The Extraterrestrial's Handbook to Obstetrics & Gynecology
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Steve Behram, MD, FACOG
CONTENTS
Covers more than 70 relevant and up-to-date OB/GYN topics, organized logically to mirror how patients are typically seen in clinical practice.
CONTENTS Introduction Let Your Cosmic Journey Begin � � � � � � � � � � � � � � � � � � � 9 Approach to the Female Patient � � � � � � � � � � � � � � � � � 10 History & Physical � � � � � � � � � � � � � � � � � � � � � � � � � � � � 11 Well Woman Visit � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 14 Pre-conception & Early Pregnancy Early Pregnancy Loss � � � � � � � � � � � � � � � � � � � � � � � � � � 19 Nausea & Vomiting in Pregnancy � � � � � � � � � � � � � � � � 21 Medical Abortions � � � � � � � � � � � � � � � � � � � � � � � � � � � � 28 Anemia During Pregnancy � � � � � � � � � � � � � � � � � � � � � 32 Chromosomal Abnormalities � � � � � � � � � � � � � � � � � � � 37 Multi-fetal Gestations� � � � � � � � � � � � � � � � � � � � � � � � � � 45 Pregnancy & Heart Disease � � � � � � � � � � � � � � � � � � � � � 49 Thyroid Disease in Pregnancy � � � � � � � � � � � � � � � � � � � 58 Chronic Hypertension � � � � � � � � � � � � � � � � � � � � � � � � � 61 Inherited Thrombophilia in Pregnancy � � � � � � � � � � � 68 Neural Tube Defects� � � � � � � � � � � � � � � � � � � � � � � � � � � 71 Prevention of Rh D Alloimmunization � � � � � � � � � � � � 73 Ultrasound in Pregnancy � � � � � � � � � � � � � � � � � � � � � � � 78 Screening for Genetic Disorders � � � � � � � � � � � � � � � � 83 Maternal Infections & Pregnancy � � � � � � � � � � � � � � � � 87 Cervical Incontinence � � � � � � � � � � � � � � � � � � � � � � � � � 92 Antiphospholipid Syndrome � � � � � � � � � � � � � � � � � � � � 93 Bariatric Surgery and Pregnancy � � � � � � � � � � � � � � � � 96 Psychiatric Illness and Pregnancy � � � � � � � � � � � � � � � 98 Asthma and Pregnancy � � � � � � � � � � � � � � � � � � � � � � � 101 Hepatitis and Pregnancy � � � � � � � � � � � � � � � � � � � � � � 104 Hemoglobinopathies and Pregnancy � � � � � � � � � � � � 109 Pregestational Diabetes � � � � � � � � � � � � � � � � � � � � � � � 111 Later in the pregnancy Gestational Diabetes � � � � � � � � � � � � � � � � � � � � � � � � � 118 Macrosomia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 122 Obesity in Pregnancy � � � � � � � � � � � � � � � � � � � � � � � � � 126 Antepartum Fetal Surveillance � � � � � � � � � � � � � � � � � 131 Buy Now!
