Hemant Deshpande MBBS MD
Professor and Head Department of Obstetrics and Gynecology Padmashree Dr DY Patil Medical College and Hospital
Pimpri, Pune, Maharashtra, India
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Textbook of High-Risk Pregnancy
© 2011, Jaypee Brothers Medical Publishers
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 editor and the publisher.
First Edition: 2011
9789350250389
Typeset at JPBMP type setting unit
Printed at
5Dedication to
Shri Guru Raghvendra Swamiji with who's blessings this book has come into reality
7Contributors
- Ambarisha Bhandiwad
- Professor and Head of Department
- Department of Obstetrics and Gynecology
- JSS Medical College and Hospital
- Mysore, Karnataka
- A Vivekanand
- Professor and Head of Department
- Department of Obstetrics and Gynecology
- Kakatiya Medical College and Hospital
- Warangal, Andhra Pradesh
- Anjali Deshpande
- Clinical Pathologist
- Department of Pathology
- Padmashree Dr DYPatil Medical College and Hospital
- Pimpri, Pune, Maharashtra
- Amol S Agarwal
- Consultant Cardiologist
- Ahmedabad, Gujarat
- BR Nilgar
- Professor
- Department of Obstetrics and Gynecology
- Jawaharlal Nehru Medical College and KLE Hospital
- Belgaum, Karnataka
- B Sarvottam Rao
- Professor
- Department of Obstetrics and Gynecology Navodaya Medical College and Hospital
- Raichur, Karnataka
- BG Boricha
- Professor and Head of Department
- Department of Obstetrics and Gynecology
- MGM Medical College and Hospital
- Kamothe, Navi Mumbai, Maharashtra
- Hemant Deshpande
- Professor and Head of Department
- Department of Obstetrics and Gynecology
- Padmashree Dr DY Patil Medical College and Hospital
- Pimpri, Pune, Maharashtra
- Joshi Suyajna D
- Professor and Head of Department
- Department of Obstetrics and Gynecology
- Vijaynagar Institute of Medical Sciences
- Bellary, Karnataka
- Haresh U Doshi
- Associate Professor and Head
- Department of Obstetrics and Gynecology
- BJ Medical College and Civil Hospital
- Ahmedabad, Gujarat
- Mrinalini Sahasrabhojanee
- Assistant Professor
- Goa Medical College and Hospital
- Bambolin, Goa
- Manjusha Jindal
- Associate Professor
- Goa Medical College and Hospital
- Bambolin, Goa
- Nitin Kshirsagar
- Professor and Head of Department
- Department of Obstetrics and Gynecology
- Krishna Institute of Medical Sciences
- Karad, Maharashtra
- Pankaj Desai
- Dean (Students) and Associate Professor
- Department of Obstetrics and Gynecology
- Medical College and SSG Hospital
- Baroda, Gujarat
- Prakash K Mehta
- Mahavir Hospital
- Bengaluru
- Karnataka
- PT Jadhav
- Professor
- Department of Obstetrics and Gynecology
- Al-Ameen Medical College
- Bijapur, Karnataka
- Palaniappan N
- Associate Professor
- Department of Obstetrics and Gynecology
- Shri Ramachandra Medical College (SRMC)
- Porur, Chennai, Tamil Nadu
- Shilpa Chaudhari
- Professor
- Department of Obstetrics and Gynecology
- Padmashree Dr DY Patil Medical College and Hospital
- Pimpri, Pune, Maharashtra
- Shivamurthy HM
- Professor
- Department of Obstetrics and Gynecology
- JJM Medical College and Hospital
- Davangiri, Karnataka
- Shivani Sharma
- Registrar
- Department of Obstetrics and Gynecology
- Padmashree Dr DY Patil Medical College and Hospital
- Pimpri, Pune, Maharashtra
- Yukti Wadhawan
- Registrar
- Department of Obstetrics and Gynecology
- Padmashree Dr DY Patil Medical College and Hospital
- Pimpri, Pune, Maharashtra
- Shankar J
- Professor
- Department of Obstetrics and Gynecology
- Vijaynagar Institute of Medical Sciences
- Bellary, Karnataka
- Surabhi Tomar
- Registrar
- Department of Obstetrics and Gynecology
- Padmashree Dr DY Patil Medical College and Hospital
- Pimpri, Pune, Maharashtra
- Suman Mittal
- Associate Professor
- Department of Obstetrics and Gynecology
- SMS Medical College and Hospital
- Jaipur, Rajasthan
- Savita Chandra
- Professor and Head of Department
- Department of Obstetrics and Gynecology
- Goa Medical College and Hospital
- Bambolin, Goa
- Sonali Deshpande
- Associate Professor
- Department of Obstetrics and Gynecology
- Government Medical College and Hospital
- Aurangabad, Maharashtra
- SR Nayak
- Professor and Head of Department
- Department of Obstetrics and Gynecology
- Kasturba Medical College and Hospital
- Mangalore, Karnataka
- Vidya Gaikwad
- Professor
- Department of Obstetrics and Gynecology
- Padmashree Dr DY Patil Medical College and Hospital
- Pimpri, Pune, Maharashtra
- Vidya Thobbi
- Professor and Head of Department
- Department of Obstetrics and Gynecology
- Al-Ameen Medical College
