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Williams Obstetrics by F. Gary Cunningham 24th Edition pdf

This 24th edition of Williams Obstetrics has been extensively and strategically reorganized. Primarily writing for the busy practitioner—those “in the trenches”—we continue to present the detailed staples of basic obstetrics such as maternal anatomy and physiology, preconceptional and prenatal care, labor, delivery, and the puerperium, along with detailed discussions of obstetrical complications exemplified by preterm labor, hemorrhage, hypertension, and many more.

Once again, we emphasize the scientific-based underpinnings of clinical obstetrics with special emphasis on biochemical and physiological principles of female reproduction. And, as was the hallmark of previous editions, these dovetail with descriptions of evidence-based practices. The reorganized format allows a greater emphasis on the fetus as a patient along with expanded coverage of fetal diagnosis and therapy.

These changes are complemented by more than 100 new sonographic and magnetic resonance images that display normal fetal anatomy and common fetal anomalies. Finally, to emphasize the “M” in maternal–fetal medicine, we continue to iterate the myriad medical and surgical disorders that can complicate pregnancy.

Acknowledgement – Williams Obstetrics

During the creation and production of this textbook, we were fortunate to have the assistance and support of countless talented professionals both within and outside the Department of Obstetrics and Gynecology. To begin, we acknowledge that an undertaking of this magnitude would not be possible without the unwavering support provided by Dr. Barry Schwarz, Vice-Chairman, whose financial and academic endorsement has been essential.

This 25th edition shows a notable absence of three colleagues who provided valuable editorial assistance for prior editions of Williams Obstetrics. Colleagues from the University of Texas Southwestern Medical Center include Dr. George Wendel, Jr.—associate editor for the 22nd and 23rd editions—who has now assumed the important role of Executive Director of the American Board of Obstetrics and Gynecology.

Dr. Jeanne Sheffield, with her especial expertise in obstetrical and perinatal infections, has left Dallas and is now the Division Director of Maternal–Fetal Medicine at Johns Hopkins University School of Medicine. From the University of Alabama at Birmingham, Dr. John Hauth, who served as an editor for the 21st through 23rd editions, provided valuable contributions to chapters on chronic hypertension, preterm labor, and labor induction, which have endured in updated forms in this edition. Williams Obstetrics

We are especially grateful for the contributions of our two returning Associate Editors. Dr. Mala Mahendroo is a talented basic scientist who continues to perform a magnificent job of providing a coherent translational version of basic science aspects of human reproduction. Dr. Diane Twickler—the consummate radiologist—has been an invaluable mentor for our residents, fellows, and faculty. She adds her fantastic experiences and extensive knowledge regarding clinical and technological advances related to fetal and maternal imaging to add considerable depth to this textbook. Dr. Seth Hawkins served us well as an Associate Editor in this edition and brought additional strengths to the areas of clinical and academic Maternal–Fetal Medicine. His rigorous analysis of evidence-based data on topics of maternal physiology, fetal-growth disorders, obesity, liver disease, and labor induction has added new perspectives to these chapters. Williams Obstetrics

To add academic breadths to our endeavor, we have enlisted new Contributing Editors—all from UT Southwestern Medical Center—each of whom has expertise in important areas of maternal and perinatal medicine. From the Division of Maternal–Fetal Medicine, Dr. C. Edward Wells adds his extensive clinical experience and his incredible skills with prior cesarean delivery and obstetrical sonography. Dr. April Bailey, with joint appointments in the Departments of Radiology and Obstetrics and Gynecology, shared her tremendous knowledge regarding fetal and maternal imaging with sonography, radiography, computed tomography, and magnetic resonance techniques. Dr. David Nelson brings strong clinical knowledge regarding preterm labor, stillbirth, management of obstetrical hemorrhage, psychiatric disorders in pregnancy, and multifetal gestation. From the Department of Anesthesia, Dr. Weike Tao provided academic insight and clinical mastery in obstetrical anesthesia. Similarly, Dr. Erica Grant graciously and skillfully advanced the discussion of this topic. Dr. Myra Wyckoff, from the Department of Pediatrics, contributed greatly to chapters regarding the term and preterm newborn. Her expertise both in normal care and in treatment for the more vulnerable neonates has greatly strengthened the evidence-based content of these chapters. In toto, the strength of each contributor has added to create the sum total of our academic endeavor. Williams Obstetrics

In constructing such an expansive academic compilation, the expertise of many colleagues was needed to add vital and contemporaneous information. It was indeed fortuitous for us to have access to a pantheon of collaborators from here and from other academic medical centers. From our own Department of Obstetrics and Gynecology, our nationally known pelvic anatomist, Dr. Marlene Corton, prepared graphic masterpieces for the anatomy chapter. Dr. Elysia Moschos contributed a number of sonographic images of early pregnancy and uterine malformations. Drs. Claudia Werner and William Griffith lent valuable insight into the management of cervical dysplasia. Dr. Emily Adhikari was an invaluable source in the construction of the chapters on maternal and perinatal infections. Finally, clinical photographs were contributed by many faculty and fellows, who include Drs. Patricia Santiago-Muñoz, Julie Lo, Elaine Duryea, Jamie Morgan, Judith Head, David Rogers, Kimberly Spoonts, and Emily Adhikari. From the Department of Radiology, Drs. Michael Landy, Jeffrey Pruitt, and Douglas Sims added insights and provided computed tomographic and magnetic resonance images. From the Department of Pathology, Dr. Kelley Carrick generously donated exemplary photomicrographs. Dr. Kathleen Wilson, director of the cytogenomic microarray analysis laboratory, graciously assisted us in updating our cytogenomic nomenclature. Williams Obstetrics

We are also indebted to contributions made by our national and international colleagues. Experts in placental pathology who shared their expertise and images include Drs. Kurt Benirschke, Ona Marie Faye-Petersen, Mandolin Ziadie, Michael Conner, Brian Levenson, Jaya George, and Erika Fong. Input for hypertensive disorders was provided by Drs. John Hauth, Marshall Lindheimer, and Gerda Zeeman; for operative vaginal delivery by Dr. Edward Yeomans; and seminal images were contributed by Drs. Kevin Doody, Timothy Crombleholme, Michael Zaretsky, Togas Tulandi, Edward Lammer, Charles Read, Frederick Elder, April Bleich, Laura Greer, and Roxane Holt.

In addition to these contributors, we relied heavily on our colleagues in the Division of Maternal–Fetal Medicine. These professionals, in addition to providing expert content, graciously assisted us by covering clinical duties when writing and editing were especially time consuming. These include Drs. Scott Roberts, Oscar Andujo, Vanessa Rogers, Charles Brown, Julie Lo, Robyn Horsager, Patricia Santiago-Muñoz, Shivani Patel, Elaine Duryea, Jamie Morgan, Morris Bryant, Shena Dillon, Denisse Holcomb, Robert Stewart, Stephan Shivvers, Ashley Zink, and Mark Peters. In addition, warm thanks go to our Residency Director, Dr. Vanessa Rogers, and her Associate Program Director, Dr. Stephanie Chang, who have created a nurturing environment for our residents to flourish. Similarly, our Maternal–Fetal Medicine (MFM) Division Associate Fellowship Director, Dr. Charles Brown, has aided our work through his talented mentoring of our MFM fellows.

We also emphasize that production of Williams Obstetrics would not be feasible without the help of our Maternal–Fetal Medicine fellows and our residents in Obstetrics and Gynecology. Their insatiable curiosity serves to energize us to find new and effective ways to convey age-old truths, new data, and cutting-edge concepts. Their logical and critical questions lead us to weaknesses in the text, and thereby, always help us to improve our work. In addition, we sincerely thank them for their vigilance in capturing photographs of spectacular examples of both obstetrical pathology and normal findings. For example, included in this edition are photographs contributed by Drs. Devin Macias, Maureen Flowers, Paul Slocum, Jonathan Willms, Stacey Thomas, Kara Ehlers, Nidhi Shah, Abel Moron, Angela Walker, and Elizabeth Mosier.

