Recent Advances in Postpartum Care Mandakini Megh, Reena Wani
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1Recent Advances in Postpartum Care2
Federation of Obstetric and Gynaecological Societies of India
3Recent Advances in Postpartum Care
Editor Mandakini Megh MD DGO FICMCH FICMU FICOG Vice President FOGSI, Past Chairperson, FOGSI Imaging Science Committee, Past President, IFUMB Joint Organizing Secretary, AICOG (2013), Mumbai Dean, Indian College of Medical Ultrasound Maternal Health Consultant Government of Maharashtra, India Co-editor Reena Wani MD MRCOG FICOG DNBE DFP DGO FCPS Professor (Addl), I/C Family Welfare Program TNMC and BYL Nair Charitable Hospital Mumbai, Maharashtra, India
4
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Recent Advances in Postpartum Care
First Edition: 2013
9789350904435
Printed at:
5Dedicated to
All the Mothers
God made a wonderful mother,
A mother who never grows old;
He made her smile of the sunshine,
And He moulded her heart of pure gold;
In her eyes He placed bright shining stars,
In her cheeks fair roses you see;
God made a wonderful mother,
And He gave that dear mother to us.6
Contributors 13Foreword
“Amongst the greatest freedoms we can have is the freedom from avoidable ill-health and escapable mortality....”
—Amartya Sen, Nobel Laureate
Friends,
As obstetricians, we have a unique position in health care —we look after two patients (mother and fetus), we make the difference between life and death for both of them.... hence we have a double responsibility.
In the postnatal period, once the fetus is born, although we may hand over the baby to neonatologist, our job does not end...in fact this extended time of 6 weeks is special for patients and doctors and should not be neglected. I congratulate Dr Mandakini Megh, Chief Editor & Vice President, FOGSI and Dr Reena Wani, Co-editor for the FOGSI Publication on “Recent Advances in Postpartum Care” focusing on this part of our clinical spectrum and coming out with an excellent book that comprehensively covers the time from immediate to delayed puerperium, both normal and abnormal.
I am sure this book will be a useful source of information for the practicing obstetricians, general practitioners and postgraduate students for normal and Normal aspects of the postpartum period.
I wish the team all the best for success of this FOGSI Publication-book.
Warm Regards,
C N Purandare
President-Elect FIGO14
15Message
Dear FOGSIan's
I am happy that there is a book that is being released on an issue in obstetrics which is often most neglected—“The Postpartum”..... the main job of delivery done—everyone is heaving a sigh of relief and celebrating and then .... the real trouble begins !!!! In a most unexpected way ... in a most unexpected case. The array of chapters Normal Puerperium, Third Stage Complications, Abnormal Puerperium, Neonatal Care, New Trends and National Programs... addressed here are so very crucial for safe care and also an opportunity for postpartum contraception—a national program which India is revisiting.
The issue of “Population Explosion” in India should explore the concept of “unmet need” for family planning (FP), and present new strategies FP programs can use to meet this need. Unmet need affects over 100 million women in developing countries (one-third of them in India) and an average of 20% of all married women of reproductive age in the developing world.
Strategies to address unmet need should (i) Maximize access to good quality services, (ii) Emphasize communication, (iii) Focus on men as well as women, and (iv) Collaborate with other services for new mothers and young children.
This book is indeed the need of the hour and is a food for thought for possible programmatic steps to address the most common reasons for unmet need. So, the large issue of fighting population explosion and fresh thinking on PPIUCD program has been my passion. i thank Dr Megh and team for the opportunity given to script a chapter on this issue. You will discover more when you read.
I conclude by saying that
“Problems have been fixed—it is time to fix solutions !”
And, therefore, it is the time for action !
Hema Divakar
President, FOGSI (2013)16
17Preface
“Childbirth is not a medical condition; it is a promise.” But for the women who succumb to pregnancy-related complications, it is a promise shamefully betrayed. To die while giving birth must surely be the mother of all ironies. The need for care does not stop as soon as the birth is over. The hours, days, and weeks that follow birth may be dangerous for women as well as for their babies. The welcome emphasis, in recent years, on improving skilled attendance at birth should not divert attention from this critical period, during which half of maternal deaths as well as a considerable amount of illness occur. In developing country like India, uptake of postpartum care is even lower than that of care at childbirth. This is an area of crucial importance with much scope for improvement.
With impetus from the Millennium Development Goals (MDGs), specifically MDG-5, priorities are starting to shift and nations are beginning to pay more attention to women. Our mission, however, is not simply to reduce maternal deaths, but to achieve maternal health.
International Federation of Gynaecology and Obstetrics (FIGO) is committed to reduce the maternal mortality, and “FIGO saving Mothers and Newborns initiative” started in 2006 and the Federation of Obstetrics and Gynaecological Societies of India (FOGSI) is collaborating this project.
As a nationwide organization, FOGSI has consistently stressed not only on the issues of maternal health but also on postpartum care issues. In the year 2012–2013, FOGSI had conducted nationwide workshops on “Advances in Postpartum Care” under supervision of the National Coordinator, Dr Mandakini Megh, Vice President, FOGSI. Keeping in mind this powerful base, we conceptualized this multipronged text Recent Advances in Postpartum Care.
We have included appropriate topics “Postpartum Collapse, Uterine Inversion, Approach to Fever in Puerperium, BFHI etc.”
“Postpartum Contraception, Role of Imaging in Postpartum Period, Critical Care in Obstetrics and Gynecology-HDO, PPIUCD” are few of the advances in postpartum care and many other interesting topics.
This book on postpartum care is meant to be a ready reference material with practical pointers and clinical situations for practising obstetricians, gynecologists, and postgraduate students, Government Medical Officers, NRHM and NGOs, highlighting recent advances.
Mandakini Megh
18Acknowledgments
We would like to thank the following persons without whom this handbook would not have been possible