Acute Abdomen During Pregnancy

Foreword I to the Second Edition
Foreword II to the Second Edition
Preface to the Third Edition
Preface to the Second Edition
Preface to the First Edition
Contents
Part I: General Considerations
	1: Radiology
		1.1	 General Considerations
			1.1.1	 Examinations That Do Not Require Verification of Pregnancy Status
			1.1.2	 Examinations That May Require Verification of Pregnancy Status
		1.2	 Abdominal Ultrasound
		1.3	 Abdominal CT
		1.4	 Abdominal MRI
		1.5	 MRCP
		1.6	 Nuclear Medicine Examinations
		1.7	 Radiologic Interventional Techniques
		1.8	 ERCP
			1.8.1	 Radiation
			1.8.2	 Techniques
			1.8.3	 Contrast Agents
			1.8.4	 Maternal and Fetal Outcomes
		1.9	 Endovascular Techniques
		1.10	 Intraoperative Cholangiography
		References
	2: Anesthetic and Perioperative Management
		2.1	 Anesthetic Management
			2.1.1	 Anesthetic Medications
				2.1.1.1	 General Anesthesia
				2.1.1.2	 Sedation and Spinal Anesthesia
			2.1.2	 Airway Management
				2.1.2.1	 Diaphragmatic Hernia
				2.1.2.2	 Abdominal Trauma
					Head and Neck Injury
					Spinal Cord Injury
				2.1.2.3	 Increased Intra-Abdominal Pressure
				2.1.2.4	 Acute Appendicitis
				2.1.2.5	 Uterine Rupture
			2.1.3	 Intraoperative CO2 Monitoring
			2.1.4	 Extracorporeal Membranous Oxygenation
				2.1.4.1	 Considerations in Pregnancy
				2.1.4.2	 Amniotic Fluid Embolism
				2.1.4.3	 Maternal Trauma
		2.2	 Perioperative Medications
			2.2.1	 Antibiotics
				2.2.1.1	 Acute Appendicitis
				2.2.1.2	 Acute Cholecystitis
			2.2.2	 Pain Management
				2.2.2.1	 NSAIDs
				2.2.2.2	 Paracetamol
				2.2.2.3	 Opioids
				2.2.2.4	 Local Anesthesia
			2.2.3	 Thromboprophylaxis and Anticoagulation
				2.2.3.1	 General Recommendations
				2.2.3.2	 Low-Risk Surgery
				2.2.3.3	 Elective Cholecystectomy
				2.2.3.4	 Emergent Cholecystectomy
					IVF Pregnancy
				2.2.3.5	 General IBD Patients (ECCO Consensus)
				2.2.3.6	 Cesarean Section
				2.2.3.7	 Torsion of the Gravid Uterus
				2.2.3.8	 Venous Thromboembolism
					Mesenteric Vein Thrombosis
		2.3	 Perioperative Management
			2.3.1	 Fetal Heart Rate Monitoring
			2.3.2	 Perioperative Nutrition
				2.3.2.1	 Total Parenteral Nutrition and Refeeding Syndrome
					Pathophysiology
					Total Parenteral Nutrition in Pregnancy
				2.3.2.2	 Perinatal Outcome
			2.3.3	 Hemorrhage Management
				2.3.3.1	 Cardiopulmonary Resuscitation
				2.3.3.2	 Major Hemorrhage
				2.3.3.3	 Fetal Assessment
		References
	3: Increased Intra-abdominal Pressure
		3.1	 Physiology and Pathophysiology
			3.1.1	 Introduction
			3.1.2	 The Physiology of Normal Pregnancy
			3.1.3	 Intra-abdominal Pressure in Normal Pregnancy
			3.1.4	 Pathophysiology of IAH/ACS
				3.1.4.1	 Physical Laws of IAP in Pregnancy
				3.1.4.2	 Digestive System Pathophysiology
				3.1.4.3	 IAH/ACS and the Fetus
		3.2	 Etiopathogenesis
			3.2.1	 Nonoperative Conditions
				3.2.1.1	 Preeclampsia
				3.2.1.2	 HELLP Syndrome
				3.2.1.3	 Ovarian Hyperstimulation Syndrome
				3.2.1.4	 Obesity
				3.2.1.5	 Obstetric/Gynecologic Conditions
			3.2.2	 Operative Conditions
				3.2.2.1	 Laparoscopic Pneumoperitoneum
					The Postpartum Period
					Combined or Consecutive Operations During the Same Pregnancy
					Gasless Laparoscopy
				3.2.2.2	 Burst Abdomen
					Definition
					Incidence and Etiopathogenesis
				3.2.2.3	 Acute Surgical Conditions
					Acute Pancreatitis
					Intestinal Obstruction
					Acute Appendicitis
					Spontaneous Hepatic Rupture
		3.3	 Clinical Presentation
		3.4	 Diagnosis
			3.4.1	 Intra-abdominal Pressure Measurement
			3.4.2	 Laboratory Findings
			3.4.3	 Plain Chest X-Ray
			3.4.4	 Abdominal Ultrasound
		3.5	 Treatment
			3.5.1	 Nonoperative Treatment
				3.5.1.1	 Nutrition
				3.5.1.2	 Medical Treatment
					Enteral Decompression
					Evacuation of Intra-abdominal Lesions or Fluid
					Management of the Underlying Disease
					Abdominal Wall Compliance Optimization
					Optimization of Fluid Administration
			3.5.2	 Operative Treatment
				3.5.2.1	 Source Control
				3.5.2.2	 Planned Relaparotomy
				3.5.2.3	 Decompression Laparotomy
					Vacuum-Assisted Closure (VAC)
			3.5.3	 Obstetric Management
				3.5.3.1	 Burst Abdomen
				3.5.3.2	 Postpartum
		3.6	 Prognosis
			3.6.1	 Maternal Outcome
				3.6.1.1	 Burst Abdomen
				3.6.1.2	 Acute Pancreatitis
			3.6.2	 Fetal Outcome
				3.6.2.1	 Burst Abdomen
				3.6.2.2	 Acute Pancreatitis
				3.6.2.3	 Acute Appendicitis
				3.6.2.4	 Obesity
		References
	4: Acute Abdomen-Induced Preterm Labor
		4.1	 Definitions
		4.2	 Physiology of Labor
			4.2.1	 Myometrial Contractility
			4.2.2	 Cervical Remodeling
			4.2.3	 Decidual/Membrane Activation
			4.2.4	 Prostaglandins and Parturition
		4.3	 Etiopathogenesis of Preterm Labor
			4.3.1	 Inflammation
				4.3.1.1	 Ascending Intrauterine Infection
				4.3.1.2	 Hematogenous Spread to the Placenta
				4.3.1.3	 Intraperitoneal Infection
				4.3.1.4	 Molecular Basis of Infection
					Pro-inflammatory Cytokines
					Anti-Inflammatory Cytokines
					Cytokeratins
			4.3.2	 Maternal and Fetal Stress
			4.3.3	 Decidual Hemorrhage
				4.3.3.1	 Decidual Spiral Arteries Disruption
				4.3.3.2	 Infection-induced Placental Abruption
				4.3.3.3	 Trauma-induced Preterm Labor
					Placental Abruption
					Traumatic Uterine Contractions
			4.3.4	 Maternal Nutritional Status
			4.3.5	 Final Common Pathway
		4.4	 Clinical Presentation
		4.5	 Diagnosis
			4.5.1	 Prediction of Preterm Labor
				4.5.1.1	 Uterine Contractions
				4.5.1.2	 Laboratory Findings
				4.5.1.3	 Transvaginal Ultrasound
			4.5.2	 Preterm Premature Rupture of Membranes
			4.5.3	 Placental Pathology
		4.6	 Treatment
			4.6.1	 Nontocolytic Treatment
				4.6.1.1	 Bed Rest
				4.6.1.2	 Antibiotics
					Intrauterine Infection
					Acute Abdomen
				4.6.1.3	 Antioxidants
				4.6.1.4	 Inhibitors of Thrombin-mediated Contractions
				4.6.1.5	 Vitamin D
			4.6.2	 Tocolytic Treatment
				4.6.2.1	 Magnesium Sulfate
					Abdominal Trauma
					Renal Colic
				4.6.2.2	 Progesterone
					Adnexal Torsion/Ovariectomy
					Abdominal Trauma
				4.6.2.3	 Anti-Inflammatory Agents
					NSAIDs/Indomethacin
					Experimental Anti-Inflammatory Agents
						NF-kB Inhibitors
						TLR4 Antagonists
						Anti TNF-α Antibodies
						Cytokine Suppressive Anti-Inflammatory Drugs (CSAIDs)
						Resveratrol
				4.6.2.4	 Betamimetics
			4.6.3	 Combination Treatment
				4.6.3.1	 Combination Tocolysis
				4.6.3.2	 Tocolysis and Non-Tocolytic Agents
			4.6.4	 Placental Abruption Treatment
		4.7	 Prognosis
			4.7.1	 Fetal Inflammatory Response Syndrome
				4.7.1.1	 Pathophysiology
				4.7.1.2	 Prevention and Treatment
			4.7.2	 Fetal Mortality
				4.7.2.1	 Fetal Infection
				4.7.2.2	 Fetal Trauma
				4.7.2.3	 Placental Abruption
			4.7.3	 Fetal Morbidity
				4.7.3.1	 Brain Injury
					Cerebral Palsy
						Infection/Inflammation
						Trauma
					Epilepsy
				4.7.3.2	 Lung Injury
				4.7.3.3	 Low Gestational Weight and Birth Defects
					Domestic Violence
					Motor Vehicle Accidents
			4.7.4	 Maternal Outcome
				4.7.4.1	 Placental Abruption
				4.7.4.2	 Intrauterine Fetal Death
				4.7.4.3	 Intra-abdominal Infection
		References
	5: Fetal Trauma
		5.1	 Fetal Physiology
		5.2	 Blunt Fetal Trauma
			5.2.1	 Incidence
			5.2.2	 Pathophysiology
				5.2.2.1	 Direct Fetal Injury
				5.2.2.2	 Indirect Fetal Injury
				5.2.2.3	 Childbirth Trauma
			5.2.3	 Clinical Presentation
				5.2.3.1	 Intrauterine Trauma
				5.2.3.2	 Birth Trauma
			5.2.4	 Diagnosis
				5.2.4.1	 Intrauterine Diagnosis
				5.2.4.2	 Postdelivery
				5.2.4.3	 Diagnosis at Delivery
			5.2.5	 Differential Diagnosis
			5.2.6	 Treatment
				5.2.6.1	 Intrauterine Fractures
				5.2.6.2	 Brain Injury
					Subdural Hematoma
				5.2.6.3	 Birth-Related Fractures
					Cerebral Palsy
			5.2.7	 Prognosis
				5.2.7.1	 Fetal Mortality
					Maternal Pelvic Fractures
					Fetal Subdural Hematoma
				5.2.7.2	 Fetal Morbidity
		5.3	 Penetrating Fetal Trauma
			5.3.1	 Incidence
			5.3.2	 Pathophysiology
				5.3.2.1	 Fetal Gunshot Wound Characteristics
				5.3.2.2	 Fetal Skin Restitution
			5.3.3	 Clinical Presentation
				5.3.3.1	 Stab Wound
				5.3.3.2	 Gunshot Wound
					Head
				5.3.3.3	 Lethal Injuries
				5.3.3.4	 Delayed Presentation
			5.3.4	 Diagnosis
				5.3.4.1	 Preoperative Diagnosis
				5.3.4.2	 Intraoperative Diagnosis
				5.3.4.3	 Postdelivery Diagnosis
				5.3.4.4	 Delayed Diagnosis
			5.3.5	 Treatment
				5.3.5.1	 Obstetric Management
				5.3.5.2	 General Wound Treatment
					Tetanus Vaccinations/Prophylaxis
					Prophylactic Antibiotics
				5.3.5.3	 Subcutaneous and Limb Injury
				5.3.5.4	 Head Injury
					Neuroprotection
					Brain Surgery
				5.3.5.5	 Thoracoabdominal Injury
			5.3.6	 Prognosis
				5.3.6.1	 Penetrating Head Injury
				5.3.6.2	 Penetrating Thoracoabdominal Injury
				5.3.6.3	 Perimortem Cesarean Section
		References
Part II: Gynecology
	6: Adnexal Torsion
		6.1	 Introduction
