, THIRD EDITION
v
CASE FILES® v
ObstetricsandGynecology v v
Eugenev C.v Toy,v MD
ThevJohnvS.vDunn,vSeniorvAcademicvChairvandvProgramvDirect
orvThevMethodistvHospitalvOb/GynvResidencyvProgram
Houston,vTexas
Vicev Chairv ofvAcademicv AffairsvDepartm
entv ofv Obstetricsv andv GynecologyvThev Me
thodistv Hospital
Houston,v Texas
Associatev Clinicalv Professorv andv Clerkshipv Directo
rvDepartmentvofvObstetricsvandvGynecologyvUniv
ersityvofvTexasvMedicalvSchoolvatvHoustonvHoust
on,v Texas
Associatev Clinicalv Professor
WeillvCornellvCollegevofvMedicine
BentonvBakervIII,vMD
ProfessorvofvObstetricsvandvGynecologyvUniversi
tyvofvTexasvMedicalvSchoolvatvHoustonvHouston,v T
exas
PattivJaynevRoss,vMD
ProfessorvandvClerkshipvDirectorvDepartm
entv ofv Obstetricsv andv GynecologyvHoldervofv
thevPattivJaynevRossvProfessorship
UniversityvofvTexasvMedicalvSchoolvatvHoustonvHo
uston,v Texas
JohnvC.vJennings,v MD
RegionalvDean,vSchoolvofvMedicine/
RodenvProfessorvofvObstetricsvandvGynecology
vTexasvTechvUniversityvHealthvSciencesvCente
rvOdessa,v Texas
NewvYorkv v Chicagovvvv SanvFranciscov v Lisbonv v Londonv v Madridv v Mexicov Cityvvvv Mila
nvNewvDelhivvvv SanvJuanvvvv Seoulv v Singaporev v Sydneyv v Toronto
,www.cambodiamed.blogspot.comv|vBestvMedicalvBooksv|vChyvYong
Copyrightv©v2009vbyvThevMcGraw-
HillvCompanies,vInc.vAllvrightsvreserved.vExceptvasvpermittedvundervthevUnitedvStatesvCopyrightvActv
ofv1976,vnovpartvofvthisvpublicationvmayvbevreproducedvorvdistributedvinvanyvformvorvbyvanyvmeans,vo
rvstoredvinvavdatabasevorvretrievalvsystem,vwithoutvthevpriorvwrittenvpermis-vsionvofvthevpublisher.
ISBN:v978-0-07-160581-6
MHID:v0-07-160581-9
ThevmaterialvinvthisveBookvalsovappearsvinvthevprintvversionvofvthisvtitle:vISBN:v978-0-07-160580-
9,vMHID:v0-07-160580-0.
Allvtrademarksvarevtrademarksvofvtheirvrespectivevowners.vRathervthanvputvavtrademarkvsymbolvaftervev
eryvoccurrencevofvavtrademarkedvname,vwevusevnamesvinvanveditorialvfashionvonly,vandvtovthevbenefitv
ofvthevtrademarkvowner,vwithvnovintentionvofvinfringementvofvthevtrademark.vWherevsuchvdesignationsv
appearvinvthisvbook,vtheyvhavevbeenvprintedvwithvinitialvcaps.
McGraw-
HillveBooksvarevavailablevatvspecialvquantityvdiscountsvtovusevasvpremiumsvandvsalesvpromotions,vorvf
orvusevinvcorporatevtrainingvprograms.vTovcontactvavrepresentativevpleaseve-
.
