Sabaratnam Arulkumaran DCH FRCS FRCOG FAMS MD PhD FACOG FSLCOG FSOGC
Hon. Professor and Head Division of Obstetrics and Gynaecology St. George's Hospital Medical School,
London, UK
V Sivanesaratnam MBBS (S'pore) FRCOG FICS FACS FAMM
Professor, Department of Obstetrics and Gynaecology Faculty of Medicine University of Malaya Kuala Lumpur,
Malaysia
Alokendu Chatterjee FRCOG FICS
Formely, Professor and Head Department of Obstetrics and Gynaecology NRS Medical College and Hospital,
Calcutta Salt Lake City, Kolkata
Pratap Kumar MD DGO FICS FICOG FICMCH
Professor and Head Department of Obstetrics and Gynaecology Kasturba Medical College,
Manipal
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Essentials of Obstetrics
© 2004, Editors
All rights reserved. No part of this publication and CD ROM of illustrations should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher.
First Edition: 2004
9788180613623
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd., A-14, Sector 60, Noida
4Foreword
This book rightly focuses on undergraduates since the future truly rests on them.
We live in an era of hope with awesome scientific advances, with an ever-growing need to identify fetal well-being and obstetric aberrations. This book is truly the work of select obstetricians who have a deep concern for women's health and in these chapters, they have dealt with practical aspects, with utmost care to provide a crystal clear pathway to obstetric management for the undergraduates.
The greatest benchmark for the disparity in medical care between rich and poor countries is their obstetric outcome—their reproductive status. The Editors deep concern for this problem is easily visualized through a comprehensive chapter on Safe Motherhood and the emphasis on fundamentals of reproduction as an opening chapter, at the same time not ignoring important players like endocrinal and immunological components.
I feel privileged and happy to welcome this addition to our literature and look forward to it becoming a boon to all hues of obs-Gyn. practitioners. Its rich contents should please every undergraduate as well as his teachers.
Shirish S Sheth
Past President
FIGO
27th April, 2004
5Preface
The knowledge in obstetrics is expanding and one finds it difficult to keep pace with recent research. Research findings of today form the basis of practice in years to come. The core knowledge keeps changing and forms the basis of understanding of the disease process and management and is covered in this book. One may think of obstetrics as childbirth and its complications, but the expansion of knowledge in this area is exemplified by 46 chapters under 2 subsections. The book starts with issues related to conception, implantation and growth of the fetus and placenta. From this point, it expands to the knowledge needed for prenatal care followed by normal pregnancy and childbirth. The various obstetric and medical complications in the antenatal period are covered followed by normal and abnormal labor including operative deliveries. It ends with normal and complicated puerperium.
This book is multi-authored and hence the tendency for some overlap and repetition of knowledge. The editors have taken great effort in avoiding such duplications, but where it is felt that it may enhance continuity of reading an individual chapter, little change has been made. The authors have been selected based on their individual expertise, which has been useful to provide the best knowledge. This has led to the standards set high for many chapters. The knowledge provided straddles between what is needed for an undergraduate and a postgraduate. The editors had the difficult task of trimming down many chapters to make this book a reference source for undergraduates. In addition, it will form a basic reading book for postgraduates. The authors are from a variety of backgrounds and countries. This has led to some differences in the style and reporting of incidence of disease, but it does not alter the subject material.
We believe that this will be a good reference source for undergraduates and would welcome any comments or criticism that will help us to make this book better in the next edition. Your suggestions can be sent to any one of the editors or the publishers.
Sabaratnam Arulkumaran
V Sivanesaratnam
Alokendu Chatterjee
Pratap Kumar
6Acknowledgements
The editors would like to sincerely thank the contributors to this book. It had a long conception period due to some chapters arriving late and the need to have an extensive editorial process to make the chapters uniform, avoid duplication and step down postgraduate into undergraduate knowledge. The latter process has made some chapters so different from the original submission by authors. We ask the authors for their understanding and acceptance of this process. The principal editor collated the chapters from the other editors to streamline the publication and would like to acknowledge the help and advice provided by Mrs. Sue Cunningham at St. George's Hospital Medical School, University of London. We are grateful to the authors and publishers for their patience in the production of this book. Mr. JP Vij, Chairman and Managing Director and his team from Jaypee Brothers Medical Publishers (P) Ltd. need special commendation for the constant encouragement, in-house editorial work and production of the vast number of figures in the book. We would like to thank Dr. Shirish Sheth, past President of FIGO and an internationally renowned Obstetrician and Gynaecologist for writing the foreword for this book.
