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Do’s and Don’ts in Obstetrics and Gynecology Practice
Tushar Kar, Asaranti Kar
1:
Making of a Postgraduate
INTRODUCTION
GOALS AND OBJECTIVES OF PG EDUCATION
Goals
Objectives
PG CURRICULUM
Theoretical Knowledge
Practical and Clinical Skills
Indoor
Teaching Schedule
Clinical Posting
THESIS
Guideline for Thesis
ASSESSMENT
Formative Assessment
Internal Assessment
Personal Attributes
Summative Assessment
DO'S AND DONT'S IN OBSTETRICS AND GYNECOLOGY
Do's
Dont's
FEW SUGGESTIONS FROM AUTHORS
2:
Antenatal Assessment
DEFINITION
FREQUENCY AND CONTENT OF ANTENATAL CARE
Traditional Care Protocol
The WHO ‘Focused Antenatal Care’ Protocol
ORGANIZATION OF ANC
Do's
Antenatal Visits
Do's
Dont's
SCREENING FOR MATERNAL COMPLICATIONS
Anemia
Do's
Dont's
Blood Group
Do's
Infections
Do's
Dont's
Pre-eclampsia
Dont's
Gestational Diabetes Mellitus
Do's
Dont's
Preterm Labor
Dont's
Placenta Previa
Do's
SCREENING FOR FETAL COMPLICATIONS
Fetal Viability/Dating
Screening for Down's Syndrome
Do's
Dont's
Screening for Fetal Anomalies
Screening for Fetal Well-being
Dont's
MANAGEMENT OF SPECIFIC CONDITIONS
Breech Presentation at Term
Do's
Dont's
Corticosteroids for Preterm Labor
Do's
Dont's
SUMMARY
3:
Routine Ultrasonography in Pregnancy
FIRST TRIMESTER ULTRASOUND
NORMAL SONOGRAPHIC APPEARANCE
Gestational Sac
Yolk Sac
Embryo and Amnion
ECTOPIC PREGNANCY
Specific Sonographic Findings
Live Embryo in the Adnexa
NONSPECIFIC FINDINGS
Adnexal Mass
Tubal Ring
Free Fluid
Normal Sonogram
Transvaginal Color Flow Doppler
EARLY PREGNANCY FAILURE
Ultrasound Diagnosis
Embryonic Cardiac Activity
Gestational Sac Characteristics
Amnion and Yolk Sac Characteristics
Embryonic Bradycardia
Mean Gestational Sac Diameter in Relation to the CRL
Relation of B-hCG to Mean Gestational Sac Diameter
Subchorionic Hemorrhage
TVCFD Predictors of Pregnancy Failure
FETAL ANOMALIES
FIRST TRIMESTER MASSES
Ovarian Masses
Uterine Masses
Ultrasound in 2nd and 3rd Trimester
Fetal Number
Gender of the Twins
Number of Placenta
Assessment of Gestational Age
Biparietal Diameter
Head Circumference
Femur Length
Abdominal Circumference
Head Circumference
Placental Sonography
Thrombi and Hematomas
Placenta Previa
Umbilical Cord
Nuchal Cord
Ultrasound and Amniotic Fluid
Evaluation of the Cervix
Fetal Biophysical Profile
Ultrasound in Congenital Malformations
DOPPLER ULTRASONOGRAPHY IN OBSTETRICS
Fetal Arterial Circulation
Uterine Arteries
Umbilical Arteries
Middle Cerebral Arteries
Thoracic Aorta
Fetal Venous Circulation
Umbilical Vein (UV)
Ductus Venosus (DV)
4:
Pre-eclampsia
INTRODUCTION
DEFINITION OF HYPERTENSION IN PREGNANCY
Severe Hypertension in Pregnancy
White Coat Hypertension
RECORDING BLOOD PRESSURE IN PREGNANCY
Measurement Devices
Diagnosis of Clinically Significant Proteinuria
