The statements and opinions contained in the chapters of the book on Do's and Don'ts in Obstetrics and Gynecology Practice are solely those of the individual authors and contributors, and not necessarily reflect the opinions or recommendation of the FOGSI.
Because of the rapid advances in the medical science, the editors recommended that independent verification of diagnosis or drug doses should be undertaken and references should always be made to the approved prescribing information for any product or procedure prior to its use.
Articles which have been published, become the property of FOGSI and should not be published or reproduced in full or in part without the permission of the editors. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic mechanical, photographing, recording, or otherwise without the prior written permission of the editors of the book.
Headquarter
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: jaypee@jaypeebrothers.com
Overseas Offices
J.P. Medical Ltd.,
83 Victoria Street London
SW1H 0HW (UK)
Phone: +44-2031708910
Fax: +02-03-0086180
Email: info@jpmedpub.com
Jaypee-Highlights Medical Publishers Inc.
City of Knowledge, Bld. 237, Clayton
Panama City, Panama
Phone: + 507-301-0496
Fax: + 507-301-0499
Email: cservice@jphmedical.com
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2012, Federation of Obstetric and Gynaecological Societies of India (FOGSI)
All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
This book has been published in good faith that the contents provided by the contributors contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the editor specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the editor. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Do's and Don'ts in Obstetrics and Gynecology Practice
First Edition: 2012
9789350258095
Printed at:
5Dedicated to
Our parents and wellwishers in our life who have guided all throughout for honesty, transparency, dedication and hard work
Be tough but look soft
Be tense but look cool
Be a winner but look like a beginner
Essence of life
- A Tamilselvi dgo mrcog
- Clinical and Research Fellow
- Department of Urogynecology
- Institute of Social Obstetrics
- Government Kasturba Gandhi
- Hospital and Madras Medical College
- Chennai, Tamil Nadu, India
- AB Bhatt md mrcog
- Dr Bhatt's Hospital
- Mumbai, Maharashtra, India
- AE Dastur md ficog fcps dgo dfp ficmu atmf (usa)
- Honorary Professor Emeritus and Dean
- Seth GS Medical College and Nowrosjee Wadia Maternity Hospital
- Mumbai, Maharashtra, India
- Ajay S Dhawle md dnb
- Fellow in Perinatology
- Divakars Global Hospital
- Bengaluru, Karnataka, India
- E-mail: drajaysd@gmail.com
- Anuradha Gupta md
- Research Officer
- All India Institute of Medical Sciences
- New Delhi-110029
- Arindam Halder md
- Gynecology and Obstetric
- RMO-cum-Clinical Tutor
- Chittaranjan Seva Sadan
- Kolkata, West Bengal, India
- Asaranti Kar md
- Assistant Professor
- Department of Pathology
- SCB Medical College and Hospital
- Joint Secretary (HQ) IAPM
- Past Editor, OJPM
- Cuttack, Orissa, India
- Christopher B Lynch ma (oxon) frcs frcog
- Consultant Obstetrician and Gynaecological Surgeon
- Professor (Visiting) Cranfield
- University (Health Faculty)
- Bedfordshire, UK
- Milton Keynes General Hospital NHS
- Foundation Trust (Oxford Deanery)
- Standing way, Eaglestone
- Milton Keynes, Bucks MK6 5LD
- Email: Christopherbl@aol.com
- CN Purandare md ma (Obst) dgo dfp rcpi (Dublin) frcog (uk) ficog ficmch pgd mls (Law)
- Consultant
- Obstetrician and Gynecologist
- President, FOGSI (2009)
- President Indian College of Obs & Gyne (2009)
- Editor, Journal-FOGSI
- Project Director, FOGSI-FIGO-MBCF-MNH Project
- Secretary General, FOGSI (2003-08)
- President, MOGS (2003-04)
- Ex Hon Professor
- Department of Obstetric and Gynecology
- Grant Medical College and JJ Hospital
- Mumbai, Maharashtra, India
- Hon Consultant
- Mumbai Police and Indian Armed Forces
- Hon Consultant, St Elizabeth Hospital and BSES Hospital
- Deepali P Kale dnbe fcps dgo (muhs) dgo (cps)
- Research Fellow (Perinatology)
- Kokilaben Dhirubhai Ambani
- Hospital and Research Center
- Mumbai, Maharashtra, India
- Gangadhar Sahoo md
- Professor
- Department of Obstetric and Gynecology
- VSS Medical College
- Burla, Orissa, India
