Chapter 1．APPLIED EMBRYOLOGY 1
Gametogenesis 1
Fertilization 3
Development of the Embryo 5
Fetal Growth 12
Extraembryonic Fetal Structures 21
Ovular Defects 26
Abnormalities of the Placenta，Cord and Membranes 29
Twinning 31
Chapter 2．EMBRYONIC DEVELOPMENT OF THE GENITALIA 34
Stage 1 34
Stage 2 39
Stage 3 42
Stage 4 45
Stage 5 50
Development of the Pelvic Floor 51
Development of the Bony Pelvis 52
Clinical Connotations 54
Chapter 3．DEVELOPMENTAL ABNORMALITIES OF THE GENITALIA 57
Perineum and Vulva 57
Urethra，Bladder and Ureter 57
Hymen 60
Vagina 61
Uterus 63
Uterine Tube 67
Ovary 67
Intersexuality 68
Chapter 4．GYNECOLOGIC ASPECTS OF CHILDHOOD 73
Genital Development 73
Development of the Bony Pelvis 76
Psychologic Development 77
History and Examination 78
Endocrine Disorders 80
Genital Infections 89
Genital Tumors 93
Chapter 5．GYNECOLOGIC PROBLEMS OF ADOLESCENCE 99
Growth Processes 99
History and Examination 102
Instruction in Genital Physiology 103
Menstrual Problems 103
The Management of Menstrual Disorders 107
Leukorrhea 110
Genital Neoplasms 111
Pregnancy 112
Other Problems 112
Chapter 6．APPLIED ANATOMY OF THE ADULT GENITALIA 114
Perineum 114
Pelvic Diaphragm 122
Genital Viscera 123
The Urinary Tract 129
Pelvic Bowel 134
Supporting Structures 136
Other Pelvic Muscles 140
Pelvic Lymphatics 141
Pelvic Blood Vessels 143
Pelvic Autonomic Nerves 146
Bony Structure of the Pelvis 148
Pelvic Articulations and Ligaments 155
Chapter 7．APPLIED HISTOLOGY OF THE ADULT GENITALIA 159
The Vulva 159
The Vagina 162
The Cervix 163
Isthmic Portion of the Uterine Corpus 168
The Uterine Corpus 169
The Uterine Tubes 178
The Broad Ligaments 181
The Ovary 184
Chapter 8．PHYSIOLOGY OF THE FEMALE GENITALIA(EXCLUSIVE OF PREGNANCY) 200
Endocrine Factors 200
The Ovary 207
The Uterine Tube 213
The Uterus 214
Cervix 224
Vagina 226
Vestibule and Vulva 228
Libido and Coitus 229
The Effect of Hysterectomy 231
The Pelvic Musculofascial Supporting Structures 231
Chapter 9．GYNECOLOGIC EXAMINATION 235
History 235
Examination 238
Chapter 10．MENSTRUAL DISORDERS 245
Ovulatory Pain 245
Premenstrual Disturbances 245
Dysfunctional Uterine Bleeding 246
Intermenstrual Bleeding 251
Anovulatory Menstruation 253
Extragenital Menstruation 255
Primary Dysmenorrhea 255
Secondary Dysmenorrhea 258
Amenorrhea 259
Infrequent Menstruation 268
Chapter 11．COITAL DIFFICULTIES 271
Causative Factors 271
History 274
Examination 274
Management 275
Chapter 12．REPRODUCTIVE FAILURE 278
History 278
Examination 279
Etiology 281
Diagnosis 288
Treatment 297
Chapter 13．PHYSIOLOGIC CHANGES IN PREGNANCY 305
Ovary 305
Uterine Tube 307
Uterus 308
Vagina 315
Vulva and Perineum 316
Pelvic Vasculature and Lymphatics 316
Pelvic Supporting Tissues 316
Bony and Ligamentous Pelvis 316
Cardiovascular System 317
Respiratory Tract 318
Gastrointestinal Tract 319
Liver 319
Urinary Tract 320
The Blood 322
Endocrine System 325
Metabolic Changes 327
Breasts 346
Psychologic Changes 346
Skin 347
Skeletal Changes 347
Fetus 347
Umbilical Cord 350