		6.2	 Historical Perspective
		6.3	 Incidence
		6.4	 Risk Factors
			6.4.1	 Adnexal Mass
			6.4.2	 Anatomic Variations of Adnexa
			6.4.3	 Assisted Reproductive Technologies
			6.4.4	 Pregnancy and Trimester
		6.5	 Pathology
		6.6	 Clinical Presentation
			6.6.1	 Medical History
			6.6.2	 Physical Examination
		6.7	 Differential Diagnosis
		6.8	 Diagnosis
			6.8.1	 Laboratory Findings
			6.8.2	 Transvaginal Ultrasound
			6.8.3	 Abdominal CT
			6.8.4	 Abdominal MRI
		6.9	 Treatment
			6.9.1	 Operative Principles
				6.9.1.1	 Abdominal Access
				6.9.1.2	 Adnexal Preservation or Resection
				6.9.1.3	 Underlying or Concomitant Disease
			6.9.2	 Operative Techniques
				6.9.2.1	 Detorsion/Unwinding
					Laparoscopy
					Single Incision Laparoscopic Surgery
				6.9.2.2	 Ovariopexy (Oophoropexy)
				6.9.2.3	 Laparotomy
			6.9.3	 Obstetric Management
				6.9.3.1	 Prevention and Treatment of Preterm Labor
				6.9.3.2	 Hormonal Pregnancy Support
				6.9.3.3	 Ovarian Function
		6.10	 Prognosis
			6.10.1	 Maternal Outcome
				6.10.1.1	 Preservation of Fertilzation
				6.10.1.2	 Delivery
				6.10.1.3	 Risk of Recurrence
			6.10.2	 Fetal Outcome
		References
	7: Isolated Fallopian Tube Torsion
		7.1	 Historical Perspective
		7.2	 Incidence
		7.3	 Etiopathogenesis
			7.3.1	 Risk Factors
			7.3.2	 Pathophysiology
		7.4	 Classification
		7.5	 Clinical Presentation
		7.6	 Differential Diagnosis
		7.7	 Diagnosis
			7.7.1	 Laboratory Findings
			7.7.2	 Abdominal Ultrasound
			7.7.3	 Abdominal CT
			7.7.4	 Abdominal MRI
		7.8	 Treatment
			7.8.1	 Abdominal Entry
				7.8.1.1	 Laparoscopy
				7.8.1.2	 Laparotomy
			7.8.2	 Operative Procedures
				7.8.2.1	 Detorsion (Untwisting)
				7.8.2.2	 Salpingectomy
			7.8.3	 Obstetric Management
				7.8.3.1	 Cesarean Section
				7.8.3.2	 Pregnancy Follow-Up
		7.9	 Prognosis
			7.9.1	 Maternal Outcome
			7.9.2	 Fetal Outcome
		References
	8: Complex Ovarian Mass
		8.1	 Incidence and Classification
			8.1.1	 Ovarian Cysts
			8.1.2	 Ovarian Teratoma
			8.1.3	 Ovarian Carcinoma
			8.1.4	 Ovarian Endometrioma
		8.2	 Clinical Presentation
		8.3	 Differential Diagnosis
		8.4	 Diagnosis
			8.4.1	 Laboratory Findings
			8.4.2	 Abdominal Ultrasound
			8.4.3	 Abdominal MRI
		8.5	 Treatment
			8.5.1	 Introduction
			8.5.2	 Conservative Treatment
				8.5.2.1	 Observation
					Asymptomatic
					Abdominal Pain
					Borderline Ovarian Tumors/Suspected Malignancy
				8.5.2.2	 Ultrasound-Guided Aspiration
			8.5.3	 Surgical Treatment
				8.5.3.1	 Emergency Laparotomy
					Hemorrhagic Corpus Luteum
					Ovarian Teratoma
					Obstructed Labor
				8.5.3.2	 Elective Laparotomy
					Ovarian Teratoma
				8.5.3.3	 Minimally Invasive Surgery
					General Considerations
					Gasless Laparoscopy
					Robotic or Single-Site Surgery
					Cystectomy
				8.5.3.4	 Incidental Tumors
			8.5.4	 Anesthetic and Perioperative Management
				8.5.4.1	 First Trimester
				8.5.4.2	 Bilateral Ovariectomy
			8.5.5	 Adjuvant Chemotherapy
		8.6	 Prognosis
			8.6.1	 Maternal Outcome
				8.6.1.1	 Continuation of Pregnancy
				8.6.1.2	 Malignant Tumors
			8.6.2	 Fetal Outcome
				8.6.2.1	 Fetal Morbidity
				8.6.2.2	 Fetal Mortality
		References
	9: Ruptured Ectopic Pregnancy
		9.1	 Ectopic Pregnancy in General
			9.1.1	 Incidence
			9.1.2	 Risk Factors
			9.1.3	 Classification
				9.1.3.1	 Tubal Pregnancy
				9.1.3.2	 Non-tubal Ectopic Pregnancy
				9.1.3.3	 Heterotopic Pregnancy
				9.1.3.4	 Persistent Ectopic Pregnancy
			9.1.4	 Clinical Presentation
				9.1.4.1	 Medical History
				9.1.4.2	 Physical Examination
			9.1.5	 Differential Diagnosis
			9.1.6	 Diagnosis
				9.1.6.1	 Laboratory Findings
				9.1.6.2	 Transabdominal Ultrasound
				9.1.6.3	 Transvaginal Ultrasound
				9.1.6.4	 Abdominal CT
				9.1.6.5	 Abdominal MRI
				9.1.6.6	 Culdocentesis
				9.1.6.7	 Diagnostic Exploration
			9.1.7	 Treatment
				9.1.7.1	 Historical Perspective
				9.1.7.2	 Medical Treatment
				9.1.7.3	 Fallopian Tube Pregnancy
					Fallopian Tube-Sparing Surgery
					Salpingectomy
					Hemodynamically Unstable Patient
					Laparoscopy
				9.1.7.4	 Cervical Pregnancy
				9.1.7.5	 (Incidental) Appendectomy
			9.1.8	 Prognosis
		9.2	 Ruptured Cornual Pregnancy
			9.2.1	 Definition
			9.2.2	 Incidence and Pathophysiology
			9.2.3	 Clinical Presentation
			9.2.4	 Diagnosis
				9.2.4.1	 Abdominal Ultrasound
				9.2.4.2	 Hysterosalpingography
				9.2.4.3	 Abdominal CT
				9.2.4.4	 Abdominal MRI
			9.2.5	 Treatment
				9.2.5.1	 Intra-Abdominal Access
				9.2.5.2	 Procedures
					Excision of Rudimentary Horn with Ipsilateral Salpingectomy
					Cornuotomy and Cornual Resection
					Microsurgical Fallopian Tube Transposition
				9.2.5.3	 Anesthetic and Perioperative Management
			9.2.6	 Prognosis
		9.3	 Abdominal Pregnancy
			9.3.1	 Historical Perspective
			9.3.2	 Classification
			9.3.3	 Incidence
			9.3.4	 Risk Factors
			9.3.5	 Clinical Presentation
			9.3.6	 Diagnosis
				9.3.6.1	 Laboratory Findings
				9.3.6.2	 Transabdominal Ultrasound
				9.3.6.3	 Abdominal MRI
			9.3.7	 Treatment
				9.3.7.1	 Conservative Treatment
					>20 Weeks Gestation
					<20 Weeks Gestation
				9.3.7.2	 Surgical Treatment
					Perioperative Embolization
					Operative Procedure
					Postoperative Management
			9.3.8	 Prognosis
				9.3.8.1	 Maternal Outcome
				9.3.8.2	 Fetal Outcome
					Mortality
					Morbidity/Deformations
		9.4	 Primary Hepatic Pregnancy
			9.4.1	 Historical Perspective
			9.4.2	 Incidence
			9.4.3	 Risk Factors and Pathophysiology
			9.4.4	 Clinical Presentation
			9.4.5	 Differential Diagnosis
			9.4.6	 Diagnosis
				9.4.6.1	 Laboratory Findings
				9.4.6.2	 Transvaginal Ultrasound
				9.4.6.3	 Transabdominal Ultrasound
				9.4.6.4	 Abdominal CT
				9.4.6.5	 Abdominal MRI
				9.4.6.6	 PET-CT
			9.4.7	 Treatment
				9.4.7.1	 Medical Treatment
				9.4.7.2	 Radiological Intervention Techniques
				9.4.7.3	 Surgical Treatment
				9.4.7.4	 Continuation of Pregnancy and Delivery
				9.4.7.5	 Anesthetic and Perioperative Management
		9.5	 Primary Ovarian Pregnancy
			9.5.1	 Historical Perspective
			9.5.2	 Incidence
			9.5.3	 Risk Factors and Pathophysiology
			9.5.4	 Clinical Presentation
			9.5.5	 Diagnosis
				9.5.5.1	 Laboratory Findings
				9.5.5.2	 Transvaginal Ultrasound
				9.5.5.3	 Culdocentesis
			9.5.6	 Differential Diagnosis
			9.5.7	 Treatment
				9.5.7.1	 Medical Treatment
				9.5.7.2	 Surgical Treatment
			9.5.8	 Prognosis
				9.5.8.1	 Maternal Outcome
				9.5.8.2	 Fetal Outcome
		References
	10: Uterine Rupture and Perforation
		10.1	 Spontaneous Uterine Rupture
			10.1.1	 Historical Perspective
			10.1.2	 Definition and Classification
			10.1.3	 Mechanisms
				10.1.3.1	 Scarred Uterus
					Uterine Scar Rupture
					Atypical Site Rupture
				10.1.3.2	 Unscarred Uterus
				10.1.3.3	 Simultaneous Uterus and Bladder Rupture
			10.1.4	 Incidence
				10.1.4.1	 Developed vs. Undeveloped Countries
				10.1.4.2	 Decade Dependency
			10.1.5	 Risk Factors
				10.1.5.1	 Scarred Uterus
					Classic Cesarean Delivery
					Low-Vertical Cesarean Section
					Unknown Uterine Scar
					Low-Transverse Cesarean Section
					Cesarean Section Without a Subsequent Trial of Labor
					Cesarean Section with Subsequent Spontaneous Labor
					Cesarean Section with Subsequent Augmentation of Labor
					Cesarean Section and Induction of Labor
						Prostaglandins
						Mechanical Methods
					Cesarean Section with Previous Successful Vaginal Delivery
					Cesarean Section with Subsequent Successful VBACs
					Interdelivery Interval
					Single-Layer vs. Two-Layer Hysterotomy Closure
					Multiple Cesarean Sections
					Placenta Percreta
					Sexual Intercourse
					Gestational Age
				10.1.5.2	 Unscarred Uterus
					Oxytocin and Prostaglandins
					Assisted Vaginal Delivery
					Parity, Age, and Race
					Congenital Uterine Anomalies
						Rudimentary Horn
					Uterine Sacculation
					Uterine Diverticulum
					Genetic Susceptibility for Rupture
					Antenatal Care
					Epidural Anesthesia
					Uterine Fibroids
				10.1.5.3	 Operative Procedure
					Prepregnancy Uterine Myomectomy
					Medical Abortion
					Uterine Curettage
					Salpingectomy
					Uterine Artery Embolization
			10.1.6	 Prevention
				10.1.6.1	 Scarred Uterus
			10.1.7	 Clinical Presentation
				10.1.7.1	 Symptoms
					Pregnancy
					Labor and Postpartum
					Scarred Uterus
					Incomplete and Silent Rupture
					Delayed Presentation
					Epidural/Spinal Anesthesia
				10.1.7.2	 Physical Examination
			10.1.8	 Diagnosis
				10.1.8.1	 Laboratory Findings
				10.1.8.2	 Abdominal Ultrasound
				10.1.8.3	 Abdominal CT
				10.1.8.4	 Abdominal MRI
				10.1.8.5	 Cardiotocography
			10.1.9	 Differential Diagnosis
				10.1.9.1	 Acute Pubic Symphysis Rupture
					Incidence
					Pathophysiology
					Clinical Presentation
					Diagnosis
					Treatment
					Prognosis
			10.1.10	 Treatment
				10.1.10.1	 Anesthetic and Perioperative Management
