Educational literature for medical students

OBSTETRICS

Edited by

Academician R A M N G. M. Savelieva

"The medicine"

UDC 618.2(075.8) BBK 57.16

Reviewer prof. I.B. Manukhin, head Department of Obstetrics and Gynecology, Moscow State University of Medicine and Dentistry

Compiled by: A.P. Kiryushchenkov, L.G. Sichinava, R.I. Shalina

Obstetrics: Textbook / G.M. Savelyeva, V.I. Kulakov, A44 A.N. Strizhakov and others; Ed. G.M. Savelyeva. - M.:

Medicine, 2000. - 816 p: ill. (Study literature for students of medical universities)

ISBN 5-225-04549-9

This textbook is the result of the work of a team of authors - leading experts in the field of obstetrics. The textbook details the information of classical obstetrics about the physiological and complicated course of pregnancy and childbirth, obstetric operations. The latest data on the pathogenesis, therapy and prevention of the most common complications of pregnancy are presented. The issues of perinatal medicine, ways of reducing perinatal morbidity and mortality are considered. Modern additional research methods are described that allow obtaining objective information about the state of the body of the mother and fetus. Various aspects of family planning were reflected, including modern methods of contraception, and issues of organizing obstetric and gynecological care.

For students of medical universities, residents and graduate students.

Savelyeva G.M. - Academician of the Russian Academy of Medical Sciences, Professor, Head. Department of Obstetrics and Gynecology, Faculty of Pediatrics, Russian State Medical University.

Kulakov VI - Academician of the Russian Academy of Medical Sciences, Professor, Director of the Scientific Center for Obstetrics, Gynecology and Peripathology of the Russian Academy of Medical Sciences.

Strizhakov A.N. - Academician of the Russian Academy of Medical Sciences, Professor, Head, Department No. 2 of Obstetrics and Gynecology, Moscow Medical Academy. I.M. Sechenov.

Serov VN - Academician of the Russian Academy of Medical Sciences, Professor, Deputy Director of the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences.

Krasnopolsky VI Corresponding Member of the Russian Academy of Medical Sciences, Professor, Director of the Moscow Regional Research Institute of Obstetrics and Gynecology.

Knryushchenkov A.P.-Professor of the Department No. 1 of Obstetrics and Gynecology, Moscow Medical Academy. I.M. Sechenov.

Makarov O.V.-professor, head. Department of Obstetrics and Gynecology, Faculty of Medicine, Russian State Medical University.

Makatsaria A.D. - professor, head. Department of Obstetrics and Gynecology of the Medical and Preventive Faculty of the Moscow Medical Academy. I.M. Sechenov.

Pobedinsky N.M.-Professor, Director of the Clinic of Obstetrics and Gynecology, Head. Department No. 1 of Obstetrics and Gynecology, Moscow Medical Academy. I.M. Sechenov.

Sidelnikova V.M.-Professor, Head of the Department for the Prevention and Treatment of Miscarriage of the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences.

Sidorova I.S. Corresponding Member of the Russian Academy of Medical Sciences, Professor, Head. Department of Obstetrics and Gynecology, Faculty of Postgraduate Professional Education, Moscow Medical Academy. I.M. Sechenov.

Sichinava L.G. - Professor of the Department of Obstetrics and Gynecology, Faculty of Pediatrics, Russian State Medical University.

Strizhova N.V.-professor, head. Department of Obstetrics and Gynecology, Evening Faculty, Russian State Medical University

Fedorova M. V. - professor, deputy. Director of the Moscow Regional Research Institute of Obstetrics and Gynecology.

Chernukha E.A.-Professor, Head of the Obstetrics Department No. 1 of the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences.

Shalina R.I.-Professor of the Department of Obstetrics and Gynecology, Faculty of Pediatrics, Russian State Medical University.

WARNING

Foreword
Chapter 1. The main stages in the development of obstetrics. Pernatology
	The main stages in the development of obstetrics
	Perinatology
Chapter 2. Anatomy and physiology of the female reproductive system
	Anatomy of the female genital organs
		female pelvis
	2.1.2. External and internal genital organs
		Pelvis from an obstetric point of view

2.2. Physiology of the female reproductive system. menstrual

		cycle. V.P. Estimator
	Physiology of pregnancy
		Fertilization. Early embryogenesis
			Fertilization
			Early embryogenesis
		Placenta
			Development and functions of the placenta
			amniotic fluid
			Umbilical cord and afterbirth
		Fetal physiology
		The fetus in certain periods of intrauterine development
		The fetus as an object of childbirth
		Changes in a woman's body during pregnancy
Chapter 4	Diagnosis and management of pregnancy
		Pregnancy diagnostics
		Examination of a pregnant woman
			Objective examination
			Determining the gestational age. Provision sheet
			as disability for pregnant women and women in childbirth. .
			Signs of previous birth

4.3. Additional research methods in obstetrics and perinatal

4.3.1. Methods for obtaining information about cardiac activity

4.3.4. Doppler study of blood flow in the system

4.3.5. Ultrasound examination of the head brain (neuro-

sonography) newborn

				Methods for the study of amniotic fluid
				Colpocytological study
				X-ray examination
				Determination of tissue P Q Y
				Fetal and newborn blood test
				Biopsy (aspiration) of chorionic villi
				Fetoscopy
				Study of the hormonal profile
		Management of pregnancy
				Basics of rational nutrition for pregnant women
				Mode and personal hygiene of pregnant women
				Principles of preparing pregnant women for childbirth
	4 . 5 . Antenatal diagnosis of the fetal condition
	Physiology of childbirth
		Causes of childbirth
		Harbingers of childbirth
	5 . 3 . childbirth periods. Changes in the uterus during childbirth
		Childbirth mechanism
			The mechanism of childbirth in the anterior view of the occipital pre-
			The mechanism of childbirth in the posterior view of the occipital presentation
		5 . 4 . 3, Influence of the mechanism of childbirth on the shape of the head
				Theories of the mechanism of childbirth
		Clinical course of childbirth
				The course of childbirth in the period of disclosure
				The course of childbirth in the period of exile
				The course of childbirth in the afterbirth period
		Birth management
		5 . 6. one . Conducting childbirth in the period of disclosure
				Conducting childbirth during exile
				Primary treatment of the newborn
				Follow-up management
	Physiology of the postpartum period
		Changes in the mother's body
				State of hormonal homeostasis
				Sex organs and mammary glands
		6 .1.3.		The cardiovascular system
		6 .1.4.		urinary system
				Digestive organs
		Management of the postpartum period
Chapter 7
	7. one . Classification
	7. 2. Diagnostics
		Childbirth mechanism
		The course of pregnancy and childbirth
		Management of pregnancy and childbirth
	Multiple pregnancy
		Management of pregnancy
		The course of childbirth
		Birth management

Chapter 9		Miscarriage
			Spontaneous abortion (miscarriage)
				Threatened abortion
				Started abortion
			9-13. Abortion in progress, incomplete and complete abortion
					Missed miscarriage (non-developing pregnancy)
				Septic abortion
			Habitual miscarriage
			habitual miscarriage
			preterm birth
					Rapid preterm birth
						premature birth with weakness of the generic
				activities
					Management of preterm labor in antenatal effusion
				tia amniotic fluid
			Characteristics of a premature baby
		Ectopic pregnancy
		10.1. Clinical picture and diagnosis of progressive tubal
			pregnancy
			Clinical picture and diagnosis of abortion
			ty by type of tubal abortion
			Clinical picture and diagnosis of rupture of the fallopian tube
			Clinical picture and diagnosis of rare forms of ectopic
			pregnancy
		10.5. Differential diagnosis of ectopic pregnancy
		10.6. Treatment for ectopic pregnancy and recovery
			productive function
	11. Postterm pregnancy
			Clinical picture and diagnosis
			Management of pregnancy
		11.3. The course and management of childbirth
Chapter 12
		during pregnancy
		12.1. Diseases of the cardiovascular system
					Hypertonic disease
					Arterial hypotension
			12.1.3. Diseases of the veins
						Varicose disease of the lower extremities. . .
						venous thrombosis, thrombophlebitis, thromboembolism
					Heart defects
						Acquired rheumatic heart disease
						congenital heart defects
						Pregnancy and heart surgery
					12.1.4.4. Delivery of pregnant women with heart defects
			Respiratory diseases
					Bronchitis
					pneumonia
					Bronchial
		12.3. kidney disease and					urinary tract
					Pyelonephritis of pregnant women
					Glomerulonephritis
					Urolithiasis disease
					and pregnancy

12 .5.	Diseases of the nervous system and organ of vision
	12.5.1. Diseases of the nervous system
		Diseases of the organ of vision
12 .6.	Diseases of the digestive system.
12 .7.	Hereditary and congenital thrombophilia. Thrombocytope-
	12.7.1. Hereditary and congenital thrombophilia
		Thrombocytopathies
			Idiopathic thrombocytopenic
			Hereditary thrombocytopathies
			Pool deficiency diseases
			accumulation
	salary diabetes
12 .9.	Sexually transmitted diseases
12.10. Tuberculosis
12.11. Pathology of the reproductive system
	12.11.1. Uterine fibroids
	12.112. Neoplasms of the ovaries
	12.11.3. Congenital anomalies of the genital organs
	12.11.4. Infantilism
	12.11.5. Cancer of the cervix. V.P. Kozachenko
Chapter 13
Chapter 14
14.1. Toxicosis
		Vomiting pregnant
		Salivation
		Clinical picture and diagnosis
		Methods of delivery, childbirth
		Prevention of severe forms of gestosis
Chapter 15
Chapter 16
us, placenta
16.1. Embryo- and fetopathy
	Congenital malformations of the fetus