CONTENTS Fetal Heart Rate Tracings � � � � � � � � � � � � � � � � � � � � � 134 Fetal Growth Restriction � � � � � � � � � � � � � � � � � � � � � � 136 Gestational Hypertension and Preeclampsia � � � � � � 138 Preterm Rupture of Membranes � � � � � � � � � � � � � � � � 146 Thrombocytopenia in Pregnancy � � � � � � � � � � � � � � � 150 Alloimmunization in Pregnancy � � � � � � � � � � � � � � � � 154 Genital Herpes in Pregnancy � � � � � � � � � � � � � � � � � � 157 Preterm Labor � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 162 Delivery & Postpartum Induction of Labor � � � � � � � � � � � � � � � � � � � � � � � � � � � 168 Operative Vaginal Birth � � � � � � � � � � � � � � � � � � � � � � � 175 Obstetric Analgesia and Anesthesia � � � � � � � � � � � � � 178 Vaginal Birth After Cesarean Section � � � � � � � � � � � � 185 Obstetrical Lacerations � � � � � � � � � � � � � � � � � � � � � � � 193 Prophylactic Antibiotics in L&D � � � � � � � � � � � � � � � � 199 Thromboembolism in Pregnancy � � � � � � � � � � � � � � � 204 Postpartum Hemorrhage � � � � � � � � � � � � � � � � � � � � � � 207 Shoulder Dystocia � � � � � � � � � � � � � � � � � � � � � � � � � � � 215 Neoplastic Conditions Vulvar Skin Disorders � � � � � � � � � � � � � � � � � � � � � � � � 222 Hereditary Breast and Ovarian Cancer Syndrome � � 225 Breast Cancer Risk Assessment� � � � � � � � � � � � � � � � � 231 Adnexal Masses � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 235 Endometrial Cancer � � � � � � � � � � � � � � � � � � � � � � � � � � 241 Cervical Cancer � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 246 Benign Conditions Tubal Ectopic Pregnancy � � � � � � � � � � � � � � � � � � � � � � 254 Endometriosis � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 260 Chronic Pelvic Pain � � � � � � � � � � � � � � � � � � � � � � � � � � 265 Vaginitis � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 270 Polycystic Ovarian Syndrome � � � � � � � � � � � � � � � � � � 276 Symptomatic Uterine Leiomyomas � � � � � � � � � � � � � � 283 Management of Abnormal Uterine Bleeding � � � � � � 291 Pelvic Organ Prolapse � � � � � � � � � � � � � � � � � � � � � � � � 294 Female Sexual Dysfunction � � � � � � � � � � � � � � � � � � � � 300 Includes sections that enable readers to test their knowledge through multiplechoice questions and organize their thoughts using mindmaps.
Fecal Incontinence � � � � � � � � � � � � � � � � � � � � � � � � � � 307 Benign Breast Disease � � � � � � � � � � � � � � � � � � � � � � � � 313 Urinary Incontinence � � � � � � � � � � � � � � � � � � � � � � � � 322 Menopause � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 332 Contraception Sterilization � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 338 Implants and Intrauterine Devices � � � � � � � � � � � � � � 343 Emergency Contraception � � � � � � � � � � � � � � � � � � � � � 349 Challenges in Hormonal Contraception � � � � � � � � � � 353 Surgical Considerations Informed Consent � � � � � � � � � � � � � � � � � � � � � � � � � � � 368 Patient Safety � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 371 Hemostatic Agents � � � � � � � � � � � � � � � � � � � � � � � � � � � 376 Thromboembolism in Gynecologic Surgery � � � � � � 382 Gynecologic Infections � � � � � � � � � � � � � � � � � � � � � � � 387 Peri-operative Pain Management � � � � � � � � � � � � � � � 392 Minimally Invasive Surgery � � � � � � � � � � � � � � � � � � � � 404 The Alien Data Dump Here's What We've Learned � � � � � � � � � � � � � � � � � � � � 410 Neural Interface Direct Information Transfer � � � � � � � � � � � � � � � � � � � 450
Culinary Creations Placenta Poppers � � � � � � � � � � � � � � � � � � � � � � � � � � � � 461 Veggie Rolls with Placenta � � � � � � � � � � � � � � � � � � � � � 461 Placenta Crostini � � � � � � � � � � � � � � � � � � � � � � � � � � � � 462 Placenta Fritters � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 462 Placenta Stew � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 463 Placenta Quesadillas � � � � � � � � � � � � � � � � � � � � � � � � � 463 Grilled Placenta � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 464 Placenta Patties on a Bun � � � � � � � � � � � � � � � � � � � � � 464 Placenta Truffles � � � � � � � � � � � � � � � � � � � � � � � � � � � � 465 Placenta Ice Cream � � � � � � � � � � � � � � � � � � � � � � � � � � 465 Closing Credits References � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 468 Buy Now!