				10.1.10.2	 Operative Treatment
					Suture Repair
					Hysterectomy
						Total Abdominal Hysterectomy
						Subtotal Hysterectomy
					First and Second Trimester
					Urinary Bladder Rupture or Injury
					Elective Cesarean Section
			10.1.11	 Prognosis
				10.1.11.1	 Maternal Outcome
					Repeated Uterine Rupture
					Maternal Morbidity
					Maternal Mortality
				10.1.11.2	 Fetal Outcome
					Fetal Morbidity
						Fetal Hypoxia
						Hypoxic–Ischemic Encephalopathy
					Fetal Mortality
		10.2	 Traumatic Uterine Rupture
			10.2.1	 Historical Perspective
			10.2.2	 Incidence
			10.2.3	 Etiopathogenesis
			10.2.4	 Clinical Presentation
			10.2.5	 Diagnosis
			10.2.6	 Treatment
			10.2.7	 Prognosis
		10.3	 Uterine Perforation
			10.3.1	 Traumatic
			10.3.2	 Iatrogenic
				10.3.2.1	 Incidence
				10.3.2.2	 Pathophysiology and Presentation
				10.3.2.3	 Diagnosis and Treatment
				10.3.2.4	 Prognosis
		References
	11: Torsion of the Gravid Uterus
		11.1	 Historical Perspective
		11.2	 Incidence
		11.3	 Etiopathogenesis
			11.3.1	 General Population
			11.3.2	 Pregnancy
			11.3.3	 Puerperium
		11.4	 Clinical Presentation
			11.4.1	 Pregnancy
				11.4.1.1	 Medical History
				11.4.1.2	 Physical Examination
			11.4.2	 Puerperium
		11.5	 Differential Diagnosis
		11.6	 Diagnosis
			11.6.1	 Laboratory Findings
			11.6.2	 Plain Abdominal X-Ray
			11.6.3	 Abdominal Ultrasound
			11.6.4	 Abdominal CT
			11.6.5	 Abdominal MRI
		11.7	 Treatment
			11.7.1	 Operative Treatment
				11.7.1.1	 Uterine Detorsion
				11.7.1.2	 Hysterotomy
				11.7.1.3	 Hysterectomy
			11.7.2	 Obstetric Management
		11.8	 Prognosis
			11.8.1	 Maternal Outcome
				11.8.1.1	 Morbidity and Mortality
				11.8.1.2	 Future Pregnancy
			11.8.2	 Fetal Outcome
		References
	12: Symptomatic Uterine Myoma
		12.1	 Definition and Classification
		12.2	 Incidence
			12.2.1	 Red Degeneration
			12.2.2	 Spontaneous Bleeding
			12.2.3	 Uterine Fibroid Torsion
			12.2.4	 Gravid Uterus Torsion
		12.3	 Natural History
			12.3.1	 Uterine Fibroid Growth
			12.3.2	 Acute Red Degeneration
			12.3.3	 Uterine Fibroid Torsion
			12.3.4	 Spontaneous Bleeding
			12.3.5	 Uterine Incarceration
		12.4	 Clinical Presentation
			12.4.1	 Medical History
			12.4.2	 Physical Examination
		12.5	 Differential Diagnosis
		12.6	 Diagnosis
			12.6.1	 Laboratory Findings
			12.6.2	 Abdominal Ultrasound
			12.6.3	 Abdominal MRI
			12.6.4	 Abdominal CT
		12.7	 Treatment
			12.7.1	 Historical Perspective
			12.7.2	 Conservative Treatment
			12.7.3	 Operative Treatment
				12.7.3.1	 Abdominal Access
				12.7.3.2	 Myomectomy
				12.7.3.3	 Elective Myomectomy
				12.7.3.4	 Emergency Myomectomy
				12.7.3.5	 Cesarean Myomectomy
		12.8	 Prognosis
			12.8.1	 Maternal Outcome
				12.8.1.1	 Maternal Mortality
				12.8.1.2	 Maternal Morbidity
			12.8.2	 Fetal Outcome
		References
	13: Complicated Pelvic Inflammatory Disease
		13.1	 General Female Population
			13.1.1	 Tubo-Ovarian Abscess
				13.1.1.1	 Incidence
				13.1.1.2	 Pathophysiology
				13.1.1.3	 Microbiology
				13.1.1.4	 Prevention
				13.1.1.5	 Clinical Presentation
				13.1.1.6	 Diagnosis
				13.1.1.7	 Treatment and Prognosis
			13.1.2	 Ovarian Abscess
				13.1.2.1	 Historical Perspective
				13.1.2.2	 Pathophysiology
		13.2	 Historical Considerations
		13.3	 Incidence
			13.3.1	 Acute Salpingitis
			13.3.2	 Tubo-Ovarian Abscess
			13.3.3	 Ovarian Abscess
			13.3.4	 Intramyometrial and Uterine Horn Abscess
		13.4	 Etiopathogenesis
			13.4.1	 Suppurative Salpingitis
				13.4.1.1	 Acute Suppurative Puerperal Salpingitis
				13.4.1.2	 Acute Salpingitis
			13.4.2	 Tubo-Ovarian Abscess
				13.4.2.1	 In Vitro Fertilization–Embryo Transfer
				13.4.2.2	 In Vitro Fertilization–Embryo Transfer and Endometriosis
				13.4.2.3	 Previous Pelvic Inflammatory Disease
				13.4.2.4	 Puerperium
				13.4.2.5	 Tubal Sterilization
				13.4.2.6	 Genital Anomalies
				13.4.2.7	 Infective Non-Gynecologic Etiology
			13.4.3	 Ovarian Abscess
			13.4.4	 Intramyometrial Abscess
		13.5	 Microbiology
		13.6	 Clinical Presentation
			13.6.1	 Suppurative Salpingitis
				13.6.1.1	 Acute Suppurative Puerperal Salpingitis
			13.6.2	 Tubo-Ovarian Abscess
			13.6.3	 Ovarian Abscess
		13.7	 Differential Diagnosis
		13.8	 Diagnosis
			13.8.1	 Laboratory Findings
			13.8.2	 Abdominal Ultrasound
			13.8.3	 Abdominal CT
			13.8.4	 Abdominal MRI
			13.8.5	 Bacterial Cultures
		13.9	 Prevention
			13.9.1	 Preprocedural Elimination of Endometriosis
			13.9.2	 Procedural Vaginal Antisepsis
			13.9.3	 Prophylactic Antibiotics/Antifungal Agents
		13.10	 Treatment
			13.10.1	 Medical Treatment
				13.10.1.1	 Tubo-Ovarian Abscess
				13.10.1.2	 Ovarian Abscess
			13.10.2	 Nonsurgical Drainage
			13.10.3	 Surgical Treatment
				13.10.3.1	 Indications
				13.10.3.2	 Operative Principles
			13.10.4	 Obstetric Management
		13.11	 Prognosis
			13.11.1	 Maternal Outcome
				13.11.1.1	 Tubo-Ovarian Abscess
				13.11.1.2	 Ovarian Abscess
				13.11.1.3	 Surgical Complications
			13.11.2	 Fetal Outcome
				13.11.2.1	 Acute Salpingitis
				13.11.2.2	 Tubo-Ovarian Abscess
				13.11.2.3	 Ovarian Abscess
		References
	14: Vernix Caseosa Peritonitis
		14.1	 Definition and Historical Perspective
		14.2	 Incidence
		14.3	 Pathology
			14.3.1	 Physiology of Vernix Caseosa
			14.3.2	 Vernix Caseosa Peritonitis/Granuloma
			14.3.3	 Intraperitoneal Meconium Peritonitis/Granuloma
		14.4	 Pathophysiology
			14.4.1	 Vernix Caseosa Peritonitis/Granuloma
			14.4.2	 Intraperitoneal Meconium Peritonitis/Granuloma
		14.5	 Clinical Presentation
		14.6	 Differential Diagnosis
		14.7	 Diagnosis
			14.7.1	 Laboratory Findings
			14.7.2	 Diagnostic Imaging
				14.7.2.1	 Plain X-Rays
				14.7.2.2	 Transabdominal Ultrasound
				14.7.2.3	 Abdominal CT
				14.7.2.4	 Abdominal PET-CT
				14.7.2.5	 Abdominal MRI
			14.7.3	 Fine-Needle Aspiration
			14.7.4	 Diagnostic Exploration
		14.8	 Treatment
			14.8.1	 Conservative Treatment
			14.8.2	 Surgical Treatment
				14.8.2.1	 Vernix Caseosa Peritonitis
				14.8.2.2	 Vernix Caseosa Granuloma
		14.9	 Prognosis
			14.9.1	 Maternal Outcome
			14.9.2	 Fetal Outcome
		References
Part III: Surgery
	15: Acute Appendicitis
		15.1	 Historical Perspective
		15.2	 Incidence
		15.3	 Risk Factors
			15.3.1	 Age and Multiple Pregnancies
			15.3.2	 Trimester
			15.3.3	 Other
		15.4	 Pathogenesis
			15.4.1	 Immunologic Changes
			15.4.2	 Anatomical/Physiological Changes
			15.4.3	 Recurrent/Chronic Appendicitis
			15.4.4	 Female Sex Hormones
		15.5	 Clinical Presentation
			15.5.1	 Medical History
			15.5.2	 Physical Examination
		15.6	 Differential Diagnosis
			15.6.1	 Round Ligament Pain/Syndrome
			15.6.2	 Meckel’s Diverticulitis
			15.6.3	 Crohn’s Disease
			15.6.4	 Urolithiasis/Urinary Tract Infection
			15.6.5	 Vomiting of Pregnancy
			15.6.6	 Fitz–Hugh–Curtis Syndrome
			15.6.7	 Puerperium-Associated Diseases
				15.6.7.1	 Metritis
				15.6.7.2	 Pelvic Thrombophlebitis/Ovarian Vein Syndrome
		15.7	 Diagnosis
			15.7.1	 Laboratory Findings
			15.7.2	 Diagnostic Scoring Systems
				15.7.2.1	 Alvarado Score and Modifications
			15.7.3	 Transabdominal Ultrasound
			15.7.4	 Transvaginal Ultrasound
			15.7.5	 Abdominal MRI
			15.7.6	 Abdominal CT
		15.8	 Treatment
			15.8.1	 Conservative Treatment
			15.8.2	 Open Appendectomy
				15.8.2.1	 Muscle Splitting Incision (McBurney’s Incision, Gridiron Incision)
				15.8.2.2	 Lower Midline Vertical Incision
				15.8.2.3	 Right Transrectal/Pararectal/Paramedian Incision
			15.8.3	 Laparoscopic Appendectomy
				15.8.3.1	 Trimester
				15.8.3.2	 Pneumoperitoneum
				15.8.3.3	 Laparoscopic Technique
			15.8.4	 Perioperative Considerations
				15.8.4.1	 Pathohistological Examination
				15.8.4.2	 Postoperative Course
		15.9	 Specific Considerations
			15.9.1	 Normal Appendix
				15.9.1.1	 Incidence
				15.9.1.2	 Appendectomy
			15.9.2	 Incidental Meckel’s Diverticulum
			15.9.3	 Ectopic/Heterotopic Pregnancy
				15.9.3.1	 Incidence and Pathophysiology
				15.9.3.2	 Clinical Presentation
				15.9.3.3	 Diagnosis
				15.9.3.4	 Treatment
			15.9.4	 Assisted Reproductive Techniques
				15.9.4.1	 Incidence
				15.9.4.2	 Differential Diagnosis
				15.9.4.3	 Diagnosis
				15.9.4.4	 Treatment
			15.9.5	 Prognosis
			15.9.6	 Sickle Cell Disease
				15.9.6.1	 Incidence
				15.9.6.2	 Clinical Presentation and Laboratory Findings
				15.9.6.3	 Prognosis
			15.9.7	 Appendiceal Endometriosis/Deciduosis
				15.9.7.1	 Historical Considerations
				15.9.7.2	 Incidence
				15.9.7.3	 Risk Factors
				15.9.7.4	 Clinical Presentation
				15.9.7.5	 Diagnosis
				15.9.7.6	 Prognosis
			15.9.8	 Appendiceal Carcinoid
			15.9.9	 Perityphlitic/ Postappendectomy Abscess
			15.9.10	 Puerperium
		15.10	 Prognosis
			15.10.1	 Conservative Treatment
			15.10.2	 Perforation Rate
			15.10.3	 Maternal Outcome
				15.10.3.1	 Maternal Mortality
				15.10.3.2	 Maternal Morbidity
			15.10.4	 Fetal Outcome
				15.10.4.1	 General Considerations
				15.10.4.2	 Historical Perspective
				15.10.4.3	 Fetal Mortality
				15.10.4.4	 Fetal Morbidity
				15.10.4.5	 Negative Appendectomy
				15.10.4.6	 Open Vs. Laparoscopic Approach
				15.10.4.7	 Conversion from Laparoscopic to Open Approach
				15.10.4.8	 Long-Term Outcome
		References
	16: Biliary Tract Emergencies
		16.1	 Acute Cholecystitis/Biliary Colic
			16.1.1	 Historical Perspective
			16.1.2	 Incidence
				16.1.2.1	 General Population
				16.1.2.2	 Pregnancy and Puerperium
			16.1.3	 Risk Factors
				16.1.3.1	 Biliary Sludge
				16.1.3.2	 Multiparity
				16.1.3.3	 Diabetes Mellitus, Obesity, and Bariatric Surgery
				16.1.3.4	 Oral Contraceptives
				16.1.3.5	 Age
				16.1.3.6	 Gallbladder Volume and Function
			16.1.4	 Pathogenesis
				16.1.4.1	 Estrogens/Progesterone
					Progesterone
					Estrogen
				16.1.4.2	 Insulin
				16.1.4.3	 Diabetes Mellitus, Obesity, and Bariatric Surgery
				16.1.4.4	 Other
			16.1.5	 Clinical Presentation
				16.1.5.1	 Medical History
				16.1.5.2	 Physical Examination
			16.1.6	 Differential Diagnosis
				16.1.6.1	 Hyperemesis Gravidarum
				16.1.6.2	 Perihepatitis (Fitz-Hugh–Curtis Syndrome)
				16.1.6.3	 Costal Margin Pain
			16.1.7	 Diagnosis
				16.1.7.1	 Laboratory Findings
				16.1.7.2	 Transabdominal Ultrasound
				16.1.7.3	 Endoscopic Ultrasound
				16.1.7.4	 Magnetic Resonance Cholangiopancreatography
			16.1.8	 Treatment
				16.1.8.1	 Historical Perspective
				16.1.8.2	 Conservative Treatment
					Total Parenteral Nutrition
					Diet
					Pain Management and Antibiotics
					Anticholinergic Antispasmodics
					Ursodeoxycholic Acid
				16.1.8.3	 Percutaneous Biliary Drainage
				16.1.8.4	 Operative Treatment
					General Population
					Pregnant Population
						Contraindications for Laparoscopic Surgery
				16.1.8.5	 Specific Considerations
					Diabetic Pregnant Patient
					IVF Pregnancy
				16.1.8.6	 Surgical Procedures
					Open Cholecystectomy
					Laparoscopic Cholecystectomy
						Third Trimester
						Open (Hasson) Technique
						Single-Incision Laparoscopic Cholecystectomy
						Gasless Laparoscopy
						The Postpartum Surgery
					Intraoperative Cholangiography
					Duration of Hospitalization
			16.1.9	 Prognosis
				16.1.9.1	 Maternal Outcome
					Maternal Mortality
					Maternal Morbidity
					Obstetric Complications
					Uterine Injury
					Gallstone-Related Hospitalization During the First Postpartum Year
				16.1.9.2	 Fetal Outcome
		16.2	 Common Bile Duct Stones and Acute Cholangitis
			16.2.1	 Incidence
			16.2.2	 Risk Factors
			16.2.3	 Clinical Presentation
			16.2.4	 Differential Diagnosis
				16.2.4.1	 Intrahepatic Cholestasis of Pregnancy
					Incidence and Risk Factors
					Clinical Presentation
					Diagnosis
					Therapy
					Prognosis
				16.2.4.2	 Acute Fatty Liver of Pregnancy
					Incidence and Risk Factors
					Pathophysiology
					Clinical Presentation
					Diagnosis
					Differential Diagnosis
					Treatment
					Prognosis
			16.2.5	 Diagnosis
				16.2.5.1	 Laboratory Findings
				16.2.5.2	 Transabdominal Ultrasound
				16.2.5.3	 MRCP
				16.2.5.4	 ERCP
					Indications
					Timing
					Sedation
					Complications
				16.2.5.5	 Endoscopic Ultrasound
			16.2.6	 Treatment
				16.2.6.1	 Laparoscopic Cholecystectomy After ERCP
					Wait-and-See Approach
					Mandatory Cholecystectomy
				16.2.6.2	 Hybrid Laparoendoscopic Approach
				16.2.6.3	 Common Bile Duct Exploration
					Transcystic Approach
					Choledochotomy
					Intraoperative Cholangiography
					Choledochoscopy
					Intraoperative Ultrasound
				16.2.6.4	 Puerperium
			16.2.7	 Prognosis
				16.2.7.1	 Maternal Outcome
				16.2.7.2	 Fetal Outcome
		16.3	 Symptomatic Choledochal Cysts
			16.3.1	 Historical Perspective
			16.3.2	 Incidence
			16.3.3	 Pathophysiology
			16.3.4	 Clinical Presentation
			16.3.5	 Differential Diagnosis
			16.3.6	 Diagnosis
			16.3.7	 Treatment
				16.3.7.1	 Asymptomatic Choledochal Cyst
				16.3.7.2	 Complicated Choledochal Cyst
					Acute Cholangitis
					Choledochal Cyst Rupture
				16.3.7.3	 Obstetric Management
			16.3.8	 Prognosis
				16.3.8.1	 Maternal Outcome
				16.3.8.2	 Fetal Outcome
		16.4	 Spontaneous Biliary Tract Perforations
			16.4.1	 Historical Perspective
			16.4.2	 Incidence
				16.4.2.1	 Gallbladder Perforation
				16.4.2.2	 Perforation of the Common Bile Duct
			16.4.3	 Pathogenesis
			16.4.4	 Clinical Presentation
			16.4.5	 Differential Diagnosis
			16.4.6	 Diagnosis
				16.4.6.1	 Laboratory Findings
				16.4.6.2	 Transabdominal Ultrasound
				16.4.6.3	 Abdominal CT
			16.4.7	 Treatment
			16.4.8	 Prognosis
		References
	17: Acute Pancreatitis
		17.1	 Historical Perspective
		17.2	 Incidence
			17.2.1	 Age, Trimester, and Race
			17.2.2	 Biliary
			17.2.3	 Hyperlipidemia/Dyslipidemia
			17.2.4	 Alcohol Abuse
				17.2.4.1	 Pancreatic Pseudocysts
			17.2.5	 Primary Hyperparathyroidism
			17.2.6	 Preeclampsia/Eclampsia
			17.2.7	 Pancreatic Neoplasms
			17.2.8	 Acute Fatty Liver of Pregnancy
		17.3	 Etiopathogenesis
			17.3.1	 Introduction
			17.3.2	 Biliary
			17.3.3	 Primary Hyperparathyroidism
				17.3.3.1	 Calcium-PTH Metabolism in Pregnancy
				17.3.3.2	 Calcium-Induced Acute Pancreatitis
			17.3.4	 Acute Fatty Liver of Pregnancy
			17.3.5	 Hyperlipidemia/Dyslipidemia
			17.3.6	 Hypothyroidism
			17.3.7	 Alcohol Abuse
			17.3.8	 Medications
			17.3.9	 Post-ERCP
			17.3.10	 Pancreatic Neoplasms
			17.3.11	 Preeclampsia/Eclampsia
			17.3.12	 Puerperium
		17.4	 Clinical Presentation
			17.4.1	 Medical History
				17.4.1.1	 Primary Hyperparathyroidism
				17.4.1.2	 Acute Fatty Liver of Pregnancy
				17.4.1.3	 Hypertriglyceridemia
				17.4.1.4	 Medications
			17.4.2	 Physical Examination
		17.5	 Diagnosis
			17.5.1	 Laboratory Findings
				17.5.1.1	 Liver and Pancreatic Enzymes
				17.5.1.2	 Serum Lipids
				17.5.1.3	 Serum Calcium and Parathormone
				17.5.1.4	 Other Serum Markers
				17.5.1.5	 Confounding Laboratory Findings
					Amylase/Lipase
					Triglycerides
					Parathyroid Hormone
				17.5.1.6	 Ranson Criteria
			17.5.2	 Transabdominal Ultrasound
			17.5.3	 Abdominal CT
			17.5.4	 Endoscopic Ultrasound
			17.5.5	 Abdominal MRI and MRCP
			17.5.6	 Endoscopic Retrograde Cholangiopancreatography
			17.5.7	 Pancreatic Cyst Fluid Analysis
			17.5.8	 Parathyroid Gland Imaging
		17.6	 Differential Diagnosis
			17.6.1	 Acute Pancreatitis
			17.6.2	 Hypercalcemia
		17.7	 Treatment
			17.7.1	 Conservative Treatment
				17.7.1.1	 Supportive Measures
				17.7.1.2	 Antibiotics
				17.7.1.3	 Continuous Renal Replacement Therapy
				17.7.1.4	 Intensive Care Unit
				17.7.1.5	 Hyperlipidemic Pancreatitis
					Lipid-Lowering Diet
					Total Parenteral Nutrition
					l-Thyroxine
					Insulin
					Heparin
					Plasmapheresis
					Lipid-Lowering Medications
						Fibrates
						Statins
				17.7.1.6	 Primary Hyperparathyroidism
				17.7.1.7	 Acute Fatty Liver of Pregnancy
			17.7.2	 Surgical Treatment
				17.7.2.1	 Pancreatic Pseudocysts
				17.7.2.2	 Pancreatic Tumors
				17.7.2.3	 Primary Hyperparathyroidism
				17.7.2.4	 Biliary
			17.7.3	 Therapeutic Delivery
				17.7.3.1	 Hyperlipidemia/Dyslipidemia
				17.7.3.2	 Gallstones and Unknown Causes
				17.7.3.3	 Preeclampsia/Eclampsia
				17.7.3.4	 Acute Fatty Liver of Pregnancy
				17.7.3.5	 HELLP Syndrome
			17.7.4	 Obstetric Management
				17.7.4.1	 Mode of Delivery
		17.8	 Prognosis
			17.8.1	 General Considerations
				17.8.1.1	 Maternal Outcome
				17.8.1.2	 Fetal Outcome
			17.8.2	 Primary Hyperparathyroidism
				17.8.2.1	 Maternal Outcome
				17.8.2.2	 Fetal Outcome
			17.8.3	 Acute Fatty Liver of Pregnancy
			17.8.4	 Hypertriglyceridemia
				17.8.4.1	 Maternal Outcome
				17.8.4.2	 Fetal Outcome
			17.8.5	 Biliary
			17.8.6	 Medications
			17.8.7	 Alcohol Abuse
				17.8.7.1	 Maternal Outcome
				17.8.7.2	 Fetal Outcome
			17.8.8	 Preeclampsia/Eclampsia
		References
	18: Intestinal Obstruction
		18.1	 General Considerations
			18.1.1	 Historical Perspective
			18.1.2	 Incidence
			18.1.3	 Clinical Presentation
			18.1.4	 Differential Diagnosis
				18.1.4.1	 Constipation
				18.1.4.2	 Irritable Bowel Syndrome
				18.1.4.3	 Postpartum Acute Intestinal Pseudo-Obstruction
					Incidence and Risk Factors
					Pathophysiology
					Clinical Presentation
					Diagnosis
					Conservative Treatment
					Surgical Treatment
					Prognosis
			18.1.5	 Treatment
			18.1.6	 Prognosis
				18.1.6.1	 Maternal Outcome
				18.1.6.2	 Fetal Outcome
		18.2	 Intussusception
			18.2.1	 General Considerations
			18.2.2	 Historical Perspective
			18.2.3	 Incidence
				18.2.3.1	 Pregnancy
				18.2.3.2	 Puerperium
			18.2.4	 Etiopathogenesis
				18.2.4.1	 Pregnancy
				18.2.4.2	 Intraluminal Pathology
				18.2.4.3	 Bariatric Surgery
			18.2.5	 Clinical Presentation
			18.2.6	 Differential Diagnosis
			18.2.7	 Diagnosis
				18.2.7.1	 Plain Abdominal X-Ray
				18.2.7.2	 Transabdominal Ultrasound
