Hacker And Moores Essentials Of Obstetrics And Gynecology Pdf

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Labor is a process that permits a series of extensive physiologic changes in the mother to allow for the delivery of her fetus through the birth canal. It is defined as progressive cervical effacement and dilation resulting from regular uterine contractions that occur at least every 5 minutes and last 30 to 60 seconds.

The role of the obstetrician is to anticipate and manage abnormalities that may occur to either the maternal or the fetal process. When a decision is made to intervene, it must be considered carefully because each intervention carries not only potential benefits but also potential risks.

In most cases, the best management may be close observation and, when necessary, cautious intervention. The head is the largest and least compressible part of the fetus.

Thus, from an obstetric viewpoint, it is the most important part, whether the presentation is cephalic or breech.

The fetal skull consists of a base and a vault cranium. The base of the skull has large, ossified, firmly united, and noncompressible bones. This serves to protect the vital structures contained within the brain stem. The cranium consists of the occipital bone posteriorly, two parietal bones bilaterally, and two frontal and temporal bones anteriorly. The cranial bones at birth are thin, weakly ossified, easily compressible, and interconnected only by membranes.

The membrane-occupied spaces between the cranial bones are known as sutures. The anterior fontanelle bregma is found at the intersection of the sagittal, frontal, and coronal sutures. The posterior fontanelle is Y- or T-shaped and is found at the junction of the sagittal and lambdoid sutures. The fetal skull is characterized by a number of landmarks. Moving from front to back, they include the following Figure :. The following measurements are considered average for a term fetus:.

Suboccipitobregmatic 9. Supraoccipitomental Submentobregmatic 9. Biparietal 9. The average circumference of the term fetal head, measured in the occipitofrontal plane, is The bony pelvis is made up of four bones: the sacrum, coccyx, and two innominates composed of the ilium, ischium, and pubis. These are held together by the sacroiliac joints, the symphysis pubis, and the sacrococcygeal joint. The union of the pelvis and the vertebral column stabilizes the pelvis and allows weight to be transmitted to the lower extremities.

The anterior surface of the sacrum is usually concave. It articulates with the ilium at its upper segment, with the coccyx at its lower segment, and with the sacrospinous and sacrotuberous ligaments laterally. It articulates with the sacrum, forming a joint, and occasionally the bones are fused. The pelvis is divided into the false pelvis above and the true pelvis below the linea terminalis. The false pelvis is bordered by the lumbar vertebrae posteriorly, an iliac fossa bilaterally, and the abdominal wall anteriorly.

Its only obstetric function is to support the pregnant uterus. The true pelvis is a bony canal and is formed by the sacrum and coccyx posteriorly and by the ischium and pubis laterally and anteriorly. Its internal borders are solid and relatively immobile. The posterior wall is twice the length of the anterior wall. The true pelvis is the area of concern to the obstetrician because its dimensions are sometimes not adequate to permit passage of the fetus. These planes are imaginary, flat surfaces that extend across the pelvis at different levels.

Except for the plane of greatest diameter, each plane is clinically significant. The fetal head enters the pelvis through this plane in the transverse position. It is bordered by the posterior midpoint of the pubis anteriorly, the upper part of the obturator foramina laterally, and the junction of the 2nd and 3rd sacral vertebrae posteriorly. The fetal head rotates to the anterior position in this plane.

It is bordered by the lower edge of the pubis anteriorly, the ischial spines and sacrospinous ligaments laterally, and the lower sacrum posteriorly. Low transverse arrests generally occur in this plane. The anterior triangle is bordered by the subpubic angle at the apex, the pubic rami on the sides, and the bituberous diameter at the base. The posterior triangle is bordered by the sacrococcygeal joint at its apex, the sacrotuberous ligaments on the sides, and the bituberous diameter at the base.

This plane is the site of a low pelvic arrest. The diameters of the pelvic planes represent the amount of space available at each level. The key measurements for assessing the capacity of the maternal pelvis include the following:. The pelvic inlet has five important diameters Figure The anteroposterior diameter is described by one of two measurements. The plane of greatest diameter has two noteworthy diameters.

The plane of least diameter has three important diameters. The pelvic outlet has four important diameters Figure Based on the general bony architecture, the pelvis may be classified into four basic types Figure Note that the widest diameter of the inlet is posteriorly situated in an android or anthropoid pelvis. The gynecoid pelvis illustrates the location of the sacrosciatic notch, present in all pelvic types. It has the following characteristics:.

Round at the inlet, with the widest transverse diameter only slightly greater than the anteroposterior diameter. These features create a cylindrical shape that is spacious throughout. The fetal head generally rotates into the occipitoanterior position in this type of pelvis. Triangular inlet with a flat posterior segment and the widest transverse diameter closer to the sacrum than in the gynecoid type.

This type of pelvis has limited space at the inlet and progressively less space as one moves down the pelvis, owing to the funneling effect of the side walls, sacrum, and pubic rami. Thus, the amount of space is restricted at all levels. The fetal head is forced to be in the occipitoposterior position to conform to the narrow anterior pelvis.