This edition is heavily populated with seminal examples of sonographic findings. We are grateful for the mentorship and talent of Drs. Diane Twickler and April Bailey; Mary Gibbs, RDMS; Rafael Levy, RDMS; Michael Davidson, RDMS; and the many talented sonographers at Parkland Hospital.

Thanks to generous funding from McGraw-Hill Education, this 25th edition now contains more than 200 color illustrations. Most of these were crafted by several skilled medical illustrators who include Ms. Marie Sena, Ms. Erin Frederickson, Mr. Jordan Pietz, Ms. SangEun Cha, and Ms. Jennifer Hulsey. All of these talented artists trained here at UT Southwestern under the tutelage of Mr. Lewis Calver. Additional artistic support came from Mr. Jason McAlexander and Ms. Suzanne Ghuzzi, of MPS North America LLC, who provided the full-color graphs and line art used to enhance this edition. Their team tirelessly coordinated efforts between author and artist and graciously accommodated our numerous changes and tweaks.

Production of the 5000-page manuscript would not have been possible without a dedicated team to bring these efforts together. Once again, we are deeply indebted to Ms. Dawn Wilson and Ms. Melinda Epstein for their untiring efforts with manuscript production. Ms. Mercedes Salinas also provided excellent, conscientious manuscript assistance. Information technology support was provided by the very knowledgeable and responsive Mr. Charles Richards and Mr. Thomas Ames. For these and many more that go unnamed, we could not have done our job without their expertise.

It again has been a privilege and a pleasure to work with the dedicated professionals from McGraw-Hill Education. Mr. Andrew Moyer has brought his considerable intelligence, unwavering work ethic, and creativity to this edition of Williams Obstetrics. His dedication to creating the best textbook possible equaled our efforts, and we are in awe of his productive, gracious style. His assistant, Ms. Jessica Gonzalez, provided professional, timely, and ever-sunny aid. Mr. Richard Ruzycka served as production supervisor for this edition of the textbook. He skillfully kept our project on track through an array of potential hurdles. Last, we have had the pleasure to work with Mr. Armen Ovsepyan in coordinating the artwork for many of our editions. His organization and efficiency are unrivaled.

Our text took its final shape under the watchful care of our compositors at Aptara, Inc. We thank Ms. Indu Jawwad for her talents in graciously and masterfully coordinating and overseeing composition. Her dedicated attention to detail and organization were vital to completion of our project. Also, at Aptara, Mr. Mahender Singh performed a crucial task of quality control. He also assisted, along with Mr. Surendra Mohan Gupta and Mr. Anil Varghese, in creating beautiful chapter layouts to highlight our content aesthetically and informatively. This edition’s chapters, for the first time, were posted and available online for use prior to print publication. We thank Mr. Braj Bhushan and Mr. Ashish Kumar Sharma for preparing this content so brilliantly. Special thanks go to Ms. Kristin Landon. As copyeditor for now several editions of both Williams Obstetrics and Williams Gynecology, Kristin has added precision and clarity to our efforts. Her endurance and pleasant professionalism through many challenging chapters has made our text better.

Finally—but certainly not last—we acknowledge our significant debt to the women who have entrusted themselves and their unborn children to us for obstetrical care. The clinical expertise and many graphic illustrations presented in this text would not have been possible without their collaborative spirit to help us advance obstetrical knowledge. We also offer enthusiastic and heartfelt appreciation to our families and friends. Without their patience, generosity, love, and encouragement, this task would have been impossible.