According to SOGC
CLASSIFICATION OF HYPERTENSIVE DISORDERS IN PREGNANCY
DEFINITION OF PRE-ECLAMPSIA
Pathogenesis
Gestational Hypertension
Chronic Hypertension
RISK FACTORS
MANAGEMENT OF PRE-ECLAMPSIA AND GESTATIONAL HYPERTENSION
Diagnosis
Investigations
HELLP Syndrome5
Diagnostic Criteria
Fetal Surveillance
TREATMENT
TREATMENT OF OTHER MANIFESTATIONS
Thromboprophylaxis
Intravenous Fluids
HELLP
POSTPARTUM HYPERTENSION
PROPHYLACTIC THERAPIES
5:
Eclampsia
INTRODUCTION
ETIOPATHOGENESIS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
GENERAL MEASURES
Specific Management
Management Option
TREATMENT DURING SEIZURE
CONTROLING SEIZURE AND PREVENTING THEIR RECURRENCE
Magnesium Sulfate Therapy (Pritchard Regime)
Phenytoin Therapy
Lytic Cocktail Regimes (KM Regime)
Diazepam Therapy (Lean Regime)
TREATMENT OF HYPERTENSION
FLUID AND ELECTROLYTE BALANCE
LABOR AND DELIVERY
DO'S IN ECLAMPSIA
DONT'S IN ECLAMPSIA
6:
Sickle Cell Disease and Pregnancy
INTRODUCTION
NORMAL HEMOGLOBIN
PATHOPHYSIOLOGY
SICLE CELL CRISES
Vaso-occlusive Crises and End-organ Damage
Acute Chest Syndrome
HEMATOLOGICAL CRISES
Screening
Use of Ethnicity as a Screening Criterion
Antepartum Management
SICKLING CRISES
Transfusion Therapy
Intrapartum
Postpartum
Contraception
DO'S AND DONT'S IN SICKLE CELL DISEASE
7:
Management of Multifetal Pregnancy
OVERVIEW
MANAGEMENT
Prepregnancy—Prevention
DIAGNOSIS
History and Clinical Examination
Ultrasonography
Determination of Chorionicity
Prenatal Screening, Diagnosis of Fetal Anomalies
Role of Selective Reduction or Termination
ANTENATAL MANAGEMENT
Diet, Supplementation
Frequent Antenatal Check-ups and Antepartum Fetal Surveillance
Prevention of Preterm Labor
DELIVERY CONSIDERATIONS
Labor and Vaginal Delivery
Role of Induction/Augmentation of Labor
First Stage of Labor
Delivery of the First Twin
Delivery of the Second Twin
CESAREAN SECTION
UNIQUE PROBLEMS RELATED TO MULTIPLE GESTATION
Twin Reverse Arterial Perfusion Sequence
Twin-to-Twin Transfusion Syndrome
Monoamniotic Gestation
Discordant Twins
Locked Twin
8:
Third Trimester Bleeding
ANTEPARTUM HEMORRHAGE
ETIOLOGY
Initial Assessment
History and Initial Assessment
Basic Life Support
Examination
Fetal Well-being Assessment
Ultrasound Scan
Medications
PLACENTA PREVIA
Pathophysiology
Risk Factor
Clinical Presentation
Effects of Placenta Previa13
Complications
Maternal
Diagnosis
Vaginal examination
Sonography
Prediction of Placenta Previa at Delivery12
Management
Do's and Dont's of Placenta Previa
Do's
Dont's
ABRUPTIO PLACENTAE
Classification
Grades of Abruption
Pathophysiology
Risk Factors
Diagnosis
Ultrasonography
Serum Biochemical Tests2
Clinical Features
Symptoms
Signs
Differential Diagnosis
Management
Rapid Management
Immediate interventions
Monitoring
