D C Dutta’s Textbook of Obstetrics Hiralal Konar, DC Dutta
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1DC DUTTA's TEXTBOOK OF OBSTETRICS: including Perinatology and Contraception
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3DC DUTTA's TEXTBOOK OF OBSTETRICS: including Perinatology and Contraception
Enlarged & Revised Reprint of Seventh Edition
DC DUTTA MBBS, DGO, MO(CAL) Professor and Head, Department of Obstetrics and Gynecology Nilratan Sircar Medical College and Hospital, Kolkata, India Edited byHIRALAL KONAR (HONS; GOLD MEDALLIST) MBBS (CAL), MD (PGI), DNB (INDIA) MNAMS, FACS (USA), FRCOG (LONDON) Chairman, Indian College of Obstetricians and Gynecologists Professor, Department of Obstetrics and Gynecology Calcutta National Medical College and C.R. Hospital, Kolkata, India One time Professor & Head, Dept. Obst. & Gyne., Midnapore Medical College & Hospital, West Bengal University of Health Sciences, Kolkata, India; Rotation Registrar in Obstetrics, Gynecology and Oncology Northern and Yorkshire Region, Newcastle-upon-Tyne, UK Examiner of MBBS, DGO, MD and PhD of different Indian Universities and National Board of Examination, New Delhi, India
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© Copyright reserved by Mrs Madhusri Konar
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
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Information contained in this book is uptodate, believed to be reliable when checked with the sources and is in accordance with the accepted standard, at the time of publication. However, with ongoing research and passage of time, new knowledge may modify some of it. The reader should, therefore, approach the book with a realistic attitude (particularly the drugs and doses) and should carry the professional responsibility. The readers are asked to verify the information contained herein from other sources. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
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Textbook of Obstetrics
Enlarged & Revised Reprint of Seventh Edition: November 2013
9789351520672
Printed at
5Dedicated to
The students of obstetrics past and present
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7Preface to the seventh edition
It is almost 28 years now since the publication of its first edition that Dutta's Textbook of Obstetrics continues to provide basic knowledge to medical students, trainee residents, doctors and midwives for improved patient care. It is a great pleasure to see this book come out with international quality in its seventh edition as there was an overwhelming demand for the new thoroughly revised edition of the book in many parts of the world. Dutta's text is committed to be revised and updated continually. Maximum attention has been paid to update the “core curricula” that impart fundamental knowledge, learning and skill. In view of expanding knowledge of molecular biology, genetics, imaging and other diagnostic modalities, major changes have been incorporated in all the chapters of the current edition. New management options are also discussed. Object of the text is to provide a current cutting edge information which is again easy to read, understand, and above all will be based on evidence.
This seventh edition of DC Dutta's widely acclaimed comprehensive textbook of obstetrics has come up in a fully colored format. It is profusely illustrated with 407 full colored line drawings, photographs and sketches. The special attractions of this text like summary boxes, tables, algorithms are for easy understanding and reproducibility. The key points at the end of each chapter is for quick revision without referring to the text. The uniqueness of this text lies in its presentation style which is simple, clear and concise. The language throughout the text has been kept lucid and unambiguous. Medical advances upto the time of publication have been incorporated.
Recent research has necessitated major changes in all the chapters in the text. Few chapters have been exhaustively updated while some have been completely rewritten. Operative obstetrics (chapter 36) has been thoroughly updated and amply illustrated for easy learning of common obstetric operations and skills. The incorporated CD will be of immense help for this purpose. The chapter on practical obstetrics (chapter 41) has been rewritten considering the importance of practical obstetrics. This chapter has been enriched with numerous (51) high quality photographs covering instruments, specimens, drugs and plates of imaging studies. There are several hundreds of model questions with answers and explanations. This chapter is to help the students while preparing for the clinical and viva voce part of the examination. In fact the total information given in chapter 41, amounts to a “mini textbook-cum-color atlas” on obstetrics.