16.2.1. Malformations of the central nervous system. . . . 440

16.2.2. Malformations of the kidneys and urinary tract. . . . 442

		congenital heart defects
	16.2.4. Anomalies in the formation of the walls of the abdominal cavity and
		malformations of the gastrointestinal tract
	16.2.5. Anomalies of the facial structures, neck and skeletal system
	Fetal hypoxia
	intrauterine infection
		Viral diseases of the embryo and fetus
		Intrauterine bacterial infection of the fetus
	Gestational trophoblastic disease. V.P. Kozachenko. . . .
	Low water, polyhydramnios
	Umbilical cord anomalies
16 .8.	placental insufficiency

Chapter 17
17.1. narrow pelvis
	Conducting childbirth with a narrow pelvis. Clinically narrow pelvis
		Birth management
		Clinically narrow pelvis
	large fruit
	Shoulder dystocia
	Cord prolapse
17.6. Asynclitic head inserts
		High straight head position
		Low transverse head position
Chapter 18
Chapter 19
19.1. Anterior presentation
19.2. frontal prediction
19.3. Face presentation
Chapter 20
20.1. Pathological preparatory (preliminary) period
	Primary weakness of labor activity
	Secondary weakness of labor activity
	Excessively strong labor activity
	Hypertensive uterine dysfunction
	20.5.1. Discoordination of labor activity
		Tetanus of the uterus (total dystonia)
	Prevention of anomalies of labor activity
Chapter 21
placenta, premature detachment of a normally located
placenta)
21.1. placenta previa
	Premature detachment of a normally located plate
21.3. General principles of examination of pregnant women with bleeding
Chapter 22
22.1. Pathology of the subsequent period
	22.1.1. Retained placenta
		Bleeding in the aftermath
	Pathology of the postpartum period
		Bleeding in the early postpartum period
Chapter 23
	Tears of the vulva, vagina and perineum
	Cervical ruptures
	Uterine ruptures

23.4. Management of pregnancy and childbirth in the presence of a scar on the uterus after a previous caesarean section and other operations

24.1.2. Thrombocytopathies

Hemorrhagic shock

DIC

Amniotic fluid embolism

Chapter 25

induced abortion

Termination of pregnancy before 12 weeks

Late pregnancy termination

Complications during and after termination of pregnancy

ness in the early and late periods

Operations in the afterbirth and postpartum periods

Operations that prepare the birth canal

Artificial rupture of the membranes (amniotomy)

Operations that correct the position and presentation of the fetus

(obstetrical turn)

25.6. Obstetric forceps

25.6.1. Forceps operation

Possible difficulties during the operation of imposing aku

sher tongs

25.6.3. Complications during the operation of imposing obstetric

25.7. Obstetric benefits and operations for breech presentations

Manual aid for breech presentation

Extraction of the fetus by the pelvic end

25.7.3. Difficulties and complications in obstetric benefits and

operations for breech presentation of the fetus

Vacuum extraction of the fetus

Cesarean section

25.9.1. Abdominal caesarean section

Immediate and long-term results of the caesarean operation

va section

Abdominal caesarean section for termination

pregnancy

25.9.4. Caesarean section on a dead and dying pregnant woman

25.10. Obstetrical delivery operations

25.11. Fruit-destroying operations

Chapter 26

26.1. Features of the state of newborns in early neonatal

period

Borderline (special) conditions and diseases of newborns

Transient states

Diseases of newborns in early neonatal

Infectious diseases in newborns. . . . . .

Hemolytic disease of the newborn

Respiratory distress syndrome

26.3. Newborn care

Name: Gynecology
Zanko S.N.
The year of publishing: 2010
The size: 29.27 MB
Format: pdf
Language: Russian

The manual "Gynecology" edited by Zanko S.N. discusses the organization of gynecological services, outlines the anatomical and physiological prerequisites for the development of gynecological diseases, their etiopathogenesis, clinical picture, diagnosis, and treatment methods. Aspects of pediatric gynecology, gynecological endocrinology, oncogynecology, emergency conditions are covered. For medical students, gynecologists, anesthesiologists.

Name: Medical abortion in outpatient practice.
Dicke G.B.
The year of publishing: 2018
The size: 3.73 MB
Format: pdf
Language: Russian
Description: The book "Medicated abortion in outpatient practice" considers such topical issues as modern standards for artificial termination of pregnancy, medical abortion is characterized in ... Download the book for free

Name: Scheme for writing the history of childbirth.
Kaptilny V.A., Berishvili M.V., Murashko A.V.
The year of publishing: 2016
The size: 2.83 MB
Format: pdf
Language: Russian
Description: The manual "Scheme for writing the history of childbirth" in obstetrics considers such main accents of the history of childbirth as the design of the title page, passport data, an algorithm for displaying the history of birth is presented ... Download the book for free

Name: Obstetrics. National leadership. 2nd edition.
Savelyeva G.M., Sukhikh G.T., Serov V.N.
The year of publishing: 2018
The size: 13.3 MB
Format: pdf
Language: Russian
Description: The book "Obstetrics. National leadership" edited by G.M. Savelieva of the 2018 edition at a high professional level from the standpoint of modern evidence-based medicine considers the issues of rendering ... Download the book for free

Name: Antiphospholipid syndrome - immune thrombophilia in obstetrics and gynecology
Makatsaria A.D., Bitsadze V.O., Baimuradova S.M., Dolgushina N.V., Yudaeva L.S., Khizroeva D.Kh., Akinshina S.V.
The year of publishing: 2013
The size: 13 MB
Format: pdf
Language: Russian
Description: The book "Antiphospholipid syndrome - immune thrombophilia in obstetrics and gynecology" ed., Pakatsaria A.D., et al.

Name: Guide to Reproductive Medicine
Carr B., Blackwell R., Aziz R.
The year of publishing: 2015
The size: 39.08 MB
Format: pdf
Language: Russian
Description: The book "Guide to Reproductive Medicine" edited by Carr B., et al., considers topical issues of reproductive medicine. Questions of normal physiology and morphogenesis of the reproductive system are covered... Download the book for free

Name: cervicitis
Trusov Yu.V., Kramarsky V.A.
The year of publishing: 2016
The size: 91.96 MB
Format: pdf
Language: Russian
Description: In the book "Cervicitis" ed., Trusov Yu.V., et al., the etiological structure of acute cervicitis, epidemiology, as well as opportunistic infections that play a role in the development of this pathology are considered ... Download the book for free

Name: Selected lectures on gynecology.
Khashaeva T.Kh-M., Omarov N.S-M.
The year of publishing: 2001
The size: 11.58 MB
Format: pdf
Language: Russian
Description: The presented textbook "Selected Lectures on Gynecology" covers in a fairly accessible form the main issues of gynecology, which includes the regulation of the reproductive system, amenorrhea of ​​various types ... Download the book for free

Name: Gynecology.
Radzinsky V.E., Fuks A.M.
The year of publishing: 2014
The size: 236.03 MB
Format: pdf
Language: Russian
Description: Excellent textbook "Gynecology" edited by V.E. Radzinsky and A.M. Fuchs considers the main issues of gynecology at the modern level, citing data from the Russian Federation, the USA and Europe. Describe in your textbook...

See also sections related to section Books on gynecology:

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Below you can download e-books and textbooks for free and read articles and lessons for the Gynecology Books section:

Section content

Description of the section "Books on gynecology"

In this section, you are provided with Books on gynecology. Gynecology is a branch of medicine that studies diseases that are characteristic only of a woman's body, primarily diseases of the female reproductive system. Most gynecologists at the present stage are also obstetricians.

In addition to books on gynecology, in the section you can download books on obstetrics, because gynecology is related to obstetrics, which studies the phenomena in the female body related to pregnancy and childbirth, from the moment of conception to the end of the postpartum period; it is also close to surgery and other departments of practical medicine - nervous, internal diseases, etc.; outstanding representatives of gynecology were in the vast majority at the same time obstetricians or surgeons; but the sexual life of a woman is so complex, it influences the functions of all the organs of her body so much, and the pathological changes in her sexual sphere are so numerous and varied that gynecology itself has become a separate science.

Presented to your attention the book “Obstetrics and gynecology. Abstract of lectures "author Ilyin A.A. designed to prepare students of medical universities for passing tests and exams. The book includes a full course of lectures on obstetrics and gynecology, is written in an accessible language and will be an indispensable tool for those who want to quickly prepare for the exam and pass it successfully.

In the book "Physiology of Human Sexual Life or Marriage Under the Microscope" by author Kiness M., the rich experience of doctors is presented, as well as materials of scientific observations and studies of sexologists from many countries of the world are used.

