Mc graw hill oxorn foote human labor and birth 6th edition 2013 retail ebook ke

Oxorn-Foote

HUMAN
LABOR
& BIRTH
Sixth Edition


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Oxorn-Foote

HUMAN
LABOR
& BIRTH
Sixth Edition

Glenn D. Posner, MDCM, MEd, FRCSC
Associate Professor, The University of Ottawa
Department of Obstetrics and Gynecology
The Ottawa Hospital
Ottawa, Ontario, Canada

Jessica Dy, MD, MPH, FRCSC
Assistant Professor, The University of Ottawa
Department of Obstetrics and Gynecology
The Ottawa Hospital
Ottawa, Ontario, Canada

Amanda Black, MD, MPH, FRCSC
Associate Professor, The University of Ottawa
Department of Obstetrics and Gynecology
The Ottawa Hospital
Division of Pediatric Gynecology, Children’s Hospital of Eastern Ontario
Ottawa, Ontario, Canada

Griffith D. Jones, MBBS, MRCOG, FRCSC
Assistant Professor, The University of Ottawa
Medical Director, Obstetrics & Gynecology Ultrasound
Division of Maternal–Fetal Medicine
Department of Obstetrics and Gynecology
The Ottawa Hospital
Ottawa, Ontario, Canada

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DEDICATION

to Dr. Harry oxorn. We hope you’d be proud.


╇ Birth record of Dr. Griffith D. Jones. Dr. Foote played an even more important role in HIS history!


xvii

Part i: clinical Anatomy

1

1 Pelvis: Bones, Joints, and Ligaments
2 The Pelvic Floor
3 Perineum

3

9

15

4 Uterus and Vagina
5 Obstetric Pelvis

21

37

6 The Passenger: Fetus

53

7 Fetopelvic Relationships

65

8 Engagement, Synclitism, Asynclitism

Part ii: First Stage of Labor
9 Examination of the Patient

87

89

10 Normal Mechanisms of Labor

101

11 Clinical Course of Normal Labor
12 Fetal Health Surveillance in Labor
13 Induction of Labor
14 Labor Dystocia

77

119
143

173

193

15 Abnormal Cephalic Presentations

211

CONTENTS

Contributors xi
Preface xv
Acknowledgments


viii

Contents

Part III: Second Stage of Labor  263
16 The Second Stage of Labor  265
17 Operative Vaginal Delivery  283
18 Shoulder Dystocia  333

Part IV: Third Stage of Labor  351
19 Delivery of the Placenta, Retained
Placenta, and Placenta Accreta  353
20 Postpartum Hemorrhage  367
21 Episiotomy, Lacerations, Uterine Rupture, and
Inversion  389

Part V: Complicated Labor  431
22 Cesarean Section  433
23 Trial of Labor After Previous
Cesarean Section  457
24 Obesity in Pregnancy  463
25 Breech Presentation  471
26 Transverse Lie  515
27 Compound Presentations  523
28 The Umbilical Cord  529
29 Multiple Pregnancy  537




Contents

Part VI: Other Issues  567
30 Preterm Labor  569
31 Antepartum Hemorrhage  587
32 Maternal Complications in Labor  601
33 Labor in the Presence of Fetal Complications  635
34 Intrapartum Infections  647
35 Postterm Pregnancy  663
36 Obstetric Anesthesia and Analgesia  671
37 Intrapartum Imaging  695
38 The Puerperium  707
39 The Newborn Infant  725
Index  747

ix


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Yaa Amankwah, MBcHB, FRcSc
Assistant Professor, The University of Ottawa
Department of Obstetrics and Gynecology
The Ottawa Hospital
Ottawa, Ontario, Canada [18]
Nadya Ben Fadel, MD, FAAP, FRcPc
Assistant Professor, The University of Ottawa
Division of Neonatology
Department of Pediatrics
Children’s Hospital of Eastern Ontario

Ottawa, Ontario, Canada [39]
Dan Boucher, MD, MSc
Clinical Fellow, The University of Ottawa
Department of Medicine
The Ottawa Hospital
Ottawa, Ontario, Canada [32]
Yvonne cargill, MD, FRcSc
Assistant Professor, The University of Ottawa
Division of Maternal–Fetal Medicine
Department of Obstetrics and Gynecology
The Ottawa Hospital
Ottawa, Ontario, Canada [28]
Darine el-chaar, MD, FRcSc
Clinical Fellow, The University of Toronto
Division of Maternal–Fetal Medicine
Department of Obstetrics and Gynecology
The Toronto University Health Network
Toronto, Ontario, Canada [12, 15, 22, 23, 24, 25]
Ramadan el Sugy, MD, FRcSc
Department of Obstetrics and Gynecology
William Osler Health System
Brampton, Ontario, Canada [21]

