The history of the Department of Gynecology and Obstetrics extends over 130 years. We are very proud of our historic tradition of leadership in gynecology, obstetrics, and our subspecialties, dating back to Drs. Howard Kelly, J.W. Williams, Richard TeLinde, Nicholson Eastman, Howard and Georgeanna Jones, and so many others who have come before us. Our proud tradition inspires us today to advance our tripartite mission of clinical care, research, and education. In an era of economic and market challenges to academic medicine, we remain steadfast to ensuring advances in all arms of our tripartite mission. Now in its sixth edition, this manual continues to be created by the cooperative efforts of a resident or fellow, faculty preceptor, and a senior faculty editor at Johns Hopkins. It draws its strength from the collaboration of experienced faculty and insightful practical input from rising stars in our field. In using this edition, we hope you will appreciate the camaraderie in which the manual was created. This manual is truly a team effort. Over the years, this book has been a trusted companion carried in the lab coats of residents, medical students, and busy clinicians.

This edition contains several new chapters addressing contemporary topics affecting our patients. Substance abuse, specifically opioid use, in pregnancy has escalated dramatically in recent years. The rise of fetal therapy programs including management options for twin-to-twin transfusion led us to expand content on multifetal gestation. The recognition of the role of genetics prompted a new chapter on genetic and hereditary syndromes. In addition to new chapters in obstetrics addressing substance abuse and multifetal gestation we added chapters on psychiatric disorders, dermatologic disease, and neoplastic disease in pregnancy. New gynecologic chapters focus on organ prolapse, incontinence, and benign vulvar disease. Emphasis on safety sciences and value-based care is pervasive in modern medicine and is now incorporated throughout the practice of obstetricians and gynecologists. We dedicate a new chapter in this edition of the manual to this most important topic. As much as things change, we hope and trust that the content, readability, portability, format, and size continue to have great appeal for practicing clinicians and learners.

Andrew J. Satin, MD

Jessica Bienstock, MD, MPH

Betty Chou, MD