7Contributors
- Sabaratnam Arulkumaran
- dch, frcs, frcog, fams, md, phd
- Hon: facog, fslcog, fsogc
- Professor and Head
- Division of Obstetrics and Gynaecology
- St George's Hospital Medical School
- London, United Kingdom
- Gita Basu (Banerjee) dgo, md (g & o), dnb, mrcog,
- r.m.o./clinical tutor,
- NRS Medical College and Hospital
- Kolkata, India
- Rajesh Bhakta md
- Assistant Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College
- Manipal, India
- Sudip Chakravarti frcog, frcs, ficog
- Professor
- Dept. of Obstetrics and Gynaecology
- Vivekananda Institute of Medical Sciences
- Kolkata, India
- BN Chakravarty md, frcog, dsc (hon)
- Professor
- Institute of Reproductive Medicine
- Salt Lake City
- Kolkata, India
- Alokendu Chatterjee frcog, fics
- Formerly Professor and Head
- Dept. of Obstetrics and Gynaecology
- NRS Medical College and Hospital, Kolkata
- Salt Lake City
- Kolkata, India
- Tan Peng Chiong
- mbbs (lond), mrcog, ccst (o & g uk)
- Lecturer in Obstetrics and Gynaecology
- Department of Obstetrics and Gynaecology
- University of Malaya
- Kuala Lumpur, Malaysia
- Teresa WP Chow mrcog
- Department of Obstetrics and Gynaecology
- University of Malaya Medical Centre
- Kuala Lumpur
- Malaysia
- NN Roy Chowdhury
- md, phd, frcs, frcog, facs, fams, ficog
- Ex-Professor of Obstetrics and Gynaecology
- Medical College
- Kolkata, India
- S Dasgupta frcs, frcog, ficog
- Formerly Professor of Obstetrics and Gynaecology
- Jamshedpur Medical College
- Jamshedpur
- India
- Sajal Datta mbbs, md, dnb
- Reader
- Dept. of Obstetrics and Gynaecology
- Vivekananda Institute of Medical Sciences
- Kolkata, India
- Pankaj Desai md, ficog, ficmch
- A. Professor and Head
- Dept. of Obstetrics and Gynecology
- Medical College and SSG Hospital
- Baroda, India
- KK Diwakar md
- Head, Neonatal Division
- Professor, Department of Pediatrics
- Malankara Orthodox Syrian Church Medical College
- Kolenchery, Kochi, Kerala, India
- Suku Mathew George md dnb
- Assistant Professor
- Department of Obstetrics and Gynaecology
- Kasturba Medical College
- Manipal, India
- Krishnendu Gupta mbbs, dgo, md, ficmch, ficog
- Professor
- Dept. of Obstetrics and Gynaecology
- Vivekananda Institute of Medical Sciences
- Kolkata, India
- Samiksha Gupta
- Malhotra Nursing and Maternity Home (P) Ltd
- Agra, India
- Jamiyah Hassan mbbs (um), mmed (o & g)
- Associate Professor and Consultant
- Department of Obstetrics and Gynaecology
- University of Malaya Medical Centre
- Kuala Lumpur
- Malaysia
- Shripad Hebbar md
- Associate Professor of O & G
- Kasturba Medical College
- Manipal
- India
- Thaneemalai Jeganathan mbbs, mog
- Dept. of Obstetrics and Gynecology
- University of Malaya Medical Centre
- Kuala Lumpur
- Malaysia
- Devendra Kanagalingam
- Locum Lecturer in Obstetrics and Gynaecology
- St. George's Hospital Medical School
- London
- United Kingdom
- Hira Lal Konar mbbs, md, dnb, mrcog
- Assistant Professor
- Department of Obstetrics and Gynaecology
- NRS Medical College
- Kolkata, India
- Eugene Leong Weng Kong
- Lecturer
- Department of Obstetrics and Gynaecology
- University of Malaya Medical Centre
- Kuala Lumpur
- Malaysia
- Chan Yoo Kuen mbbs (mal), ffarcs (ireland)
- Professor
- Department of Anaesthesiology
- Faculty of Medicine
- University of Malaya
- Kuala Lumpur
- Malaysia
- Pratap Kumar md, dgo, fics, ficog, ficmch
- Professor and Head
- Department of Obstetrics and Gynecology
- Kasturba Medical College
- Manipal
- India
- Jaideep Malhotra
- Malhotra Nursing and Maternity Home (P) Ltd
- Agra
- India
- Narendra Malhotra
- Malhotra Nursing and Maternity Home (P) Ltd
- Agra
- India
- Matthews Mathai md, mobstet, phd