The volume of the text has been kept concise, in spite of incorporation of huge amount of new information. Contents and index have been expanded for easy text references. A list of up to date reviews with few websites are included for enthusiastic readers who wish to know more and strive for excellence.
The job of editing such a comprehensive text is stupendous. I have consulted many of my esteemed colleagues in profession in this country and abroad, a multitude of eminent authors, many current evidence based studies, guidelines and recommendations. I do gratefully acknowledge my legacy to all the teachers and the related authors and publishers. The editor expresses his sincere thanks to many of his esteemed colleagues for their valued suggestions, criticisms and contribution of photographs. The editor sincerely acknowledges the support of all the students (undergraduates and postgraduates) of different medical institutions for their opinions, valued suggestions and new ideas. The editor always welcomes the views of students and the teachers who often write to us on emails (h.kon@vsnl.net/ncbapvtltd@eth.net).
The editor is specially grateful to Dr KM Gun, MD, FRCOG, FRCS, FACS, Professor (Rtd); Dr BN Chakravorty MD, FRCOG, DSc (Rtd), Director, Institute of Reproductive Medicine, Calcutta; Dr B Hore, MD Professor (Rtd), Consultant Anesthetist and Dr Subir Kumar Dutta, MD, Professor (Rtd), Consultant Pathologist for their contribution, continued guidance and valuable suggestions. The manuscript concerning 8the chapters on Perinatology has been thoroughly read and revised authoritatively by Dr Shymal Banerjee, Professor, Department of Pediatrics, NRS Medical College, Calcutta for which I express my sincere thanks.
Mrs Madhusri Konar, MA, BEd, deserves full credit for her. sincere and patient secretarial job as ever.
Lastly, I am grateful to all who have taught me, most of all, the patients and my beloved students.
I do hope this comprehensive textbook will continue to be of immense value to the students as ever.
According to the author's desire, the book is dedicated to the students of Obstetrics—past and present who strive continuously to improve the maternal and newborn health wherever they work.
 
Preface to the Enlarged and Revised Reprint of Seventh Edition
Progress of science, technology and knowledge has necessitated Dutta's Textbook of Obstetrics to come up with an interim revision of the entire textbook. Few chapters have been revised and updated as to its need. New chapters have been incorporated. Contents and the index have been expanded for easy text reference. The author, as in the past always welcome the views of students and the teachers, who often write to us (www.dcdutta.com). Information regarding examination situation (theory questions, viva-voce, multiple choice questions and answers with explanatory notes, clinical examination procedure, operation video-clips) have been provided through our electronic sources (www.dcdutta.com/www.hiralalkonar.com).
I gratefully acknowledge the help of Shri Jitendar P. Vij (Group Chairman), Mr Ankit Vij (Managing Director) and Dr Sakshi Arora (Chief Development Editor) along with entire team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, for their professional guidance, suggestion and support in bringing out the enlarged and revised reprint of seventh edition.
I do hope this comprehensive textbook will continue to be of immense educational resource to the readers as ever.
P 13, New C.I.T Road
Kolkata 700 014
HIRALAL KONAR
9Preface to the first edition
Over the years, there was an absolute dearth of a single comprehensive textbook of obstetrics worth to prescribe to the students. Moreover, of the textbooks currently available, most have been written with an orientation for the developed countries.
Being constantly insisted and hard pressed by my beloved students, I ultimately decided to write a compact, comprehensive and practically oriented textbook of obstetrics. It is an attempt to encourage the students to learn obstetrics in a comparatively easy way. The aim was to emphasize the simplicities rather than complexities of knowledge. The book is written in a clear and concise language and in author's own style which holds the reader's interest. Controversies are avoided and the management of the obstetrical problems being highlighted with the facilities available to most of the Third World countries. Extensive illustrations and flow charts (schemes) have been used as and where needed to add lucidity and clarity to the subject and to emphasize the practical nature of the book.