Cosmic
THE EXTRATERRESTRIAL'S HANDBOOK TO OBSTETRICS & GYNECOLOGY 6 1 1
INTRODUCTION
7 CHAPTER ONE
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Conversational tone, fun writing, and irreverent graphics create a relaxed learning atmosphere for overwhelmed learners.
Gomer-3
The oocytes of the native lifeforms on Gomer-3 can be up to 4 meters in diameter. It is widely believed that this species was the first to discover Mittelschmerz and invented the combined oral contraceptive to treat the same.
Let Your Cosmic Journey Begin
Welcome to "The Extraterrestrial's Handbook to Obstetrics and Gynecology"!
This book is a general guide to understanding the complex and fascinating world of the human female reproductive health, designed specifically for those unfamiliar with the intricacies of human anatomy and physiology In this book, we will explore the various stages of human reproduction, from conception to childbirth, and everything in between� We will also review the importance of health surveillance and also the diagnosis and management of gynecologic conditions
I hope you will find the tone in this book to be fun and engaging� In writing this book, I did not use any charts, tables, or figures whatsoever; instead, I favored a more concise and clinically relevant narrative that I hope will be useful to anyone interested in women's care� Figure 1 depicts the hyper-dimensional sub-plot of the relationship between information acquisition by sentient life-forms and the utilization of humor-infused teaching modalities in support of this simplified didactic approach�
Now, you may be wondering about the meaning behind the title of this book As you may have surmised, this handbook was written without any preconceived notions about how much or how little the reader knows about the topic For extra-terrestrials just venturing into human obstetrics and gynecology, the secrets of this field may seem as mysterious as the singularity in a black hole Fear not, this book aims to demystify these complexities in a fun and engaging manner� Human readers, too, can enjoy the fresh, lighthearted approach, which will provide new insights and entertainment while exploring the wonders of women's health
As you venture into the vast expanse of this textbook, don't forget to make full use of the resources we've designed specifically for you� Challenge your understanding with the multiple-choice questions in the Alien Data Dump and expand your mental horizons by exploring the mind maps located in the Neural Interface section� Readers are also provided an extensive list of primary and secondary sources to help you continue with your voyage And when hunger inevitably strikes during your educational journey, why not treat yourself to a snack from our Cosmic Culinary Creations? However, our human friends might want to steer clear of the recipe section, as the focus on placenta-based dishes could be seen as a tad too close to cannibalism for comfort Our extraterrestrial audience, on the other hand, may find these recipes to be quite scrumptious and delicious�
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Figure 1. Hyper-Dimensional Sub-Plot of the Interplay of Humor-Infused Teaching Modalities (Gigglons) and Information Acquisition (Knowtons) in Obstetrics and Gynecology, with Engagement Level (Enthuzons) as the Third Axis (p<0�05)�
OBSTETRICS
PRE-CONCEPTION & EARLY PREGNANCY
CHAPTER TWO
THE EXTRATERRESTRIAL'S HANDBOOK TO OBSTETRICS & GYNECOLOGY 10
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Concisely organized and pragmatically structured, this book enables quick learning and assimilation for students, focusing on common problems encountered in the field.
Zarnia
The time-traveling women of Zarnia actually give birth to their own parents. It is the only known instance where a miscarriage could result in a time paradox that would end the universe as we know it.
