編輯推薦
正版原版,原汁原味,留學生與雙語教學用。
內容簡介
本書係統地介紹瞭婦産科學的基本知識,包括婦産科的解剖、生理、孕産期保健、産科常見並發癥和閤並癥及各種婦科疾病的診斷與治療等。內容簡明易懂,圖文並茂,適閤作為臨床醫學專業本科生中英文雙語教學、留學生英文教學、碩士研究生和博士研究生教學的婦産科學教材。本書也可以作為其他醫學相關專業學生和青年醫生學習婦産科學的參考教材。
作者簡介
薛鳳霞,天津醫科大學總醫院婦産科行政主任,教授,博導。中華醫學會婦産科分會常委,中華婦産科雜誌編委,從事國際學院、7年製教學多年。國傢十一五教材《婦産科學》編委,全國高等醫藥院校教材《婦産科學》五年製、七年製編委。主持國傢自然基金等科研項目10餘項。獲得天津市科技進步奬等多項奬項。
內頁插圖
目錄
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
精彩書摘
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.
……
《婦産科學:為留學生與雙語教學量身打造的經典之作》 引言 在醫學飛速發展的今天,婦産科學作為一門古老而又充滿活力的學科,始終站在守護女性生命與健康的最前沿。從生命的孕育到分娩的奇跡,再到女性生殖係統的健康維護,婦産科學的研究和臨床實踐覆蓋瞭女性一生中的關鍵時期。為瞭滿足日益增長的國際醫學交流需求,以及為全球各地的雙語教學提供堅實的學術支撐,《婦産科學(英文原版改編版留學生與雙語教學用)》應運而生。本書並非簡單的翻譯,而是基於權威英文原版教材,針對留學生及雙語教學的特殊需求,進行瞭深入的改編與優化,旨在提供一本既符閤國際學術標準,又易於理解和掌握的婦産科學學習指南。 本書特色與價值 本書的核心價值在於其“為留學生與雙語教學量身打造”的定位。這意味著它在內容選擇、編排結構、語言錶述以及教學輔助等方麵,都充分考慮瞭非母語學習者的認知特點和教學實踐中的實際需求。 精選與優化內容,聚焦核心知識: 針對留學生在有限的學習時間內需要掌握的婦産科核心知識點,本書精選瞭最具代錶性、最實用、最前沿的醫學內容。原版教材的廣博性是其優勢,但對於初學者或需要集中精力攻剋特定知識點的學習者而言,精煉和聚焦則更為重要。本書的改編過程,正是對大量信息進行梳理、提煉和優化的過程,確保瞭學習者能夠高效地抓住婦産科學的精髓。 雙語教學的無縫對接: 本書的另一大亮點是其對雙語教學的完美支持。它不僅保留瞭英文原版的嚴謹學術體係,更在必要之處輔以詳盡的中文解釋和說明。這種設計使得教師在進行雙語授課時,能夠輕鬆地在兩種語言之間切換,為學生提供清晰、準確的學習路徑。對於留學生而言,本書提供瞭深入理解醫學概念的橋梁,有助於他們在掌握英文醫學術語的同時,不失對概念本身的深刻理解。 嚴謹的學術風格與現代的臨床視角: 本書在保留原版教材嚴謹的學術風格的同時,積極融入瞭最新的臨床研究成果和治療指南。從胚胎發育的微觀機製,到各種婦科疾病的診斷與治療,再到圍産期醫學的最新進展,本書都力求展現當前婦産科學領域的最新動態和最佳實踐。這使得本書不僅是學習理論知識的工具,更是瞭解行業前沿、培養臨床思維的寶貴資源。 清晰的結構與直觀的呈現: 為瞭方便讀者理解和記憶,本書在結構編排上力求清晰。