Ambiguity and Intersexuality…………………………………………………………………………… 333
28 Contraception…………………………………………………………………………………………………… 341
Section Three Obstetrics
29 Preconceptional Counseling, Physiological Changes in Pregnancy and Antenatal Care………………………… 365
XIV
Contents
30 Normal Labor…………………………………………………………………………………………………… 393
31 First Trimester Vaginal Bleeding………………………………………………………………………………… 415
32 Recurrent Pregnancy Loss and Bad Obstetrical History………………………………………………………… 436
33 Late Pregnancy Complications… ……………………………………………………………………………… 442
34 Third Trimester Bleeding… …………………………………………………………………………………… 464
35 Disproportionate Fetal Growth… ……………………………………………………………………………… 478
36 Multiple Pregnancy……………………………………………………………………………………………… 485
37 Disorders of Amniotic Fluid… ………………………………………………………………………………… 494
38 Special Cases in Obstetrics… …………………………………………………………………………………… 499
39 Hypertensive Disorders in Pregnancy…………………………………………………………………………… 502
40 Diabetes Mellitus and Pregnancy………………………………………………………………………………… 514
41 Hematological Disorders in Pregnancy… ……………………………………………………………………… 521
42 Cardiac Disease in Pregnancy…………………………………………………………………………………… 532
43 Thyroid Dysfunction with Pregnancy…………………………………………………………………………… 539
44 Jaundice, Hepatitis and Gastrointestinal Disorders in Pregnancy………………………………………………… 544
45 Renal Disorders in Pregnancy…………………………………………………………………………………… 551
46 Nervous System Disorders in Pregnancy………………………………………………………………………… 556
47 Asthma in Pregnancy… ………………………………………………………………………………………… 561
48 Local Abnormalities……………………………………………………………………………………………… 565
49 Infection During Pregnancy… ………………………………………………………………………………… 573
50 Malpresentation and Malposition……………………………………………………………………………… 581
51 Dystocia and Cephalopelvic Disproportion……………………………………………………………………… 600
52 Postpartum Hemorrhage………………………………………………………………………………………… 609
53 Puerperium……………………………………………………………………………………………………… 621
54 Essential of Normal Newborn Assessment and Care… ………………………………………………………… 628
55 Special Topics in Obstetrics……………………………………………………………………………………… 636
56 Critical Care Obstetric…………………………………………………………………………………………… 657
Section Four Appendices
Appendix 1 Investigations in Gynecology… ……………………………………………………………………… 667
Appendix 2 Operative Obstetrics…………………………………………………………………………………… 677
Appendix 3 Fetal Medicine………………………………………………………………………………………… 699
Appendix 4 Drug Use in Pregnancy………………………………………………………………………………… 701
Appendix 5 Psychological Aspects in Obstetrics and Gynecology… ……………………………………………… 703
Section Five Annexures
Annexure 1 Medical Eligibility Criteria for Initiation and Continuation of Intrauterine Devices (IUDs)… ……… 711
Annexure 2 Medical Eligibility Criteria for Initiation and Continuation of Combined OCs/Combined Injects/
Transdermal Patches and Vaginal Rings… …………………………………………………………… 714
Annexure 3 Medical Eligibility Criteria for Emergency Contraceptive Pills (ECPs)… …………………………… 717
Annexure 4 Normal Values in Pregnancy… ……………………………………………………………………… 718
Annexure 5 Indications and Risks of Common Vaccines During Pregnancy……………………………………… 720
精彩书摘
Conception, Fertilization
3
and Implantation
A baby is God’s opinion that the world should go on.
introdUction
Life begins when an oocyte is fertilized by sperm. The union of egg and sperm at fertilization is one of the most important process in biology.
