PArt 1 기초산부인과학
Chapter 01 해부학······································································· 3
1. 외음부································································································ 3
2. 내부생식기관······················································································· 6
3. 뼈골반································································································ 8
4. 골반 바닥·························································································· 10
Chapter 02 태생학······································································11
1. 성의 분화·························································································· 11
2. 생식 세포의 발달················································································ 12
3. 성기의 분화······················································································· 13
Chapter 03 생식 생리··································································17
1. 시상하부··························································································· 17
2. 뇌하수체··························································································· 20
3. 생식샘에서 분비되는 호르몬: 성호르몬··················································· 22
4. 월경주기··························································································· 25
5. 난포의 성장······················································································· 27
PArt 2 일반부인과학
Chapter 04 생식기 기형과 성 발달 이상··········································33
1. 외부 생식기 기형················································································ 33
2. 내부 생식기 기형················································································ 35
3. 성 발달 이상······················································································ 36
Chapter 05 유산··········································································41
1. 정의································································································· 41
2. 자연유산··························································································· 43
3. 유발유산··························································································· 47
4. 유산 방법·························································································· 47
5. 반복유산··························································································· 51
6. 자궁경부 무력증················································································· 54
Chapter 06 자궁외 임신·······························································59
1. 정의, 빈도 및 발생 부위······································································· 59
2. 난관임신의 원인 및 위험인자······························································· 61
3. 난관임신의 병태생리··········································································· 62
4. 임상적 증상······················································································· 62
5. 진단································································································· 63
6. 치료 ································································································ 64
7. 난관이외 부위의 자궁외 임신································································ 66
Chapter 07 가족계획···································································69
1. 서론································································································· 69
2. 자연피임법························································································ 71
3. 장벽방법과 살정제·············································································· 72
4. 자궁내 장치······················································································· 73
5. 호르몬 피임제···················································································· 76
6. 응급 피임·························································································· 81
7. 영구피임 방법···················································································· 82
Chapter 08 자궁근종···································································85
1. 병태생리··························································································· 85
2. 위험 인자·························································································· 86
3. 증상································································································· 86
4. 위치에 따른 분류 ·············································································· 87
5. 진단································································································· 88
6. 감별진단··························································································· 89
7. 생식능력에 대한 근종의 영향································································ 89
8. 임신과 자궁근종················································································· 90
9. 치료································································································· 91
Chapter 09 자궁내막증································································95
1. 정의 ································································································ 95
2. 호발 부위·························································································· 95
3. 역학································································································· 96
4. 위험인자··························································································· 97
5. 병인론······························································································ 97
6. 임상 양상 ························································································· 98
7. 진단································································································· 99
8. 복강경 소견····················································································· 100
9. 치료······························································································· 101
Chapter 10 골반통과 월경통·······················································105
1. 서론······························································································· 105
2. 급성 골반통····················································································· 105
3. 주기성 통증: 일차성과 이차성 월경통·················································· 109
4. 만성 골반통····················································································· 111
Chapter 11 비정상 자궁출혈·······················································115
1. 서론······························································································· 115
2. 정상 월경의 양상·············································································· 116
3. 비정상 월경을 설명하는 용어의 정의··················································· 116
4. 기능성 자궁출혈의 원인에 따른 분류··················································· 116
5. 진단······························································································· 117
6. 감별진단························································································· 118
7. 치료······························································································· 119
8. 연령에 따른 비정상 자궁출혈····························································· 120
Chapter 12 성매개병과 요로감염·················································125
1. 외음부 감염····················································································· 125
2. 기생충 감염····················································································· 128
3. 생식기 궤양····················································································· 131
4. 질염······························································································· 136
5. 자궁경부염······················································································ 141
6. 골반염···························································································· 145
7. 난관난소농양··················································································· 147
8. 자궁내막염······················································································ 148
PArt 3 산과학
Chapter 13 서론········································································151
1. 산과학의 정의·················································································· 151
2. 산과학 용어의 정의··········································································· 151
3. 역학 및 통계 ·················································································· 153
Chapter 14 태아 순환································································155