Management of Stable Patient with Grade 1 Abruption
Indication for Cesarean Section in Abruptio Placentae
Complications
Maternal
Disseminated Intravascular Coagulation1
Fetal Complication
Prevention
Do's and Don't's of Abruption Placentae
Do's
Dont's
PLACENTA ACCRETA, INCRETA AND PERCRETA
Definition
Diagnosis
Management
Do's and Dont's of Morbidly Adhered Palcenta
Do's
VASA PREVIA14
Etiology
Diagnosis
Management
Do's and Dont's of Vasa Previa
Do's
Dont's
9:
Dysfunctional Labor
INTRODUCTION
THEORETICAL BACKGROUND
INCIDENCE
CLINICAL IMPORTANCE OF THE DIAGNOSIS AND MANAGEMENT
ABNORMALITIES OF POWER
TYPES OF UTERINE POWER DYSFUNCTION
Hypotonic Uterine Dysfunction
Hypertonic Uterine Dysfunction
CAUSES OF DYSFUNCTION (POWER ABNORMALITIES)
ABNORMALITIES OF THE PASSENGER
ABNORMALITIES OF THE PASSAGE15
DIAGNOSIS AND MANAGEMENT OF DYSFUNCTIONAL LABOR
DIAGNOSIS OF ABNORMAL UTERINE ACTIVITY
Partogram16
MANAGEMENT OF DYSFUNCTIONAL LABOR
Amniotomy
Oxytocin Infusion
EFFECTS OF DYSFUNCTIONAL LABOR ON MOTHER AND FETUS
RECENT ADVANCES IN MYOMETRIAL PHYSIOLOGY
DO'S
DONT'S
10:
Assisted Vaginal Delivery in Modern Obstetrics
INTRODUCTION
ASSISTED VAGINAL DELIVERY
Indications for Assistance in Delivery
Predelivery Considerations
FORCEPS DELIVERY
Classification of Forceps Deliveries (ACOG 1988)
Outlet Forceps
Low Forceps
Midforceps
High Forceps
Trial of Forceps
Failed Forceps
Clinical Experience with Forceps Delivery Surveyed
VACUUM EXTRACTOR OR VENTOUSE
Purpose
Types
Indications for Vacuum Extraction
Fetal Indications
Maternal Indications
Obstetric indications
Vacuum Extraction in Clinical Practice
Highlights of the Technique of Vacuum Extraction
Forceps vs Vacuum Extractor
COMPLICATIONS OF OPERATIVE VAGINAL DELIVERIES
Maternal Complications
Fetal Complications
Overview of Complications of Operative Vaginal Deliveries
Controversies and Recommendations
What are the Contraindications for Instrumental Vaginal Assisted Delivery?
What is the Role of Trial Forceps and Trail Vacuum Extraction?
What are the Guidelines for Selecting Proper Equipment/Instrument to Ensure Improved Obstetric Outcome During Operative Vaginal Delivery?
Is there a Place for Midforceps Rotational Delivery in Current Practice?
SUMMARY
OBSTETRIC FORCEPS
VACUUM EXTRACTION
11:
Cesarean Section
INTRODUCTION
CESAREAN SECTION–EVOLUTIONARY ASPECTS
HISTORY OF CESAREAN DELIVERY
EPIDEMIOLOGY
Indications of Cesarean Delivery
SURGICAL TECHNIQUES FOR CESAREAN DELIVERY
PREOPERATIVE EVALUATION
CHOICE OF THE SKIN INCISION
TRANSVERSE INCISION
The Pfannenstiel Incision
Maylard Incision
Cherney Incision
Joel-Cohen Incision
VERTICAL INCISIONS
Right Paramedian Incision
Approach to Lower Uterine Segment
UTERINE INCISION
Lower segment transverse (Kerr incision)
Lower segment vertical incision
Classical incision
Variations
TECHNIQUE OF BABY DELIVERY