- Gaurav S Desai mbbs
- Hema Divakar md dgo pgdmle
- Consultant
- Divakars Global Hospital
- Bengaluru, Karnataka, India
- Email: hemadivakar@hotmail.com
- Hiralal Konar mbbs (cal) md (pgi) dnb (India) mnams facs (usa) frcog (London)
- Professor and Head
- Department of Obstetrics and Gynecology
- Midnapore Medical College and Hospital
- Midnapore, West Bengal, India
- Vice President, FOGSI 2008
- Committee Chairperson, FOGSI:
- 2001-2005
- Indu GN ms dnb
- Clinical and Research Fellow
- Department of Urogynaecology
- Institute of Social Obstetrics
- Government Kasturba Gandhi
- Hospital and Madras Medical College
- Chennai, Tamil Nadu, India
- Joydev Mukherjee
- Professor
- RG Kar Medical College
- Kolkata, West Bengal, India
- K Seethalakshmi dgo Diplomate National Board (Obs & Gyne) mnams
- Assistant Professor
- Department of Urogynecology
- Institute of Social Obstetrics
- Government Kasturba Gandhi
- Hospital and Madras Medical College
- Chennai, Tamil Nadu, India
- Khyati A Patel dgo (muhs) dgo (cps)
- Kirti Rekha Mohapatra md
- Associate Professor
- Department of Obstetrics and Gynecology
- SCB Medical College
- Cuttack, Orissa, India
- Komal md
- VSS Medical College
- Burla, Orissa, India
- Madhuri Patel md (bom) dgo ficog
- Professor and Head
- Department of Obstetric and Gynecology
- Employees’ State Insurance
- Corporations
- Postgraduate Institute of Medical
- Science and Research
- Mahatama Gandhi Memorial
- Hospital
- Parel, Mumbai, Maharashtra, India
- Ex-Associate Professor, GMC
- Mumbai, Maharashtra, India
- Joint Secretary, FOGSI, 2009
- Chairperson, Study on Female Breast
- Committee, FOGSI
- Chairperson, Medicolegal Committee and Managing Council Member
- MOGS
- N Rajamaheswari md dgo mch
- (Urology)
- Professor
- Department of Urogynaecology
- Government Kasturba Gandhi
- Hospital and Madras Medical College
- Chennai, Tamil Nadu, India
- President
- Urogynaecology and Reconstructive
- Pelvic Surgery Society of India
- (URPSSI)
- Email: dr_nrm@sify.com
- Nikhil Purandare
- Ojoswini Patel
- Assistant Professor
- Department of Obstetric and Gynecology
- VSSMC, Burla, Orissa, India
- PD Tank md dnbe fcps dgo dfp mnams micog mrcog
- Honorary Clinical Associate
- Nowrosjee Wadia Maternity Hospital
- Ashwini Maternity and Surgical
- Hospital
- Center for Endoscopy and IVF
- Mumbai, Maharashtra, India
- Picklu Chaudhuri dgo md
- Assistant Professor
- Department of Obstetrics and Gynecology
- NRS Medical College and Hospital
- Kolkata, West Bengal, India
- PK Shah md dgo dfp fcps
- Professor and Unit Head
- Department of Obstetrics and Gynecology
- Secretary General, FOGSI
- Pradeep Garg
- Faculty
- Department of Obstetrics and Gynecology
- All India Institute of Medical Sciences
- New Delhi, India
- E-mail: pkgarg_in2004@yahoo.com
- Prakash Trivedi
- Director, NILES and Aakar IVF~ICSI Centre
- Dr Trivedi's Total Woman's Health Care Centre
- Mumbai, Maharashtra, India
- Professor and Head
- Department of Obstetric and Gynecology
- Rajawadi Hospital and DY Patil
- Medical College
- Mumbai, Maharashtra, India
- Consultant Endoscopist
- ART and Urogynecology
- Jaslok and BARC Hospital
- Sr Vice President 2008, FOGSI
- FOGSI Infertility Committee
- Chairman, 2003~2007
- Email: dr.ptrivedi@gmail.com
- Priyanka Shah md dnbe dgo
- Senior Resident
- Department of Obstetric and Gynecology
- Employees’ State Insurance
- Corporations
- Postgraduate Institute of Medical
- Science and Research
- Mahatama Gandhi Memorial
- Hospital
- Parel, Mumbai, Maharashtra, India
- R Karunamoorthy ms mch
- (Urology)
- Assistant Professor
- Department of Urogynecology
- Institute of Social Obstetrics
- Government Kasturba Gandhi
- Hospital and Madras Medical College
- Chennai, Tamil Nadu, India
- Rajat Mohanty md
- Consultant
- Department Obstetrics and Gynecology
- SCB Medical College
- Cuttack, Orissa, India
- Rakhee Sahu md dgo fcps dfp
- Senior Lecturer
- Department of Obstetric and Gynecology
- Nowrosjee Wadia Maternity Hospital and Research Centre
- Parel, Mumbai, Maharashtra, India
- RK Panigrahi
- Senior Resident
- Department of Obstetric and Gynecology
- VSS Medical College
- Burla, Orissa, India
- Sakshi Tomar md dnb rd
- Lakhimpur Kheri
- Uttar Pradesh, India
- Email: sakshi10tomar@yahoo.co.in
- Shrutika Kamath-Thakkar md