For students of medical faculties, the textbook "Gynecology" by the author Baisov B.I. is very suitable, which contains modern information on the diagnosis and medical tactics for the main diseases of the female genital organs in both adults and children. A description of currently used additional methods of research is presented, which allow revising some of the provisions of gynecology.

Download all materials of the section for free and without registration.

Ministry of Health of the Russian Federation

St. Petersburg State Medical Academy

named after I.I. Mechnikov

OBSTETRICS

GYNECOLOGY

Quick guide

by practical skills

Under the editorship of prof. D.F. Kostyuchek

Saint Petersburg 2001

UDC 618.1/.7(06)

Obstetrics and gynecology: A brief guide to practical skills / Ed. D. F. Kostyuchek. - St. Petersburg: SPbGMA, 2001. - 116 p.

This publication contains materials necessary for students

VI course in preparation for the state exam in the specialty "obstetrics and gynecology". The focus of the manual is given to the practical skills that students must master upon graduation from a medical school.

The allowance is also necessary for students

IV and V courses, clinical residents, interns, general practitioners (family doctors) and novice obstetrician-gynecologists

The manual was compiled by employees of the Department of Obstetrics and Gynecology No. 1 of the St. Petersburg State Medical Academy named after I.I. Mechnikova (Head of the Department - Prof. D.F. Kostyuchek): associate professors R.K. Ryzhova, E L Nezhentseva, L I Golovina and assistants O.D. Butorina, K.A. Zakharov, V.V. Kropaneva, MG Miroshnichenko, S E Pokrovsky, E.A. Rukoyatkina, N.P. Smirnova.

© St. Petersburg State Medical Academy named after I.I. Mechnikov 2001

INTRODUCTION

The creation of a brief manual was intended to offer students specific materials, the study of which will allow them to consolidate their knowledge and practical skills in the course of "obstetrics and gynecology".

The manual was compiled on the basis of many years of practical and pedagogical experience of the staff of the department and in accordance with the requirements of the State Educational Standard in the specialty 04.01.00 "Medicine".

The section "Obstetrics" covers the issues of diagnosing pregnancy in the early and late periods, examination of the pregnant woman and the condition of the fetus, conducting physiological labor and the postpartum period. Clinical and laboratory criteria for diagnosing physiological and pathological conditions during pregnancy, childbirth and in the postpartum period are presented. The principles of treatment of developed complications are given, indicating specific schemes for the use of drugs. The sequence of actions of an obstetrician in providing emergency care to a pregnant woman, a woman in labor, a puerperal woman and a newborn is succinctly outlined.

In the "Gynecology" section, the main attention is paid to the issues of diagnosing gynecological diseases and plans for examining patients. Clinical and laboratory criteria for substantiating the diagnosis and specific treatment regimens for the most common gynecological diseases are given. Briefly describes the sequence of actions of a gynecologist when performing some gynecological operations. Schemes of modern methods of contraception are presented.

We hope that this manual will facilitate the process of mastering practical skills for students of medical universities, and will help young professionals to successfully use them in practical obstetrics and gynecology.

Section 1. Obstetrics

Section 2. GYNECOLOGY.

Abramchenko V.V., Kiselev A.G., Orlova O.O., Abdulaev D.N. Management of high-risk pregnancy and childbirth. - St. Petersburg, 1995.

Ailamazyan E.K. Obstetrics: Textbook. - St. Petersburg, 1997. - 496 p.

Obstetrics and gynecology: A guide for doctors and students / Per. from English. - M.: Medicine. 1997.

Arias F. Pregnancy and high-risk childbirth. - M.: Medicine, 1989.

Zilber A.P., Shifman E.M. Obstetrics through the eyes of an anesthesiologist. Petrozavodsk. 1997. - 396 p.

linovsky M .S.Operative obstetrics. - M.. 1974.

Savelyeva G.M., Fedorova M.V., Klimenko P.

A ., Sichinova N.G../ Placental insufficiency. - M.: Medicine, 1991. - 276 p.

Seroe VN Strizhakov A N, Markin S A Practical obstetrics: A guide for physicians. M.. 1989.

Solsky Ya.P., Ivchenko VN, Bogdanova G Yu Infectious-toxic shock in obstetric and gynecological practice. - Kyiv Health, 1990. - 272 p.

Repina M.A. Rupture of the uterus. - L.: Medicine, 1984. 203 p.

Repina M.A. Mistakes in obstetric practice. - L Medicine, 1988. - 248 p.

Chernukha E A Generic block. - M.. 1991.

Yakovlev I.I. Emergency care for obstetric pathology. - L., 1965.

Abramchenko V.V., Bashmakova M.A., Korkhov V.V.