Fetus in Transverse Lie
Placental Delivery
Uterine Exteriorization
Uterine Closure
Peritoneal Closure
Abdominal Closure
Care of the Baby
Postoperative Care
Hospital Stay and Discharge
INFECTION CONTROL POLICY
COMPLICATIONS
Early Postoperative Complications
Reactionary Hemorrhage
Retention of Urine
Paralytic Ileus
Infection
Abdominal Wound Problems
Thromboembolism
Commonly occurring complication RCOG recommends
Amniotic Fluid Embolism
Special Precautions
INJURY—URINARY TRACT/GI
Urinary Tract Injuries (Fig. 11.7)
Reducing Ureteral Injuries
Bowel Injury
Reducing Bowel Injuries
UNANTICIPATED GYNECOLOGICAL/SURGICAL PATHOLOGY
Leiomyomas
Ovarian Tumors
DIFFICULTIES IN CESAREAN SECTION
Choice of Indications
Difficult Abdominal Access
Difficulties in Uterine Incision and Closure
DIFFICULT BABY DELIVERIES
Extraction of Fetus in Cephalic Presentation
Extraction of Fetus: Floating Head
Extraction of the Fetus: Deeply Engaged Head
Malpresentaion: Breech
Multiple Pregnancies
DIFFICULT PLACENTAL DELIVERIES
DIFFICULTIES IN CONTROLLING THE HEMORRHAGE
CONTROL OF INTRAOPERATIVE BLEEDING
Localized Site
Uterine Artery Ligation
Internal Iliac Artery Ligation
Hysterectomy
B-Lynch Procedure (Figs 11.11A and B)
Pelvic Packing
VAGINAL BIRTH AFTER CESAREAN SECTION
BENEFITS OF VAGINAL BIRTH AFTER CESAREAN (VBAC)
Risk Factors During at Trial of Labor after a Repeat Cesarean Delivery
Factors Known at the Outset of Pregnancy
Current Pregnancy Characteristics
DETERMINATION OF SCAR INTEGRITY
CONTRIBUTING FACTORS FOR SUCCESSFUL VBAC
Positive Factors
Negative Factors
Criteria for Trial of Scar (ACOG Guidelines for VBAC)
Risk of Rupture: Summary
MANAGEMENT OF A PATIENT WITH PREVIOUS CESAREAN DELIVERY
Antenatal Period
Antenatal Examination
Antenatal Follow-up
Counseling of Patient
Intrapartum Management
USE OF PROSTAGLANDINS
DIAGNOSIS OF RUPTURE OF CESAREAN SECTION SCAR IN LABOR
MANAGEMENT OF RUPTURED UTERUS
CESAREAN DELIVERY AFTER A PRIOR CESAREAN BIRTH
RISKS OF REPEAT CESAREAN SECTION
ANESTHESIA FOR CESAREAN SECTION
TECHNIQUES OF ANESTHESIA FOR CESAREAN SECTION
Regional Anesthesia
GENERAL ANESTHESIA
Regional Anesthesia
General Anesthesia
ANESTHESIA FOR SPECIAL SITUATIONS
Pre-eclampsia and eclampsia
Cardiac Disease
Diabetes Mellitus
Thrombophilia and Pregnancy
Other Diseases
LOCAL ANESTHESIA FOR CESAREAN SECTION
CESAREAN HYSTERECTOMY
Historical Aspect
Indications
Technique of Surgery
Forceps Applications in Cesarean Section
Indications for Forceps Application in Cesarean Section (Fig. 11.12)
High Floating Head
Deeply Engaged Head
After Coming Head of Breech
Preterm Cesarean Delivery
Small Incisions
Advantages of Forceps Application at Cesarean Section
Medicolegal Aspects of Cesarean Section
CONSENT FOR CS
Informed Refusal can be Disastrous to the Caring Doctor!!