Gametogenesis is the process involved in the maturation of two highly specialized cells (spermatozoon in male and ovum in the female) before they unite to form zygote.
oogenesis
The process involved in development of mature ovum is called oogenesis. The primitive germ cells take their origin from the yolk sac at about the end
of 3rd week of intrauterine life and their migration
to the developing gonadal ridge is completed round about the end of 4th week. In female gonads the germ cells undergo a number of rapid mitotic divisions and differentiate into Oogonia. The numbers of oogonia are maximum at 20th week, which number about 7 million. While the majority of oogonia continue to
divide, some enter into the prophase of first meiotic
division and are called primary oocytes. Primary oocyte is surrounded by flat cells and is called primordial follicle which are present in the cortex of the ovary. After birth there is no more mitotic division and all oogonia are replaced by the primary oocytes
which have finished the prophase of the first meiotic
division and remain in the resting phase (dictyotene stage) between prophase and metaphase. Total
number of primary oocyte at birth is approximately
2 million.
Maturation of oocyte is reduction of the number of chromosomes to half. Before the onset of first meiotic division, the primary oocyte doubles its DNA by replication, so they have double amount of normal protein content. There are 22 pairs of autosomes which determine the body characteristics and one
pair of sex chromosomes named XX. The first stage of
maturation occurs with full maturation of the ovarian follicle just prior to ovulation. Final maturation occurs only after fertilization.
The primary oocyte undergoes first meiotic division giving rise to secondary oocyte and one polar body. The secondary oocyte contains haploid number of chromosomes (23X) and nearly all the cytoplasm. Small polar body contains half of chromosomes (23X) but only scanty cytoplasm. Ovulation occurs just after the formation of secondary oocytes (Fig. 3.1B).
The secondary oocyte completes the second meiotic division only after fertilization by the sperm in the fallopian tube. It results again in formation of 2 daughter cells. The larger one is called mature ovum containing (23X) and the smaller one is called second polar body containing same number of chromosomes. The first polar body may also undergo the second meiotic division. In the absence of fertilization, the secondary oocyte does not complete the second meiotic division and degenerates as such.
Structure of Mature Ovum
A fully mature ovum is the largest cell in the body
measuring 130 μm in diameter. It consists of cytoplasm
and a nucleus with eccentric nucleolus and contains
23X chromosomes. During fertilization, the nucleus
is converted into a female pronucleus. The ovum is surrounded by a cell membrane called vitelline membrane. There is an outer transparent mucoprotein
Section –1 . Basic Sciences in Obstetrics and Gynecology
envelope called Zona pellucida. In between vitelline membrane and Zona pellucida there is a narrow space called, perivitelline space which accommodates the polar bodies. After escape from primordial follicle, oocyte retains a covering of granulosa cells known as corona radiata, which is derived from cumulus oophorous (refer Figs 2.4A and B).
Spermatogenesis
Spermatogenesis is the production of mature sperm. It occurs in the seminiferous tubules of the testis. The primordial germ cells divide to produce spermatogonia, the precursor of mature sperm. At onset of puberty the spermatogonia located at the basal lamina of the seminiferous tubercle begin to divide mitotically to produce primary spermatocytes.
Primary spermatocytes remain in stage of prophase of the first meiotic division for long time (16 days). Each spermatocytes contains 22 pair of autosomes and one pair of sex chromosomes named XY.With completion of first meiotic division, two secondary spermatocytes are formed having equal share of cytoplasm and haploid number of chromosomes either 23X or 23Y. Immediately after there is a second meiotic division with formation of 4 spermatids, each containing
haploid numbers of chromosomes, two with 23X and two with 23Y (Fig. 3.1A). Spermiogenesis is the differentiation of round spermatids to motile spermatozoa. In this process a series of morphological changes occur which produce motile sperms and takes about 61 days. The most visible change is the reduction in size and formation of tail, which allows the sperm cell to swim. The chromosomes in the sperm cells are almost crystallized by a special set of sperm specific proteins called protamines. In fact this protamine induced condensation of the sperm chromosome is so extensive that the size of sperm nucleus is about one thirtieth of the size of the mature human egg. This compact structure of the sperm is important for its motility.
The production of spermatozoa in the testis requires the presence of germ cells and their transformation and maturation is under the control of hypothalamic and pituitary hormones and testicular androgens.
The Mature Sperm
Spermatozoa are produced at the onset of puberty in boys. Thereafter, the seminiferous tubules of the testis will go on producing sperms daily until 60 years of age and beyond. Following spermatogenesis, the spermatozoa pass through seminiferous tubule to rete testis, on to the vasa differentia, the head of the epididymis and hence, 12 days later to the tail of epididymis. The transport of mature sperm is facilitated via muscular activity within the epididymis
and vas. The seminal fluid is made up from secretion
of bulbourethral gland, seminal vesicle, the prostrate and epidymal fluid. During this time the sperm acquire motility and undergo the final biochemical changes that give them ability to fertilize the ovum.
The sperm has complex structure. It contains haploid number of chromosomes (22 + X or Y). It is few microns long. It has head which consist principally of the condensed nucleus and acrosomal cap. Acrosome is rich in enzyme. Tail gives the motility and propulsion while the mid piece acts as energy source. At the time of intercourse, million of sperms are deposited in vagina (Fig. 3.2). Seminal fluid containing sperm coagulates immediately following ejaculation. Under normal circumstances it liquefies within 20 minutes. The basic pH of the seminal fluid protects the spermatozoa from acidity of vagina. They travel in all directions, some through the cervix, where in midcycle the molecules of cervical mucus untangle their barbed fence like morphology to assume straight lines.
……
