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In this 23rd edition of Williams Obstetrics, we continue to emphasize the science-based underpinnings and evidence-based practices of our specialty. Most professional and academic organizations embrace these principles, and while some promulgate guidelines and recommendations, others provide funding for such investigations. Our policy is to cite these whenever possible. A major impetus for these studies comes from the Eunice Shriver Kennedy National Institute of Child Health and Human Development—also called the NICHD. For many decades, this Institute has supported basic and clinical research to improve healthcare for women and children. We especially rely on investigations performed through NICHD-sponsored Maternal-Fetal Medicine Units and Neonatal Units Networks. There is also fiscal support for young investigators in obstetrics and allied specialties that comes from a number of societies and organizations. Among others, these include the American College of Obstetricians and Gynecologists, the American Gynecological and Obstetrical Society, the Society for Maternal-Fetal Medicine, the Society for Gynecological Investigation, and the American Board of Obstetrics and Gynecology.

A major objective of this book is to provide a convenient source that will aid the busy practitioner—those “in the trenches.” To this end, we summarize new data that has influenced evidence-based management to improve pregnancy outcomes. And while we cite numerous sources to accomplish this, we again mention some important caveats. For example, while we try to avoid—or at least soften—dogmatism that creeps into obstetrical practice, we often cite our combined clinical experiences drawn from large teaching services. We remain convinced that these are disciplined examples of evidence-based obstetrics. Importantly, we do not represent that these constitute the sole method of management.

To succeed in these self-imposed mandates, we have again added new editors with especial expertise in important areas to ensure accurate interpretation of recent scientific and clinical advances. To allow for this, two editors who have served with distinction for several editions of this book have passed their pens on to others. Dr. Larry Gilstrap has traded the Chair of Obstetrics, Gynecology, and Reproductive Sciences at the University of Texas-Houston Medical School to become Executive Director of the American Board of Obstetrics and Gynecology. Dr. Kathy Wenstrom has left the University of Alabama at Birmingham to become Chief of Maternal-Fetal Medicine at Brown University. We will miss them both and value their contributions. To fill their shoes, two associate editors have assumed their duties. Dr. Dwight Rouse from the University of Alabama at Birmingham continues to lend his expertise in many areas of obstetrics, maternal-fetal medicine, and epidemiology. He also has many years of experience as a leading investigator in the Maternal-Fetal Medicine Units Network. Dr. Catherine Spong continues her ever-increasing duties as Chief of the Pregnancy and Perinatology Branch of the Eunice Shriver Kennedy National Institute of Child Health and Human Development. Cathy also serves as program scientist for the vitally important Maternal-Fetal Medicine Units Network cited above. A third vacancy in the associate editorship is Dr. William Rainey, who left UT Southwestern and is a Regents' Professor of Physiology at the Medical College of Georgia. Bill performed a fantastic job for the 22nd edition in dissecting basic science principles of human reproduction in a textbook written primarily for clinicians.

Dr. George Wendel remains on the team as associate editor. He is internationally recognized for his expertise in obstetrical, perinatal, and sexually transmitted infections. He is widely published in these fields and has mentored numerous fellows who have followed in his footsteps. Also joining us from UT Southwestern as associate editor is Dr. Diane Twickler, Professor of Radiology as well as Obstetrics and Gynecology. Her incredible wealth of knowledge and clinical and research experience with a variety of imaging techniques used during pregnancy have been unsung contributions for many previous editions of this book.

Reflecting the rapidly accruing knowledge in clinical obstetrics is the further addition of six extremely talented contributing editors, all from UT Southwestern Medical Center. Dr. Jodi Dashe uses her extensive experience and incredible skills with obstetrical sonography, fetal diagnosis, and prenatal genetics to provide input for this 23rd edition as she has namelessly done now for many previous ones. Dr. Barbara Hoffman has widespread clinical expertise with contraception and sterilization issues, embryology and anatomy, and especial interest in congenital and acquired genital tract anomalies. Equally importantly, she has served as the in-house production editor for the 22nd and 23rd editions and has spent countless evenings and weekends applying her considerable editorial talents and creative illustration production. Dr. Mala Mahendroo is a basic scientist who performs a magnificent job of providing a coherent clinical translational version of basic science aspects of human reproduction. To do so, she draws from her own research experience with cervical remodeling during pregnancy and initiation of human labor. Dr. Jim Alexander brings his expertise with the conduct of normal as well as abnormal labor and delivery, cesarean delivery, conduction analgesia, preeclampsia, and obstetrical hemorrhage. Dr. Brian Casey lends his in-depth clinical and research experience with diabetes, fetal growth disorders, and thyroid physiology. Dr. Jeanne Sheffield joins us as a vital member of the obstetrical infectious diseases group. In addition to her wealth of clinical and research experience with maternal, perinatal, and sexually transmitted infections, she also has extensive experience in managing drug dependency as well as a host of other medical and surgical disorders that complicate pregnancy.

