Mastering the right diagnostic and therapeutic approaches within a field as broad as high risk obstetrics is a formidable task. It requires drawing on a knowledge base to procure and filter through the clinical and laboratory data, to develop a differential diagnosis, and finally to make a rational treatment plan. To gain these skills, the clinician is best guided and instructed by experienced teachers and accomplished surgeons, and inspired toward self-directed, diligent reading and practicing one's craft. Clearly, there is no replacement for experience at the bedside, delivery room, or operating room. Unfortunately, younger physicians will not have encountered the diversity of clinical situations, or dealt with the more unusual maternal-fetal complications. Perhaps the best alternative is a carefully crafted patient case designed to stimulate the clinical and surgical approach and decision making. In an attempt to achieve that goal, we have constructed a collection of clinical vignettes to teach diagnostic, therapeutic, and surgical approaches relevant to obstetrics and gynecology. Most importantly, the explanations for the cases emphasize the underlying principles, rather than merely rote questions and answers.
This book is organized for versatility: It allows the physician "in a rush" to go quickly through the scenarios and check the corresponding answers, and it provides more detailed information for the clinician who wants thought-provoking explanations. The answers are arranged from simple to complex: a summary of the pertinent points, the bare answers, an analysis of the case, an approach to the topic, a comprehension test at the end for reinforcement and emphasis, and a list of resources for further reading. The clinical vignettes are purposely placed in random order to simulate the way that real patients present to the practitioner. A listing of cases is included in Section III. The information is presented with the degree of evidence of support. Several multiple-choice questions are included at the end of each case discussion (comprehension questions) to reinforce concepts or introduce related topics.
Each case is designed to simulate a patient encounter with open-ended questions. At times, the patient's complaint is different from the most concerning issue, and sometimes extraneous information is given. The answers are organized into four different parts: