B Presannakumari MD DGO
Former Professor of Obstetrics and Gynecology Medical College,
Thiruvananthapuram, Kerala, India
Senior Consultant in Obstetrics and Gynecology Sree Uthradum Thirunal General Hospital
Thiruvananthapuram, Kerala, India
Jitendar P Vij
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Postgraduate Gynecology
© 2011, 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: 2011
9789350250822
Typeset at JPBMP typesetting unit
Dedicated to the fond memory of my beloved brother
Twin brother Bhasi nice and warm
Born to teachers wise and calm
Amid the charm of rice and palm
Always to needy ice and balm
Friend indeed when in need
Beloved teacher to kids plenty
Refrains not from sharing views
Rich and vast his range and depth
Learning is earning he did view
Yearning for learning anything new
As you drain, so you gain
Vidyadhan, the treasure supreme
When values turn valueless
Dishonour is high ‘honour’
Perversion is the ‘right’ version
Disorder the new order
Then love and concern incarnate
Find just and truth do alienate
Peace in life shifts farther remote
Heaven calls them not too late
To shine a new star among the stars!
7Contributors
- B Presannakumari md dgo
- Former Professor of Obstetrics and Gynecology
- Medical College, Thiruvananthapuram, Kerala, India
- Senior Consultant in Obstetrics and Gynecology
- Sree Uthradum Thirunal General Hospital
- Thiruvananthapuram, Kerala, India
- K Jayakrishnan md dgo dnb
- Consultant Reproductive Medicine
- KJK Hospital
- Fertility Research Centre
- Nalanchira, Thiruvananthapuram,
- Kerala, India
- Madhu KN md
- Paul's Hospital
- Kochi, Kerala, India
- NS Sreedevi md dgo
- Former Professor and HOD
- Department of Obstetrics and Gynecology
- Medical College Kozhikode
- Calicut, Kerala, India
- PG Paul mbbs dgo
- Director, Endoscopic Surgeon
- Paul's Hospital, Kochi, Kerala, India
- Sareena Gilvaz mbbs md dgo
- Associate Professor and HOD,
- Department of Obstetrics and Gynecology
- Jubilee Mission Medical College
- Trichur, Kerala, India
- Sejal Naik md
- Department of Gynecology Endoscopy
- Paul's Hospital
- Kochi, Kerala, India
Medical education around the world is rapidly expanding and there is an adequate need for the development of women's health education. The Council on Graduate Medical Education's (COGME) Fifth Report on Women and Medicine states that “changes in undergraduate and graduate medical education, in addition to continuing medical education, are needed to address adequately the comprehensive health needs of women.” The objective of this book is to be an invaluable resource for the medical practitioners, who step into the field of gynecology. This book proposes them to have a systematic study of the subject, for empowering them with the knowledge and skills required for the practice of gynecology. Keeping this in mind, the best efforts have been made into this work to make it pleasant for the readers.
At-a-Glance Outline Format
Chapters are introduced with a non-formal statement that sets the tone for developing the core idea. They are then structured into subtopics and are further divided into small and discrete sections to which the reader's attention is sought.
Concise Points in Boxes
Concise, high-yield subject matter is provided in boxes, to enhance the study experience of the students.
Flow Charts
Flow charts give easy understanding of evaluation and management protocols in a student-friendly manner.
Evidence-based Management Approach
The practicing obstetrician-gynecologist should be equipped today with a far richer armamentarium than ever before. This is in part due to sheer expansion in knowledge and technology and in part due to the conditionality of evidence-based practice. Evidence-based practice is gaining momentum and where possible it is in the interest of both the clinician and the patient to subscribe to these rules as they support the better traditions of medical care. In order to be successful, the clinician should be able to sift through evidence and make decisions considering the patient's socioeconomic background, attitudes and believes.
Work-out of Real-time Clinical Scenarios
A unique feature of this book is the work-out of real-time clinical scenarios, giving explanations as to how to arrive at a rational clinical diagnosis and management. This helps the students understand the topic in a better way, equipping them to manage the patients themselves.