				18.2.7.3	 Abdominal CT
				18.2.7.4	 Abdominal MRI
				18.2.7.5	 Additional Modalities
			18.2.8	 Treatment
				18.2.8.1	 General Principles
				18.2.8.2	 Conservative Treatment
				18.2.8.3	 Surgical Treatment
			18.2.9	 Prognosis
		18.3	 Transvaginal Instrumental Uterine Perforation
			18.3.1	 Introduction
			18.3.2	 Incidence
			18.3.3	 Risk Factors
			18.3.4	 Mechanisms of Small Bowel Obstruction
				18.3.4.1	 Transvaginal Small Bowel Prolapse
				18.3.4.2	 Greater Omentum Incarceration
				18.3.4.3	 Adhesive Small Bowel Obstruction
				18.3.4.4	 Richter’s Hernia-Type of Small Bowel Obstruction
			18.3.5	 Clinical Presentation
				18.3.5.1	 Mechanism of Small Bowel Obstruction
				18.3.5.2	 Small Bowel Obstruction with Bleeding
			18.3.6	 Diagnosis
				18.3.6.1	 Laboratory Findings
				18.3.6.2	 Plain Abdominal X-Ray
				18.3.6.3	 Abdominal Ultrasound
				18.3.6.4	 Abdominal CT
				18.3.6.5	 Abdominal MRI
			18.3.7	 Treatment
				18.3.7.1	 Conservative Treatment
				18.3.7.2	 Surgical Treatment
				18.3.7.3	 Obstetric Management
			18.3.8	 Prognosis
		18.4	 Adhesions
			18.4.1	 Definition and Classification
			18.4.2	 Incidence
			18.4.3	 Pathophysiology
				18.4.3.1	 Postoperative Adhesions
				18.4.3.2	 Gravid Uterine Enlargement
				18.4.3.3	 Previous Appendectomy
			18.4.4	 Prevention
				18.4.4.1	 Surgical Technique
				18.4.4.2	 Mechanical Barriers
				18.4.4.3	 Chemical Agents
			18.4.5	 Diagnosis
			18.4.6	 Treatment
				18.4.6.1	 Conservative Treatment
				18.4.6.2	 Surgical Treatment
		18.5	 Small Bowel Volvulus
			18.5.1	 Small Bowel Volvulus
				18.5.1.1	 Incidence
				18.5.1.2	 Pathophysiology
				18.5.1.3	 Clinical Presentation
				18.5.1.4	 Diagnosis
					Transabdominal Ultrasound
					Abdominal CT
				18.5.1.5	 Treatment
				18.5.1.6	 Prognosis
			18.5.2	 Congenital Intestinal Malrotation
				18.5.2.1	 Incidence
				18.5.2.2	 Etiopathogenesis
				18.5.2.3	 Clinical Presentation
				18.5.2.4	 Diagnosis
				18.5.2.5	 Treatment
				18.5.2.6	 Prognosis
			18.5.3	 Ileosigmoid Knotting
				18.5.3.1	 Historical Perspective and Definition
				18.5.3.2	 Incidence
				18.5.3.3	 Etiopathogenesis
				18.5.3.4	 Clinical Presentation
				18.5.3.5	 Diagnosis
					Plain Abdominal X-Ray
					Transabdominal Ultrasound
					Abdominal CT
				18.5.3.6	 Treatment
				18.5.3.7	 Prognosis
		18.6	 Colorectal Carcinoma
			18.6.1	 Historical Perspective
			18.6.2	 Incidence
			18.6.3	 Carcinogenesis and Risk Factors
				18.6.3.1	 Hormonal Receptors
				18.6.3.2	 Cox-2 Enzymes
				18.6.3.3	 Other
			18.6.4	 Clinical Presentation
				18.6.4.1	 Elective Presentation
				18.6.4.2	 Emergent Presentation
			18.6.5	 Differential Diagnosis
			18.6.6	 Diagnosis
				18.6.6.1	 Laboratory Findings
				18.6.6.2	 Plain Abdominal X-Ray
				18.6.6.3	 Transabdominal Ultrasound
				18.6.6.4	 Abdominal MRI
				18.6.6.5	 Abdominal CT
			18.6.7	 Treatment
				18.6.7.1	 Surgical Treatment
					Elective Surgery
					Emergency Surgery
				18.6.7.2	 Conservative and Bridge Therapy
				18.6.7.3	 Mode of Delivery
				18.6.7.4	 Chemotherapy
				18.6.7.5	 Radiotherapy
					Ovarian Transposition
						Medial Ovarian Transposition
						Lateral Ovarian Transposition
			18.6.8	 Prognosis
				18.6.8.1	 Maternal Outcome
					Genetic Counseling
				18.6.8.2	 Fetal Outcome
		18.7	 Intestinal Stomal Obstruction
			18.7.1	 Intussusception and Prolapse
				18.7.1.1	 Incidence
				18.7.1.2	 Risk Factors
				18.7.1.3	 Clinical Presentation
				18.7.1.4	 Diagnosis
				18.7.1.5	 Treatment
					Intussusception
					Prolapse
				18.7.1.6	 Prognosis
			18.7.2	 Extraluminal Stomal Compression
				18.7.2.1	 Incidence
				18.7.2.2	 Diagnosis
				18.7.2.3	 Treatment and Prognosis
		18.8	 Sigmoid Volvulus
			18.8.1	 Incidence
			18.8.2	 Pathophysiology and Risk Factors
			18.8.3	 Clinical Presentation
			18.8.4	 Differential Diagnosis
			18.8.5	 Diagnosis
				18.8.5.1	 Laboratory Findings
				18.8.5.2	 Plain Abdominal X-Ray
				18.8.5.3	 Abdominal MRI
				18.8.5.4	 Abdominal CT
				18.8.5.5	 Colonoscopy
			18.8.6	 Treatment
				18.8.6.1	 Conservative Treatment
				18.8.6.2	 Surgical Treatment
			18.8.7	 Prognosis
		18.9	 Cecal Volvulus
			18.9.1	 General Considerations
			18.9.2	 Historical Perspective
			18.9.3	 Incidence and Risk Factors
			18.9.4	 Clinical Presentation
			18.9.5	 Differential Diagnosis
			18.9.6	 Diagnosis
			18.9.7	 Treatment
			18.9.8	 Prognosis
				18.9.8.1	 Maternal and Fetal Outcome
		18.10	 Incarcerated Internal Hernia
			18.10.1	 Bariatric Surgery
			18.10.2	 Congenital Defects
				18.10.2.1	 Sigmoid Mesocolon Hernia
					Incidence
					Classification
					Etiology
					Clinical Presentation
					Diagnosis
					Treatment
					Prognosis
				18.10.2.2	 Transomental Hernia
				18.10.2.3	 Falciform Ligament Hernia
		18.11	 Gastric Outlet Obstruction
			18.11.1	 Heterotopic Pancreas
				18.11.1.1	 Incidence
				18.11.1.2	 Embryology
				18.11.1.3	 Clinical Presentation
				18.11.1.4	 Diagnosis
				18.11.1.5	 Treatment
		18.12	 Gynecologic Causes
			18.12.1	 Ovarian Teratoma
				18.12.1.1	 Incidence
				18.12.1.2	 Clinical Presentation
				18.12.1.3	 Diagnosis
				18.12.1.4	 Treatment
				18.12.1.5	 Prognosis
			18.12.2	 Ectopic Pregnancy
				18.12.2.1	 Incidence
				18.12.2.2	 Clinical Presentation
				18.12.2.3	 Differential Diagnosis
				18.12.2.4	 Diagnosis
				18.12.2.5	 Treatment
					Surgical Treatment
					Gynecologic Treatment
			18.12.3	 Normal Pregnancy
				18.12.3.1	 Historical Perspective
				18.12.3.2	 Incidence
				18.12.3.3	 Pathophysiology
				18.12.3.4	 Diagnosis
				18.12.3.5	 Treatment
		References
	19: Symptomatic Abdominal Wall Hernia
		19.1	 Groin Hernia
			19.1.1	 Historical Perspective
			19.1.2	 Incidence
				19.1.2.1	 General Population
				19.1.2.2	 Pregnancy
			19.1.3	 Etiopathogenesis and Risk Factors
			19.1.4	 Clinical Presentation
			19.1.5	 Differential Diagnosis
				19.1.5.1	 Round Ligament Varicosities
					Historical Remarks
					Incidence
					Pathophysiology
					Clinical Presentation
					Diagnosis
					Treatment and Prognosis
				19.1.5.2	 Round Ligament Stretch/Pain
					Pathophysiology
					Clinical Presentation
					Differential Diagnosis
					Diagnosis
					Treatment and Prognosis
				19.1.5.3	 Inguinal/Round Ligament Endometriosis
				19.1.5.4	 Hydrocele of the Canal of Nuck
				19.1.5.5	 Myoma of the Round Ligament
			19.1.6	 Diagnosis
				19.1.6.1	 Plain Abdominal X-ray
				19.1.6.2	 Transabdominal Ultrasound
			19.1.7	 Treatment
				19.1.7.1	 Conservative Treatment
				19.1.7.2	 Surgical Treatment
				19.1.7.3	 Gynecologic Treatment
				19.1.7.4	 Inguinal Herniorrhaphy During Cesarean Section
					Surgical Technique
			19.1.8	 Prognosis
				19.1.8.1	 Hernia Recurrence
				19.1.8.2	 Postherniorrhaphy Pain
				19.1.8.3	 Surgical Site/Mesh Infection
		19.2	 Umbilical Hernia
			19.2.1	 Historical Perspective
			19.2.2	 Incidence
			19.2.3	 Etiopathogenesis
				19.2.3.1	 Risk Factors
				19.2.3.2	 Uterine Fibroids
				19.2.3.3	 Gravid Uterus
				19.2.3.4	 Laparoscopic/Single-Port Surgery
			19.2.4	 Clinical Presentation
			19.2.5	 Differential Diagnosis
				19.2.5.1	 Omphalitis/Periumbilical Abscess
				19.2.5.2	 Umbilical Endometriosis
					Incidence
					Clinical Presentation
					Diagnosis
					Treatment
					Prognosis
				19.2.5.3	 Umbilical Endosalpingiosis
					Pathogenesis
					Clinical Presentation
					Diagnosis
					Treatment
			19.2.6	 Diagnosis
				19.2.6.1	 Plain Abdominal X-ray
				19.2.6.2	 Transabdominal Ultrasound
			19.2.7	 Treatment
				19.2.7.1	 Indications and Timing
				19.2.7.2	 Umbilical Hernioplasty During Cesarean Section
					Internal Umbilical Hernia Repair
					External Umbilical Hernia Repair
				19.2.7.3	 Uterine Fibroids in Umbilical Hernia
				19.2.7.4	 Gravid Uterus in Umbilical Hernia
					Historical Remarks
					Incidence
					Diagnosis
					Treatment
				19.2.7.5	 Obstetric Management
			19.2.8	 Prognosis
				19.2.8.1	 Maternal Outcome
				19.2.8.2	 Fetal Outcome
		19.3	 Epigastric Hernia
			19.3.1	 Historical Perspective
			19.3.2	 Incidence
			19.3.3	 Clinical Presentation
			19.3.4	 Differential Diagnosis
			19.3.5	 Diagnosis
			19.3.6	 Treatment
				19.3.6.1	 Indications and Timing
				19.3.6.2	 Surgical Techniques
			19.3.7	 Prognosis
		19.4	 Incisional Hernia
			19.4.1	 Historical Perspective
			19.4.2	 Incidence and Risk Factors
				19.4.2.1	 Incisional Hernia with Gravid Uterus
				19.4.2.2	 Incisional Hernia with Abdominal Wall Endometrioma
			19.4.3	 Clinical Presentation
				19.4.3.1	 Incisional Hernia with Gravid Uterus
				19.4.3.2	 Incisional Hernia with Abdominal Wall Endometrioma
			19.4.4	 Diagnosis
				19.4.4.1	 Incisional Hernia with Gravid Uterus
				19.4.4.2	 Incisional Hernia with Abdominal Wall Endometrioma
			19.4.5	 Treatment
				19.4.5.1	 Indications
				19.4.5.2	 Open Repair
				19.4.5.3	 Component Separation Technique
				19.4.5.4	 Laparoscopic Repair
