Advances in research, knowledge and clinical practice in all branches of medicine have been rapid over the past decades and the speed is accelerating. Thus, as we enter the 1980s the pressure on specialists is to concentrate on ever-narrowing fields of their science. For the research worker this is desirable, but the practising clinician Our patient is a whole can have no clearly defined dividing lines. individual and every aspect of her makeup, physical and psychological, must always be taken fully into account. This is of vital importance in obstetrics and gynaecology. These two closely inter­ woven disciplines are branches of medical science in which emergency situations are not uncommon. Thus every practitioner, doctor, mid­ wife and nurse needs understanding of these subjects. Although tech­ nology advances rapidly, many basic principles remain the same. The chapters that follow deal with these, and modern trends in clinical management are discussed. For some decades the author has been in clinical charge of a matern­ ity hospital some 12 miles south of Central London. The hospital is a training school for obstetricians and midwives, and the local popula­ tion is adequately supplied with a general practitioner service. These circumstances are of some relevance because many views expressed are based on personal experience while others are based on countless books, articles, congresses and discussion with colleagues. To every source of information I express my thanks.

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1 Anatomy.- The pelvis.- The fetal skull.- The vulva or external genitalia.- The vagina.- The uterus.- The fallopian tubes.- The ovaries.- The musculature of the pelvic floor.- The anatomy of labour.- 2 Physiology.- Cyclical changes in the ovary.- Cyclical changes in the endometrium.- Fertilization and early development.- Genetics.- 3 Amenorrhoea: the diagnosis and duration of pregnancy.- Amenorrhoea.- Diagnosis of pregnancy.- Estimated date of delivery (EDD).- Intrauterine fetal death.- 4 Prenatal care.- The aims of prenatal care.- Diet.- Frequency of prenatal consultations.- The first examination.- Blood tests and screening techniques.- Abdominal palpation.- 5 Blood testing and the anaemias of pregnancy.- Iron-deficiency anaemia.- Megaloblastic anaemias.- Other anaemias.- Routine preventive therapy.- The haemoglobinopathies.- 6 Urine analysis and its significance.- Proteinuria.- Glycosuria.- Ketonuria.- 7 The physiology of labour.- The onset of labour.- Physiology of the first stage.- Physiology of the second stage.- Physiology of the third stage.- Postpartum haemorrhage and the management of the third stage of labour.- 8 The mechanisms of labour.- The vertex presentation in the left occipito-anterior (LOA) position.- The fetus in the right occipito-posterior (ROP) position.- Clinical features of occipito-posterior position.- 9 The management of labour.- The first stage.- The portogram: active management and monitoring in labour.- Relief of pain in labour.- The second stage.- Episiotomy.- 10 Breech presentations.- Causes of malpresentations.- Breech presen tation.- The management of the uncomplicated breech presentation.- Management of the complicated breech delivery.- 11 Face, brow and shoulder presentations.- Face presentation.- Brow presentation.- Shoulder presentation: transverse and oblique lie.- 12 The umbilical cord: presentation and prolapse.- A bnormalities of the cord.- Presentation and prolapse.- 13 Twins and multiple pregnancy.- Diagnosis of multiple pregnancy.- Management of multiple pregnancy.- Management of labour in multiple pregnancy.- Rare conditions.- 14 Pre-eclampsia.- Definition of pre-eclampsia.- A etiology of pre-eclampsia.- Clinical features of pre-eclampsia.- Manifestations of severe pre-eclampsia.- Treat men t of pre-eclampsia.- Fetal assessment.- 15 Eclampsia.- Eclamptic fits.- Treatment of eclampsia.- Sedation in pre-eclampsia and eclampsia.- Management during labour.- 16 Vomiting in pregnancy and hyperemesis gravidarum.- 17 Haemorrhages of pregnancy.- Haemorrhage in early pregnancy.- Haemorrhage in late pregnancy.- 18 Contracted pelvis and disproportion.- Types of pelvis.- Diagnosis of contracted pelvis and disproportion.- Management of disproportion and trial of labour.- Trial of labour.- 19 Abnormal uterine action.- Hypotonic uterine inertia.- The rigid cervix or cervical dystocia.- The hypertonic uterus or incoordinate uterine action.- Obstructed labour and rupture of the uterus.- 20 The placenta and its functions: maturity and the at-risk fetus.- Important functions of the placenta.- Prematurity and the dysmaturity184 Prolonged pregnancy (postmaturity or post- term delivery).- 21 Induction of labour.- Indications for induction of labour.- Methods of induction.- Dangers of induction.- 22 The puerperium.- Physiological changes.- Psychological aspects.- 23 Puerperal pyrexia and infection.- Causes of puerperal pyrexia.- Genital tract infections.- 24 Thromboembolism.- Varicose veins.- Superficial thrombophlebitis.- Zteep vein thrombosis.- Pulmonary embolism.- 25 Heart disease, pulmonary tuberculosis and venereal diseases in pregnancy.- Heart disease.- Pulmonary tuberculosis.- Venereal diseases.- 26 The rhesus factor and haemolytic disease.- Fetal haemolytic disease.- Reducing the adverse effects on Rh incompatibility isoimmunization.- 27 The postnatal examination and family planning.- Postnatal examination.- Family planning.- 28 The breasts.- A natomy of the breasts.- Breast engorgement.- Cracked nipples and mastitis.- Inhibition of lactation.