CONTRIBUTORS

Numbers in brackets refer to the chapter(s) written or co-written by
the contributor.


xii

Contributors

Karen Fung Kee Fung, MD, FRCSC, MHPE
Associate Professor, The University of Ottawa
Division of Maternal–Fetal Medicine
Department of Obstetrics and Gynecology
The Ottawa Hospital
Ottawa, Ontario, Canada [29]
Laura M. Gaudet, MD, MSc, FRCSC
Assistant Professor, Dalhousie University
Division of Maternal–Fetal Medicine
Department of Obstetrics & Gynecology
The Moncton Hospital, Horizon Health Network
Moncton, New Brunswick, Canada [33, 35]
Catherine Gallant, MD, FRCPC
Assistant Professor, The University of Ottawa
Department of Anesthesiology
The Ottawa Hospital
Ottawa, Ontario, Canada [36]
Andrée Gruslin, MD, FRCSC
Professor, The University of Ottawa
Division of Maternal–Fetal Medicine
Departments of Obstetrics and Gynecology & Cellular and Molecular Medicine
The Ottawa Hospital
Ottawa, Ontario, Canada [34]
Samantha Halman, MD
Clinical Fellow, The University of Ottawa
Department of Medicine
The Ottawa Hospital

Ottawa, Ontario, Canada [32]
Alan Karovitch, MD, MEd, FRCPC
Associate Professor, The University of Ottawa
Division of General Internal Medicine
Departments of Medicine & Obstetrics and Gynecology
The Ottawa Hospital
Ottawa, Ontario, Canada [32]
Erin Keely, MD, FRCPC
Professor, The University of Ottawa
Division of Endocrinology and Metabolism
Departments of Medicine & Obstetrics and Gynecology
The Ottawa Hospital
Ottawa, Ontario, Canada [32]




Contributors

Felipe Moretti, MD
Assistant Professor, The University of Ottawa
Division of Maternal–Fetal Medicine
Department of Obstetrics and Gynecology
The Ottawa Hospital
Ottawa, Ontario, Canada [38]
Lawrence Oppenheimer, MD, MA, FRCSC, FRCOG
Professor, The University of Ottawa
Division of Maternal–Fetal Medicine
Department of Obstetrics and Gynecology
The Ottawa Hospital

Ottawa, Ontario, Canada [16, 19]
Dante Pascali, MD, FRCSC
Assistant Professor, The University of Ottawa
Division of Urogynecology and Pelvic Reconstructive Surgery
Department of Obstetrics and Gynecology
The Ottawa Hospital
Ottawa, Ontario, Canada [1, 2, 3, 4]
Samira Samiee, MD, FRCPC
Clinical Fellow, The University of Ottawa
Division of Neonatology
Department of Pediatrics
Children’s Hospital of Eastern Ontario
Ottawa, Ontario, Canada [39]
Gihad Shabib MD, MRCOG, FRCSC
Assistant Professor, The University of Ottawa
Department of Obstetrics and Gynecology
The Ottawa Hospital
Ottawa, Ontario, Canada [17]
George Tawagi, MD, FRCSC
Assistant Professor, The University of Ottawa
Division of Maternal–Fetal Medicine
Department of Obstetrics and Gynecology
The Ottawa Hospital
Ottawa, Ontario, Canada [26, 27]

xiii


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PREFACE

This latest edition of Dr. Harry Oxorn’s text is the result of collaboration between numerous physicians in the Department of
Obstetrics and Gynecology at the Ottawa Hospital. Although
modern medicine relies heavily on science and technology,
the most astute accoucheurs still practice the art of obstetrics
embraced in this book. Much has changed, but much has remained the same. Although every chapter has been revised and
refreshed, we’ve endeavored to stay true to the utilitarian spirit
of the book that Dr. Oxorn intended. This textbook is not a
treatise on theoretical evidence-based obstetrics that can only
be practiced at tertiary centers; rather, it is a handbook of useful information for practitioners in the trenches who need real
advice on how to manage real problems. New additions, such
as a chapter on the challenges of obesity in pregnancy, descriptions of modern techniques for the management of postpartum
hemorrhage, and an expanded treatment of multiples, reflect
the modernization of Dr. Oxorn’s work.
It has always been our intention to bring this text into the
twenty-first century while respecting its heritage. As such, we
owe a great debt to the previous contributors for giving us
such a solid foundation; their legacy resides both within these
pages as well as in the halls of the labor wards in Ottawa.


This page intentionally left blank


ACKNOWLEDGMENTS

We would like to thank our project manager, Erica PhillipsPosner, for keeping us on schedule and making this textbook
happen.