Usage of Latest Technologies in Gynecology
Imaging modalities like ultrasonography, CT, MRI and PET-scan, have developed in a big way in the recent times. The usage of these imaging modalities is discussed in appropriate situations in the various chapters. Though most of the imaging modalities are rightly under the purview of the radiologist, every student and specialist in obstetrics-gynecology ought to have proficiency in ultrasonography. In numerous clinical emergency situations like ectopic gestation, as well as in the routine diagnosis of uterine and ovarian pathologies, the obstetrician-gynecologist will be better placed to perform, interpret and decide on emerging issues. Thus, sonography has become an essential part of any specialist training. Explanations on the techniques, tips and interpretations of ultrasonography have been detailed in a separate chapter. The obstetrician-gynecologist should acquire the knowledge and skills in the field of ultrasonography so much so that it evolves as an essential armamentarium for diagnosis and management by themselves.10
The author believes that the guiding philosophy behind the book would naturally justify its existence. It is felt that the postgraduate students, who are the specialists of tomorrow to whom it attempts to reach out, would find the book accessible to them and that the dealing of the subject is appropriate to their requirements.
Online Access
Students can log onto the above site for contacting the author for posting their queries.
B Presannakumari
11Acknowledgments
To the Almighty for His Blessings
At the fag end of 32 years of my clinical career, I realized that something was missing. Pondering over it, it struck me that it is my urge to compile the knowledge that I have acquired over the years of dedicated work. When I ventured into it, volumes of help came pouring from my colleagues, teachers, students and my family members. My dream came true due to their collective efforts. I am indebted to them for extending me their time and support to make this book a reality.
First and foremost, I would like to thank all my teachers for the foundation they helped to lay in shaping my career.
Special thanks to Dr Aasams Jacob for translating the contents and the tables into the digital format. I would like to thank him for his perseverance and commitment.
I would like to thank Dr Vivek Krishnan, Dr Divya Nambiar and Dr Megha Jayaprakash who also helped in typing the contents. I would like to appreciate the sincere efforts of Dr Lekshmi Ammal and Dr Deepti B in the proofreading of the draft of the book. Special thanks to Dr Sreekala MD, for helping me in editing the chapter on PCOS. I would like to appreciate the brilliant efforts of the artists, Dr Renjit Nair and Dr Lekshmi Vijai. I would like to thank Mr Nishanth Rajan for securing the required copyright permissions from the international organizations like FIGO, ASRM and AJOG.
Special thanks to Dr Beena Guhan MD, DGO, Dr Sumangala Devi, MD, DGO and Dr Jyothy Chandran, MD, DGO (Medical College, Calicut) for providing a number of excellent clinical pictures.
I would like to express my heartfelt gratitude to my brother Bhasi's friend, Prof Mukundan K, who has penned the poem in the fond memory of my brother.
I would like to thank all my family for their love and support. This book would not have been possible but for the great sacrifice from my husband Dr Sivanandan who is a physician and Ex-Major, Indian Army. He committed himself to the fulfillment of the book by benevolently accepting and adjusting to the loneliness created by my unavailability. I could not have been what I am today but for my late parents who were teachers. I remember them at this juncture with great love and affection.
I would like to thank the following for copyrights
- Giedre Liepyte, Administration Assistant, FIGO—the International Federation of Gynecology and Obstetrics, FIGO “Staging and classification of gynecological malignancies and treatment recommendations”
- Mitzi Mize, Director of Communications, Eleanor Nicoll, Public Affairs Manager, American Society for Reproductive Medicine
- Kerry Parker, Rights Assistant, Elsevier Limited (for American Journal of Obstetrics and Gynecology)
I thank M/s Jaypee Brothers Medical Publishers (P) Ltd. for their whole-hearted cooperation in bringing out this book.
And most of all, thanks to all of my patients for helping me to bring this book to life.