Bedside Obstetrics and Gynecology Richa Saxena
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1BEDSIDE OBSTETRICS AND GYNECOLOGY2
3BEDSIDE OBSTETRICS AND GYNECOLOGY
Richa Saxena MBBS MD (Obstetrics and Gynecology) PG Diploma in Clinical Research New Delhi, India
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India
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Bedside Obstetrics and Gynecology
© 2010, Jaypee Brothers Medical Publishers (P) Ltd.
All rights reserved. No part of this publication 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 author and the publisher.
First Edition: 2010
9788184489880
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset & Packagings Ltd., New Delhi
5Dedicated to
My Mother, Mrs Bharati Saxena
and all the Mothers
Who have undergone much pain and sufferings for their children.
A mother is the most trusted friend we have, when trials, heavy and sudden, fall upon us;
When adversity takes the place of prosperity; when friends who rejoice with us in our sunshine, desert us;
When troubles thicken around us, still she will cling to us
and counsel to dissipate the clouds of darkness, causing peace to return to our hearts;
and has proven time and time again that no matter whatever circumstances may come between mother and
her children, their lives are interwoven forever.
— Washington Irving6
7Preface
Father, lead me day by day, ever in thy own sweet way.
Teach me to be pure and good and tell me what I ought to do.
—Amen
I strongly believe that no task whatsoever in this world can be accomplished without His permission and divine intervention. With this in mind, I have started this preface with a small prayer of thanks to the Almighty, which I was taught in my childhood.
The concept of a bedside book is not new, but is a novel one and unique in itself. It may sound funny, but when I told a non-medical editor from a reputed publishing house that I was writing a book titled, “Bedside Obstetrics and Gynecology”, he laughed asking whether the book is meant to remain at the bedside of the patient or the doctor? Jokes apart, who else other than the medical personnel would know the importance of the education which takes place at the patient's bedside. In today's world of scientific advancement and technology, the clinical art of medicine is sadly dying off …
The doctors today do not believe in auscultating the patient's chest or merely palpating the patient's abdomen. A stethoscope can diagnose a consolidated lung suggestive of Kochs at a much earlier stage than a chest X-ray or even a bronchoscopic-guided biopsy. Hence, it is important for the medical personnel to become acquainted with the skills of taking history and performing a clinical examination. The purpose of the book is to promote the art of good history taking and clinical examination, and reaching the final diagnosis by obtaining only a few selective investigations or special evaluations. The book highlights the classical and systematic approach towards diagnosis of the disease. Each case study has been carefully designed to simulate the clinical practice scenarios as far as possible in order to evoke the right patient approach and clinical decision making. Unlike the small clinical vignettes described in most other books, detailed explanation of the pathology relevant to the case study in question has been described in all the chapters. One of the key features of this book is its versatility. Not only will the book be useful to the undergraduates who are required to get acquainted with the clinical examination skills but also for the busy postgraduates who are in the rush to go through the clinical scenarios.
I believe that writing a book involves a continuous learning process. Though extreme care has been taken to maintain accuracy while writing this book, constructive criticism shall be greatly appreciated. Please e-mail me your comments at richasaxena@womanhealthsimplified.com. Also, please feel free to refer your patients to my website titled www.womanhealthsimplified.com for obtaining information related to various health-related issues of women.
I wish to express my thanks and appreciation to all the related authors and publishers whose references have been used in this book. It is needless to say that this book would not have been possible without the encouragement and support of Shri Jitendar P Vij (Chairman and Managing Director) and Mr Tarun Duneja (Director-Publishing) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi. Last but not the least, I would like to thank the entire team of Jaypee Brothers Medical Publishers who worked sincerely on this book, especially the production manager and coordinators, who streamlined the process of publishing and the entire team of creative designers, artists, operators and the editorial board who worked hard on this book. May God bless them all!
Richa Saxena
10Introduction
As previously described, this book emphasizes the patient rather than the disease. For example, a patient may be presenting with jaundice, fever, and malaise, but the actual diagnosis may turn out to be hepatitis. So simply knowing about hepatitis is not enough, one needs to have the ability to diagnose the condition based on the findings of history and clinical examination. Promoting clinical acumen is the basic purpose of this book. Each chapter has been written keeping in mind the clinical presentation of the patient. Various clinical scenarios have been divided into seven sections in all, out of which the first three deal with obstetrics and last four with gynecology. All the chapters have been divided into various subparts with the help of the symbols as described below:
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