Medicinevisvanvever-
changingvscience.vAsvnewvresearchvandvclinicalvexperiencevbroadenvourvknowledge,vchangesvinvtreatm
entvandvdrugvtherapyvarevrequired.vThevauthorsvandvthevpublishervofvthisvworkvhavevcheckedvwithvsou
rcesvbelievedvtovbevreliablevinvtheirveffortsvtovprovidevinformationvthatvisvcompletevandvgenerallyvinva
ccordvwithvthevstandardsvacceptedvatvthevtimevofvpublication.vHowever,vinvviewvofvthevpos-
vsibilityvofvhumanverrorvorvchangesvinvmedicalvsciences,vneithervthevauthorsvnorvthevpublishervnorvanyvo
thervpartyvwhovhasvbeenvinvolvedvinvthevpreparationvorvpublicationvofvthisvworkvwarrantsvthatvthevinfo
rmationvcontainedvhereinvisvinveveryvrespectvaccuratevorvcomplete,vandvtheyvdisclaimvallvresponsibility
vforvanyverrorsvorvomissionsvorvforvthevresultsvobtainedvfromvusevofvthevinformationvcontainedvinvthisv
work.vReadersvarevencouragedvtovconfirmvthevinformationvcontainedvhereinvwithvothervsources.vForvexa
mplevandvinvparticular,vreadersvarevadvisedvtovcheckvthevproductvinformationvsheetvincludedvinvthevpac
kagevofveachvdrugvtheyvplanvtovadministervtovbevcertainvthatvthevinformationvcontainedvinvthisvworkvisv
accuratevandvthatvchangesvhavevnotvbeenvmadevinvthevrecommendedvdosevorvinvthevcontraindicationsvf
orvadministration.vThisvrecommendationvisvofvparticularvimportancevinvconnectionvwithvnewvorvinfreq
uentlyvusedvdrugs.
TERMSvOFvUSE
ThisvisvavcopyrightedvworkvandvThevMcGraw-HillvCompanies,vInc.v(“McGraw-
Hill”)vandvitsvlicensorsvreservevallvrightsvinvandvtovthevwork.vUsevofvthisvworkvisvsubjectvtovthesevterms
.vExceptvasvpermittedvundervthevCopyrightvActvofv1976vandvthevrightvtovstorevandvretrievevonevcopyvof
vthevwork,vyou vmayvnotvdecom-
vpile,vdisassemble,vreversevengineer,vreproduce,vmodify,vcreatevderivativevworksvbasedvupon,vtransmit,vd
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Hill’svpriorvconsent.vYouvmayvusevthevworkvforvyourvownvnoncommercialvandvpersonalvuse;vanyvotherv
usevofvthevworkvisvstrictlyvprohibited.vYourvrightvtovusevthevworkvmayvbevterminatedvifvyouvfailvtovcomp
lyvwithvthesevterms.
THEvWORKvISvPROVIDEDv“ASvIS.”vMcGRAW-
HILLvANDvITSvLICENSORSvMAKEvNOvGUARAN-
vTEESvORvWARRANTIES vASvTOvTHEvACCURACY,vADEQUACYvORvCOMPLETENESSvOFvO
RvRESULTSvTOvBEvOBTAINEDvFROMvUSINGvTHEvWORK,vINCLUDINGvANYvINFORMATIO
NvTHATvCANvBEvACCESSEDvTHROUGHvTHEvWORKvVIAvHYPERLINKvORvOTHERWISE,vA
NDvEXPRESSLYvDISCLAIMvANYvWARRANTY,vEXPRESSvORvIMPLIED,vINCLUDINGvBUTvN
OTvLIMITEDvTOvIMPLIEDvWARRANTIESvOFvMERCHANTABILITYvORvFITNESSvFORvAvPAR
TICU-
LARvPURPOSE.vMcGraw-
Hillvandvitsvlicensorsvdovnotvwarrantvorvguaranteevthatvthevfunctionsvcontainedvinvthevworkvwillvmeetvy
ourvrequirementsvorvthatvitsvoperationvwillvbevuninterruptedvorverrorvfree.vNeithervMcGraw-
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sedvofvthevpossibilityvofvsuchvdamages.vThisvlimitationvofvliabilityvshallvapplyvtovanyvclaimvorvcausev
whatsoevervwhethervsuchvclaimvorvcausevarisesvinvcontract,vtortvorvotherwise.
