Berek & Novak's Gynecology by Jonathan S. Berek MD MMS

By Jonathan S. Berek MD MMS

The premier textual content in gynecology is in its Fourteenth version, completely revised and up-to-date and now in complete colour all through. geared up into 8 sections, this finished and basic gynecological textbook presents assistance for the administration of particular gynecological stipulations. the 1st sections disguise ideas of perform and preliminary evaluate and the correct uncomplicated technological know-how. The 3rd part is on preventive and first take care of ladies, and the rest 5 sections are directed at tools of prognosis and administration in most cases gynecology, operative common gynecology, urogynecology and pelvic reconstructive surgical procedure, reproductive endocrinology, and gynecologic oncology.

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1 The lithotomy position for the pelvic examination. After thorough visualization and palpation of the external genitalia, including the mons pubis and the perianal area, a speculum is inserted in the vagina. In a normal adult who is sexually active, a Pederson speculum is typically used. The types of specula that are used in gynecology are presented in Fig. 2. In general, the smallest speculum necessary to produce adequate visualization should be used. The larger Graves speculum may be required in women who have lax vaginal walls, are pregnant, or will be undergoing cervical or endometrial biopsies or procedures.

Inspect the vagina for the following: a. The presence of blood b. Discharge. This should be studied to detect trichomoniasis, monilia, and clue cells and to obtain cultures, primarily for gonococci and chlamydia. c. , color, lesions, superficial vascularity, and edema) The lesion may be: 1. Inflammatory—redness, swelling, exudates, ulcers, vesicles 2. Neoplastic 3. Vascular 4. Pigmented—bluish discoloration of pregnancy (Chadwick's sign) 5. , endometriosis, traumatic lesions, and cysts) d. Structural abnormalities (congenital and acquired) 2.

3 The bimanual examination. The adnexa are then palpated gently on both sides, paying particular attention to any enlargements. Again, the size, shape, mobility, and consistency of any adnexal structures should be carefully noted. A digital rectal examination is suggested periodically in women 40 years of age and older (see American College of Obstetricians and Gynecologists guidelines, Chapter 8) and may be helpful in premenopausal women in whom there is any difficulty ascertaining the adnexal structures (Fig.

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