AVOIDING THE LITIGATIONS IN CESAREAN SECTION
Cardinal Principles
Intraoperative Complications
Cautions During Blood Transfusion
Situation in Case of Death on Table
Good Practice Promotes Good Recording while Shoddy Records Suggests Shoddy Care
Professional Indemnity Insurance
Extraperitoneal Cesarean Section
Audit in Cesarean Section
CONCLUSION
DO's IN CESAREAN SECTION
DONT's IN CESAREAN SECTION
APPENDIX
Cesarean Section: Current Evidence from Caesar Trial
Recommendation
Uterine Incision
Recommendations
Delivery of Placenta
Closure of the Peritoneum
RECOMMENDATIONS
SKIN CLOSURE
CONCLUSION
12:
Retained Placenta
INTRODUCTION
TYPES OF RETAINED PLACENTA
EPIDEMIOLOGY
RISK FACTORS
CLINICAL PRESENTATION AND DIAGNOSIS
MANAGEMENT OF RETAINED PLACENTA: DO'S AND DONT'S
Preventive Measures
Preparation
Physiological Versus Active Management
Placental Delivery
DO'S FOR TREATMENT OF RETAINED PLACENTA
Expectant Management
Ultrasonography
Treatment of Trapped Placenta
Treatment of Retained Placenta
Medical
Surgical
Treatment of Placenta Accreta
Surgical
DONT'S FOR TREATMENT OF RETAINED PLACENTA
13:
Postpartum Collapse
INTRODUCTION
BACKGROUND AND CLINICAL IMPORTANCE
MASSIVE POSTPARTUM HEMORRHAGE
Uterine Rupture
Uterine Inversion
Pulmonary Thromboembolism
Amniotic Fluid Embolism
Anesthesia
Pre-eclampsia and Eclampsia
MANAGEMENT PROTOCOL
Resuscitation and Stabilization
Identifying a Potential Cause
Subsequent Management
Massive Postpartum Hemorrhage
Uterine Rupture
Uterine Inversion
Severe Pre-eclampsia and Eclampsia
Pulmonary Embolism
Postpartum Collapse: Do's
Postpartum Collapse: Dont's
CONCLUSION
14:
Management of the Third Stage of Labor
INTRODUCTION
PHYSIOlOGICAL CHANGES OF THE THIRD STAGE
Placental Separation
Planning of Timed Cord Clamping
Preventive Measures and Medical Management of Third Stage
Placental Retention
POSTPARTUM HEMORRHAGE
Medical Management
surgical Management
ABNORMAL PLACENTATION: TEXTURE
Velamentouse Insertion of the Cord
Partial Vesicular Mole
Twin Placenta
ABNORMAL IMPLANTATION
Placenta Previa
Placenta Increta
Placenta Percreta
15:
Amenorrhea
DEFINITIONS
HISTORY
MECHANISM
ETIOLOGY OF PRIMARY AMENORRHEA
Secondary Sexual Characteristic-Normal
Secondary Sexual Characteristic-Absent
Heterosexual
ETIOLOGY OF SECONDARY AMENORRHEA
Anatomical Site
Functional Compartment (Speroff et al)1
Hormonal
Etiological
HYPOTHALAMIC CAUSES
OTHER ETIOLOGICAL FACTORS
WEIGHT RELATED AMENORRHEA
OBESITY
STRESS
PSEUDOCYESIS
POST PILL AMENORRHEA
SYSTEMIC DISORDERS CAUSING SECONDARY AMENORRHEA
CHRONIC RENAL FAILURE
LIVER DISORDERS
ENDOCRINE DISORDERS
PULMONARY TUBERCULOSIS
When to Investigate
INVESTIGATIONS
Accurate History
Intelligent Clinical Examination
Primary Amenorrhea
Secondary Amenorrhea
Management
PRIMARY AMENORRHEA
CONCLUSION
DO'S
DON'TS
16:
Uterine Fibroids
INTRODUCTION
EPIDEMIOLOGY AND RISK FACTORS
Menstrual History
Childbearing History
Use of Exogenous Hormones
