Fourth Edition
Editors Narendra Malhotra MD FICOG FRCOG (Hon Causa)
Professor, Dubrovnik International University, Croatia
FOGSI representative to FIGO Director, Ian Donald School of Ultrasound Consultant (Obstetrics and Gynecology) and Managing Director Malhotra Nursing and Maternity (P) Ltd and Rainbow Health Care Agra, Uttar Pradesh, India
PK Shah MD FCPS FICOG FICMU FICMCH DGO DFP
Professor Department of Obstetrics and Gynecology Seth GS Medical College and King Edward VII Memorial Hospital Mumbai, Maharashtra, India
President FOGSI 2012
Hema Divakar MBBS MD (Obstetrics and Gynecology) DGO
President FOGSI 2013 Director, Divakar's Speciality Hospital, Bengaluru, Karnataka, India
Co-Editors Saroj Singh MS (Obs & Gynae) MNAMS FICOG FICMCH FIAJAGO
Professor and Head Department of Obstetrics and Gynecology SN Medical College Agra, Uttar Pradesh, India
Jaideep Malhotra MD FICOG FICMCH
Professor, Dubrovnik International University, Croatia
President Elect ASPIRE Director, Rainbow IVF Agra, Uttar Pradesh, India
Editorial Consultants CN Purandare,
Nozer Sheriar,
Suchitra Pandit,
PC Mahapatra,
Arun Nagrath,
Anupam Gupta
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Principles and Practice of Obstetrics and Gynecology for Postgraduates
First Edition: 1996; Second Edition: 2003; Third Edition: 2008
Fourth Edition: 2014
9789351521631
Printed at
5Dedicated to
Our teachers
for teaching us the Art and Science of Obstetrics and Gynecology and
for their major contribution in making us what we are today
Our patients
for their unstained faith in us, which has helped us to develop
our vast clinical experience and self-confidence
Our students
who continue to stimulate us to be researchers, teachers as well as students
Our families
for their support and for tolerating our repeated stints at various works and
for sharing their personal family time and of course
for supporting us and for always encouraging us
Federation of Obstetric and Gynaecological Societies of India (FOGSI)
for giving us an opportunity to express ourself and to serve Science and Humanity
7Contributors
- Abha Majumdar
- New Delhi
- Aditi Singhi
- Mumbai
- AK Debdas
- Jamshedpur
- Alka Kriplani
- New Delhi
- Alka Saraswat
- Agra
- Alokendu Chatterjee
- Kolkata
- Alok Vashishtha
- Haridwar
- Ameet Patki
- Mumbai
- Ameya C Purandare
- Mumbai
- Amitava Mukhopadhyay
- Kolkata
- Amol P Pawar
- Mumbai
- Anand N Bhalerao
- Pune
- Anita Sabharwal
- New Delhi
- Anjali Taneja
- New Delhi
- Anjoo Agarwal
- Lucknow
- Anupama Rao
- Bengaluru
- Anupam Gupta
- Agra
- Anurag Gupta
- Anu Pathak
- Agra
- Anu Vij
- Mumbai
- Arti Matah
- Varanasi
- Arun Tewari
- Agra
- Asha Oumachigui
- Puducherry
- Asha R Rao
- Coimbatore
- Ashish Kale
- Aurangabad
- Ashok Khurana
- New Delhi
- Ashwini Bhalerao Gandhi
- Mumbai
- Ashwini Kale
- Atul Munshi
- Ahmedabad
- Barun Sarkar
- Agra
- Basab Mukherjee
- Kolkata
- Beena
- Behram S Anklesaria
- Ahmedabad
- Bijit Chowdhury