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PART I
Clinical
Anatomy


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Dante Pascali

CHAPTER 1

Pelvis: Bones,
Joints, and
Ligaments


4

Part I  Clinical Anatomy

PELVIC BONES
The pelvis is the bony basin in which the trunk terminates and through
which the body weight is transmitted to the lower extremities. In females,
it is adapted for childbearing. The pelvis consists of four bones: the two

innominates, the sacrum, and the coccyx. These are united by four joints.

Innominate Bones
The innominate bones are placed laterally and anteriorly. Each is formed
by the fusion of three bones—the ilium, ischium, and pubis—around the
acetabulum.

Ilium
The ilium is the superior bone: It has a body (which is fused with the
ischial body) and an ala. Points of note concerning the ilium include:
1. The anterior superior iliac spine gives attachment to the inguinal ligament
2. The posterior superior iliac spine marks the level of the second sacral
vertebra. Its presence is indicated by a dimple in the overlying skin
3. The iliac crest extends from the anterior superior iliac spine to the
posterior superior iliac spine

Ischium
The ischium consists of a body in which the superior and inferior rami
merge.
1.
2.
3.
4.

The body forms part of the acetabulum
The superior ramus is posterior and inferior to the body
The inferior ramus fuses with the inferior ramus of the pubis
The ischial spine separates the greater sciatic from the lesser sciatic
notch. It is an important landmark. Part of the levator ani muscle is
attached to it

5. The ischial tuberosity is the inferior part of the ischium and is the bone
on which humans sit

Pubis
The pubis consists of the body and two rami.
1. The body has a rough surface on its medial aspect. This is joined to the
corresponding area on the opposite pubis to form the symphysis pubis.
The levator ani muscles are attached to the pelvic aspect of the pubis


Chapter 1  Pelvis: Bones, Joints, and Ligaments

5

2. The pubic crest is the superior border of the body
3. The pubic tubercle, or spine, is the lateral end of the pubic crest. The
inguinal ligament and conjoined tendon are attached here
4. The superior ramus meets the body of the pubis at the pubic spine and
the body of the ilium at the iliopectineal line, where it forms a part of
the acetabulum
5. The inferior ramus merges with the inferior ramus of the ischium

Landmarks can be identified:
1. The iliopectineal line extends from the pubic tubercle back to the sacroiliac joint. It forms the greater part of the boundary of the pelvic inlet
2. The greater sacrosciatic notch is between the posterior inferior iliac
spine superiorly and the ischial spine inferiorly
3. The lesser sacrosciatic notch is bounded by the ischial spine superiorly
and the ischial tuberosity inferiorly
4. The obturator foramen is delimited by the acetabulum, the ischial
rami, and the pubic rami

Sacrum
The sacrum is a triangular bone with the base superiorly and the apex
inferiorly. It consists of five vertebrae fused together; rarely, there are four
or six. The sacrum lies between the innominate bones and is attached to
them by the sacroiliac joints.
The upper surface of the first sacral vertebra articulates with the lower
surface of the fifth lumbar vertebra. The anterior (pelvic) surface of the
sacrum is concave, and the posterior surface is convex.
The sacral promontory is the anterior superior edge of the first sacral
vertebra. It protrudes slightly into the cavity of the pelvis, reducing the
anteroposterior diameter of the inlet.

Coccyx
The coccyx (tail bone) is composed of four rudimentary vertebrae. The
superior surface of the first coccygeal vertebra articulates with the inferior
surface of the fifth sacral vertebra to form the sacrococcygeal joint. Rarely,
there is fusion between the sacrum and coccyx, with resultant limitation
of movement.
The coccygeus muscle, levator ani muscles, and sphincter ani externus
are attached to the anterior aspect of the coccyx. They are important to
pelvic floor function.

CLINICAL ANATOMY




6

Part I  Clinical Anatomy

PELVIC JOINTS AND LIGAMENTS
The sacrum, coccyx, and two innominate bones are linked by four
joints: the symphysis pubis, the sacrococcygeal, and the two sacroiliac
synchondroses (Fig. 1-1).

Sacroiliac Joint
The sacroiliac joint lies between the articular surfaces of the sacrum and the
ilium. The weight of the body is transmitted through it to the pelvis and
then to the lower limbs. It is a synovial joint and permits a small degree of
movement. The capsule is weak, and stability is maintained by the muscles
around it as well as by four primary and two accessory ligaments.
cr
Iliac est

Post. sup. iliac spine
Sacrum

Ilium

Acetabulum

hiu

Sacrospinous lig.

Greater
sciatic
notch

m

Coccyx
Ant. sacroiliac lig.

is

b
Pu

Isc

Sacral promontory

Inf. ramus of pubis
Ischial
spine

Ischial tuberosity

Ant. sup. iliac spine
Sacrotuberous lig.

Pectineal line
Pubic tubercle

Symphysis pubis
Arcuate pubic lig.

Pubic crest

Figure 1-1.  Bones and joints of the pelvis.

Obturator
foramen