Early Pregnancy Loss
Early pregnancy loss is defined as the loss of a nonviable, intrauterine pregnancy within the first 12 6/7 weeks of gestation It is a common occurrence, affecting 10% of clinically recognized pregnancies, with approximately 80% of all cases of pregnancy loss occurring in the first trimester� Fetal chromosomal abnormalities are the cause of approximately 50% of early pregnancy losses, with advanced maternal age and prior early pregnancy loss being the most commonly identified risk factors� To confirm a diagnosis of early pregnancy loss, a thorough evaluation is necessary, which may include ultrasonography and serum β-hCG testing Treatment options include expectant management, medical treatment, or surgical evacuation, and patients should be counseled about the risks and benefits of each option
When evaluating a patient for early pregnancy loss, it is important to distinguish it from other early pregnancy complications, as treatment before a confirmed diagnosis can have detrimental consequences� Ultrasonography is the preferred modality to verify the presence of a viable intrauterine gestation� The use of ultrasound criteria to confirm the diagnosis of early pregnancy loss has been challenged, and the Society of Radiologists in Ultrasound Multispecialty Panel has created guidelines with stricter cutoffs However, obstetrician-gynecologists should consider other clinical factors when interpreting the guidelines, and individualize them to patient circumstances�
Management options for early pregnancy loss include expectant management, medical treatment, or surgical evacuation, and patients should be counseled about the risks and benefits of each option Expectant management is successful in achieving complete expulsion in approximately 80% of women, and patients should be counseled on symptoms and provided with educational materials� Follow-up approaches, such as standardized phone calls or serum β-hCG measurements, may be useful for women with limited access to follow-up ultrasound examination� Expectant management should not be recommended for losses beyond the first trimester�
Women who experience early pregnancy loss and do not have infection, severe anemia, bleeding disorders, or hemorrhage can consider medical management to shorten the time to complete expulsion without surgical intervention� Misoprostol-based regimens are effective for this purpose, with larger doses and vaginal or sublingual administration being more effective than smaller doses or oral administration In cases where medical management is indicated, an initial treatment of 800 micrograms of vaginal misoprostol, with a repeat dose if needed, is recommended� Adding a dose of mifepristone 24 hours before misoprostol administration can significantly improve treatment efficacy and reduce the need for surgical intervention� Patients should be counseled on what to expect during the tissue passage,
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when to seek medical attention, and given prescriptions for pain medications� Follow-up typically involves ultrasound examination or serum β-hCG measurement to confirm complete expulsion� The availability of mifepristone is currently limited by FDA restrictions, but the American College of Obstetricians and Gynecologists supports improving access to it for reproductive health indications Insufficient evidence exists to support or refute the use of misoprostol for incomplete pregnancy loss�
For women experiencing early pregnancy loss with retained tissue, surgical uterine evacuation has traditionally been the preferred approach� Urgent surgical evacuation is recommended for women presenting with hemorrhage, hemodynamic instability, or signs of infection� Surgical evacuation may also be preferred in cases where medical comorbidities such as severe anemia, bleeding disorders, or cardiovascular disease are present� Some women may choose surgical evacuation over expectant or medical treatment due to the immediate completion of the process and reduced need for follow-up
Sharp curettage alone used to be the standard method of uterine evacuation, but studies indicate that suction curettage is more effective when used alone or in conjunction with sharp curettage� The routine use of sharp curettage in the first trimester does not provide any added benefit, as long as the obstetrician-gynecologist or other gynecologic provider is confident that the uterus is empty� Suction curettage can be performed in an office setting with an electric vacuum source or manual vacuum aspirator, under local anesthesia with or without sedation Officebased surgical management is often more convenient for patients and provides significant cost savings compared to performing the same procedure in the operating room