				19.4.5.5	 Incisional Hernia with Gravid Uterus
					Complications
					Treatment
				19.4.5.6	 Incisional Hernia with Abdominal Wall Endometrioma
			19.4.6	 Prognosis
				19.4.6.1	 Prepregnancy Open Repair
				19.4.6.2	 Prepregnancy Mesh Repair
				19.4.6.3	 Gravid Uterus in an Incisional Hernia
				19.4.6.4	 Abdominal Wall Endometrioma
		19.5	 Parastomal Hernia
			19.5.1	 Classification
				19.5.1.1	 Definition and Classification
				19.5.1.2	 Ostomy Types
			19.5.2	 Incidence
			19.5.3	 Clinical Presentation
				19.5.3.1	 Medical History
				19.5.3.2	 Physical Examination
			19.5.4	 Diagnosis
			19.5.5	 Treatment
				19.5.5.1	 Conservative Treatment
				19.5.5.2	 Emergent Operation
		19.6	 Diastasis Recti Abdominis
			19.6.1	 Abdominal Wall Muscle Changes During Pregnancy
			19.6.2	 Incidence and Risk Factors
			19.6.3	 Classification
			19.6.4	 Clinical Presentation
			19.6.5	 Diagnosis
			19.6.6	 Treatment
				19.6.6.1	 Conservative Treatment
				19.6.6.2	 Surgical Treatment
					Indications
					Techniques
		References
	20: Symptomatic Diaphragmatic Hernia
		20.1	 Historical Perspective
		20.2	 Incidence and Etiology
			20.2.1	 Acute Diaphragmatic Fatigue
			20.2.2	 Diaphragmatic Eventration
			20.2.3	 Diaphragmatic Hernia
				20.2.3.1	 Congenital
				20.2.3.2	 Traumatic
					Penetrating Trauma
					Blunt Trauma
					Iatrogenic
					Spontaneous Rupture During Labor
				20.2.3.3	 Hiatal Hernia
		20.3	 Clinical Presentation
			20.3.1	 Diaphragmatic Eventration
			20.3.2	 Hiatal Hernia
			20.3.3	 Posttraumatic Hernia
			20.3.4	 Congenital Diaphragmatic Hernia
		20.4	 Differential Diagnosis
		20.5	 Diagnosis
			20.5.1	 Laboratory Findings
			20.5.2	 Chest Radiography
				20.5.2.1	 Plain Chest X-ray
				20.5.2.2	 Chest X-ray with Peroral Contrast
			20.5.3	 Thoracic Ultrasound
			20.5.4	 Thoracic CT
			20.5.5	 Thoracic MRI
		20.6	 Treatment
			20.6.1	 Conservative Treatment
			20.6.2	 Surgical Treatment
				20.6.2.1	 Operative Indications
					Before Pregnancy
					Asymptomatic Patients
					Symptomatic Patients
					Emergent Presentation
				20.6.2.2	 Open Surgery
					Transthoracic Approach
					Transabdominal Approach
					Thoracoabdominal Approach
				20.6.2.3	 Laparoscopic Surgery
					Supine Position
					Lateral Position
				20.6.2.4	 Diaphragmatic Defect Closure
				20.6.2.5	 Abdominal Organ Operations
			20.6.3	 Obstetric Management
		20.7	 Prognosis
			20.7.1	 Maternal Outcome
				20.7.1.1	 Maternal Mortality
				20.7.1.2	 Recurrent Diaphragmatic Hernia
			20.7.2	 Fetal Outcome
		References
	21: Acute Inflammatory Bowel Disease
		21.1	 Crohn’s Disease
			21.1.1	 Historical Perspective and Incidence
			21.1.2	 Effect of Pregnancy
				21.1.2.1	 Modulatory Effects of Pregnancy on Inflammatory Bowel Disease
				21.1.2.2	 Disease Activity During Pregnancy
					Classification
				21.1.2.3	 Pregnancy and Surgical Therapy for CD
			21.1.3	 Pathophysiology
				21.1.3.1	 Free Intestinal Perforation
			21.1.4	 Clinical Presentation
				21.1.4.1	 Elective Presentation
				21.1.4.2	 Emergent Presentation
					Intestinal Perforation
					Intestinal Obstruction
					Intestinal Stomal Obstruction
					Presentation Mimicking Acute Appendicitis
					Obstetric Emergencies
			21.1.5	 Differential Diagnosis
			21.1.6	 Diagnosis
				21.1.6.1	 Laboratory Findings
				21.1.6.2	 Imaging Modalities
				21.1.6.3	 Endoscopy
			21.1.7	 Treatment
				21.1.7.1	 Conservative Treatment
					Antibiotics
					Aminosalicylates (FDA B)
					Electrolytes and Supplements
					Corticosteroids (FDA C)
					Thiopurines (FDA D)
					Cyclosporine (FDA C)
					Immunomodulators (FDA B)
					Methotrexate (FDA X)
					Thalidomide (FDA X)
					Probiotics
					Enteral/Parenteral Nutrition
					Antidiarrheal Agents
				21.1.7.2	 Surgical Treatment
					Colorectal Crohn’s Disease
					Small Bowel Crohn’s Disease
					Presentation Mimicking Acute Appendicitis
				21.1.7.3	 Obstetric Management
					Mode of Delivery
						Elective Cesarean Section
						Emergent Cesarean Section
			21.1.8	 Prognosis
				21.1.8.1	 Maternal Outcome
					Morbidity and Mortality
					Fertility and Sexual Health
				21.1.8.2	 Fetal Outcome
					Inheritance of CD
					Perinatal Outcome
					Breastfeeding and Vaccination
		21.2	 Ulcerative Colitis
			21.2.1	 Incidence
			21.2.2	 Effect of Pregnancy
			21.2.3	 Classification
			21.2.4	 Pathophysiology
				21.2.4.1	 Free Intestinal Perforation
				21.2.4.2	 Toxic Megacolon
			21.2.5	 Clinical Presentation
				21.2.5.1	 Elective Presentation
				21.2.5.2	 Emergent Presentation
					Toxic Megacolon
			21.2.6	 Differential Diagnosis
				21.2.6.1	 C. Difficile-Associated Toxic Colitis
			21.2.7	 Diagnosis
				21.2.7.1	 Elective Presentation
				21.2.7.2	 Emergent Presentation
			21.2.8	 Treatment
				21.2.8.1	 Conservative Treatment
				21.2.8.2	 Surgical Treatment
					Indications for Emergent Operation
					Turnbull “Blowhole” Procedure
					Subtotal and Total Colectomy
					Synchronous Cesarean Section and Surgery
				21.2.8.3	 Therapeutic Abortion/Delivery
				21.2.8.4	 Obstetric Management
					Mode of Delivery
			21.2.9	 Prognosis
				21.2.9.1	 Maternal Outcome
					Mortality
					Breastfeeding
					Fertility and Sexual Health
				21.2.9.2	 Perinatal Outcome
					Mortality
					Morbidity
		References
	22: Gastrointestinal Perforation or Rupture
		22.1	 Perforated Peptic Ulcer
			22.1.1	 Peptic Ulcer in Pregnancy
				22.1.1.1	 Incidence
				22.1.1.2	 Pathophysiology
					Gastric Position Changes
					Hypochlorhydria
					Hormones
					Fertility Rate and Peptic Ulcer
				22.1.1.3	 Risk Factors
					Helicobacter pylori Infection
					Medications
					Lifestyle Factors
					Severe Physiological Stress
					Hypersecretory States
					Fasting (General Population)
					Additional Risk Factors
				22.1.1.4	 Clinical Presentation
				22.1.1.5	 Diagnosis
				22.1.1.6	 Treatment
				22.1.1.7	 Prognosis
					Maternal Outcome
					Fetal Outcome
				22.1.1.8	 Specific Conditions
					Zollinger–Ellison Syndrome
					Helicobacter pylori
					Gastric Outlet Obstruction
			22.1.2	 Perforated Peptic Ulcer in Pregnancy
				22.1.2.1	 Historical Perspective
				22.1.2.2	 General Population
				22.1.2.3	 Pregnancy
					Historical Perspective
					Incidence
					Risk Factors
					Ulcer Type
					Clinical Presentation
					Puerperium
				22.1.2.4	 Diagnosis
				22.1.2.5	 Treatment
					Surgical Treatment
					Perioperative Gastric Acid Suppression
						Histamine2 Receptor Antagonists (H2RA)
						Proton-Pump Inhibitors (PPIs)
					Gastric Acid Suppression During Lactation
						Antacids
						Histamine2 Receptor Antagonists
						Proton-Pump Inhibitors
				22.1.2.6	 Prognosis
		22.2	 Perforated Gastric Carcinoma
			22.2.1	 Gastric Cancer in Pregnancy
				22.2.1.1	 Incidence
					Krukenberg Tumor
				22.2.1.2	 Pathology
				22.2.1.3	 Pathophysiology
				22.2.1.4	 Clinical Presentation
					Perforated Malignant Ulcer/Cancer
					Krukenberg Tumor
					Gastric Cancer
				22.2.1.5	 Diagnosis
				22.2.1.6	 Treatment
					Primary Gastric Tumor
					Krukenberg Tumor
					Hormonal Therapy
				22.2.1.7	 Prognosis
					Maternal Outcome
					Fetal Outcome
			22.2.2	 Perforated Gastric Cancer in Pregnancy
				22.2.2.1	 Incidence
				22.2.2.2	 Treatment
				22.2.2.3	 Prognosis
		22.3	 Spontaneous Gastric Rupture
			22.3.1	 Historical Perspective and Incidence
			22.3.2	 Etiopathogenesis
				22.3.2.1	 Spontaneous Gastric Rupture
				22.3.2.2	 Intestinal or Gastric Obstruction
				22.3.2.3	 Diaphragmatic Hernia
				22.3.2.4	 Postbariatric Surgery
			22.3.3	 Clinical Presentation
			22.3.4	 Diagnosis
				22.3.4.1	 Laboratory Findings
				22.3.4.2	 Plain Abdominal or Chest X-Ray
				22.3.4.3	 Esophagogastroduodenoscopy
				22.3.4.4	 Abdominal CT
			22.3.5	 Differential Diagnosis
			22.3.6	 Treatment
				22.3.6.1	 Surgical Treatment
				22.3.6.2	 Obstetric Management
			22.3.7	 Prognosis
		22.4	 Intestinal Perforation
			22.4.1	 Intestinal Endometriosis
				22.4.1.1	 Introduction
				22.4.1.2	 Incidence
				22.4.1.3	 Pathophysiology
				22.4.1.4	 Clinical Presentation
				22.4.1.5	 Differential Diagnosis
				22.4.1.6	 Diagnosis
				22.4.1.7	 Treatment
				22.4.1.8	 Prognosis
			22.4.2	 Bowel Perforation
				22.4.2.1	 Colorectal Carcinoma
				22.4.2.2	 Stercoral Colorectal Perforation
					Incidence
					Risk Factors
					Diagnosis
					Treatment
					Prognosis
				22.4.2.3	 Colorectal Obstruction and Pseudo-Obstruction
				22.4.2.4	 Spontaneous Intestinal Perforation
					Incidence
					Risk Factors
					Prevention
					Treatment
				22.4.2.5	 Transvaginal Instrumental Abortion
					Incidence
					Risk Factors
					Clinical Presentation
					Diagnosis
					Treatment
						Surgical Treatment
						Obstetric Management
					Prognosis
		References
	23: Bariatric Surgery Emergencies
		23.1	 Bariatric Surgery and Pregnancy
			23.1.1	 Introduction
			23.1.2	 Complications
			23.1.3	 Prognosis
				23.1.3.1	 Maternal Outcome