- Bimal Mody
- Mumbai
- BI Patel
- Ahmedabad
- BK Mitra
- Durgapur
- BL Nayak
- Cuttack
- BN Chakravarty
- Kolkata
- B Shakuntala Baliga
- Bengaluru
- CB Nagori
- Ahmedabad
- Chandrawati
- Lucknow
- CN Purandare
- Mumbai
- Deepika Deka
- New Delhi
- DK Dutta
- Kolkata
- D Pushpalatha
- Hyderabad
- Dujal Munshi
- Ahmedabad
- Duru Shah
- Mumbai
- E Sarulatha
- Gautam Bhattacharjee
- Gautam N Allahbadia
- Mumbai
- Gayatri P Nagpure
- Giovanni Miniello
- Italy
- Girija Wagh
- Pune
- Gita Ganguly Mukherjee
- Kolkata
- Gourisankar Kamilya
- Kolkata
- Harshad Parasnis
- Pune
- Hema Divakar
- Bengaluru
- Himangi Warke
- Mumbai
- Hiralal Konar
- Kolkata
- Hrishikesh Pai
- Mumbai
- Jaideep Malhotra
- Agra
- Jayant G Mehta
- UK (London)
- Jaya Prakash Shah
- Ahmedabad
- Jaydeep Tank
- Mumbai
- Joshep Kurian
- Chennai
- Joydeb Mukherjee
- Kolkata
- Jyotsna Gandhi
- Mumbai
- Kaizad R Damania
- Mumbai
- Kamal Buckshee
- Noida
- Kamini A Rao
- Bengaluru
- Kanan Yelikar
- Aurangabad
- Kavita N Singh
- Jabalpur
- KC Gurnani
- Agra
- Kiran Agarwal
- Bareilly
- K Jayakrishnan
- Kerala
- KK Das
- Bokaro
- KM Nadkarni
- Vapi, Gujarat
- K Mitra
- Durgapur
- Krishnendu Gupta
- Kolkata
- Krutika Khopkar
- Mumbai
- Kuldeep Singh
- New Delhi
- Kumud M Ingle
- Mumbai
- Kurush P Paghdiwalla
- Mumbai
- Latha Chaturvedula
- Madhulika Kabra
- New Delhi
- Madhuri A Patel
- Mumbai
- Mahendra N Parikh
- Mumbai
- Mandakini Megh
- Mandakini Parihar
- Mumbai
- Maninder Ahuja
- Faridabad
- Manish Banker
- Ahmedabad
- Manjari Matah
- Varanasi
- Manju Mataliya
- Mumbai
- Manju Puri
- New Delhi
- Manu Sobti
- Mumbai
- Markandey Katju
- New Delhi
- Maya Hazra
- Vadodara
- Maya Lulla
- Mumbai
- Maya Sood
- New Delhi
- M Banumathy
- Meenakshi Bharath
- Navi Mumbai
- Meenal Jain
- Agra
- Meera Desai
- Baroda
- Mehroo Hansotia
- Mumbai
- Milind R Shah
- Sholapur
- Mohita Pengoria
- Agra
- Monesh Shah
- Pune
- MP Patil
- Sangli
- Mukta Jain
- Murad E Lala
- Mumbai
- Murari S Nanavati
- Mumbai
- Nandita Maitra
- Baroda
- Nandita Palshetkar
- Mumbai
- Narendra Malhotra
- Agra
- Nayna A Dastur
- Mumbai
- Narayan M Patel
- Neera Agarwal
- New Delhi
- Neeraja Gupta
- New Delhi
- Neha Agarwal
- Agra
- Neharika Malhotra Bora
- Agra
- Nidhi Gupta
- Agra
- Nikhil Jani
- Mumbai
- N Purandare
- Mumbai
- Nivedita Chattopadhyay
- Kolkata
- Nozer Sheriar
- Mumbai
- Nutan Jain
- Muzaffarnagar
- P Biju
- Cochin
- Pankaj Desai
- Baroda
- Parikshit D Tank
- Mumbai
- Partha Guharoy
- Kolkata
- Partha Mukherjee
- Kolkata
- Parul J Kotdawala
- Ahmedabad
- Parul Mittal
- Agra
- PG Paul
- Kochi
- Picklu Choudhury
- PK Sekharan
- Calicut
- PK Shah
- Mumbai
- Poonam Yadav
- Agra
- Prachi Bhikaji Shitut
- Mumbai
- Pradeep Kumar Garg
- New Delhi
- Pradnya Parulkar
- Mumbai
- Prakash Bhatt
- Surat
- Prakash K Mehta
- Bengaluru
- Prakash Trivedi
- Mumbai
- Prakash V Pawar
- Mumbai
- Pranay Shah
- Mumbai
- Pratap Kumar
- Manipal
- Pratima Anjaria
- Pravin M Patel
- Ahmedabad
- Preeti Matah