Antibiotics in obstetrics and gynecology: A guide for physicians. - St. Petersburg: SpecLit. 2000 219s.

Abramchenko V.V., Kostyuchek D.F., Khadzhieva E.D. Purulent-septic infection in obstetric and gynecological practice St. Petersburg, 2000 520 s

Ailamazyan E.K. Emergency care for extreme conditions in gynecology. - St. Petersburg, 1992.

Bohman Ya.V. Guide to oncogynecology - L .: Medicine, 1989 -464 p.

Serov V.N., Prilepskaya V.N., Pshenichnikova T.Ya. Gynecological Endocrinology: Scientific and Practical Edition. - M.: Medicine, 1993 - 419 s

Smetnykh V.P., Tumilovich L.G., Non-operative gynecology A guide for physicians. - Prince. 1, 2. - St. Petersburg: Sotis, 1995. - 224 p.; 224 s

Handbook of Obstetrics and Gynecology / Ed.

I M. Savelieva - M.. Medicine. 1992.

Cand. honey. Sciences B.I. Baisova, Dr. honey. sciences, prof. DA Bizhanova, Ph.D. honey. Sciences L.N. Boginskaya, Dr. honey. sciences, prof. V.G. Breusenko, Ph.D. honey. Sciences Yu.A. Head, Ph.D. honey. Sciences AA Evseev, Ph.D. honey. sciences, prof. L.M. Kappushsva, dr. honey. sciences, prof. V.F. Kokolina, Ph.D. honey. Sciences I.A. Krasnova, Ph.D. honey. Sciences K.V. Krasnopolskaya, prof., acad. RAMS G.M. Savelyeva, Ph.D. honey. Sciences A.A. Solomatina, Ph.D. honey. Sciences S V. Shtyrov

R e e n s e n t s:

Head Department No. 2 of Obstetrics and Gynecology, Moscow Medical Academy. THEM. Sechenov prof., acad. RAMN A.N. Strizhakov; head Department of Obstetrics and Gynecology of the Medical Faculty with a postgraduate education course of the Moscow State University of Medicine and Dentistry, Dr. honey. sciences, prof.I. B. Manukhin

Illustrations for the publication were prepared by Ph.D. honey. Sciences St. Shtyrov. Figures 1.1,1.2, 1.5-1.7, 22.2, 22.3 were made by surgeon A.V. Evseev.

G49 Gynecology: Textbook / Ed. G.M. Savelieva, V.G. Breusen co. - M.: GEOTAR - MED, 2004. - 480 p.

ISBN 5-9231-0330-3

The textbook was created by the staff of the Department of Obstetrics and Gynecology of the Pediatric Faculty of the Russian State Medical University in accordance with the curriculum and contains up-to-date information on the diagnosis and medical tactics for the main diseases of the female genital organs in both adults and children. A description of currently used additional methods of research is presented, which allow revising some provisions of gynecology. Much attention is paid to ultrasonic diagnostics using dopplerometry of blood flow in the ovaries, uterus, hydrosonography. The importance of endoscopy (hysteroscopy and laparoscopy) in gynecological practice is shown. The textbook is illustrated with original photographs of ultrasound and endoscopy data.

The rights to this publication belong to the publishing house "GEOTAR-MED". No part or whole publication may be reproduced or distributed in any form without the written permission of the publishing house.

© Illustrations. Evseev A.V., 2004

ISBN 5-9231-0330-3 © GEOTAR-MED Publishing House, 2004

FOREWORD

In connection with the rapid development of technology, many provisions in medicine, including gynecology, are constantly being revised. Diagnostics is being refined, therapeutic measures are being improved. So, at present, ultrasound diagnostics, hydrosonography, and the study of blood flow in tumors of the uterus and appendages provide invaluable assistance in the diagnosis of diseases of the female genital organs. It is difficult to overestimate the importance of endoscopy (hysteroscopy and laparoscopy) both in the diagnosis and treatment of many gynecological diseases. With the introduction of endoscopy, it became possible to carry out organ-preserving measures. Pediatric gynecology has become an important section, which is not specially allocated in many regions of the country, and developments in this area are becoming more and more relevant.

Textbooks do not always keep up with the changes taking place in clinical practice, which should be known to both young doctors and gynecologists working in medical institutions. This determined the need for the publication of a textbook on topical issues of gynecology.

Acad. RAMS prof. G.M. Savel'eva, Honored Doctor of the Russian Federation prof. V.G. Breusenko, Professor V.F. Kokolina, L.M. Kappusheva, D.A. Bizhanova, associate professor doctor of medical sciences K.V. Krasnopolskaya, associate professors, candidates of medical sciences L.N. Boginskaya, A.A. Evseev, A.A. Solomatina, Candidate of Medical Sciences I.A. Krasnova, Yu.A. Head, B.I. Baisova, Leading Researcher Candidate of Medical Sciences SV. Shtyrov.