- Bijapur, Karnataka
- Veerendrakumar CM
- Associate Professor
- Department of Obstetrics and Gynecology
- Vijaynagar Institute of Medical Sciences
- Bellary, Karnataka
- Venkatesh N
- Consulting Gynecologist
- Chief Academician
- Gunasheela Hospital and Research Center
- Bengaluru, Karnataka
It is a great honor to endorse book on High-Risk Pregnancy particularly as the first ideas regarding this book are addressed to the need of Maternal and Child Welfare Program. The maternal mortality rate is very high in many parts of the world. The common causes of maternal mortality include hemorrhage, toxemia, anemia, sepsis and unsafe termination of pregnancy. All these and many more factors including diabetes, thyroid disorders, renal diseases, malaria, hepatitis and others have been scholarly dealt with by a galaxy of authors.
The pedagogic idea of the authors is to harmonize the main aim of providing guidelines in uncommon situations for fruitful and happy outcome of pregnancy. The most appropriate methodology for diagnosis and therapy at the right time, at right place, at reasonable cost with convincing applications that the benefits of prompt treatment outweigh the potential risk to the mother and the child.
I congratulate Prof Hemant Deshpande and other authors for their timely and stupendous task.
KC Singhal md
Vice Chancellor
NIMS University
Jaipur, Rajasthan, India
11Foreword
This innovative book on high-risk pregnancy is a welcome addition to the field of obstetrics and gynecology. An excellent textbook on clinical approach to the subject was long overdue. This important publication is timely and meets the needs of students and practicing physicians. It is a sincere effort to initiate students to learn obstetrics and gynecology in the proper perspective.
The contributors to this volume have focused as much on the subject as on the central theme of learning clinical skills. The book is edited by Dr Hemant Deshpande, Prof and HOD, in Obstetrics and Gynecology of Padmashree Dr DY Patil Medical College, Pimpri, Pune, Maharashtra. He is a committed, hard working and a conscientious medical teacher. This institution is well known for bringing about innovations in medical education. Indeed the book makes a valuable contribution towards highlighting both the critical needs of clinical skill development and necessary strategies for providing quality reproductive health services for high-risk cases in obstetrics.
The editor must be complimented for his excellent work. It is fervently hoped that this brilliant publication will be widely used by undergraduate and postgraduate students and practicing obstetricians and gynecologists.
Amarjit Singh md
Dean, Padmashree Dr DY Patil Medical College
Hospital and Research Center
Pimpri, Pune, Maharashtra, India
13Preface
You see things; and you say ‘Why?’
But I dream things that never were; and I say ‘Why not?’
—George Bernard Shaw
Medical knowledge is constantly changing. In this constant changing world, it gives me an immense pleasure to introduce the first edition of my book Textbook of High-Risk Pregnancy. Editing and publishing the first edition of the book has been, to me, just like bringing a new life into this world. Though there have been constant changes in the treatment, procedures and other protocols in managing the patients with high-risk all over the world and in this book I have tried to incorporate all the basic facts along with the recent knowledge.
This book is aimed for not only undergraduates and postgraduates but also for the practicing clinicians who also encounter these complications in their day-to-day practice.
The contributors of this book are highly acclaimed obstetricians from renowned medical institutions, who have acclaimed their fort in this field.
Over the course of 24 chapters, most of the clinically important aspects of pregnancy - associated risks are covered, ranging through the overall a ntenatal till the puerperal and further management of the same. It is clear that the book has been written by all experienced obstetricians, as the topics are organized in a fashion that illuminates the principle of thinking and application correlation, which is the tool with which obstetricians approach clinical problems.
I am deeply honored and thankful to all my colleagues who have taken out time from their busy schedules and contributed their part in this book and to my family for their utmost support and p atience.
I have been very careful and have tried to make this book very informative, but all suggestions will be welcomed.
Hemant Deshpande