v
CASE FILES® v
ObstetricsandGynecology v v
Eugenev C.v Toy,v MD
ThevJohnvS.vDunn,vSeniorvAcademicvChairvandvProgramvDirect
orvThevMethodistvHospitalvOb/GynvResidencyvProgram
Houston,vTexas
Vicev Chairv ofvAcademicv AffairsvDepartm
entv ofv Obstetricsv andv GynecologyvThev Me
thodistv Hospital
Houston,v Texas
Associatev Clinicalv Professorv andv Clerkshipv Directo
rvDepartmentvofvObstetricsvandvGynecologyvUniv
ersityvofvTexasvMedicalvSchoolvatvHoustonvHoust
on,v Texas
Associatev Clinicalv Professor
WeillvCornellvCollegevofvMedicine
BentonvBakervIII,vMD
ProfessorvofvObstetricsvandvGynecologyvUniversi
tyvofvTexasvMedicalvSchoolvatvHoustonvHouston,v T
exas
PattivJaynevRoss,vMD
ProfessorvandvClerkshipvDirectorvDepartm
entv ofv Obstetricsv andv GynecologyvHoldervofv
thevPattivJaynevRossvProfessorship
UniversityvofvTexasvMedicalvSchoolvatvHoustonvHo
uston,v Texas
JohnvC.vJennings,v MD
RegionalvDean,vSchoolvofvMedicine/
RodenvProfessorvofvObstetricsvandvGynecology
vTexasvTechvUniversityvHealthvSciencesvCente
rvOdessa,v Texas
NewvYorkv v Chicagovvvv SanvFranciscov v Lisbonv v Londonv v Madridv v Mexicov Cityvvvv Mila
nvNewvDelhivvvv SanvJuanvvvv Seoulv v Singaporev v Sydneyv v Toronto
,www.cambodiamed.blogspot.comv|vBestvMedicalvBooksv|vChyvYong
Copyrightv©v2009vbyvThevMcGraw-
HillvCompanies,vInc.vAllvrightsvreserved.vExceptvasvpermittedvundervthevUnitedvStatesvCopyrightvActv
ofv1976,vnovpartvofvthisvpublicationvmayvbevreproducedvorvdistributedvinvanyvformvorvbyvanyvmeans,vo
rvstoredvinvavdatabasevorvretrievalvsystem,vwithoutvthevpriorvwrittenvpermis-vsionvofvthevpublisher.
ISBN:v978-0-07-160581-6
MHID:v0-07-160581-9
ThevmaterialvinvthisveBookvalsovappearsvinvthevprintvversionvofvthisvtitle:vISBN:v978-0-07-160580-
9,vMHID:v0-07-160580-0.
Allvtrademarksvarevtrademarksvofvtheirvrespectivevowners.vRathervthanvputvavtrademarkvsymbolvaftervev
eryvoccurrencevofvavtrademarkedvname,vwevusevnamesvinvanveditorialvfashionvonly,vandvtovthevbenefitv
ofvthevtrademarkvowner,vwithvnovintentionvofvinfringementvofvthevtrademark.vWherevsuchvdesignationsv
appearvinvthisvbook,vtheyvhavevbeenvprintedvwithvinitialvcaps.
McGraw-
HillveBooksvarevavailablevatvspecialvquantityvdiscountsvtovusevasvpremiumsvandvsalesvpromotions,vorvf
orvusevinvcorporatevtrainingvprograms.vTovcontactvavrepresentativevpleaseve-
.