- Professor of Obstetrics and Gynaecology
- Christian Medical College and Hospital
- Vellore, India
- Vanaj Mathur
- Malhotra Nursing and Maternity Home (P) Ltd
- Agra, India
- Wong Yat May mrcog, mbchb
- Lecturer
- Department of Obstetrics and Gynaecology
- University of Malaya Medical Centre
- Kuala Lumpur
- Malaysia
- Idora Mohamed mbbs (mal) mmed (o & g) (mal)
- Lecturer
- Department of Obstetrics and Gynaecology
- University of Malaya Medical Centre
- Kuala Lumpur
- Malaysia
- Joydev Mukherji md (gynae and obst)
- Associate Professor
- Dept. of Gynaecology and Obstetrics
- North Bengal Medical College
- West Bengal
- India
- Gautam Mukhopadhyay md, dnb
- Dept. of Obstetrics and Gynaecology
- NRS Medical College and Hospital, Kolkata)
- Salt Lake City
- Kolkata
- India
- Partha Mukhopadhyay mbbs, dgo, md
- Assistant Professor
- Department of Obstetrics and Gynaecology
- NRS Medical College
- Kolkata
- India
- Sambit Mukhopadhyay
- Consultant
- Department of Obstetrics and Gynaecology
- Norfolk and Norwich University Hospital NHS Trust
- Norwich
- United Kingdom
- Muralidhar V Pai
- Associate Professor
- Dept. of Obstetrics and Gynaecology
- Kasturba Medical College
- Manipal
- India
- Suchitra N Pandit
- bpharm, md, dnbe, dgo, dfp, mrcog (uk), micog
- Associate Professor and Head of Unit
- Department of Obstetrics and Gynecology
- LT Medical College and
- LT Municipal General Hospital
- Mumbai
- India
- Sukhpreet Patel md, dnb, fcps, dgo
- Mumbai
- India
- Lavanya Rai md, dgo
- Department of Obstetrics and Gynecology
- Kasturba Medical College Hospital
- Manipal, Karnataka
- India
- A Padma Rao md, dgo
- Emeritus Professor and Retired Head and
- Director of Postgraduate Studies
- Department of Obstetrics and Gynaecology
- Kasturba Medical College, Manipal, Karnataka
- India
- Sanjay B Rao md, dnbe, dgo, dfp, fcps, dicog
- Lecturer
- Department of Obstetrics and Gynaecology
- LT Medical College and LT Municipal General Hospital
- Mumbai, India
- Charu Rawat md (o & g)
- Department of Obstetrics and Gynecology
- Medical College and SSG Hospital, Baroda
- India
- Silvam Sellappan mbbs (mal.), mog (mal)
- Department of Obstetrics and Gynaecology
- Faculty of Medicine
- University of Malaya
- Kuala Lumpur
- Malaysia
- Duru Shah md, fcps, fics, ficog, dgo, dfp, ficmch
- Mumbai
- India
- Jyothi Shetty md
- Associate Professor
- Dept. of Obstetrics and Gynaecology
- Kasturba Medical College
- Manipal, India
- Kamala Sikdar md, frcog, mnams, phd, facs
- Professor and Head
- Department of Obstetrics and Gynaecology
- NRS Medical College and Hospital
- Kolkata
- India
- Amita Singh
- Malhotra Nursing and Maternity Home (P) Ltd
- Agra
- India
- V Sivanesaratnam mbbs (s'pore), frcog, fics, facs, famm
- Professor
- Department of Obstetrics and Gynaecology
- Faculty of Medicine
- University of Malaya
- Kuala Lumpur
- Malaysia
- B Subhasri md
- Lecturer in Obstetrics and Gynaecology
- Christian Medical College and Hospital
- Vellore, India
- K Sujata
- Sofiah Sulaiman mbbch, mmed (o & g)
- Lecturer
- Department of Obstetrics and Gynaecology
- University of Malaya Medical Centre
- Kuala Lumpur
- Malaysia
- Onnig Tamizian
- Specialist Registrar
- Department of Obstetrics and Gynaecology
- Kings Mill Hospital
- Nottingham
- United Kingdom
- Lim Chin Theam
- mbbs, frcp (lond), frcp (edin), famm (fellow academy of medicine malaysia)
- Professor and Senior Consultant Neonatologist
- Department of Paediatrics
- University of Malaya Medical Centre
- Kuala Lumpur
- Malaysia
- Dr Anita Thomas md
- Assistant Professor
- Department of Obstetrics and Gynaecology
- Kasturba Medical College
- Manipal
- India