1. 정상 태아 순환················································································· 155
2. 출생 후 순환···················································································· 157
Chapter 15 모체의 변화·····························································159
1. 대사기능의 변화··············································································· 159
2. 내분비계의 변화··············································································· 161
3. 혈액학적 변화·················································································· 162
4. 심장혈관계의 변화············································································ 164
5. 호흡기계의 변화··············································································· 165
6. 소화기계의 변화··············································································· 166
7. 비뇨기계의 변화··············································································· 167
8. 피부의 변화····················································································· 168
9. 근골격계의 변화··············································································· 169
10. 중추신경계의 변화·········································································· 169
11. 유방의 변화···················································································· 169
12. 생식기 계통···················································································· 170
Chapter 16 산전관리·································································173
1. 산과용어························································································· 173
2. 임신의 진단····················································································· 174
3. 임신주수 판정과 출산예정일 계산······················································· 176
4. 산전관리의 목적··············································································· 177
5. 초기 산전평가·················································································· 177
6. 추적 산전관리·················································································· 180
7. 임신 중 영양···················································································· 182
8. 임신 중 동반되는 증상과 일반 상식····················································· 184
Chapter 17 정상 분만진통 및 분만···············································189
1. 정상 분만의 기전·············································································· 189
2. 분만진통························································································· 194
3. 후두위에서의 정상 분만 기전····························································· 198
4. 정상진통의 분만의 관리···································································· 202
Chapter 18 비정상 분만진통과 유도분만······································213
1. 난산······························································································· 213
2. 유도분만························································································· 215
3. 비정상 태위····················································································· 218
4. 급속 분만 ······················································································· 223
Chapter 19 생식관의 이상··························································225
1. 생식관의 발달이상············································································ 225
2. 후천성 생식기계 이상········································································ 229
Chapter 20 수술적 산과학··························································233
1. 흡입분만························································································· 233
2. 제왕절개술······················································································ 235
3. 제왕절개술 후의 질식분만································································· 237
Chapter 21 산과마취·································································241
1. 부위마취························································································· 241
2. 부위마취의 합병증············································································ 242
Chapter 22 산후관리·································································245
1. 산욕기의 정의·················································································· 245
2. 산욕기의 변화·················································································· 245
3. 모유수유························································································· 248
4. 산욕기 이상····················································································· 250
Chapter 23 산전 태아 안녕평가···················································257
1. 서론······························································································· 257
2. 태아운동························································································· 257
3. 태아호흡························································································· 259
4. 비수축검사······················································································ 260
5. 생물리학계수··················································································· 261
6. 탯줄동맥 도플러 초음파 검사····························································· 262
Chapter 24 분만 중 태아 건강평가···············································265
1. 분만 중 자궁수축·············································································· 265
2. 태아 심박동수의 양상········································································ 265
3. 태아곤란증······················································································ 270
Chapter 25 조산········································································273
1. 용어의 정의····················································································· 273
2. 조산의 개괄····················································································· 274
3. 조산의 원인····················································································· 275
4. 조산 위험이 있는 임신부의 예측 및 조기 발견······································· 277
5. 임신 유지에 있어서 Progesterone의 역할············································· 278
6. 조기양막파수의 관리········································································· 279
7. 양막파수가 없는 상태에서의 조기진통·················································· 280
Chapter 26 과숙임신·································································285
1. 정의······························································································· 285
2. 빈도······························································································· 285
3. 원인······························································································· 285
4. 진단······························································································· 285
5. 과숙임신의 병태생리········································································· 286
6. 과숙임신의 합병증············································································ 287
7. 과숙임신의 처치··············································································· 287
Chapter 27 태아성장 이상··························································289
1. 정상 태아 발육················································································· 289
2. 태아 발육부전·················································································· 290
3. 태아과도성장··················································································· 293
Chapter 28 양수량의 이상··························································295
1. 양수량의 조절과 측정방법·································································· 295
2. 양수과다증······················································································ 296
3. 양수과소증······················································································ 297
Chapter 29 다태임신·································································301
1. 다태임신의 원인··············································································· 301
2. 다태임신의 진단··············································································· 305
3. 다태임신 모체의 임신적응································································· 305
4. 임신 결과························································································ 306
5. 다태임신의 특이 합병증···································································· 309
6. 다태임신의 분만··············································································· 312
7. 선택적 감수술 및 중절술···································································· 314
Chapter 30 태아 및 신생아 질환··················································315
I. 조산 태아 및 신생아 질환······································································315
1. 신생아호흡곤란증후군······································································· 315