各章節圍繞特定的主題展開,邏輯嚴謹,循序漸進。大量的插圖、圖錶、病例分析等視覺化和案例化的呈現方式,極大地增強瞭內容的直觀性和易讀性。這些輔助材料不僅有助於概念的理解,更能幫助學習者將理論知識與實際臨床情境聯係起來。 為臨床實踐打下堅實基礎: 婦産科學是一門高度依賴臨床實踐的學科。本書通過深入淺齣的講解,將復雜的理論知識轉化為易於理解的語言,並結閤大量臨床案例,幫助學習者理解疾病的發生、發展過程,以及各種診斷和治療方法的原理與應用。這為未來的臨床實習和執業打下瞭堅實的基礎,使其能夠自信地應對各種臨床挑戰。 內容概覽(未包含具體書籍內容,僅為一般性介紹) 本書全麵覆蓋瞭婦産科學的各大分支,為讀者提供瞭一個完整的知識體係。 第一部分:普通婦科學(General Gynecology) 此部分深入探討瞭女性生殖係統的解剖生理、發育與衰老、月經生理與病理,以及女性生殖器官的常見疾病。 女性生殖係統的解剖與生理: 從宏觀到微觀,詳細闡述瞭女性外生殖器、陰道、子宮、輸卵管、卵巢等器官的結構特徵,以及它們在維持生殖功能和內分泌平衡中的作用。生理部分則著重講解瞭下丘腦-垂體-卵巢軸的調控機製,排卵過程,以及雌激素、孕激素等激素的生理作用。 生殖道的發育與衰老: 梳理瞭女性生殖器官在青春期、成年期、圍絕經期及絕經期各個階段的生理性變化,有助於理解不同年齡段女性可能麵臨的健康問題。 月經生理與病理: 詳細解釋瞭正常的月經周期,以及由此可能引發的月經失調,如月經過多、過少、痛經、閉經等。書中將結閤最新的研究,分析月經紊亂的常見病因和發病機製。 婦科炎癥與感染: 涵蓋瞭外陰、陰道、宮頸、子宮、輸卵管、卵巢等部位的常見炎癥和感染性疾病,包括細菌性陰道病、滴蟲性陰道炎、黴菌性陰道炎、盆腔炎等。重點講解病原體、臨床錶現、診斷方法以及抗菌藥物的選擇與應用。 子宮肌瘤與子宮內膜異位癥: 作為婦科常見的良性腫瘤和慢性疾病,本書將詳細介紹這兩類疾病的發病機製、臨床錶現、影像學診斷、手術與藥物治療策略,以及對生育的影響。 卵巢囊腫與腫瘤: 針對各種類型的卵巢囊腫和卵巢腫瘤,本書將提供詳細的鑒彆診斷方法,包括影像學、腫瘤標誌物等,並介紹手術治療的原則和進展。 女性生殖器官的良性與惡性腫瘤: 重點關注宮頸癌、子宮內膜癌、卵巢癌等常見婦科惡性腫瘤,深入分析其病因、危險因素、篩查方法、早期診斷、分期、放化療及靶嚮治療等綜閤治療手段。 盆底功能障礙: 隨著人口老齡化,盆底功能障礙越來越受到重視。本書將介紹尿失禁、盆腔髒器脫垂等常見問題,並探討其預防和治療方法。 不孕不育: 詳細闡述瞭女性不孕的各種原因,包括排卵障礙、輸卵管因素、子宮因素、免疫因素等,並介紹輔助生殖技術(ART)如體外受精-胚胎移植(IVF-ET)的應用。 計劃生育與避孕: 涵蓋瞭各種避孕方法的原理、效果、適應癥與禁忌癥,以及人工流産、計劃生育手術等內容。 第二部分:産科學(Obstetrics) 此部分聚焦於妊娠、分娩、産褥期以及新生兒的健康,強調母嬰安全。 妊娠生理: 詳細描述瞭受精、著床、胎盤形成、羊水生成與吸收等早期妊娠過程,以及母體在妊娠期間發生的解剖、生理和內分泌變化,如心血管係統、呼吸係統、消化係統、泌尿係統和內分泌係統的適應性改變。 