Studies have shown that expectant, medical, and surgical management of early pregnancy loss all result in complete evacuation of pregnancy tissue in most patients, with serious complications being rare� Surgical evacuation is the fastest and most predictable approach, with success rates approaching 99% Medical management is a reasonable option for any pregnancy failure type and has been shown to be more cost-effective than surgical management in an operating room� Office-based surgical management can also be more effective and less costly than medical management in certain circumstances�
Patients should be counseled regarding interpregnancy interval after early pregnancy loss, with no quality data supporting the delay of conception to prevent subsequent early pregnancy loss or other complications They should also be advised to abstain from vaginal intercourse for 1-2 weeks after complete passage of pregnancy tissue to reduce the risk of infection� Women who desire contraception may initiate hormonal contraception use immediately after completion of early pregnancy loss, and there are no contraindications to intrauterine device place-
THE EXTRATERRESTRIAL'S HANDBOOK TO OBSTETRICS & GYNECOLOGY 14
ment after surgical treatment�
No workup is generally recommended after one early pregnancy loss, but Rh D immune globulin should be considered in cases of early pregnancy loss, especially those that are later in the first trimester, to prevent alloimmunization There are no effective interventions to prevent early pregnancy loss, and therapies such as bed rest, uterine relaxants, and administration of β-hCG have not been proved to prevent early pregnancy loss
Maternal or fetal chromosomal analyses or testing for inherited thrombophilias are not recommended routinely after one early pregnancy loss, although women who have experienced at least three prior pregnancy losses may benefit from progesterone therapy in the first trimester
Nausea & Vomiting in Pregnancy
Nausea and vomiting of pregnancy is a common condition, with rates of nausea and vomiting/retching at around 50% Recurrence of symptoms with subsequent pregnancies is also common� Severity of symptoms can be measured using the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) index, which is associated with quality of life measurements� Clinical decision making regarding treatment is influenced by the woman's perception of symptom severity, desire for treatment, and potential impact on the fetus Early treatment may help prevent progression to hyperemesis gravidarum, which is a clinical diagnosis of exclusion with no single accepted definition� Hyperemesis gravidarum represents the extreme end of the spectrum of nausea and vomiting of pregnancy and can be characterized by persistent vomiting, acute starvation, and weight loss� Physical findings and diagnostic criteria can help differentiate hyperemesis gravidarum from other conditions that may cause nausea and vomiting� These include a history of chronic conditions associated with nausea and vomiting, neurological disorders, and thyroid abnormalities The appropriate management of abnormal thyroid tests related to gestational transient thyrotoxicosis or hyperemesis gravidarum is supportive therapy, and antithyroid drugs are not recommended�
The cause of nausea and vomiting of pregnancy is not fully understood, and several theories have been proposed� One of the leading theories is that the hormone human chorionic gonadotropin (hCG) produced by the placenta is responsible, as its peak concentration is closely linked to the onset of symptoms� Estrogen has also been implicated in the condition, as higher levels are associated with increased nausea and vomiting� Another theory is that nausea and vomiting of pregnancy is an evolutionary adaptation that protects the woman and fetus from potentially harmful foods However, the clinical application of this theory may lead to under-treatment of affected women� The notion that the condition is caused by
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psychologic factors has been disputed, and there is little evidence to support this claim� Risk factors for hyperemesis gravidarum, the most severe form of nausea and vomiting in pregnancy, include increased placental mass, a history of motion sickness or migraine headaches, and a family history of the condition�
Nausea and vomiting of pregnancy is a common condition, with prevalence rates for nausea ranging from 50-80%, and for vomiting and retching ranging from 50% The recurrence of nausea and vomiting of pregnancy with subsequent pregnancies varies from 15-81%� One study attempted to categorize the severity of nausea and vomiting of pregnancy by assessing the duration and amount of symptoms, but these categories were not compared to quality of life measures A validated nausea and vomiting of pregnancy severity index, known as the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE), assesses the severity of symptoms during the first trimester, and scores from the PUQE index are associated with quality of life measurements� The cause of nausea and vomiting of pregnancy is unknown, but several theories have been proposed, including hormonal stimulus, evolutionary adaptation, and psychological predisposition� Women with increased placental mass, a history of motion sickness or migraines, a family history of hyperemesis gravidarum, or who are carrying female fetuses are at increased risk of developing the condition� While death from nausea and vomiting of pregnancy is rare today, significant morbidity such as Wernicke encephalopathy, splenic avulsion, and esophageal rupture have been reported� Some women also experience significant psychosocial morbidity, resulting in a decision for pregnancy termination�
The effect of nausea and vomiting of pregnancy on the embryo and fetus depends on the severity of the condition� Mild or moderate vomiting appears to have little impact on pregnancy outcome, and some studies have even found a lower rate of miscarriage in women with nausea and vomiting of pregnancy and hyperemesis gravidarum compared to controls� This may be due to robust placental synthesis in a healthy pregnancy, rather than a protective effect of vomiting� There is no significant association between hyperemesis gravidarum and congenital anomalies� While some studies have shown no increase in low birth weight (LBW) with nausea and vomiting of pregnancy, a systematic review and meta-analysis of women with hyperemesis gravidarum found a higher incidence of LBW, small-for-gestational-age infants, and premature infants However, large retrospective cohorts have not demonstrated an association between hyperemesis gravidarum and perinatal or neonatal mortality� Long-term health effects on children or women after pregnancies complicated by hyperemesis gravidarum are not well known, but it is generally reassuring to patients that the presence of nausea and vomiting of pregnancy, and even hyperemesis gravidarum, is most often associated with positive pregnancy outcomes�
To treat nausea and vomiting of pregnancy, prevention is the first step Taking a multivitamin before pregnancy may reduce the severity of symptoms, although
THE EXTRATERRESTRIAL'S HANDBOOK TO OBSTETRICS & GYNECOLOGY 16
Vortexia
The people on the ultra fast spinning world of Vortexia are in a perpetual state of nausea and vomiting. It is the only place in the galaxy where the HCG produced during pregnancy actually leads to emetic suppression.
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Alien Data Dump The Here's What We've Learned
Data Sources Include:
• Actual Human Abductions & Interrogation
• Alien Metamorphic Societal Infiltration
• Use of Probes & Innovative Tools
• In-depth Analysis of the Brains of Human Researchers
• Theoretical Simulations
Empower students with 250 selfassessment questions, designed to gauge understanding and reinforce their grasp of key concepts in the field.
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INSTRUCTORS
Here is What You Need To Know
• The answers are contained in the QR code below and the questions are presented in the pages that follow� Depending on how your species perceives the flow of time, you should either read the answers first and then proceed to the questions, or, vice-versa, whichever makes the most sense to you�
• Obviously, the topic of obstetrics and gynecology varies across the cosmos� The correct answers have been keyed for your specific planet, asteroid or star cluster� Do not compare your answers with other species as their answers may differ�
• Species who have obstetrics, but no gynecology, should only answer the relevant obstetrical questions Species who have gynecology, but no obstetrics, should similarly focus on only the gynecological questions� Species who have neither obstetrics nor gynecology should count their blessings�
• The purpose of these questions is to help the reader identify gaps in knowledge and also help us identify civilizations we could easily conquer�
• If you're a member of a species that reproduces asexually, we are not going to judge and we're not going to tell you that you're missing out However, we encourage you to still attempt to answer the questions to the best of your ability, and to seek out additional resources and counseling, if necessary�
• Telepathic lifeforms are reminded to pre-medicate with telepathic blockers per examination protocol�
• For members who exclusively reproduce by spores, you've been reading the wrong handbook You will need to read: "Extraterrestrial's Handbook to Mycology "
• For life forms deriving sustenance from general knowledge questions, there is also an all-you-can-eat buffet at the website https://extraterrestrialhandbook�com