2. 미숙아 망막병증··············································································· 317
3. 뇌실내 출혈····················································································· 318
4. 뇌실주위백질연화증·········································································· 318
5. 괴사성 장염····················································································· 319
6. 뇌성마비························································································· 319
7. 동종면역························································································· 321
8. 태아수종························································································· 324
II. 만삭 태아 및 신생아 질환·····································································326
1. 태변흡인증후군················································································ 326
2. 신생아 뇌병증과 뇌성마비 ································································ 327
3. 신생아 혈액학적 이상 ······································································ 329
4. 신생아 손상····················································································· 331
5. 자궁내 태아사망··············································································· 333
Chapter 31 산과적 출혈·····························································337
1. 서론 ······························································································ 337
2. 산과적 출혈의 원인··········································································· 338
3. 소모성 혈액응고장애········································································· 352
4. 출혈의 관리····················································································· 355
Chapter 32 임신 중 고혈압·························································357
1. 임신 중 합병되는 고혈압의 진단 기준 ·················································· 357
2. 전자간증························································································· 358
3. 자간증···························································································· 365
4. 만성고혈압······················································································ 369
5. 중복전자간증··················································································· 371
Chapter 33 임신과 당뇨·····························································373
1. 빈도 및 역학 ·················································································· 373
2. 임신 중 당뇨병의 분류 ····································································· 373
3. 임신성 당뇨병 ················································································· 374
4. 현성 당뇨 ······················································································· 379
Chapter 34 임신과 동반된 내·외과 질환········································383
I. 심혈관 질환 ···························································································383
1. 역학······························································································· 383
2. 임신 중 심혈관계의 생리적 변화 ························································ 384
3. 정상임신에서 나타날 수 있는 증상 및 소견 ········································· 384
4. 임신 중 심장질환을 의심할 수 있는 증상 또는 진찰 소견························· 385
5. 심장 질환 환자의 임신 전 상담··························································· 385
6. 심장질환 임산부의 처치 ··································································· 386
II. 폐 및 호흡기계 질환··············································································389
1. 임신과 인플루엔자 폐렴····································································· 389
2. 임신과 수두 ··················································································· 389
3. 임신 중 결핵 치료 ··········································································· 390
4. 임신과 천식····················································································· 390
III. 간 및 위장관 질환·················································································392
1. 임신 중 위장관계 기능의 변화····························································· 392
2. 입덧······························································································· 392
3. 역류성 식도염·················································································· 393
4. 소화성 궤양····················································································· 393
5. 충수돌기염······················································································ 393
6. 염증성 장질환·················································································· 394
7. 임신성 급성 지방간··········································································· 395
8. HELLP 증후군················································································· 396
9. 바이러스성 간염과 임신 ··································································· 397
IV. 요로계 감염·························································································399
1. 요로 감염························································································ 399
2. 요로 감염의 진단 ············································································ 399
3. 무증상 세균뇨 ················································································· 400
4. 급성 신우신염·················································································· 400
V. 저혈소판증 ··························································································402
1. 빈도 및 정의···················································································· 402
2. 임신성 저혈소판증············································································ 402
3. 면역성 저혈소판증············································································ 403
VI. 갑상선 질환·························································································404
1. 갑상샘과다증··················································································· 404
2. 갑상샘저하증··················································································· 406
3. 산후 갑상샘염·················································································· 406
VII. 결합조직계 질환·················································································408
1. 전신홍반루푸스················································································ 408
2. 항인지질항체증후군·········································································· 410
VIII. 혈전색전질환·····················································································412
1. 역학······························································································· 412
2. 심부정맥혈전증················································································ 412
3. 폐색전증························································································· 413
IX. 신경 정신학적 질환·············································································415
1. 간질······························································································· 415
2. 산욕기에 발생하는 정신과적 질환 ······················································ 416
X. 피부질환·······························································································418
1. 임신성 간내 쓸개즙 정체···································································· 418
2. 임신소양성두드러기성 구진 및 판······················································· 419
3. 임신유사천포창················································································ 420
XI. 감염성 질환·························································································422
1. 바이러스 감염·················································································· 422
2. 세균감염························································································· 428
3. 원충감염························································································· 429
XII. 성매개질환··························································································432
1. 매독······························································································· 432
2. 임질······························································································· 433
3. 클라미디아 감염··············································································· 433
Chapter 35 산과 의료윤리··························································439
1. 서론······························································································· 439
2. 의료윤리의 4원칙············································································· 439
3. 의사-환자관계에서의 일반적 윤리······················································ 441
4. 임신중절 관련 법령··········································································· 444