産前檢查與保健: 強調規範化産檢的重要性,講解孕期常規檢查項目,如孕早期篩查、孕中期唐氏篩查、四維彩超等,以及孕期營養、運動、心理等保健指導。 妊娠期閤並癥與並發癥: 深入分析妊娠期高血壓疾病(包括妊娠期高血壓、子癇前期、子癇)、妊娠期糖尿病、前置胎盤、胎盤早剝、羊水過多/過少、多胎妊娠等常見疾病的病因、發病機製、臨床錶現、診斷和處理。 早孕期問題: 涵蓋瞭異位妊娠(宮外孕)、先兆流産、難免流産、稽留流産等常見早孕期並發癥的診斷與處理。 分娩生理與産程管理: 詳細講解瞭分娩的動力、産道、胎兒三個因素,以及正常産程的各個階段。重點介紹對産程的監測與評估,以及在齣現異常産程時如何進行乾預。 分娩方式: 詳細介紹瞭陰道分娩和剖宮産的適應癥、禁忌癥、手術過程和並發癥。 難産的處理: 針對骨盆狹窄、胎位異常、巨大兒等導緻的難産,本書將介紹助産技術、産鉗助産、胎頭吸引器助産以及剖宮産的適應癥和選擇。 産科齣血: 産後齣血是産科最嚴重的並發癥之一。本書將詳細闡述其病因、預防、診斷和多種止血方法,包括藥物止血、子宮填塞、手術止血等。 胎兒醫學: 涵蓋瞭胎兒生長發育的監測,胎兒宮內窘迫的診斷與處理,胎兒宮內感染,以及胎兒先天性疾病的産前診斷技術,如羊膜穿刺、絨毛膜穿刺、無創DNA檢測等。 新生兒監護: 關注新生兒的健康與安全,包括早産兒、低體重兒、宮內窘迫新生兒的監護與處理。 産褥期保健: 講解産後母體恢復過程中的生理變化、常見並發癥(如産褥感染、乳腺炎)的防治,以及母乳喂養的指導。 第三部分:生殖內分泌與生殖醫學(Reproductive Endocrinology and Reproductive Medicine) 此部分擴展瞭對生殖相關的內分泌調控以及輔助生殖技術的研究。 生殖內分泌疾病: 深入探討多囊卵巢綜閤徵(PCOS)、性早熟、青春期延遲、圍絕經期綜閤徵等內分泌失調性疾病的診斷和治療。 不孕不育的進一步探討: 在不孕不育部分的基礎上,更深入地探討免疫性不孕、內分泌性不孕的診斷與治療。 輔助生殖技術(ART): 詳細介紹體外受精(IVF)、卵胞漿內單精子注射(ICSI)、胚胎冷凍、人工授精(AI)等輔助生殖技術的操作流程、適應癥、倫理問題及最新進展。 本書的目標讀者 本書的目標讀者群體廣泛,包括但不限於: 醫學留學生: 尤其是在英語國傢學習婦産科學或希望提升英文醫學能力的學生。 國內醫學院校的教師: 緻力於開展婦産科學雙語教學的教師。 國內醫學院校的學生: 希望接觸和學習英文原版教材,拓寬學術視野的學生。 年輕的婦産科醫師: 希望通過英文原版文獻提升專業知識和臨床技能的醫生。 對婦産科學感興趣的研究人員: 需要深入瞭解國際學術前沿的科研工作者。 結語 《婦産科學(英文原版改編版留學生與雙語教學用)》的齣版,標誌著一本旨在連接全球醫學教育、促進知識交流的重要學術著作的誕生。本書憑藉其嚴謹的內容、創新的編排和對雙語教學的深刻理解,必將成為婦産科學領域留學生和雙語教學的重要參考。它不僅是知識的載體,更是思維的啓迪,是連接不同文化背景下婦産科學學習者的橋梁,為培養具有國際視野的婦産科人纔貢獻力量。通過本書的學習,讀者將能夠係統地掌握婦産科學的理論知識,培養敏銳的臨床思維,為守護女性一生健康打下堅實的基礎。