				23.1.3.2	 Fetal Outcome
				23.1.3.3	 Breastfeeding
		23.2	 Intussusception
			23.2.1	 Incidence
			23.2.2	 Pathophysiology
			23.2.3	 Clinical Presentation
			23.2.4	 Differential Diagnosis
			23.2.5	 Diagnosis
				23.2.5.1	 Plain Abdominal X-Ray
				23.2.5.2	 Transabdominal Ultrasound
				23.2.5.3	 Abdominal CT
				23.2.5.4	 Abdominal MRI
			23.2.6	 Gastroscopy
			23.2.7	 Treatment
				23.2.7.1	 Retrograde Intussusception
			23.2.8	 Prognosis
				23.2.8.1	 Maternal Outcome
				23.2.8.2	 Fetal Outcome
		23.3	 Incarcerated Internal Hernia
			23.3.1	 Classification and Pathophysiology
			23.3.2	 Incidence and Risk Factors
			23.3.3	 Clinical Presentation
			23.3.4	 Diagnosis
				23.3.4.1	 Laboratory Findings
				23.3.4.2	 Plain Abdominal X-Ray
				23.3.4.3	 Abdominal CT
				23.3.4.4	 Abdominal MRI
				23.3.4.5	 Gastroscopy
			23.3.5	 Differential Diagnosis
			23.3.6	 Treatment
			23.3.7	 Prognosis
				23.3.7.1	 Maternal Outcome
				23.3.7.2	 Fetal Outcome
		23.4	 Gastric Band Slippage
			23.4.1	 Incidence
			23.4.2	 Pathophysiology
			23.4.3	 Clinical Presentation
			23.4.4	 Differential Diagnosis
			23.4.5	 Diagnosis
			23.4.6	 Treatment
			23.4.7	 Prognosis
		23.5	 Gastric Rupture
		23.6	 Acute Cholecystitis
		References
	24: Splenic Emergencies
		24.1	 Splenic Rupture
			24.1.1	 Definition and Historical Perspective
			24.1.2	 Classification
				24.1.2.1	 Trauma
					Incidence
					Etiopathogenesis
				24.1.2.2	 Toxemia of Pregnancy
				24.1.2.3	 Underlying Splenic Disease
				24.1.2.4	 Spontaneous Rupture of Normal Spleen
					Definition
					Incidence
					Pathophysiology
				24.1.2.5	 Postpartum Splenic Rupture
					Incidence
					Etiopathogenesis
						Splenic Enlargement
						Blunt (Internal) Trauma
						Intrasplenic Aneurysm
						Cesarean Section
						Rapid Plasma Expansion
			24.1.3	 Clinical Presentation
				24.1.3.1	 Medical History
				24.1.3.2	 Physical Examination
					Postpartum Splenic Rupture
			24.1.4	 Differential Diagnosis
			24.1.5	 Diagnosis
				24.1.5.1	 Plain Abdominal X-Ray
				24.1.5.2	 Transabdominal Ultrasound
				24.1.5.3	 Angiography
				24.1.5.4	 Abdominal CT
				24.1.5.5	 Paracentesis
				24.1.5.6	 Diagnostic Exploration
			24.1.6	 Treatment
				24.1.6.1	 Historical Perspective
				24.1.6.2	 Conservative Treatment
				24.1.6.3	 Surgical Treatment
					Postpartum Splenic Rupture
					Operative Principles
					Laparoscopic Splenectomy
				24.1.6.4	 Endovascular Treatment
			24.1.7	 Prognosis
				24.1.7.1	 Maternal Outcome
				24.1.7.2	 Fetal Outcome
		24.2	 Primary Splenic Pregnancy
			24.2.1	 Definition and Classification
			24.2.2	 Incidence
			24.2.3	 Risk Factors and Pathophysiology
			24.2.4	 Clinical Presentation
			24.2.5	 Differential Diagnosis
			24.2.6	 Diagnosis
				24.2.6.1	 Laboratory Findings
				24.2.6.2	 Transvaginal Ultrasound
				24.2.6.3	 Transabdominal Ultrasound
				24.2.6.4	 Abdominal CT
				24.2.6.5	 Abdominal MRI
			24.2.7	 Treatment
				24.2.7.1	 Intramuscular Methotrexate Injection
				24.2.7.2	 Intragestational Sac Feticide Injections
				24.2.7.3	 Embolization
				24.2.7.4	 Surgical Treatment
					Laparoscopic Procedures
					Open Procedures
				24.2.7.5	 Anesthetic and Perioperative Management
				24.2.7.6	 Prevention and Treatment of Preterm Labor
			24.2.8	 Prognosis
		24.3	 Spontaneous Splenic Artery (Aneurysm) Rupture
			24.3.1	 Historical Perspective
			24.3.2	 Incidence
				24.3.2.1	 General Population
				24.3.2.2	 Splenic Artery Aneurysm Rupture
				24.3.2.3	 Trimester Distribution
			24.3.3	 Risk Factors
				24.3.3.1	 Spontaneous Splenic Artery/Vein Rupture
				24.3.3.2	 Spontaneous Splenic Artery Aneurysm Rupture
			24.3.4	 Pathophysiology
			24.3.5	 Clinical Presentation
				24.3.5.1	 Ruptured Splenic Artery Aneurysm
				24.3.5.2	 Symptomatic Splenic Artery Aneurysm
			24.3.6	 Differential Diagnosis
			24.3.7	 Diagnosis
			24.3.8	 Treatment
				24.3.8.1	 Ruptured SAA
				24.3.8.2	 (A)Symptomatic SAA
			24.3.9	 Prognosis
				24.3.9.1	 Maternal Outcome
				24.3.9.2	 Fetal Outcome
		24.4	 Spontaneous Splenic Vein (Aneurysm) Rupture
			24.4.1	 Historical Perspective and Incidence
			24.4.2	 Etiology
			24.4.3	 Risk Factors
			24.4.4	 Pathophysiology
				24.4.4.1	 Cirrhosis
				24.4.4.2	 Hemodynamic and Hormonal Changes in Pregnancy
				24.4.4.3	 Mechanical Factors
			24.4.5	 Clinical Presentation
			24.4.6	 Differential Diagnosis
			24.4.7	 Diagnosis
			24.4.8	 Treatment
				24.4.8.1	 Surgical Treatment
			24.4.9	 Prognosis
				24.4.9.1	 Maternal Outcome
				24.4.9.2	 Fetal Outcome
		24.5	 Splenic Torsion
			24.5.1	 Historical Perspective and Incidence
			24.5.2	 Etiopathogenesis
			24.5.3	 Clinical Presentation
			24.5.4	 Differential Diagnosis
			24.5.5	 Diagnosis
			24.5.6	 Treatment
				24.5.6.1	 Surgical Treatment
				24.5.6.2	 Prevention of Future Torsion
			24.5.7	 Prognosis
		References
	25: Maternal Abdominal Trauma
		25.1	 General Considerations
			25.1.1	 Incidence
			25.1.2	 Risk Factors
				25.1.2.1	 Maternal Risk Factors
			25.1.3	 Maternal Changes Relevant to Trauma
				25.1.3.1	 Maternal Anatomy and Physiology
				25.1.3.2	 The Impact of Pregnancy on Trauma Mortality
			25.1.4	 Prehospital Management
		25.2	 Anesthetic Management
		25.3	 Blunt Trauma
			25.3.1	 Historical Perspective
			25.3.2	 Incidence
			25.3.3	 Motor Vehicle Accidents
				25.3.3.1	 Introduction
				25.3.3.2	 Incidence
				25.3.3.3	 Mechanisms of Uterine and Fetal Trauma
				25.3.3.4	 The Seat Belt Use
					The Seat Belt Syndrome
					Seat Belt Use Counseling
					Belted and Unbelted Pregnant Women
					The Airbag
				25.3.3.5	 Pelvic Fractures
					Incidence
					Pathophysiology
					Clinical Presentation
					Diagnosis
					Treatment
					Obstetric Considerations
					Prognosis
				25.3.3.6	 Urinary Bladder Rupture
				25.3.3.7	 Traumatic Rectus Sheath Hematoma
			25.3.4	 Falls
			25.3.5	 Social and Domestic Violence
				25.3.5.1	 Introduction
				25.3.5.2	 Incidence
				25.3.5.3	 Risk Factors
					Age
					Substance Abuse
					Psychiatric Disorders
					Violent Coitus
				25.3.5.4	 Clinical Presentation and Diagnosis
			25.3.6	 Obstetric Complications
				25.3.6.1	 Traumatic Placental Abruption
					Incidence
					Pathophysiology
					Clinical Presentation
					Diagnosis
					Treatment
					Prognosis
				25.3.6.2	 Placental Tear
					History and Incidence
					Pathophysiology
						Countercoup Mechanism
						Direct Placental Injury
					Diagnosis
					Prognosis
				25.3.6.3	 Preterm Labor
				25.3.6.4	 Traumatic Uterine Rupture
				25.3.6.5	 Fetal-Maternal Hemorrhage
					Incidence and Risk Factors
					Clinical Presentation
					Diagnosis
					Treatment
					Prognosis
				25.3.6.6	 Amniotic Fluid Embolism
					Historical Considerations
					Incidence
					Risk Factors
					Pathophysiology
					Clinical Presentation
					Diagnosis
					Treatment
					Prognosis
			25.3.7	 Diagnosis
				25.3.7.1	 Laboratory Findings
				25.3.7.2	 Plain Abdominal X-Ray
				25.3.7.3	 Transabdominal Ultrasound
					Maternal Pelvic Free Fluid
					Placental Abruption
				25.3.7.4	 Cardiotocography
				25.3.7.5	 Abdominal CT
					Placental Abruption
			25.3.8	 Treatment
				25.3.8.1	 Conservative Treatment
				25.3.8.2	 Interventional Radiology
				25.3.8.3	 Surgical Treatment
					Initial Stabilization
					Secondary Assessment
					Pelvic Fracture Treatment
					Damage Control Surgery
				25.3.8.4	 Obstetric Management
					Fetal Assessment and Monitoring
					Maternal Pelvic Fractures
					Postpartum Care
						Placental Abruption
					Emergency Cesarean Section
					Perimortem Cesarean Section
					Salvageable Infant
			25.3.9	 Prognosis
				25.3.9.1	 Blunt Trauma
					Fetal Outcome
				25.3.9.2	 Motor Vehicle Accidents
					Maternal Outcome
					Fetal Outcome
				25.3.9.3	 Repeated Blunt Abdominal Trauma
		25.4	 Penetrating Trauma
			25.4.1	 Incidence and Pathophysiology
				25.4.1.1	 Gunshot Wounds to Uterus
				25.4.1.2	 Stab Wounds to the Uterus
			25.4.2	 Clinical Presentation
				25.4.2.1	 Neurogenic Shock
			25.4.3	 Diagnosis
				25.4.3.1	 Laboratory Findings
					Kleihauer-Betke Test
					Toxicology
				25.4.3.2	 Plain Abdominal X-ray
				25.4.3.3	 Transabdominal Ultrasound
					Maternal Status
					Obstetric Status
				25.4.3.4	 Abdominal CT
				25.4.3.5	 Peritoneal Lavage
			25.4.4	 Treatment
				25.4.4.1	 Perioperative Management
					Tetanus Prophylaxis
					Rho(D) Immune Globulin
					Spinal Cord Injury
						Immediate Measures
						Neurogenic Shock
					Pneumothorax/Hemothorax
				25.4.4.2	 Gunshot Wounds
					Historical Perspective
					Nonoperative Treatment
						Medications
					Surgical Treatment
						Uterine Injury
					Obstetric Management
						Spinal Cord Injury
				25.4.4.3	 Stab Wounds
					Conservative Management
					Surgical Treatment
					Obstetric Management
				25.4.4.4	 Fetal Injury
			25.4.5	 Prognosis
				25.4.5.1	 Gunshot Wounds