《妇产科学:为留学生与双语教学量身打造的经典之作》 引言 在医学飞速发展的今天,妇产科学作为一门古老而又充满活力的学科,始终站在守护女性生命与健康的最前沿。从生命的孕育到分娩的奇迹,再到女性生殖系统的健康维护,妇产科学的研究和临床实践覆盖了女性一生中的关键时期。为了满足日益增长的国际医学交流需求,以及为全球各地的双语教学提供坚实的学术支撑,《妇产科学(英文原版改编版留学生与双语教学用)》应运而生。本书并非简单的翻译,而是基于权威英文原版教材,针对留学生及双语教学的特殊需求,进行了深入的改编与优化,旨在提供一本既符合国际学术标准,又易于理解和掌握的妇产科学学习指南。 本书特色与价值 本书的核心价值在于其“为留学生与双语教学量身打造”的定位。这意味着它在内容选择、编排结构、语言表述以及教学辅助等方面,都充分考虑了非母语学习者的认知特点和教学实践中的实际需求。 精选与优化内容,聚焦核心知识: 针对留学生在有限的学习时间内需要掌握的妇产科核心知识点,本书精选了最具代表性、最实用、最前沿的医学内容。原版教材的广博性是其优势,但对于初学者或需要集中精力攻克特定知识点的学习者而言,精炼和聚焦则更为重要。本书的改编过程,正是对大量信息进行梳理、提炼和优化的过程,确保了学习者能够高效地抓住妇产科学的精髓。 双语教学的无缝对接: 本书的另一大亮点是其对双语教学的完美支持。它不仅保留了英文原版的严谨学术体系,更在必要之处辅以详尽的中文解释和说明。这种设计使得教师在进行双语授课时,能够轻松地在两种语言之间切换,为学生提供清晰、准确的学习路径。对于留学生而言,本书提供了深入理解医学概念的桥梁,有助于他们在掌握英文医学术语的同时,不失对概念本身的深刻理解。 严谨的学术风格与现代的临床视角: 本书在保留原版教材严谨的学术风格的同时,积极融入了最新的临床研究成果和治疗指南。从胚胎发育的微观机制,到各种妇科疾病的诊断与治疗,再到围产期医学的最新进展,本书都力求展现当前妇产科学领域的最新动态和最佳实践。这使得本书不仅是学习理论知识的工具,更是了解行业前沿、培养临床思维的宝贵资源。 清晰的结构与直观的呈现: 为了方便读者理解和记忆,本书在结构编排上力求清晰。各章节围绕特定的主题展开,逻辑严谨,循序渐进。大量的插图、图表、病例分析等视觉化和案例化的呈现方式,极大地增强了内容的直观性和易读性。这些辅助材料不仅有助于概念的理解,更能帮助学习者将理论知识与实际临床情境联系起来。 为临床实践打下坚实基础: 妇产科学是一门高度依赖临床实践的学科。本书通过深入浅出的讲解,将复杂的理论知识转化为易于理解的语言,并结合大量临床案例,帮助学习者理解疾病的发生、发展过程,以及各种诊断和治疗方法的原理与应用。这为未来的临床实习和执业打下了坚实的基础,使其能够自信地应对各种临床挑战。 内容概览(未包含具体书籍内容,仅为一般性介绍) 本书全面覆盖了妇产科学的各大分支,为读者提供了一个完整的知识体系。 第一部分:普通妇科学(General Gynecology) 此部分深入探讨了女性生殖系统的解剖生理、发育与衰老、月经生理与病理,以及女性生殖器官的常见疾病。 女性生殖系统的解剖与生理: 从宏观到微观,详细阐述了女性外生殖器、阴道、子宫、输卵管、卵巢等器官的结构特征,以及它们在维持生殖功能和内分泌平衡中的作用。生理部分则着重讲解了下丘脑-垂体-卵巢轴的调控机制,排卵过程,以及雌激素、孕激素等激素的生理作用。 生殖道的发育与衰老: 梳理了女性生殖器官在青春期、成年期、围绝经期及绝经期各个阶段的生理性变化,有助于理解不同年龄段女性可能面临的健康问题。 月经生理与病理: 详细解释了正常的月经周期,以及由此可能引发的月经失调,如月经过多、过少、痛经、闭经等。书中将结合最新的研究,分析月经紊乱的常见病因和发病机制。 妇科炎症与感染: 涵盖了外阴、阴道、宫颈、子宫、输卵管、卵巢等部位的常见炎症和感染性疾病,包括细菌性阴道病、滴虫性阴道炎、霉菌性阴道炎、盆腔炎等。重点讲解病原体、临床表现、诊断方法以及抗菌药物的选择与应用。 子宫肌瘤与子宫内膜异位症: 作为妇科常见的良性肿瘤和慢性疾病,本书将详细介绍这两类疾病的发病机制、临床表现、影像学诊断、手术与药物治疗策略,以及对生育的影响。 卵巢囊肿与肿瘤: 针对各种类型的卵巢囊肿和卵巢肿瘤,本书将提供详细的鉴别诊断方法,包括影像学、肿瘤标志物等,并介绍手术治疗的原则和进展。 