Jeffcoate's Principles of Gynaecology Narendra Malhotra, Jaideep Malhotra, Pratap Kumar, Neharika Malhotra Bora, Parul Mittal
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1Jeffcoate’s PRINCIPLES OF GYNAECOLOGY2
3Jeffcoate’s PRINCIPLES OF GYNAECOLOGY
Eighth International Edition
Revised and updated from the Seventh Edition by Narendra Malhotra MD FICOG FRCOG (Honoris Causa) Professor, Dubrovnik International University, Croatia FOGSI Representative to FIGO Consultant and Director, Global Rainbow Healthcare Agra, Uttar Pradesh, India Pratap Kumar MD DGO FICOG Professor and Head, Department of Obstetrics and Gynaecology Kasturba Medical College, Manipal, Karnataka, India Past Vice President, The Federation of Obstetric and Gynaecological Societies of India (FOGSI) Jaideep Malhotra MD FICOG Professor, Dubrovnik International University, Croatia Honorary General Secretary, Indian College of Obstetrics and Gynaecology President The Asia Pacific Initiative on Reproduction (ASPIRE) Consultant and Director, ART Rainbow-IVF Agra, Uttar Pradesh, India Neharika Malhotra Bora MD Assistant Professor, Department of Obstetrics and Gynaecology Bharati Vidyapeeth Medical College, Pune, Maharashtra, India Parul Mittal MD Consultant Global Rainbow Healthcare Agra, Uttar Pradesh, India Editorial Board Nidhi Gupta, Pranay Shah, Maninder Ahuja, Rahul Manchanda, Kavita Singh, Narayan M Patel
4
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Jeffcoate’s Principles of Gynaecology
First Edition : 1957
Fifth Edition : 1987
Sixth Edition : 2001
Seventh Edition : 2008
Eighth Edition : 2014
9789351521495
Printed at
5Dedicated to
The teachers of gynaecology and the students6
7 Preface to the Eighth International Edition
We, Narendra Malhotra and Pratap Kumar, feel very honoured for being asked to revise again the best textbook on gynaecology by Sir Norman Jeffcoate.
Dr Jaideep Malhotra (ART specialists) has especially added inputs in infertility, assisted reproductive technology and other chapters.
In the rapidly advancing age of technology and rapidly changing trends in management, diagnosis, drugs and procedures, it is of paramount importance to update books and manuals periodically. This book was earlier updated and edited (2008) by us as an international edition (Seventh edition), but soon the publishers felt the need for revising it within a span of five years.
Professor Norman had expressed in 1974 that he had endeavoured to preserve his personal approach.
We have added many new chapters and rewritten a few chapters, all together trying to maintain Sir Jeffcoate’s style. We have retained the description of Professor Jeffcoate’s original case discussions, photographs and pictures.
New additions have been made on the feedback from postgraduate students.
Dr Neharika Malhotra Bora, Assistant Professor, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India, and Dr Parul Mittal, Consultant, Global Rainbow Healthcare, Agra, Uttar Pradesh, India, have been instrumental in adding a lot of inputs.
Dr Nidhi Gupta, Dr Pranay Shah, Dr Maninder Ahuja, Dr Kanta Singh, and Dr Narayan M Patel have painstakenly revised and edited and updated many chapters.
We hope that the undergraduate and the postgraduate students will appreciate our efforts to update this Bible of Gynaecology.
Narendra Malhotra
Pratap Kumar
Jaideep Malhotra
Neharika Malhotra Bora
Parul Mittal
8 9Preface to the Fifth Edition
It was inevitable that following Professor Sir Norman Jeffcoate’s retirement, there would be pressure to continue to publish the Principles of Gynaecology.
In the last revision in 1974, Sir Norman emphasised that he had endeavoured to preserve his personal approach, bearing in mind the objectives and principles outlined in the preface to the First Edition. In addition, some of Sir Norman’s comments in the preface to his Fourth Edition are included to emphasise the guidelines the present author has taken in an attempt to maintain the format of the Principles of Gynaecology.
Much of the material presented is retained from the last edition, since it also reflects the gynaecological training of the author under Professor Jeffcoate in Liverpool. The views expressed are therefore personal ones from a pupil of Sir Norman Jeffcoate against the background of all the information available. Once given, the views expressed mean that references are excluded for the special reasons given in the preface to the First Edition.