				25.4.5.2	 Stab Wounds
		References
	26: Miscellaneous Conditions
		26.1	 Spontaneous Liver Rupture
			26.1.1	 Historical Perspective
			26.1.2	 Incidence
			26.1.3	 Etiopathogenesis
			26.1.4	 Clinical Presentation
			26.1.5	 Differential Diagnosis
			26.1.6	 Diagnosis
				26.1.6.1	 Laboratory Findings
				26.1.6.2	 Transabdominal Ultrasound
				26.1.6.3	 Abdominal CT
				26.1.6.4	 Abdominal MRI
			26.1.7	 Treatment
				26.1.7.1	 Historical Perspective
				26.1.7.2	 Conservative Treatment
				26.1.7.3	 Percutaneous Techniques
				26.1.7.4	 Surgical Treatment
					Intraoperative Hepatic Artery Occlusion
					Liver Packing
					Argon Beam Coagulation
					Segmental Liver Resection
					Liver Transplantation
				26.1.7.5	 Obstetric Management
			26.1.8	 Prognosis
				26.1.8.1	 Maternal Outcome
				26.1.8.2	 Fetal Outcome
		26.2	 Bleeding Peptic Ulcer
			26.2.1	 Historical Perspective
			26.2.2	 Incidence
			26.2.3	 Risk Factors
			26.2.4	 Clinical Presentation
			26.2.5	 Differential Diagnosis
			26.2.6	 Diagnosis
			26.2.7	 Treatment
				26.2.7.1	 Conservative Treatment
				26.2.7.2	 Surgical Treatment
			26.2.8	 Prognosis
				26.2.8.1	 Maternal Outcome
				26.2.8.2	 Fetal Outcome
		26.3	 Mesenteric Ischemia
			26.3.1	 Mesenteric Vein/Portal Vein Thrombosis
				26.3.1.1	 Historical Perspective
				26.3.1.2	 Incidence
				26.3.1.3	 Risk Factors
				26.3.1.4	 Clinical Presentation
				26.3.1.5	 Differential Diagnosis
				26.3.1.6	 Diagnosis
					Laboratory Findings
					Diagnostic Imaging
				26.3.1.7	 Treatment
					Anticoagulation
					Surgery
					Thrombectomy
					Obstetric Management
						Continuation of Pregnancy
						Mode of Delivery
				26.3.1.8	 Prognosis
		26.4	 Rectus Sheath Hematoma
			26.4.1	 Historical Perspective
			26.4.2	 Anatomy
			26.4.3	 Incidence and Risk Factors
				26.4.3.1	 Spontaneous Rectus Sheath Hematoma
				26.4.3.2	 Postcesarean Section
			26.4.4	 Mechanism of Injury
				26.4.4.1	 Direct Trauma
				26.4.4.2	 Spontaneous
			26.4.5	 Clinical Presentation
				26.4.5.1	 Spontaneous Rectus Sheath Hematoma
				26.4.5.2	 Traumatic Rectus Sheath Hematoma
			26.4.6	 Differential Diagnosis
			26.4.7	 Diagnosis
				26.4.7.1	 Transabdominal Ultrasound
				26.4.7.2	 Abdominal CT
				26.4.7.3	 Abdominal MRI
				26.4.7.4	 Angiography
			26.4.8	 Treatment
				26.4.8.1	 Conservative Treatment
				26.4.8.2	 Transarterial Embolization
				26.4.8.3	 Surgical Treatment
				26.4.8.4	 Obstetric Management
			26.4.9	 Prognosis
				26.4.9.1	 Spontaneous Rectus Sheath Hematoma
		26.5	 Omental Infarction
			26.5.1	 Incidence
			26.5.2	 Etiology
			26.5.3	 Clinical Presentation
			26.5.4	 Differential Diagnosis
			26.5.5	 Diagnosis
				26.5.5.1	 Laboratory Findings
				26.5.5.2	 X-Rays
				26.5.5.3	 Transabdominal Ultrasound
				26.5.5.4	 Abdominal CT
				26.5.5.5	 Diagnostic Exploration
			26.5.6	 Treatment
				26.5.6.1	 Conservative Treatment
				26.5.6.2	 Surgical Treatment
			26.5.7	 Prognosis
		26.6	 Gastrointestinal-Genital Communications
			26.6.1	 Introduction
			26.6.2	 Incidence
			26.6.3	 Etiopathogenesis
				26.6.3.1	 Enterouterine Fistula
				26.6.3.2	 EnteroAmniotic Fistula
					Extrauterine/Abdominal Pregnancy
					Obstetric Cause
			26.6.4	 Prevention
			26.6.5	 Clinical Presentation
			26.6.6	 Diagnosis
				26.6.6.1	 Endoscopy
				26.6.6.2	 Hysterosalpingography
			26.6.7	 Treatment
				26.6.7.1	 Gastrointestinal-Genital Fistula
				26.6.7.2	 Abdominal Pregnancy
			26.6.8	 Prognosis
		References
Part IV: Urology
	27: Complicated Urinary Tract Infections
		27.1	 Anatomic and Functional Changes of the Urinary Tract During Pregnancy
			27.1.1	 Upper Urinary Tract
			27.1.2	 Lower Urinary Tract
			27.1.3	 Composition of the Urine
		27.2	 Symptomatic Urinary Tract Stones
			27.2.1	 Incidence
			27.2.2	 Etiopathogenesis
			27.2.3	 Clinical Presentation
			27.2.4	 Differential Diagnosis
			27.2.5	 Diagnosis
				27.2.5.1	 Laboratory Findings
				27.2.5.2	 Abdominal Ultrasound
					Transabdominal Ultrasound
					Transvaginal Ultrasound
				27.2.5.3	 Abdominal CT
				27.2.5.4	 MR Urography
				27.2.5.5	 Intravenous Urography
			27.2.6	 Treatment
				27.2.6.1	 Conservative Treatment
					Diet Therapy
					Pharmacologic Therapy
					Medical Expulsive Therapy
				27.2.6.2	 Surgical Treatment
					Ureterorenoscopy with Lithotripsy
					Percutaneous Nephrostomy
					Ureteral Stents
			27.2.7	 Prognosis
		27.3	 Acute Pyelonephritis
			27.3.1	 Incidence
			27.3.2	 Etiopathogenesis and Risk Factors
			27.3.3	 Screening
			27.3.4	 Clinical Presentation
			27.3.5	 Differential Diagnosis
			27.3.6	 Diagnosis
			27.3.7	 Treatment
				27.3.7.1	 Conservative Treatment
				27.3.7.2	 Obstetric Management
			27.3.8	 Prognosis
				27.3.8.1	 Maternal Outcome
				27.3.8.2	 Fetal Outcome
		References
	28: Urinary Tract Obstruction or Rupture
		28.1	 Acute Urinary Retention
			28.1.1	 Historical Perspective
			28.1.2	 Incidence
			28.1.3	 Etiopathogenesis
				28.1.3.1	 Pregnancy
					Retroverted Uterus
					Uterine Fibroids
					Other
				28.1.4	 Postpartum
			28.1.5	 Clinical Presentation
				28.1.5.1	 Medical History
				28.1.5.2	 Physical Examination
			28.1.6	 Differential Diagnosis
			28.1.7	 Diagnosis
				28.1.7.1	 Laboratory Findings
				28.1.7.2	 Transvaginal Ultrasound
				28.1.7.3	 Abdominal MR
				28.1.7.4	 Cystoscopy
			28.1.8	 Treatment
				28.1.8.1	 Manual Reduction
				28.1.8.2	 Colonoscopic Reduction
				28.1.8.3	 Surgical Reduction
				28.1.8.4	 Obstetric Management
					Prevention and Treatment of Preterm Labor
			28.1.9	 Prognosis
		28.2	 Renal Collecting System or Parenchymal Rupture
			28.2.1	 Incidence and Etiopathogenesis
				28.2.1.1	 True Spontaneous Rupture
				28.2.1.2	 Upper Urinary Tract Obstruction
				28.2.1.3	 Renal Parenchymal Rupture
				28.2.1.4	 Other
			28.2.2	 Clinical Presentation
				28.2.2.1	 Medical History
				28.2.2.2	 Physical Examination
			28.2.3	 Differential Diagnosis
			28.2.4	 Diagnosis
				28.2.4.1	 Laboratory Findings
				28.2.4.2	 Transabdominal Ultrasound
				28.2.4.3	 Abdominal CT
				28.2.4.4	 Abdominal MR/MR Urography
				28.2.4.5	 Excretory Urography
			28.2.5	 Treatment
				28.2.5.1	 Conservative Treatment
				28.2.5.2	 Interventional Techniques
				28.2.5.3	 Surgical Treatment
					Percutaneous Nephrostomy
					Exploration
				28.2.5.4	 Obstetric Management
					Prevention and Treatment of Preterm Labor
			28.2.6	 Prognosis
				28.2.6.1	 Maternal Outcome
				28.2.6.2	 Fetal Outcome
		28.3	 Urinary Bladder Injury or Rupture
			28.3.1	 Incidence
			28.3.2	 Etiopathogenesis
				28.3.2.1	 Spontaneous Bladder Rupture
					Underlying Pathology
					Pregnancy, Delivery, and Puerperium
					Uterovesical Rupture
				28.3.2.2	 Urinary Bladder Injury
					Cesarean Section
					Total Hysterectomy
					Blunt Abdominal Trauma
			28.3.3	 Clinical Presentation
			28.3.4	 Differential Diagnosis
			28.3.5	 Diagnosis
				28.3.5.1	 Laboratory Findings
				28.3.5.2	 Imaging
				28.3.5.3	 Cystoscopy
			28.3.6	 Treatment
				28.3.6.1	 Spontaneous Bladder Rupture
					Extraperitoneal Bladder Rupture
					Intraperitoneal Bladder Rupture
					Uterovesical Rupture
				28.3.6.2	 Traumatic Bladder Rupture/Injury
					Cesarean Section
					Blunt Abdominal Trauma
			28.3.7	 Prognosis
				28.3.7.1	 Maternal Outcome
				28.3.7.2	 Fetal Outcome
		References
	29: Urinary Tract Bleeding
		29.1	 Traumatic Renal Injury/Rupture
			29.1.1	 Incidence and Risk Factors
			29.1.2	 Clinical Presentation
			29.1.3	 Differential Diagnosis
			29.1.4	 Diagnosis
				29.1.4.1	 Laboratory Findings
				29.1.4.2	 Transabdominal Ultrasound
				29.1.4.3	 Abdominal CT
				29.1.4.4	 Abdominal MRI
			29.1.5	 Treatment
			29.1.6	 Prognosis
		29.2	 Renal Artery Aneurysm Rupture
			29.2.1	 Historical Perspective and Incidence
			29.2.2	 Etiopathogenesis
			29.2.3	 Clinical Presentation
			29.2.4	 Differential Diagnosis
			29.2.5	 Diagnosis
				29.2.5.1	 Laboratory Findings
				29.2.5.2	 Transabdominal Ultrasound
				29.2.5.3	 Abdominal CT
				29.2.5.4	 Angiography
				29.2.5.5	 Abdominal MR
			29.2.6	 Treatment
				29.2.6.1	 Conservative Treatment
				29.2.6.2	 Endovascular Treatment
				29.2.6.3	 Surgical Treatment
					Operative Principles
				29.2.6.4	 Obstetric Management
			29.2.7	 Prognosis
				29.2.7.1	 Maternal Outcome
				29.2.7.2	 Fetal Outcome
		29.3	 Ruptured Renal Angiomyolipoma
			29.3.1	 Historical Perspective
			29.3.2	 Incidence
			29.3.3	 Pathophysiology
			29.3.4	 Clinical Presentation
			29.3.5	 Differential Diagnosis
			29.3.6	 Diagnosis
				29.3.6.1	 Laboratory Findings
				29.3.6.2	 Transabdominal Ultrasound
				29.3.6.3	 Abdominal CT
				29.3.6.4	 Abdominal MR/MR Urography
			29.3.7	 Treatment
				29.3.7.1	 Conservative Treatment
				29.3.7.2	 Percutaneous Embolization
				29.3.7.3	 Surgical Treatment
				29.3.7.4	 Obstetric Management
			29.3.8	 Prognosis
				29.3.8.1	 Maternal Outcome
				29.3.8.2	 Fetal Outcome
		References
Index