5. 산과 의료윤리·················································································· 445
PArt 4 생식 내분비학
Chapter 36 사춘기····································································451
1. 정의······························································································· 451
2. 정상 사춘기 발달 ············································································ 451
3. 사춘기 발달이상··············································································· 455
Chapter 37 무월경····································································459
1. 무월경의 정의와 분류 ······································································· 459
2. 2차 성징의 발현이 없는 원발성 무월경 ··············································· 461
3. 2차 성징의 발현이 있고 골반 구조가 비정상적인 경우의 무월경··············· 464
4. 2차 성징의 발현이 있고 골반 구조가 정상인 경우의 무월경····················· 465
Chapter 38 내분비 질환·····························································473
1. 고안드로겐증 ·················································································· 473
2. Prolactin disorder ··········································································· 477
Chapter 39 폐경········································································481
1. 정의 ······························································································ 481
2. 폐경 주변기 및 폐경기의 생리학 ························································ 482
3. 에스트로겐 감소로 인한 표적 장기의 반응 ··········································· 484
4. 폐경기의 임상적 양상 ······································································ 485
5. 호르몬 요법 ···················································································· 489
Chapter 40 여성 불임································································493
1. 서론······························································································· 493
2. 여성의 연령과 Fecundity··································································· 494
3. 각 불임 요인에 대한 검사와 처치························································ 496
4. 원인불명 불임·················································································· 503
5. 보조생식술······················································································ 503
PArt 5 종양학
Chapter 41 난소 양성 종양·························································509
1. 기능성 낭종····················································································· 509
2. 종양성 양성 종양 ············································································ 510
3. 기타 난소 종양················································································· 513
Chapter 42 난소암····································································515
1. 상피성 종양 ···················································································· 515
2. 임상적 평가····················································································· 520
3. 병기결정························································································· 520
4. 상피성 난소암의 병리········································································ 522
5. 전이양상························································································· 522
6. 예후인자························································································· 522
7. 치료······························································································· 525
8. 생존율···························································································· 529
9. 난소 생식세포종양············································································ 529
10. 성기삭 간질 종양············································································ 533
Chapter 43 자궁경부의 질환과 종양·············································537
1. 역학······························································································· 537
2. 발병기전························································································· 538
3. 분류 ······························································································ 538
4. 진단······························································································· 539
5. 자궁경부상피내종양의 치료································································ 543
6. 자궁경부암의 병기············································································ 545
7. 치료 방법························································································ 546
8. 진행되지 않고, 크지 않은 자궁경부암의 치료·························································549
9. 진행되지 않았으나 지름 4 cm를 넘는 자궁경부암 치료··························· 551
10. 진행된 자궁경부암 치료··································································· 551
11. 특수한 상황의 자궁경부암 치료 ························································· 551
12. 치료 후 추적검사 ··········································································· 552
Chapter 44 외음부 및 질의 질환··················································555
1. 선천성 기형····················································································· 555
2. 양성 상피성 질환·············································································· 557
3. 양성 낭종 및 종양············································································ 560
4. 감염성 질환····················································································· 561
5. 외음부의 비궤양성 감염질환······························································ 566
6. 악성질환························································································· 567
Chapter 45 자궁내막증식증과 자궁내막암····································575
I. 자궁내막증식증·····················································································575
1. 분류······························································································· 576
2. 위험요인························································································· 577
3. 진단······························································································· 577
4. 치료······························································································· 578
II. 자궁내막암····························································································579
1. 병태생리························································································· 579
2. 자궁내막암의 전이경로······································································ 579
3. 선별검사························································································· 580
4. 증상······························································································· 580
5. 이학적 검사····················································································· 581
6. 진단······························································································· 581
7. 치료 전 평가···················································································· 582
8. 조직학적 분류·················································································· 582
9. 예후······························································································· 583
10. 치료····························································································· 584
11. 자궁내막암의 재발··········································································· 586
12. 치료 후 추적관찰 ··········································································· 587
13. 자궁내막암으로 수술 후 난포호르몬 투여············································ 588
Chapter 46 임신성 융모성 질환···················································589
1. 포상기태························································································· 590
2. 악성 임신성 융모성 질환··································································· 593
PArt 6 비뇨부인과 성학
Chapter 47 비뇨부인과와 골반장기탈출증····································601
1. 배뇨의 생리학 ················································································· 601
2. 요실금 ··························································································· 605
3. 골반장기탈출증················································································ 610
Chapter 48 성징, 성기능 장애, 성폭행··········································615
1. 성징······························································································· 615
2. 성 반응에 영향을 주는 인자들···························································· 617
3. 성기능 장애····················································································· 619
4. 성폭행···························································································· 621
찾아보기······················································································································ 627