In the process of being taught Obstetrics and Gynaecology by Sir Norman, one was encouraged to consider all the facts about a case, to come to a conclusion and to be able to justify it. Even though a critical approach to each case was expected, we were never allowed to forget that we were dealing with a woman, mother or child with a personal problem. Indeed, Professor Jeffcoate’s personal approach was such that in a clinic with many students and postgraduates present, it was obvious that as far as the patient was concerned Sir Norman was the only person there. I have never been able to achieve the same effect, but I hope that my efforts in revising this book will be acceptable to an outstanding teacher, guide and friend. If so, then I am sure it will benefit all those who read it.
Victor Tindall 10
11Extracts from the Preface to the First Edition
The book is meant to add to rather than replace clinical and tutorial instruction, so those matters which can best be taught beside the patient, or which are easy for any student to learn and understand from other sources, receive little attention. In planning the text, I recalled those subjects which I myself found (and still do find) difficult to master, or on which I had to search far and long for information, and gave them disproportionate emphasis. This and other considerations resulted in a disregard for the relative importance, as judged by their clinical frequency, of different conditions. Indeed, the reader will find that quite rare conditions are mentioned, illustrated or described at length; and that all manner of asides—even some with an obstetrical flavour—creep in. This is partly because they are of special interest to me but mainly because they appeared to offer scope for presenting an attitude of mind; for discouraging loose thinking and empiricism; for inculcating a scientifically and ethically honest outlook; for emphasising the art as well as the science of gynaecology.
I have not played safe by stating only generally accepted views, nor have I played fair by giving the differing views of various authorities. Instead, after weighing the evidence, I have attempted to reach a conclusion which satisfies me as being as rational as present knowledge allows. Without intended disrespect, mention by name of authors and workers has been avoided as a rule; references clutter up the text, destroy continuity and are hardly ever used properly. On the other hand, I have not hesitated to give my own views and have, at times, been more dogmatic than clinical experience ever really justifies. I have even gone so far as to enunciate ideas which in many respects are conjectural, if not fanciful. I do not expect these all to be accepted; if they are I shall be disappointed because their object is to provoke trains of thought and discussion.
In offering this book to fellow students, I remember with affection and gratitude William Blair-Bell, one of the great gynaecologists of this century. He not only taught me gynaecology and a particular approach to it, he taught me to think and to write. He, more than anyone else, provided me with the stimulus and the opportunity to obtain the experience which has led to this work.
Norman Jeffcoate 12
13Acknowledgements
To edit a book written by a legend Professor Jeffcoate is a mammoth task. Professor Pratap Kumar, myself and Dr Jaideep Malhotra did a lot of researches and asked all our students to suggest what more they wanted in the eighth edition. Dr Neharika Malhotra Bora and Dr Parul Mittal have helped immensely in adding a lot of material to the chapters and updating many of them.
We are thankful to the editorial board members for their contributions and valuable inputs.
We are grateful to all those who have helped us to do this mammoth job. Special appreciations and thanks are to:
  1. We thank doctors and staff of Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Karnataka, India.
  2. We thank junior doctors of Malhotra Nursing and Maternity Home (P) Ltd. and Global Rainbow Healthcare, Agra, Uttar Pradesh, India.
  3. Our special thanks to the following, who have given valuable suggestions in various chapters: Professor Barun Sarkar, Professor Arun Nagrath, Dr Richa Singh, Dr Anju Sharma, Dr Alka Saraswat, Dr Anupam Gupta, Dr Sunder Rajan (Pondicherry), Dr Col R Puri (Jalandhar), late Dr Sakshi Tomar (PGI, Lucknow, Uttar Pradesh, India).
  4. Special thanks to Dr Vivek Nahar for his contribution.
    Special thanks to Dr Richa Saxena for getting the manuscript edited.
    We are thankful to our families for bearing with us and sharing family time for work like this.
    We thank Vidya, late Dr Prabha Malhotra, Deepali, Deepika, Dr RM Malhotra and Kehsav.
    We hope the students of gynaecology will like what we have produced in the eighth edition.
    We have tried to retain Professor Jeffcoate’s style and some of the valuable photographs from the first edition.
Narendra Malhotra 14