F. Gary Cunningham

Kenneth J. Leveno

Steven L. Bloom

Jodi S. Dashe

Barbara L. Hoffman

Brian M. Casey

Catherine Y. Spong

Editors

F. Gary Cunningham, MD

Beatrice & Miguel Elias Distinguished Chair in Obstetrics and Gynecology

Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center

Parkland Health and Hospital System

Dallas, Texas

Kenneth J. Leveno, MD

Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center

Parkland Health and Hospital System

Dallas, Texas

Steven L. Bloom, MD

Jack A. Pritchard MD Chair in Obstetrics and Gynecology

Professor and Chair, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center

Chief of Obstetrics and Gynecology

Parkland Health and Hospital System

Dallas, Texas

Jodi S. Dashe, MD

Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center

Director of Prenatal Diagnosis

Parkland Health and Hospital System

Dallas, Texas

Barbara L. Hoffman, MD

Professor, Department of Obstetrics and Gynecology

University of Texas Southwestern Medical Center

Parkland Health and Hospital System

Dallas, Texas

Brian M. Casey, MD

Professor, Department of Obstetrics and Gynecology

Director, Division of Maternal-Fetal Medicine

University of Texas Southwestern Medical Center

Chief of Obstetrics

Parkland Health and Hospital System

Dallas, Texas

Catherine Y. Spong, MD

Bethesda, Maryland

Preface – Williams Obstetrics

We celebrate this 25th edition of Williams Obstetrics with great appreciation for the insight and expertise that the early editors brought to this textbook. To pay tribute to the first author, J. Whitridge Williams, we begin each chapter with a passage from his 1st edition that complements the topic. During this selection process, we were inspired by the strides that modern obstetrics has made since that edition in 1903. Similarly, we were humbled by some of the classic challenges that still persist. Preterm labor, preeclampsia, and infections are some examples. That said, many of these advances were derived from rigorous, evidence-based research. And, we acknowledge and support the power of this academic ideal to further our specialty in the decades to come.

For this 25th edition, we continue to present the detailed staples of basic obstetrics such as maternal anatomy and physiology, preconceptional and prenatal care, labor, delivery, and the puerperium. These accompany detailed discussions of obstetrical complications exemplified by preterm labor, hemorrhage, hypertension, and many more. To emphasize the “M” in Maternal–Fetal Medicine, we continue to iterate the many medical and surgical disorders that can complicate pregnancy. And, our second patient—the fetus—has accrued especial attention with an entire section devoted to diagnosis and treatment of fetal disorders. For all of these, we once again emphasize the science-based underpinnings of clinical obstetrics with special emphasis on biochemical and physiological principles. As was the hallmark of previous editions, these dovetail with descriptions of evidence-based practices. Expert clinical pearls add depth to these discussions and are written for busy practitioners—those “in the trenches.”

To accomplish these goals, the text has been updated with more than 3000 new literature citations through 2017. Many of the nearly 900 figures are new, and these graphs, sonograms, magnetic resonance images, photographs, photomicrographs, and data graphs are almost all in vivid color. Much of the original artwork was rendered by our own medical illustrators.

Also, as before, we continue to incorporate contemporaneous guidelines from professional and academic organizations such as the American College of Obstetricians and Gynecologists, the Society for Maternal–Fetal Medicine, the National Institutes of Health and the National Institute for Child Health and Human Development, the Centers for Disease Control and Prevention, and other authoritative sources. Many of these data are distilled into nearly 100 tables, in which information has been arranged in an easy read-and-use format. In addition, several diagnostic and management algorithms are available to quickly guide practitioners. Although we strive to cite numerous sources and provide multiple evidence-based options for such management schemes, we also include our own clinical experiences drawn from the large obstetrical service at Parkland Hospital. We are convinced that these are disciplined examples of evidence-based obstetrics but quickly acknowledge that they do not constitute the sole method of management.

F. Gary Cunningham

Kenneth J. Leveno

Steven L. Bloom

Jodi S. Dashe

Barbara L. Hoffman

Brian M. Casey

Catherine Y. Spong

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