Although the book has been written primarily for the undergraduates, it should also prove to be useful to nurses (midwives), those aspiring for diploma and postgraduate degrees in obstetrics and also to the practising obstetricians. I, however, do not consider this book to be an ideal one but a humble attempt has been made to remove the bottlenecks, as far as possible, of the books available to the students at present.
Acknowledgements: Very little of what is worthwhile in this book could have been brought to publication without the generous cooperation, advice and assistance of many of my colleagues, seniors and juniors.
Dr BN Chakravarty, MBBS, DGO, MO (CaL), FRCOG (Eng.), Prof. Dept. of Obst. and Gyne., Nilratan Sircar Medical College, Calcutta; Dr KM Gun, MBBS, DGO, MO (CaL), FRCOG (Eng.), FRCS (Edin.), FACS, Professor, Dept. of Obst. and Gyne., Medical College, Calcutta; Dr Santosh Kr Paul, MBBS, DGO, MO (CaL), Reader, Dept. of Obst. and Gyne., Nilratan Sircar Medical College, Calcutta; Dr B Hore, MBBS, DA, MS (CaL), Prof. and Head of the Dept. of Anesthesiology, North Bengal Medical College; Dr BC Lahari, MBBS, DGO, MO (CaL), FRCS (Edin.), FRCOG (Eng.), FACS (USA), FAMS (Ind.), Prof. Dept. of Obst. and Gyne., Medical College, Calcutta; Dr P Raha, MBBS, DTM & H, PhD, FCAL, Prof. Dept. of Pathology and Bacteriology, RG Kar Medical College, Calcutta; Dr J Mitra, MBBS, DGO, MO (CaL), FLCS, FIMS, FRCOG, Prof. Dept. of Obst. and Gyne., Institute of Postgraduate Medical Education and Research, Calcutta; Dr Aroti Roy, MBBS, FRCOG (Eng.), Prof. Dept. of Obst. and Gyne., RG Kar Medical College, Calcutta, and Dr H Dattagupta, MBBS, DGO, FRCOG (Eng.), Asstt. Prof. Dept. of Obst. and Gyne., Medical College, Calcutta; Dr NN Roychowdhury, MBBS, DGO, MO (CaL), PhD, FRCS, FRCOG, FACS, FAMS, Prof. Dept. of Obst. and Gyne., Medical College, Calcutta; Dr N Chowdhury, MBBS, DGO, MO (CaL), Prof., Dept. of Obst. and Gyne., Institute of Postgraduate Medical Education and Research, Calcutta.
Dr NG Das, BSc, MBBS, MS (CaL), Prof. and Head of the Dept. of Anatomy, Nilratan Sircar Medical College, Calcutta; Dr PK Talukdar, MBBS (CaL), DCH (Lond.), MRCP (Lond.), MRCP (Eng.), Lecturer, Pediatrics, NRS Medical College, Calcutta; Dr Subir Kumar Dutta, MBBS, DCP, MD (Path. & Bact.), Lecturer, Dept. of Pathology and Bacteriology, University College of Medicine, Calcutta; Dr Samar Rudra, MBBS, DGO, MRCOG. (Eng.), of Rama Krishna Mission Seva Pratisthan, Calcutta.
I have much pleasure in expressing my cordial appreciation to the House-Surgeons, Internees and students of Nilratan Sircar Medical College, Calcutta, for all the help they have rendered in preparation of the final drafts of the manuscripts, checking the proofs and in compiling the Index. Without their constant encouragement 10and active assistance, this book could never have been published. I express my sincere thanks to my publisher “Central Educational Enterprises” for their sincere effort in publishing the book within the stipulated period in spite of the adverse circumstances.
In preparing a textbook like this, I have utilized the knowledge of a number of stalwarts in my profession and consulted many books and publications. I wish to express my appreciation and gratitude to all of them including the related authors and publishers.
As a teacher, I have learnt a lot from the students and more so while writing this book and as such I could not think to dedicate the book of anyone else but the students of obstetrics for which I express my gratitude.
Mahalaya
8th September 1983
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Kolkata 700 014
DC DUTTA