女性生殖器官的良性与恶性肿瘤: 重点关注宫颈癌、子宫内膜癌、卵巢癌等常见妇科恶性肿瘤,深入分析其病因、危险因素、筛查方法、早期诊断、分期、放化疗及靶向治疗等综合治疗手段。 盆底功能障碍: 随着人口老龄化,盆底功能障碍越来越受到重视。本书将介绍尿失禁、盆腔脏器脱垂等常见问题,并探讨其预防和治疗方法。 不孕不育: 详细阐述了女性不孕的各种原因,包括排卵障碍、输卵管因素、子宫因素、免疫因素等,并介绍辅助生殖技术(ART)如体外受精-胚胎移植(IVF-ET)的应用。 计划生育与避孕: 涵盖了各种避孕方法的原理、效果、适应症与禁忌症,以及人工流产、计划生育手术等内容。 第二部分:产科学(Obstetrics) 此部分聚焦于妊娠、分娩、产褥期以及新生儿的健康,强调母婴安全。 妊娠生理: 详细描述了受精、着床、胎盘形成、羊水生成与吸收等早期妊娠过程,以及母体在妊娠期间发生的解剖、生理和内分泌变化,如心血管系统、呼吸系统、消化系统、泌尿系统和内分泌系统的适应性改变。 产前检查与保健: 强调规范化产检的重要性,讲解孕期常规检查项目,如孕早期筛查、孕中期唐氏筛查、四维彩超等,以及孕期营养、运动、心理等保健指导。 妊娠期合并症与并发症: 深入分析妊娠期高血压疾病(包括妊娠期高血压、子痫前期、子痫)、妊娠期糖尿病、前置胎盘、胎盘早剥、羊水过多/过少、多胎妊娠等常见疾病的病因、发病机制、临床表现、诊断和处理。 早孕期问题: 涵盖了异位妊娠(宫外孕)、先兆流产、难免流产、稽留流产等常见早孕期并发症的诊断与处理。 分娩生理与产程管理: 详细讲解了分娩的动力、产道、胎儿三个因素,以及正常产程的各个阶段。重点介绍对产程的监测与评估,以及在出现异常产程时如何进行干预。 分娩方式: 详细介绍了阴道分娩和剖宫产的适应症、禁忌症、手术过程和并发症。 难产的处理: 针对骨盆狭窄、胎位异常、巨大儿等导致的难产,本书将介绍助产技术、产钳助产、胎头吸引器助产以及剖宫产的适应症和选择。 产科出血: 产后出血是产科最严重的并发症之一。本书将详细阐述其病因、预防、诊断和多种止血方法,包括药物止血、子宫填塞、手术止血等。 胎儿医学: 涵盖了胎儿生长发育的监测,胎儿宫内窘迫的诊断与处理,胎儿宫内感染,以及胎儿先天性疾病的产前诊断技术,如羊膜穿刺、绒毛膜穿刺、无创DNA检测等。 新生儿监护: 关注新生儿的健康与安全,包括早产儿、低体重儿、宫内窘迫新生儿的监护与处理。 产褥期保健: 讲解产后母体恢复过程中的生理变化、常见并发症(如产褥感染、乳腺炎)的防治,以及母乳喂养的指导。 第三部分:生殖内分泌与生殖医学(Reproductive Endocrinology and Reproductive Medicine) 此部分扩展了对生殖相关的内分泌调控以及辅助生殖技术的研究。 生殖内分泌疾病: 深入探讨多囊卵巢综合征(PCOS)、性早熟、青春期延迟、围绝经期综合征等内分泌失调性疾病的诊断和治疗。 不孕不育的进一步探讨: 在不孕不育部分的基础上,更深入地探讨免疫性不孕、内分泌性不孕的诊断与治疗。 辅助生殖技术(ART): 详细介绍体外受精(IVF)、卵胞浆内单精子注射(ICSI)、胚胎冷冻、人工授精(AI)等辅助生殖技术的操作流程、适应症、伦理问题及最新进展。 本书的目标读者 本书的目标读者群体广泛,包括但不限于: 医学留学生: 尤其是在英语国家学习妇产科学或希望提升英文医学能力的学生。 国内医学院校的教师: 致力于开展妇产科学双语教学的教师。 国内医学院校的学生: 希望接触和学习英文原版教材,拓宽学术视野的学生。 年轻的妇产科医师: 希望通过英文原版文献提升专业知识和临床技能的医生。 对妇产科学感兴趣的研究人员: 需要深入了解国际学术前沿的科研工作者。 结语 《妇产科学(英文原版改编版留学生与双语教学用)》的出版,标志着一本旨在连接全球医学教育、促进知识交流的重要学术著作的诞生。本书凭借其严谨的内容、创新的编排和对双语教学的深刻理解,必将成为妇产科学领域留学生和双语教学的重要参考。它不仅是知识的载体,更是思维的启迪,是连接不同文化背景下妇产科学学习者的桥梁,为培养具有国际视野的妇产科人才贡献力量。通过本书的学习,读者将能够系统地掌握妇产科学的理论知识,培养敏锐的临床思维,为守护女性一生健康打下坚实的基础。