Medicinevisvanvever-
changingvscience.vAsvnewvresearchvandvclinicalvexperiencevbroadenvourvknowledge,vchangesvinvtreatm
entvandvdrugvtherapyvarevrequired.vThevauthorsvandvthevpublishervofvthisvworkvhavevcheckedvwithvsou
rcesvbelievedvtovbevreliablevinvtheirveffortsvtovprovidevinformationvthatvisvcompletevandvgenerallyvinva
ccordvwithvthevstandardsvacceptedvatvthevtimevofvpublication.vHowever,vinvviewvofvthevpos-
vsibilityvofvhumanverrorvorvchangesvinvmedicalvsciences,vneithervthevauthorsvnorvthevpublishervnorvanyvo
thervpartyvwhovhasvbeenvinvolvedvinvthevpreparationvorvpublicationvofvthisvworkvwarrantsvthatvthevinfo
rmationvcontainedvhereinvisvinveveryvrespectvaccuratevorvcomplete,vandvtheyvdisclaimvallvresponsibility
vforvanyverrorsvorvomissionsvorvforvthevresultsvobtainedvfromvusevofvthevinformationvcontainedvinvthisv
work.vReadersvarevencouragedvtovconfirmvthevinformationvcontainedvhereinvwithvothervsources.vForvexa
mplevandvinvparticular,vreadersvarevadvisedvtovcheckvthevproductvinformationvsheetvincludedvinvthevpac
kagevofveachvdrugvtheyvplanvtovadministervtovbevcertainvthatvthevinformationvcontainedvinvthisvworkvisv
accuratevandvthatvchangesvhavevnotvbeenvmadevinvthevrecommendedvdosevorvinvthevcontraindicationsvf
orvadministration.vThisvrecommendationvisvofvparticularvimportancevinvconnectionvwithvnewvorvinfreq
uentlyvusedvdrugs.
TERMSvOFvUSE
ThisvisvavcopyrightedvworkvandvThevMcGraw-HillvCompanies,vInc.v(“McGraw-
Hill”)vandvitsvlicensorsvreservevallvrightsvinvandvtovthevwork.vUsevofvthisvworkvisvsubjectvtovthesevterms
.vExceptvasvpermittedvundervthevCopyrightvActvofv1976vandvthevrightvtovstorevandvretrievevonevcopyvof
vthevwork,vyou vmayvnotvdecom-
vpile,vdisassemble,vreversevengineer,vreproduce,vmodify,vcreatevderivativevworksvbasedvupon,vtransmit,vd
is-vtribute,vdisseminate,vsell,vpublishvorvsublicensevthevworkvorvanyvpartvofvitvwithoutvMcGraw-
Hill’svpriorvconsent.vYouvmayvusevthevworkvforvyourvownvnoncommercialvandvpersonalvuse;vanyvotherv
usevofvthevworkvisvstrictlyvprohibited.vYourvrightvtovusevthevworkvmayvbevterminatedvifvyouvfailvtovcomp
lyvwithvthesevterms.
THEvWORKvISvPROVIDEDv“ASvIS.”vMcGRAW-
HILLvANDvITSvLICENSORSvMAKEvNOvGUARAN-
vTEESvORvWARRANTIES vASvTOvTHEvACCURACY,vADEQUACYvORvCOMPLETENESSvOFvO
RvRESULTSvTOvBEvOBTAINEDvFROMvUSINGvTHEvWORK,vINCLUDINGvANYvINFORMATIO
NvTHATvCANvBEvACCESSEDvTHROUGHvTHEvWORKvVIAvHYPERLINKvORvOTHERWISE,vA
NDvEXPRESSLYvDISCLAIMvANYvWARRANTY,vEXPRESSvORvIMPLIED,vINCLUDINGvBUTvN
OTvLIMITEDvTOvIMPLIEDvWARRANTIESvOFvMERCHANTABILITYvORvFITNESSvFORvAvPAR
TICU-
LARvPURPOSE.vMcGraw-
Hillvandvitsvlicensorsvdovnotvwarrantvorvguaranteevthatvthevfunctionsvcontainedvinvthevworkvwillvmeetvy
ourvrequirementsvorvthatvitsvoperationvwillvbevuninterruptedvorverrorvfree.vNeithervMcGraw-
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vbilityvforvthevcontentvofvanyvinformationvaccessedvthroughvthevwork.vUndervnovcircumstancesvshallv
McGraw-
Hillvand/orvitsvlicensorsvbevliablevforvanyvindirect,vincidental,vspecial,vpunitive,vconsequentialvorvsimila
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whatsoevervwhethervsuchvclaimvorvcausevarisesvinvcontract,vtortvorvotherwise.