Membranes 350
Placenta 351
Chapter 14．THE DIAGNOSIS OF PREGNANCY 358
History 358
Signs and Symptoms 359
Examination 364
Estimating Pelvic Capacity 374
Chapter 15．ABORTION 383
Etiology 383
Threatened Abortion 388
Inevitable Abortion 390
Complete Abortion 392
Incomplete Abortion 392
Missed Abortion 393
Habitual Abortion 394
Infected Abortion 396
Uterine Perforation 399
Therapeutic Abortion 400
Chapter 16．ECTOPIC PREGNANCY 405
Tubal Pregnancy 405
Abdominal Pregnancy 417
Ovarian Pregnancy 419
Intraligamentous Pregnancy 421
Cervical Pregnancy 421
Angular Pregnancy 421
Cornual Pregnancy 421
Pregnancy in a Rudimentary Horn of the Uterus 422
Pregnancy in a Uterine Diverticulum 422
Combined Pregnancies 422
The Uterus in Ectopic Pregnancy 423
Treatment of Ectopic Pregnancy 423
Chapter 17．MANAGEMENT OF NORMAL PREGNANCY 428
First Trimester 428
Second Trimester 438
Third Trimester 444
Surgery during Pregnancy 449
Chapter 18．NORMAL LABOR 451
Prodromal Period 453
First Stage of Normal Labor 457
Second Stage of Labor 462
Third Stage 470
Immediate Pospartum Period 473
Management of Labor 474
Analgesia，Amnesia and Anesthesia 482
Chapter 19．THE PUERPERIUM 491
Early Puerperium 491
Lactation 498
Late Puerperium 498
Management of the Puerperium 500
Chapter 20．DISORDERS COMPLICATING PREGNANCY 508
Heart Disease 508
Chronic Hypertensive Vascular Disease 514
Thrombophlebitic Disorders 518
Blood Disorders 518
Diabetes Mellitus 520
Other Endocrine Disorders 525
Urinary Tract Disorders 526
Pulmonary Disorders 530
Gastrointestinal Disorders 533
Liver Disease 534
Orthopedic Disorders 535
Surgical Problems 535
Psychiatric Disturbances 538
Neurologic Disorders 539
Infectious Diseases 541
Tropical Diseases 542
Skin Disorders 543
Syphilis 543
Chapter 21．DISEASES OF PREGNANCY 549
Preeclampsia and Eclampsia 549
Chronic Hypertensive Disease with Superimposed Acute Toxemia 573
Placenta Praevia 574
Abruptio Placentae 579
Hyperemesis Gravidarum 583
Tumors of the Placenta and Membranes 585
Anomalies of the Placenta and Cord 592
Diseases of the Membranes 594
Diseases of the Placenta 595
Chapter 22．PREMATURE LABOR AND DELIVERY 600
Clinical Aspects 600
Etiology 600
Treatment 603
Chapter 23．LESS COMMON CEPHALIC PRESENTATIONS 605
Occiput Posterior Positions 605
Persistent Occiput Posterior Positions 611
Persistent Occiput Transverse Positions 615
Face Presentations 617
Brow Presentation 624
Chapter 24．BREECH PRESENTATION 628
Etiology 628
Diagnosis 628
Mechanism of Labor 630
Prognosis 633
Principles of Management 635
Management of Labor 636
Complications 640
Chapter 25．TRANSVERSE PRESENTATION 644
Diagnosis 644
Etiology 646
Labor 647
Principles of Treatment 648
Chapter 26．MULTIPLE PREGNANCY 651
Incidence 651
Antepartum Course 652
Diagnosis 654
Differential Diagnosis 654
Etiology and Development 654
Labor 656
Principles of Management 657
Conjoined Twins 659
Chapter 27．DIFFICULT LABOR DUE TO ABNORMALITIES OF PELVIC STRUCTURE 660
Etiology of Pelvic Contractions 660
Types of Contracted Pelves 662