We continue to rely heavily on other colleagues for their intellectual and clinical input and the use of photographs and other illustrations that improve immensely the readability of this 23rd edition. Although these colleagues are too numerous to mention individually, we attempt to thank those with especial contributions. From UT Southwestern and Parkland Hospital, we cite the entire faculty of the Maternal-Fetal Medicine Division, who, in addition to providing expert content, graciously helped us cover clinical duties when writing and editing were especially time consuming. These include Drs. Oscar Andujo, Morris Bryant, Susan Cox, Jennifer Hernandez, Robyn Horsager, Julie Lo, Mark Peters, Scott Roberts, Vanessa Rogers, Patricia Santiago-Munoz, Steve Shivvers, Ed Wells, Kevin Worley, and Mike Zaretsky. Also in the division, our special thanks go to Dr. Don McIntire, who retrieved and tabulated electronically stored data for Parkland Hospital obstetrical outcomes that are shown in numerous tables and figures throughout this book. Dr. Barry Schwarz shared his extensive knowledge of contraceptive management for preparation of that chapter. Dr. Kelly Carrick of the Department of Pathology contributed numerous photographs illustrating both normal and abnormal features of the female reproductive tract. Dr. Gerda Zeeman from the University of Groningen in The Netherlands—but who remains in Dallas in spirit—graciously provided magnetic resonance images from women with eclampsia. We also thank the fellows of our Maternal-Fetal Medicine Division and our many residents in obstetrics and gynecology. Their vigilant search for perfect examples of normal and abnormal findings has led to many of the photographs in this edition. We specifically thank Drs. Mina Abbassi-Ghanavati and Laura Greer for their time-consuming efforts to provide the first-ever appendix of normal values during pregnancy for common and uncommon laboratory tests. We predict that this will be a priceless resource for practitioners.

From the University of Alabama at Birmingham, Ms. Suzanne Cliver provided material for tables and figures from the perinatal database. Drs. Ona Marie Faye-Peterson and Michael Conner of the Department of Pathology generously contributed pictures and photomicrographs of placental pathology. From Bethesda, Dr. Rosemary Higgins of the Neonatal Units Network provided expert input for disorders of the fetus and newborn.

Thanks to generous funding from The McGraw-Hill Companies, this 23rd edition has full-color photographs and illustrations. Many were either replaced or redrawn for consistency of style. More than 200 of the new color illustrations were created by two talented medical illustrationists. Ms. Marie Sena was one of the major artist contributors to the inaugural edition of Williams Gynecology. To even further her experiences for the current book, she logged countless hours in labor and delivery, in the anatomy laboratory, and in model simulations. Ms. Erin Frederikson, also a veteran of our art team, added insightful images depicting cesarean delivery, peripartum hysterectomy, and fetal development. Additional artwork was generously provided by Mr. Jordan Pietz and Ms. Jennifer Hulsey. All of these talented artists trained on campus under the stimulating leadership of Mr. Lewis Calver, who is Chair of the Biomedical Communications Graduate Program. More artistic support came from Mr. Joseph Varghese and his team at Thomson Digital, who provided the full-color graphs and line art that completes this edition's art program. They were aided by medical content expert Dr. Anuradha Majumdar, who precisely translated our academic vision to each image. Both tirelessly coordinated efforts between our authors and their art team and graciously accommodated our numerous changes and tweaks. In addition to these artists, we were grateful for photographic contributions from academic giants in their field. We boast seminal placental images generously donated by a dear friend, Dr. Kurt Benirschke, laparoscopic images of ectopic pregnancies from Dr. Togas Tolandi, and fetal surgery images from Dr. Timothy Crombleholme.

Production of the 5,000-page typewritten manuscript would be impossible without a dedicated team to bring these efforts together. Once again, we are deeply indebted to Ms. Connie Utterback for her untiring efforts as production coordinator for Dallas, Birmingham, and Washington, D.C. She received able assistance with manuscript production from the Dallas group that included Ms. Minnie Tregaskis, Ms. Melinda Epstein, Ms. Mary Kay McDonald, Ms. Dina Trujillano, and Ms. Ellen Watkins. From Birmingham, production coordination and manuscript preparation were ably provided by Ms. Belinda Rials and Ms. Sue Capps. Ms. Cherry Neely coordinated database analysis and presentation with help from research nurses Ms. Allison Northen and Ms. Rachel Copper. Graphic illustration for the Birmingham group was provided by Ms. Jo Taylor.

It again has been a privilege and a pleasure to work with the dedicated personnel from McGraw-Hill. A number of individuals were crucial to the success of this 23rd edition. Dr. Anne Sydor helped us to conceive the project, and she provided the inspiration and obtained financial support to present this full-color edition. Ms. Marsha Loeb served as senior editor during the bulk of its production, and she was an efficient and steadfast advocate who frequently went above and beyond to accommodate our needs. Her responsibilities were assumed in the “home stretch” by Ms. Alyssa Fried, who has ably led us to completion. We appreciate her efforts and thank her for her help and her patience. Integral to a project of this scope and complexity is attention to detail. This 23rd edition would have never seen the light of day without the considerable talents of Mr. Phil Galea, Mr. John Williams, and Mr. Armen Ovsepan. They have been long-standing members of the Williams team and have lent their considerable talents to several editions. An especially warm thank you is extended to a long-time colleague, Ms. Karen Davis, who coordinated production of this edition. Karen has been a tireless and committed member of our Williams family. Over the many years that we have worked with her, she has always handled problems quickly and expertly as soon as they arose. Her dedication to creating the best textbook possible equaled our efforts, and we are in awe of her unflappable, gracious, and effective style. Finally, McGraw-Hill enlisted Aptara Inc. for composition. We thank Ms. Satvinder Kaur for her talents in coordinating and overseeing composition. Her attention to detail and organization skills were vital to completion of our project.

Our goal at the outset of this 23rd edition was to create a visual landmark to equal the written content. To this end, almost 90 percent of images in this edition have been upgraded or revised. Of these, 220 images were rendered by our medical illustrators cited above. It will also be apparent that almost all previous black-and-white photographs have been replaced by those in vivid color. This is supplanted by a thorough canvass of the literature with stated efforts to emphasize evidence-based management. To do this, almost 2000 new journal and textbook references were added, and more than 400 of these were published in 2009. All of this talent and hard work has come to fruition in what we hope is the best edition so far of Williams Obstetrics. We further hope that the reader will enjoy studying its content as much as we have enjoyed conveying it.

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