METHODS OF EXAMINATION OF GYNECOLOGICAL PATIENTS

1.1. HISTORY AND EXAMINATION

Scheme for collecting anamnesis of gynecological patients:

main complaint;

additional complaints;

past illnesses;

menstrual and reproductive functions, contraception;

gynecological diseases and operations on the genitals;

family history;

lifestyle, nutrition, bad habits, working and living conditions;

history of present illness.

Communication with patients is an integral part of the work of a doctor. The ability to conduct a dialogue, listen carefully and answer questions truthfully helps the doctor understand the patient, understand the causes of her illness and choose the best method of treatment.

Regardless of the style of communication, the patient should feel that the doctor is ready to listen to her and keep everything she says in secret. Previously, the doctor has always acted as a mentor, giving the patient a guide to action. Now patients prefer more equal relations, they do not expect commands, but advice, they demand respect for their own, albeit unprofessional, opinion. The patient should take an active part in the choice of treatment method, should be aware of its possible consequences and complications. The patient must give written consent to various manipulations and operations.

2 about Chapter 1

On examination, determine the type of physique;

female;

male (tall, broad shoulders, long torso, broad shoulders, narrow pelvis);

eunuchoid (tall, narrow shoulders, narrow pelvis, long legs, short torso).

Significant deviations in body type give an idea of ​​the features of the period of puberty. So, with hyperandrogenism in the pubertal period, a male or viril type of physique is formed, and with insufficiency of the hormonal function of the ovaries, the physique acquires eunuchoid features.

Phenotypic features: dysplasia and dysmorphia (micro- and retrognathia, arched palate, wide flat nose bridge, low-lying auricles, short stature, short neck with skin folds, barrel-shaped chest, etc.), characteristic of various clinical forms of genital development disorders glands.

Hair growth and skin condition: excessive hairiness, skin condition (increased sebum, acne, folliculitis, increased porosity), stretch marks, their color, number and location.

Condition of the mammary glands: size, hypoplasia, hypertrophy, symmetry, skin changes. In a patient in a standing and lying position, sequential palpation of the outer and inner quadrants of the gland is performed. It is necessary to note the absence or presence of discharge from the nipples, its color, texture and character. Brown discharge from the nipples or an admixture of blood indicate a possible malignant process or papillary growths in the ducts of the mammary gland; liquid transparent or greenish discharge is characteristic of cystic changes in the gland. The appearance of milk or colostrum with pressure on the areola, in combination with amenorrhea or oligomenorrhea, makes it possible to establish the diagnosis of ha- lactorrhea-amenorrhea - one of the forms of hypothalamic disorders of reproductive function. In this situation, it is also necessary to exclude prolactin-secreting pituitary adenoma.

Nodes in the mammary glands, determined by palpation, serve as an indication for ultrasound of the mammary glands and mammography.

Determination of body length and weight necessary to calculate the body mass index (BMI) - the ratio of body weight to the square of body length:

Methods of examination of gynecological patients * 3

The normal BMI of a woman of reproductive age is 20-26. BMI over 40 (corresponds to IV degree obesity) indicates a high probability of metabolic disorders.

With overweight, it is necessary to find out when obesity began: from childhood, at puberty, after the onset of sexual activity, after abortion or childbirth.

Abdominal examination carried out in the position of the patient lying on his back. On palpation, the sizes of individual organs are determined, ascites, flatulence, and volumetric formations are excluded. Palpation begins with determining the position, texture and shape of the edge of the liver. The size of the liver is determined by percussion. Then, in a clockwise direction, the remaining organs of the abdominal cavity are palpated. This is followed by auscultation of the abdomen. Note intestinal peristalsis.

By palpation, the state of the abdominal wall is determined (tonus, muscle protection, diastasis of the rectus abdominis muscles), painful areas, the presence of tumors, infiltrates in the abdominal cavity.

Examination of the abdomen can provide very valuable information. Thus, if a patient with a pelvic mass is found to have a mass in the epigastric or umbilical region, ovarian cancer with metastases to the greater omentum should be ruled out.

Gynecological examination carried out on a gynecological chair. The patient's legs lie on supports, buttocks on the edge of the chair. In this position, you can examine the vulva and easily insert the mirror into the vagina.

Examination of the external genitalia: condition and size of small and large labia; condition of mucous membranes (juiciness, color, condition of cervical mucus); the size of the clitoris; hair development; condition of the perineum; the presence of pathological processes (inflammation, tumors, ulcerations, warts, fistulas, scars). Hypoplasia of the labia minora and labia majora, pallor and dryness of the vaginal mucosa indicate hypoestrogenism. Juiciness and cyanosis of the mucous membrane of the vulva, abundant transparent secretion are signs of hyperestrogenism. Hypoplasia of the labia minora, an increase in the head of the clitoris, an increase in the distance between the base of the clitoris and the external opening of the urethra (more than 2 cm) in combination with hypertrichosis indicate a congenital adrenogenital syndrome. They also pay attention to the gaping of the genital slit; pre-

Chapter 4

lying down to a woman to push, determine if there is a prolapse or prolapse of the walls of the vagina and uterus.

Examination of the vagina and cervix in the mirrors (Fig. 1.1) is carried out by women who are sexually active. Timely recognition of cervical cancer, erosions, polyps and other diseases related to precancerous conditions is possible only with the help of mirrors. Particular attention is paid to the vaults of the vagina, since volumetric formations and genital warts are often located there. When examined in mirrors, swabs are taken for flora, cytological examination, a biopsy of volumetric formations of the cervix and vagina is possible.

Bimanual (two-handed vaginal-abdominal) examination

carried out after removing the mirrors. The index and middle fingers of one gloved hand (usually the right) are inserted into the vagina. The other hand (usually the left) is placed on the anterior abdominal wall. With the right hand, the walls of the vagina, its vaults and the cervix are palpated, any volumetric formations and anatomical changes are noted. Then, carefully inserting fingers into the posterior fornix of the vagina, the uterus is displaced forward and upward and palpated with the other hand through the anterior abdominal wall. They note the position, size, shape, mobility, consistency and mobility of the uterus, pay attention

on volumetric formations (Fig. 1.2).

Rectovaginal examination necessarily in postmenopause, as well as in all cases when it is necessary to clarify the condition of the uterine appendages. Some authors suggest that it be performed for all women over 40 years of age to exclude concomitant diseases of the rectum. During rectal examination, the tone of the sphincters of the anus and the condition of the muscles of the pelvic floor are determined,

Rice. 1.2. Bimanual (two-handed vaginal-abdominal) examination.

12. SPECIAL RESEARCH METHODS

1.2.1. Functional diagnostic tests

Functional diagnostic tests used to determine the functional state of the reproductive system have not lost their value so far.

Symptom "pupil" allows you to judge the production of estrogen by the ovaries. With a two-phase menstrual cycle, the external opening of the cervical canal from the 5th day of the cycle begins to expand, reaching a maximum by the time of ovulation. In the second phase of the cycle, the external uterine os begins to gradually close, and there is no mucus in its lumen.

Symptom of distension of the cervical mucus also allows you to judge the production of estrogen by the ovaries. The maximum stretching of the mucous thread from the cervical canal occurs at the time of ovulation and reaches 10-12 cm.

Karyopyknotic index (KPP)- the ratio of keratinized and intermediate cells during microscopic examination of a smear from the posterior fornix of the vagina. During the ovulatory menstrual cycle, the KPI is: per-

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in the first phase 25-30%, during ovulation - 60-80%, in the middle of the second phase - 25-30%.

Basal temperature(temperature in the rectum) depends on the phase of the menstrual cycle. In an ovulatory cycle with a full first and second phases, the basal temperature rises by 0.5 ° C immediately after ovulation and remains at this level for 12-14 days. The rise in temperature is due to the influence of progesterone on the center of thermoregulation (Fig. 1.3). If the second phase of the cycle is insufficient, the hyperthermic phase lasts less than 8-10 days, rises in steps or periodically falls below 37 ° C. During anovulation, the temperature curve remains monophasic (Fig. 1.4).

Indicators of tests of functional diagnostics during the ovulatory cycle are given in table. one.

Table 1. Indicators of functional diagnostic tests during the ovulatory menstrual cycle

Indicators		Days of the menstrual cycle
functional
diagnostics
stretching
cervical
slime, see
Symptom "pupil"
Basal
temperature, °C

Note. * - day of ovulation, (-) - days of the cycle before ovulation, (+) - days of the cycle after ovulation.

An accurate method for assessing ovarian function remains histological examination of endometrial scrapings. Secretory endometrium, removed during curettage of the uterus 2-3 days before the onset of menstruation, with an accuracy of 90% indicates that ovulation has occurred.

1.2.2. Tissue biopsy and cytology

Biopsy - intravital taking of a small amount of tissue for microscopic examination for the purpose of diagnosis. In gynecology

Rice. 1.3. Basal (rectal) temperature during a normal two-phase menstrual cycle.

Rice. 1.4. Basal (rectal) temperature during a single-phase (anovulatory) menstrual cycle.