- Assistant Professor
- Department of Obstetrics and Gynecology
- Shyam V Desai md dgo dfp fcps
- Past President, FOGSI
- SK Behera
- Professor and Head
- Department of Obstetric and Gynecology
- Dean cum Principal
- VSS Medical College
- Burla, Orissa, India
- SK Giri md ficog
- Professor and Head
- Department of Gynaecologic Oncology
- Regional Cancer Center
- Cuttack, Orissa, India
- Email: drskgiri@gmail.com
- SN Tripathy
- Retd. Professor and Head
- Department of Obstetrics and Gynecology
- SCB Medical College
- Cuttack, Orissa, India
- Salwa Et-Taher mbbch mrcog ma (Obs & Gyn)
- Consultant in Obstetrics and Fetal
- Medicine
- Visiting Researcher
- Imperial College
- Colchester Hospital University NHS Trust
- Colchester CO4 5JL, UK
- Email: s.taher@imperial.ac.uk
- Suchitra N Pandit md dnbe frcog ficog dfp mnams bpharm
- Consultant Obstetrician and Gynaecologist
- Kokilaben Dhirubhai Ambani
- Hospital and Research Centre
- Mumbai, Maharashtra, India
- Vice President, Mumbai Society of Obstetrics and Gynaecology
- Vice President, FOGSI (2008-09)
- Chairperson, Young Talent Promotion
- Committee, FOGSI (2003-2007)
- Suneeta Mittal md frcog(ae) ficog fams ficmch fimsa
- Head
- Department of Obstetrics and Gynecology
- Director-in-Charge
- WHO-CCR in Human Reproduction
- Chief
- ART Centre & IVF Facility
- All India Institute of Medical Sciences
- New Delhi, India
- Sunil Hajare
- T Sering Wangdi
- Senior resident
- Department of Obstetrics and Gynecology
- All India Institute of Medical Sciences
- New Delhi, India
- Tushar Kar md micog ficmch
- Fellowship Laparoscopic Surgery (USA)
- Associate Professor and Head
- Deptartment of Obstetrics & Gynaecology
- SCB Medical College and Hospital
- Cuttack, Orissa, India
The Chapters in Do's and Don'ts in Obstetrics and Gynecology Practice update the knowledge that many clinicians will find useful and appropriate in clinical management. The choice is broad spectrum enough to cover common and key current conditions in obstetrics and gynecology. Each Chapter provides useful information on the risks and benefits of clinical management. Obstetricians are fully aware of the unpredictable spectrum of events that they are faced with from day-to-day management in clinical conditions. For this reason, the contents with updated information are useful for the readers and practitioners internationally. Care has been taken to systematically categorize the chapters to cover the wide spectrum of events that occur in clinical practice.
Risks management issues are encountered both in the developing and the developed world of obstetrics and gynecology, therefore, each sector of the globe has to recognize the local needs and modifications that may be particularly applicable to their practice. The contents of this book offer such opportunities and cover doubtful areas of clinical practice including adverse outcome and potential medicolegal issues in obstetrics and gynecology. I strongly recommend this worldwide edition to the library of clinicians that aim to improve their practice and updating their knowledge in education and teaching of trainees. I strongly welcome its international distribution.
Christopher B Lynch ma (oxon) frcs, frcog
Consultant Obstetrician and Gynaecological Surgeon
Professor (Visiting)
Cranfield University (Health faculty)
Bedfordshire, UK
Milton Keynes General Hospital
NHS Foundation Trust (Oxford Deanery)
Standing way, Eaglestone
Milton Keynes, Bucks MK6 5LD
13Foreword
There is a long-standing desire by the postgraduate students and consultants to know the exact recommendation for individual clinical situation in Obstetrics and Gynecology. There is a constant changing trend in understanding and practicing this complex discipline. We, therefore, must update our knowledge. I know Dr Tushar Kar, who was the Vice-President of FOGSI, is an excellent academician, senior teacher par excellence and good clinician. His long-cherished desire to give important tips to the post- graduates as well as to the practicing clinicians through this textbook is evidently seen. These chapters which have been contributed by many authors of authority and senior medical teachers include from “Making of a Postgraduate” to “Newer Contraception” in Obstetrics and Gynecology practice.