Arrest of descent is common at the midpelvis. The anthropoid pelvis resembles that of the anthropoid ape. A much larger anteroposterior than transverse diameter, creating a long narrow oval at the inlet. The fetal head can engage only in the anteroposterior diameter and usually does so in the occipitoposterior position because there is more space in the posterior pelvis. The platypelloid pelvis is best described as being a flattened gynecoid pelvis.

The overall shape is that of a gentle curve throughout. The fetal head has to engage in the transverse diameter. Engagement occurs when the widest diameter of the fetal presenting part has passed through the pelvic inlet. In cephalic presentations, the widest diameter is biparietal; in breech presentations, it is intertrochanteric. The station of the presenting part in the pelvic canal is defined as its level above or below the plane of the ischial spines.

In most women, the bony presenting part is at the level of the ischial spines when the head has become engaged. The fetal head usually engages with its sagittal suture in the transverse diameter of the pelvis.

There is a distinct advantage to having the head engage in asynclitism in certain situations. In a synclitic presentation, the biparietal diameter entering the pelvis measures 9. Therefore, asynclitism permits a larger head to enter the pelvis than would be possible in a synclitic presentation. The diameters that can be clinically evaluated can be assessed at the time of the first prenatal visit to screen for obvious pelvic contractions, although some obstetricians believe that it is better to wait until later in pregnancy when the soft tissues are more distensible and the examination is less uncomfortable and possibly more accurate.

The clinical evaluation is started by assessing the pelvic inlet. The pelvic inlet can be evaluated clinically for its anteroposterior diameter. Often the middle finger of the examining hand cannot reach the sacral promontory; thus, the obstetric conjugate is considered adequate. If the diagonal conjugate is greater than or equal to The anterior surface of the sacrum is then palpated to assess its curvature.

The usual shape is concave. A flat or convex shape may indicate anteroposterior constriction throughout the pelvis. A reasonable estimate of the size of the midpelvis, however, can be obtained as follows. The pelvic side walls can be assessed to determine whether they are convergent rather than having the normal, almost parallel, configuration. The ischial spines are palpated carefully to assess their prominence, and several passes are made between the spines to approximate the bispinous diameter.

The length of the sacrospinous ligament is assessed by placing one finger on the ischial spine and one finger on the sacrum in the midline. The average length is 3 fingerbreadths.

If the sacrospinous notch that is located lateral to the ligament can accommodate two-and-a-half fingertips, the posterior midpelvis is most likely of adequate dimensions. A short ligament suggests a forward inclination of the sacrum and a narrowed sacrospinous notch see Figure 8—5, pg Finally, the pelvic outlet is assessed. This is done by first placing a fist between the ischial tuberosities.

The posterior sagittal measurement should also be greater than 8 cm. The infrapubic angle is assessed by placing a thumb next to each inferior pubic ramus and then estimating the angle at which they meet. An angle of less than 90 degrees is associated with a contracted transverse diameter in the midplane and outlet.

Hacker and Moore's Essentials of Obstetrics and Gynecology

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Written in English. There are five edition which show the greatness of the book. It is one the highly readable and sale book all around the globe. One of the primer book of Obstetrics and Gynecology that cover all the topics in appropriate depth. Neville F. Hacker, Joseph C.

Unlimited access to the largest selection of audiobooks and textbooks aligned to school curriculum on the only app specifically designed for struggling readers, like students dealing with dyslexia, blindness or other learning differences. Get guidance on evaluation, diagnosis, and management of a wide range of obstetric and gynecologic disorders from the most comprehensive and concise reference on the subject. The 5th Edition of this popular and practical resource features additional clinical photos and material on vaccination and disease prevention. The full-color design with illustrations and photographs complement the text. Access the full text online, along with an additional image gallery, case studies, and online note-taking via Student Consult for a better learning experience. Features a full-color design and images for a visually accessible guide that easily correlates to actual clinical experience. Delivers must-know information efficiently and effectively through a concise, clear writing style.

Obstetrics and Gynecology Research Guide

Labor is a process that permits a series of extensive physiologic changes in the mother to allow for the delivery of her fetus through the birth canal. It is defined as progressive cervical effacement and dilation resulting from regular uterine contractions that occur at least every 5 minutes and last 30 to 60 seconds. The role of the obstetrician is to anticipate and manage abnormalities that may occur to either the maternal or the fetal process.

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Hacker & Moore’s Essentials of Obstetrics and Gynecology, 6th Edition PDF

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Hacker, Joseph C. Gambone, and Calvin J. Neville F. Sign Up Log In. Try a Free Sample. Table of Contents Buy as you go Buy by the chapter and never pay more than the price of the full book.

Стратмор нередко пользовался этой привилегией: он предпочитал творить свое волшебство в уединении. - Коммандер, - все же возразила она, - это слишком крупная неприятность, и с ней не стоит оставаться наедине. Вам следовало бы привлечь кого-то. - Сьюзан, появление Цифровой крепости влечет за собой очень серьезные последствия для всего будущего нашего агентства. Я не намерен информировать президента за спиной директора.

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