THE EXTRATERRESTRIAL'S HANDBOOK TO OBSTETRICS & GYNECOLOGY 20
1. When is suspected fetal macrosomia or LGA fetus an indication for induction of labor?
A Anytime after 37 weeks of gestation
B� Anytime after 39 weeks of gestation
C� Before 37 weeks of gestation
D Before 39 weeks of gestation
2. What is the definition of macrosomia?
A� Growth beyond an absolute birth weight of 4,000 g or 4,500 g, regardless of gestational age
B� Growth beyond an absolute birth weight of 5,000 g, regardless of gestational age
C� Growth beyond an absolute birth weight of 4,000 g or 4,500 g at term
D Growth beyond an absolute birth weight of 5,000 g at term
3. What should be considered in obese women before performing a cesarean delivery for labor arrest?
A� The baby's head circumference
B� The mother's height
C� The mother's BMI
D Allowing a longer first stage of labor before performing cesarean delivery for labor arrest�
4. When should mechanical thromboprophylaxis be used in relation to cesarean delivery?
A� Only after cesarean delivery
B� Only before cesarean delivery
C Neither before nor after cesarean delivery
D� Both before and after cesarean delivery, if possible
5. Which measurement is recommended to diagnose oligohydramnios?
A� Amniotic fluid index
B� Percentile of amniotic fluid
C� Single deepest vertical pocket measurement
D Average of vertical pocket measurements
6. What is the benefit of adding umbilical artery Doppler velocimetry to standard fetal surveillance in growth-restricted fetuses?
A� It predicts outcomes in fetuses without growth restriction
B� It improves perinatal outcomes
C� It reduces the need for further testing
D It decreases the risk of iatrogenic preterm birth
7. What is the recommended course of action for abnormal results from an NST or a modified BPP?
A� Immediate delivery
B� No further testing necessary
C� Additional testing with CST or BPP
D Repeat the same test
21
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TheNeural Interface Direct Information Transfer
Option 1: Direct Link using High Transfer-Rate Cable
• Ensure that your brain is compatible with the high transfer-rate cable.
• Connect one end of the cable to the input port located at the back of your head.
• Connect the other end of the cable to the corresponding port on the book.
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Option 2: QR Code Scan using your Phone
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Enhance retention with detailed mind-maps, guiding students in organizing and recalling information for every topic presented in the book.
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THE EXTRATERRESTRIAL'S HANDBOOK TO OBSTETRICS & GYNECOLOGY 24
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TheClosing Credits Bibliography
In writing "The Extraterrestrial's Guide to Obstetrics & Gynecology" I owe a great debt of gratitude to the researchers, academics, and providers whose publications were used to build this content. Their tireless efforts and dedication to the field to women's healthcare has made this book possible, and they deserve recognition for their invaluable contributions.
It is my hope that their names, those of their progeny and also their institutions will be placed onto a sacred scroll, forever protected from any future alien invasion, ensuring that their legacies will live on in the universe.
To this end, the link below will serve as a bibliographic reference to the remarkable body of work created by these individuals whose work transcends to the stars.
*
Explore further with a detailed 400-page bibliography, featuring over 6,000 primary and secondary sources, perfect for students eager to dive deeper into research and reading.
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The
Extraterrestrial's Handbook to Obstetrics
& Gynecology
"If you're going to write a textbook, you have to take it more seriously� Nobody is going to want to read about space aliens and their oocytes� And, if you think you're going to ask your students to gauge their interest in the book, they're going to say they love it only because you're grading them and they're just kissing up to get a good grade� No one is going to read this book� I have no input about this book� None, whatsoever� It's going to be a failure� It's essentially a book you wrote just for yourself�"
Nancy
Dr� Behram is a passionate educator and board-certified OB/GYN, dedicated to shaping the future of women's healthcare by teaching the next generation of providers, including nurse practitioners, physician assistants, and OB/GYN residents� A graduate of the University of Maryland and Eastern Virginia Medical School, Dr� Behram completed his residency training at Riverside Regional Medical Center and received the esteemed Galloway Fellowship at Memorial Sloan-Kettering� He is a Fellow of the American Board of Obstetricians and Gynecologists and lives in Maryland with his wife and two children� He's a space nut who believes that one day man will travel to the stars�
Behram, MD, FACOG
"I have no input about this book. None, whatsoever."
–
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