Overweight and Cigarette Smoking
Diet and Physical Activity
Other Potential Risk Factors
PATHOLOGY
Gross Features
Microscopic Features
Unusual Microscopic Patterns
Changes in Leiomyomata
Unusual Behavior of Leiomyomata
CLINICAL SYMPTOMOLOGY OF UTERINE LEIOMYOMA
Asymptomatic Leiomyomata
Abnormal Uterine Bleeding
Pressure Symptoms
Pelvic Pain Syndrome
Infertility
Abortions and Pregnancy Related Problems
Rapid Growth
Other Signs and Symptoms and Associations
DIAGNOSTIC IMAGING OF FIBROIDS
Transvaginal Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
MANAGEMENT OF MYOMA
Medical Management
Estrogen and Progestin Therapy
Steroid Synthesis Inhibitors
Gonadotropin-releasing Hormone Agonists
Gonadotropin-releasing Hormone Antagonists
Aromatase Inhibitors
Steroid Receptor Modulators
Selective Estrogen Receptor Modulators
Progesterone Receptor Modulators
Selective Progesterone Receptor Modulators
Androgen Therapy
Danazol
Gestrinone
Progestin-containing Intrauterine Contraceptive Devices
SURGICAL TREATMENT OF FIBROIDS
Myomectomy
Abdominal Myomectomy
Vaginal Myomectomy
Laparoscopic Myomectomy (Figs 16.1 to 16.10)
Laparoscopically Assisted Myomectomy
Hysteroscopic Myomectomy
Hysterectomy
MINIMALLY INVASIVE APPROACHES FOR TREATING MYOMA
Myolysis
Uterine Artery Embolization
Uterine Artery Ligation and Occlusion
MRI-Guided Focused Ultrasound Surgery
Do's and Dont's of Myomectomy
Do's
Dont's
17:
Urinary Incontinence
INTRODUCTION
THEORETICAL BACKGROUND
ATTITUDE OF PATIENTS TO URINARY INCONTINENCE
Clinical Assessment
Clinical Examination
Investigations
Management
STRESS URINARY INCONTINENCE
SURGICAL OPTIONS IN STRESS URINARY INCONTINENCE
Anterior Vaginal Repair (Anterior Colporrhaphy)
NEEDLE SUSPENSION PROCEDURES
BURCH COLPOSUSPENSION
PROXIMAL URETHRAL SLINGS
MIDURETHRAL SLINGS
PERIURETHRAL BULKING AGENTS
ARTIFICIAL URINARY SPHINCTER
URGE URINARY INCONTINENCE
PHARMACOTHERAPY
Anticholinergic Drugs
Oxybutynin
Tolterodine
Trospium
Darifenacin and Solifenacin
OTHER THERAPEUTIC OPTIONS
Botulinum Toxin A Injection
Sacral Nerve Neuromodulation
SURGICAL MANAGEMENT
CONCLUSION
DO'S AND DONT'S
18:
Endoscopic Surgery
INTRODUCTION
LAPAROSCOPY AND HYSTEROSCOPY
ENDOSCOPIC SURGERY OPERATION THEATER SET UP
Do's
Dont's
TRAINING AND COMPETENCE
Do's
Dont's
CASE SELECTION
Do's
Dont's
INDIVIDUAL PATHOLOGIES
Laparoscopic Myomectomy
Do's
Dont's
LAPAROSCOPIC SURGERY FOR ECTOPIC PREGNANCY
Do's
Indications
Dont's
LAPAROSCOPIC HYSTERECTOMY
Do's
Dont's
LAPAROSCOPIC OVARIAN CYST
Indications
Dont's
LAPAROSCOPIC POLYCYSTIC OVARIAN DRILLING
Indications
Dont's
LAPAROSCOPIC TUBAL SURGERY
Indications
Contraindications
Laparoscopic Burch
Laparoscopic (Unification of Bicornuate Uterus)
Dont's
LAPAROSCOPIC SURGERY FOR YOUNG PATIENTS WITH PROLAPSE
Do's
Indications
Dont's
HYSTEROSCOPIC SURGERY
Do's
Indications
Dont's
STRESS URINARY INCONTINENCE SURGERY—SLINGS
Do's
Dont's
NEW VESSEL SEALING DEVICE FOR TOTAL LAPAROSCOPIC HYSTERECTOMY
Do's
