Preface

Acknowledgments

SECTION 1：OVERVIEW

1. Overview of Obstetrics

SECTION 2：MATERNAL ANATOMY AND PHYSIOLOGY

2. Maternal Anatomy

3. Congenital Genitourinary Abnormalities

4. Maternal Physiology

SECTION 3：PLACENTATION, EMBRYOGENESIS, AND FETAL DEVELOPMENT

5. Implantation and Placental Development

6. Placental Abnormalities

7. Embryogenesis and Fetal Development

SECTION 4：PRECONCEPTIONAL AND PRENATAL CARE

8. Preconceptional Care

9. Prenatal Care

SECTION 5：THE FETAL PATIENT

10. Fetal Imaging

11. Amnionic Fluid

12. Teratology, Teratogens, and Fetotoxic Agents

13. Genetics

14. Prenatal Diagnosis

15. Fetal Disorders

16. Fetal Therapy

17. Fetal Assessment

SECTION 6：EARLY PREGNANCY COMPLICATIONS

18. Abortion

19. Ectopic Pregnancy

20. Gestational Trophoblastic Disease

SECTION 7：LABOR

21. Physiology of Labor

22. Normal Labor

23. Abnormal Labor

24. Intrapartum Assessment

25. Obstetrical Analgesia and Anesthesia

26. Induction and Augmentation of Labor

SECTION 8：DELIVERY

27. Vaginal Delivery

28. Breech Delivery

29. Operative Vaginal Delivery

30. Cesarean Delivery and Peripartum Hysterectomy

31. Prior Cesarean Delivery

SECTION 9：THE NEWBORN

32. The Newborn

33. Diseases and Injuries of the Term Newborn

34. The Preterm Newborn

35. Stillbirth

SECTION 10：THE PUERPERIUM

36. The Puerperium

37. Puerperal Complications

38. Contraception

39. Sterilization

SECTION 11：OBSTETRICAL COMPLICATIONS

40. Hypertensive Disorders

41. Obstetrical Hemorrhage

42. Preterm Birth

43. Postterm Pregnancy

44. Fetal-Growth Disorders

45. Multifetal Pregnancy

SECTION 12：MEDICAL AND SURGICAL COMPLICATIONS

46. General Considerations and Maternal Evaluation

47. Critical Care and Trauma

48. Obesity

49. Cardiovascular Disorders

50. Chronic Hypertension

51. Pulmonary Disorders

52. Thromboembolic Disorders

53. Renal and Urinary Tract Disorders

54. Gastrointestinal Disorders

55. Hepatic, Biliary, and Pancreatic Disorders

56. Hematological Disorders

57. Diabetes Mellitus

58. Endocrine Disorders

59. Connective Tissue Disorders

60. Neurological Disorders

61. Psychiatric Disorders

62. Dermatological Disorders

63. Neoplastic Disorders

64. Infectious Diseases

65. Sexually Transmitted Infections

APPENDIX

Serum and Blood Constituents

Maternal Echocardiographic Measurements

Fetal Sonographic Measurements

Index

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