Diagnosis of Pelvic Contractions 666
Effect of Pelvic Contractions on Labor 667
Management 668
Chapter 28．DIFFICULT LABOR ASSOCIATED WITH FETAL ABNORMALITIES 671
Hydrocephalus 671
Anencephaly 673
Fetal Tumors 674
Double Monsters 676
Excessive Fetal Size 676
Prolonged Pregnancy and Postmature Fetus 678
Chapter 29．DIFFICULT LABOR DUE TO ABNORMALITIES OF THE EXPULSIVE FORCES 681
Uterine Inertia 681
Incoordinate Uterine Action 686
Pathologic Retraction 688
Constriction Ring 689
Precipitate Labor 691
Missed Labor 692
Prolonged Labor 693
Chapter 30．OPERATIVE OBSTETRICS 701
The Forceps 701
Cesarean Section 708
Cervicotomy 717
Manual Rotation 717
Manual Flexion of the Extended Head 717
Manual Rotation of the Shoulders 718
Vernon 718
Manual Extraction of the Placenta 722
Packing the Uterus 722
Symphysiotomy 722
Vaginal Hysterotomy 723
Destructive Operations 723
Chapter 31．ACCIDENTS DURING LABOR 728
Antepartum Hemorrhage 728
Rupture of the Uterus 729
Cervical Injuries 733
Vaginal Injuries 735
Injury to the Pelvic Supports 736
Perineal and Vulvar Lacerations 736
Inversion of the Uterus 738
Amniotic Fluid Embolism 740
Air Embolism 740
Prolapse of the Cord 741
Other Accidents of Labor 742
Fibrinogenopenia 743
Intrapartum and Postpartum Collapse 744
Placenta Accreta 745
Retained Placenta 746
Postpartum Hemorrhage 747
Chapter 32．DISORDERS OF THE PUERPERIUM 752
Hematomas 752
Retained Lochia 753
Subinvolution 754
Traumatic Neuritis 755
Puerperal Hemorrhage 755
Puerperal Mastitis 756
Chapter 33．THE NEWBORN INFANT 758
The Examination 758
Anoxia 759
Intracranial Hemorrhage 761
Neonatal Apnea 763
Other Injuries 768
Developmental Anomalies 770
Prematurity 774
Hyaline-Like Membrane Syndrome 776
Hemolytic Disease of the Fetus and Newborn 777
Chapter 34．TRAUMATIC LESIONS OF THE GENITALIA 789
Obstetric Injuries of the Perineum 789
Rectocele 790
Urethrocele 792
Cystocele and Cystourethrocele 792
Uterine Descensus 794
Pelvic Hernias 796
Lesions Resulting from External Trauma 798
Urogenital Fistulas 799
Enterogenital Fistulas 804
Chapter 35．URINARY INCONTINENCE 810
Regional Anatomy 810
Physiology 812
Stress Incontinence 813
Urogenital Fistulas 816
Incontinence Due to Intrinsic Urinary Tract Lesions 818
Incontinence Due to Dysfunction of the Uretrovesical Sphincteric Mechanism 819
Incontinence Due to Neurologic Disorders 819
Incontinence Due to Embryonic Malformotion of the Urinary Tract 819
Chapter 36．UTERINE DISPLACEMENTS 821
Anterior Displacements 822
Posterior Displacements 823
Lateral Displacements 830
Torsion 830
Chapter 37．DISEASES OF THE VULVA AND THE VAGINA 831
Infections 831
Allergic Disorders 847
Common Dermatologic Disorders 847
Vulvar Neurodermatitis 850
Kraurosis and Leukoplakia 851
Lesions Secondary to Systemic Disorders 854
Urethral Disorders 855
Leukorrhea 861
Chapter 38．DISEASES OF THE UTERUS，UTERINE TUBES AND OVARIES 869
Diseases of the Cervix 869
Diseases of the Uterine Corpus 881
Postabortive and Puerperal Infections 886
Other Acute Pelvic Infections 891