Dont's
CRISIS AND COMPLICATION IN ENDOSCOPIC SURGERY (FIGS 18.26 AND 18.27)
Do's
Dont's
NEW TECHNOLOGIES
Do's
Dont's
19:
Carcinoma of Cervix
INTRODUCTION
ETIOLOGY
Human Papilloma Virus (HPV) Infection
Human Immunodeficiency Virus (HIV) Infection
MECHANISM OF ACTION (POSTULATED)
HSV Type II infection
Smoking
Contraceptive Pills
PATHOLOGY
Squamous Cell Carcinomas
Adenocarcinoma
MACROSCOPIC APPEARANCE
Exophytic
Infiltrative
Ulcerative
Mode of Spread
Direct Spread
NOMENCLATURE
Papanicolaou's Classification (Oldest)
Dysplasia
WHO CLASSIFICATION
Cervical Intraepithelial Neoplasia (CIN)
Bethesda System
SCREENING
COLPOSCOPY
Others Methods to Screen the Cervical Cancer
Clinical Downstaging with Unaided/Aided Visual Inspection of Cervix
VILI (Visual Inspection after Application of Lugol's Iodine)12
Clinical Features of Carcinoma of Cervix
SYMPTOMS
SIGNS
DIAGNOSIS
Cervical Biopsy
Endocervical Curettage
Examination Under Anesthesia
FIGO Staging14
INVESTIGATIONS
COMPLICATIONS
PROGNOSIS
MANAGEMENT
Cervical Intraepithelial Neoplasia
Ablative Methods
Excision Methods17,18
Hysterectomy20
Management of Microinvasive Carcinoma
Management of Invasive Cancer
Radical Hysterectomy
Advantages of Surgical Treatment
Radiotherapy
External Beam Radiation (EBRT)
Intra-cavitary Radiation (BT)
COMPLICATIONS30–32
Incidentally Diagnosed Cervical Cancer
Carcinoma of the Cervical Stump
Vaccine Against Carcinoma of Cervix (HPV Vaccines)
DO'S AND DON'TS IN CA CERVIX
Do's
Screening in different Age Group
Screening for Cervical Cancer in Post Hysterectomy Patients
What to do in Abnormal Screening Test (Abnormal PAP Smear)
Dont's
20:
Endometrial Carcinoma
INTRODUCTION
Risk Factors
CLINICAL PRESENTATION
SCREENING AND DIAGNOSIS
CELLULAR CLASSIFICATION OF ENDOMETRIAL CARCINOMA
Endometrioid (75–80%)
Special Variant Carcinoma
MANAGEMENT (TABLES 20.1 TO 20.4)
Early Stage Disease
Lymphadenectomy
Laparoscopic Surgical Procedure
Adjuvant Treatment
Management of Advanced Endometrial Carcinoma
Management of Stage III
Management of Stage IV
Management of Type II EC
Special Clinical Circumstances
Endometrial Cancer Diagnosed after Hysterectomy (Figs 20.1 to 20.4)
Endometrial Carcinoma in Young Women
DO'S AND DONT'S
21:
Newer Contraceptives
INTRODUCTION
HORMONAL CONTRACEPTIVES
Femcon FE: Chewable Tablet
Yasmin
Do's
Dont's
EXTENDED CYCLE CONTRACEPTION
Do's
Dont's
Lybrel-A Noncycling Regimen
Do's
Dont's
Do's with all Hormonal Pills
TRANSDERMAL PATCH
Do's
Dont's
Adverse Effects
CONTRACEPTIVE VAGINAL RING
Do's
Dont's
COMBINED INJECTABLE CONTRACEPTIVES
Do's
Dont's
IMPLANON
Do's
Dont's
MIRENA IUS
Do's
Dont's
CERAZETTE (PROGESTERONE ONLY PILL)
Do's
Dont's
INJECTABLE PROGESTERONE ONLY CONTRACEPTIVES
Do's
Dont's
FEMALE CONDOM
Do's
Dont's
COPPER IUDs
Copper T 380A (Paragard)
Nova T-380A
Gynefix
Multiload 375
Do's
Dont's
TODAY SPONGE
Do's
Dont's
ESSURE
CONCLUSION
INDEX
TOC
Index
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