Every author has tried to give some information regarding Do's and Don'ts of Individual subject at the end of the chapter which will be really useful for clinical practice. In addition, a new and rare chapter on “Making of a Postgraduate in Obstetrics and Gynecology” has been contributed by Dr Tushar Kar and Dr Asaranti Kar in a different way. I am sure this uncommon book will be useful for years to come for postgraduates and consultants in Obstetrics and Gynecology.
CN Purandare
md ma (Obst) dgo dfp d obst rcpi (Dublin)
frcog (uk) ficog ficmch pgd mls (Law)
Consultant
Obstetrician and Gynecologist
President, FOGSI (2009)
President, Indian College of OB GYN (2009)
Editor, Journal-FOGSI
Project Director, FOGSI-FIGO-MBCF-MNH Project
Secretary General, FOGSI (2003-08)
President, MOGS (2003-04)
Ex Hon Professor OBGYN, Grant Medical College and JJ Hospital
Mumbai, Maharashtra, India
Hon Consultant, Mumbai Police and Indian Armed Forces
Hon Consultant, St Elizabeth Hospital and BSES Hospital
15Foreword
The greatest wealth of a professional is acquiring skills. Enormous advances in medical sciences in general and obstetrics and gynecology, in particular, have been seen in the last few decades as per as conceptual transformation, technological advances, surgical innovation and research methodology are concerned. The need of the hour remains in updating one's scientific worth of an individual and a health care provider like us. Therefore, it is my personal feeling that basic scientific foundation, clinical acumen, surgical expertise and critical analysis are the basic components needed for the practising obstetrician and gynecologist particularly in this era where the concept of perform or perish prevails.
I am extremely happy to scan every chapter of this innovative book and really amazed to see that this is aimed at postgraduates and practising obstetricians and gynecologists in the urban as well as rural areas. I am sure that this will be a technical bible for all of us not only for ready-reference but also for skill development.
I congratulate Dr Tushar Kar for his untiring effort in bringing out this unique module which will serve as best practice guidelines for the clinician in OBGYN.
PC Mahapatra md ficmch
Professor
Department of Obstetrics and Gynecology
SCB Medical College
Cuttack, Orissa, India President, FOGSI
E-mail: ctk_purnam@sancharnet.in
17Foreword
It gives me immense pleasure to write a few words for Do's and Don'ts in Obstetrics and Gynecology Practice.
I must congratulate my friend Dr Tushar Kar for making such a great effort. All the chapters are carefully selected and written very methodically. There is a clarity of thought and understanding of the subject which is evident in the writing of all the chapters.
This book will not only be useful for the common man but also for medical practitioners and postgraduates.
This is a wonderful effort and my best wishes to Dr Tushar Kar.
PK Shah
Secretary General
19Preface
Science is advancing very fast. Likewise, in medical sciences, the practice guidelines of today is becoming the guidelines of yesterday. Therefore, for a postgraduate and practising consultant, it is extremely difficult to update with the current guidelines. Keeping this in mind, we have got a long-standing desire of giving some key points regarding What to do and What not to do in our day-to-day practising situation to obstetrics and gynecology consultants and PG students. So that they can keep themselves prepared to face these conditions. Similarly, we have already come out with a book on Safe Surgical Practice which is very much useful for all the consultants as per their feedback from every corner of our country.
We have tried to cover up as many chapters as possible keeping in view of clinical importance starting from Making of a Postgraduate till Newer Contraception. In each chapter, we have initially covered relevant clinical aspects followed by Do's and Don'ts. All the contributors are pretty senior teachers and having authority in their subjects.
Professor Christopher B Lynch has also contributed a chapter on Management of Third Stage of Labor, which is extremely practical and praise worthy.
Lastly, a unique and a typical chapter like Making of a Postgraduate written by us has been a long-cherished dream of ours which will definitely guide the postgraduates towards making themselves an outstanding clinician or excellent medical teacher or a true medical scientist. As well as, this chapter will enlighten some positive suggestions regarding revamping of present-day postgraduate medical education of our country for the time to come.
Tushar Kar
Asaranti Kar