Tuberculosis 894
Gonorrhea 902
Residuals of Pelvic Infection 907
Thrombosis and Thrombophlebitis 912
Syphilis 916
Other Disorders 917
Chapter 39．BENIGN TUMORS OF THE VULVA 923
Vulvar Cysts 923
Adenomas of the Vulva 928
Vulvar Endometriosis 929
Condylomata Accuminata 930
Papillomas 931
Other Benign Tumors 931
Chapter 40．BENIGN TUMORS OF THE VAGINA 933
Mesonephric(Gartner)Duct Cysts 933
Paramesonephric Duct Cysts 935
Inclusion Cysts of the Vagina 935
Vaginal Endometriosis 936
Granulation Polyps 937
Squamous Cell Papillomas 938
Vaginal Fibromyomas 938
Vaginitis Emphysematosa 938
Other Tumors of the Vagina 939
Chapter 41．BENIGN TUMORS OF THE UTERUS 941
Benign Cervical Tumors 941
Benign Tumors of the Uterine Corpus 948
Excessive Enlargement of the Nonpregnant Uterus 969
Chapter 42．BENIGN TUMORS OF THE UTERINE TUBES AND PELVIC SUPPORTING STRUCTURES 974
Tumors of the Uterine Tubes 974
Tumors of the Broad Ligament 976
Tumors of the Other Pelvic Ligaments 979
Chapter 43．BENIGN OVARIAN TUMORS 981
Predominantly Cystic Tumors of the Ovary 984
Predominantly Solid Tumors of the Ovary 1001
Accidents to Ovarian Tumors 1008
Ovarian Tumors and Pregnancy 1012
Chapter 44．HORMONE-PRODUCING TUMORS 1016
Feminizing Tumors 1016
Virilizing Tumors 1022
Struma Ovarii 1028
Remarks Regarding Histogenesis 1026
Chapter 45．EXTERNAL ENDOMETRIOSIS 1031
Clinical Picture 1031
Pathology 1033
Diagnosis 1037
Etiology 1038
Treatment 1039
Endometriosis and Pregnancy 1041
Chapter 46．MALIGNANT TUMORS OF THE VULVA 1043
Primary Carcinoma of the Vulva 1043
Other Primary Malignant Tumors of the Vulva 1049
Metastatic Vulvar Malignancies 1050
Malignant Tumors of the Urethra 1051
Chapter 47．MALIGNANT TUMORS OF THE VAGINA 1053
Primary Malignant Tumors 1053
Secondary Malignant Tumors 1057
Chapter 48．MALIGNANT TUMORS OF THE UTERUS 1059
Epidermoid(Squamous Cell)Carcinoma of the Cervix 1060
Carcinoma of the Cervical Stump 1072
Carcinoma of the Cervix Complicated by Pregnancy 1072
Adenocarcinoma of the Cervix 1073
Adenocarcinoma of the Body of the Uterus 1074
Sarcoma of the Uterus 1078
Sarcoma of the Endometrial Stroma 1080
Management of Terminal Cancer Patients 1081
Chapter 49．MALIGNANT TUMORS OF THE UTERINE TUBES AND PELVIC SUPPORTING STRUCTURES 1088
Primary Carcinoma of the Uterine Tube 1088
Other Primary Malignant Tumors of the Uterine Tube 1090
Secondary Malignant Tumors of the Uterine Tube 1090
Primary Malignant Tumors of the Pelvic Supporting Structures 1090
Secondary Malignant Tumors of the Pelvic Supporting Tissues 1091
Chapter 50．MALIGNANT TUMORS OF THE OVARY 1092
Carcinoma 1092
Sarcoma 1103
Solid Teratomas 1104
Dysgerminoma 1105
Clear-Cell Carcinoma 1107
Mesonephroma 1107
Other Malignant Tumors 1108
Chapter 51．THE PREMENOPAUSE AND THE MENOPAUSE 1110
Symptoms 1110
Changes during the Premenopause and the Menopause 1112
Management 1113
Problems 1116
Chapter 52．GERIATRIC GYNECOLOGY 1124
Changes during Senescence 1124
Gynecologic Problems 1127
Management of the Geriatric Gynecologic Patient 1130
Index 1133