Handbook of Obstetric Emergencies Kamini A Rao
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1Handbook of Obstetric Emergencies2
3Handbook of Obstetric Emergencies
Second Edition
Kamini A Rao DGO DORCP DCh MCh (UK) FRCOG (UK) FICOG FAIS PGDMLE (Law) President, FOGSI-2001 Medical Director Bangalore Assisted Conception Center (An ISO 9002 Organization) Karnataka, India
4Pharmaceutical Edition: 2011
Published by
Jaypee Brothers Medical Publishers (P) Ltd
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Handbook of Obstetric Emergencies
© 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 author and the publisher.
This book has been published in good faith that the material provided by author is original. Every effort is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error (s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only. Not for resale.
First Edition: 2003
Second Edition: 2011
Pharmaceutical Reprint Edition: 2011
9789350251331
Typeset at JPBMP typesetting unit
Printed in Nutech Photolithographers
5To
All those who taught me to care for two lives in tandem; I do, but a small service in sharing this knowledge6
7Preface to the Second Edition
I am glad to put forth the second edition of Handbook of Obstetric Emergencies. This edition has been updated to include twelve new chapters addressing a few other commonly encountered emergencies in a high-risk obstetric unit.
It includes topics like ‘Transfusion Reaction, Anaphylaxis, Sickle Cell Crisis, Diabetic Ketoacidosis in Pregnancy, Asthma and Epilepsy in Pregnancy’ which account for the medical problems encountered during pregnancy. ‘Resuscitation of the Newborn’ is another new addition which describes comprehensively the essential newborn care with special emphasis on the basic neonatal resuscitation and steps which could be a boon to the obstetrician/fetomaternal medicine specialist attending a high-risk delivery. Chapters like ‘Intrauterine Fetal Death, Acute Fatty Liver of Pregnancy, Puerperal Sepsis/Septic Shock, Cesarean Hysterectomy and Peripartum Cardiomyopathy’ deal with essential emergency care during these situations which can be encountered by the obstetrician during the antenatal and immediate post-partum period. Reference values in pregnancy have also been updated according to recent recommendations.
In a nutshell, this new edition reflects and suffices the growing demands of a fetomaternal medicine specialist in his/her endeavor to empower himself/herself to optimally handle the emergencies in a high-risk obstetric unit.
Kamini A Rao8
9Preface to the First Edition
The dictum “A healthy mother and a healthy baby” has been spearheading advances in the field of Obstetrics and Gynecology, into areas thought implausible in yesteryears. At this stage, it would do well to review the basics of treatment, many of which have stood the test of time and continue to be gold standards in obstetric care.
This handbook, without much ado, addresses the obstetric problems faced in daily practice. It encompasses the basic principles of diagnosis and management in practical detail.
This book has been conceived as an aid to doctors working at the primary health centers and at institutions where no sophisticated facilities exist. Theoretical details have intentionally been omitted, so as to serve as a quick reference when encountered with a problem.
I hope that this handbook serves as a guide to all those involved in the care of the pregnant women, so as to make unsafe obstetric practices a thing of the past.
Kamini A Rao
10About the Center
Since its establishment in 1990, Bangalore Assisted Conception Center (BACC) has been a name synonymous with care, cutting edge technology and quality. It is one of India's premier institutions for obstetrics, gynecology and reproductive medicine with success rates comparable globally. With hi-tech innovations and state-of-the-art technology, it has developed into a highly specialized center providing total care for Infertility, Genetics and Feto Maternal Medicine. Spearheaded by Dr Kamini A Rao and with three centers in different parts of Bangalore, this is a center which offers comprehensive healthcare for women not just during pregnancy and postdelivery but also in prepregnancy planning and infertility. A hi-tech neonatal intensive care unit ensures that babies are taken care of with the latest of cutting edge technology. The center has also made inroads in the fields of adolescent medicine and menopause thus offering medical and psychological support to females from womb to tomb.
BACC offers the full range of diagnostic and therapeutic services all under one roof, keeping in mind convenience to the patient. All the staff competently integrate informal counseling into their respective specialties, thereby ensuring complete and confidential care to the patients.
The center far from being a closeted organization of knowledge believes in imparting the same in the form of training programs. The center is recognized by the National Board of Examinations for Fellowship in Reproductive Medicine and by Rajiv Gandhi University of Health Sciences for Fellowships in Reproductive Medicine, Feto Maternal Medicine and Endoscopy.
11Acknowledgments
I would like to express my sincere gratitude to Dr Revathi Govindrajan for her assistance in compiling and writing the additional twelve chapters for the second edition of this book. Dr Revathi has completed her Fellowship in Feto Maternal Medicine from Rajiv Gandhi University of Health Sciences and is a Consultant, Feto Maternal Medicine Specialist at BACC Healthcare Pvt Ltd. Her invaluable contribution in researching the various details required for the additional chapters helped immensely in bringing out this second edition.
A word of appreciation to Dr Shruthi Prasad and Dr Chaitra Satyanarayana for their invaluable contribution in editing the manuscript to bring the book to its present state.
My assistants Dr Sunitha, Dr Deepika and my students Dr Sandhya Krishnan, Dr Harpreet Kaur, Dr Mahesh Koregol, Dr Shashikanth Raghuwanshi, Dr Neha Gupta, Dr Divyashree and Dr Richa Sharma have all helped with the final proofreading.
I would like to express special thanks to Mrs Minu AS for coordinating at all stages of development of this book. This book would not have been possible without the help of all those mentioned.