- Agra
- Priti Kumar
- Lucknow
- Purnima Chatterjee
- Kolkata
- Purvi Patel
- Vadodara
- Rahul Wani
- Rajendra Singh Pardeshi
- Aurangabad
- Rajyashri Sharma
- Aligarh
- Reena
- Rekha Rani
- Agra
- Richa Saxena
- New Delhi
- Richa Singh Chauhan
- Agra
- Rishabh Bora
- Pune
- Rishma Pai
- Mumbai
- Ritu P Khiwal
- RN Goel
- Agra
- Rohit V Bhatt
- Roopa J Pai
- Coimbatore
- Ruchika Garg
- Agra
- Ruchira Menka Jha
- New Delhi
- Sadhana Desai
- Mumbai
- Safala Shroff
- Mumbai
- Sakshi Tomar
- Lakhimpur
- Saloni Nanavati
- Mumbai (Manipal)
- Sanjay B Rao
- Sanjay Gupte
- Pune
- Sanjay Munshi
- Ahmedabad
- Sarita Bhalerao
- Mumbai
- SS Mehendale
- Pune
- Saroj Singh
- Agra
- Satish K Bhargava
- Delhi
- Satyen Kasabwala
- Cochin
- Saunitra Inamdar
- Deoli, Sawangi
- Seema Jain
- Mumbai
- Shaheen
- Aligarh
- Shalini Rajaram
- New Delhi
- Shashikant Umbardand
- Mumbai
- Shifali Gupta
- Shikha Singh
- Agra
- Shirish N Daftary
- Mumbai
- Shirish Patwardhan
- Pune
- Shirish S Sheth
- Mumbai
- Shyam Desai
- Mumbai
- SK Giri
- Cuttack
- Snehamay Chaudhuri
- Kolkata
- Sonali Tank
- Mumbai
- S Karia
- Ahmedabad
- Sonal Panchal
- Ahmedabad
- Soundra Raghavan
- Sreelakshmi
- Subhash M Nargolkar
- Pune
- Subrat Lall Seal
- Kolkata
- Suchitra Pandit
- Mumbai
- Sudhanshu Bankata
- Sudip Chakraborty
- Kolkata
- Sujal Munshi
- Ahmedabad
- Sukanta Misra
- Sukhpreet Patel
- Mumbai
- Sulochana Gunasheela
- Bengaluru
- Sumita Mehta
- New Delhi
- Sunil Bansal
- Agra
- Sushma Gupta
- Agra
- Swasti
- New Delhi
- Sylvia D'Costa
- Mumbai
- Tanya B Rohatgi
- New Delhi
- Tarun Kumar Ghosh
- Kolkata
- Tejas Dave
- Ahmedabad
- Tejshree Singh
- New Delhi
- Thankam R Varma
- Chennai
- Trupti Nadkarni
- Mumbai
- Uday Thanawala
- Navi Mumbai
- Uma Vaidyanathan
- New Delhi
- Urvashi Prasad Jha
- New Delhi
- Urvashi Verma
- Agra
- Usha B Saraiya
- Mumbai
- Usha R Krishna
- Mumbai
- Vandana Chadda
- New Delhi
- Vandana G Shetty
- Mumbai
- Vandana Walvekar
- Mumbai
- Vijay Pawar
- Mumbai
- Vijay Mangoli
- Mumbai
- Vimla P Pawar
- Mumbai
- Vinita Das
- Lucknow
- Vivek M Joshi
- Pune
The popularity of Principles and Practice of Obstetrics and Gynecology for Postgraduates has made us come out with the fourth edition.
In the rapidly advancing field of Obstetrics and Gynecology, new techniques, new treatments and modifications are happening rapidly.
A postgraduate student has to read many references, journals, Internet updates to keep abreast with all the rapid changes.
This comprehensive multicontributor book, compiled by the members and the examiners of our own Federation of Obstetric and Gynaecological Societies of India (FOGSI), and updated by newly passed postgraduates and young lecturers, provides an in-depth, researched write-up on all the issues of obstetrics and gynecology.
The contributors have thoroughly researched and prepared the chapters along with clinical experiences and situations and cases peculiar to our country.
We are confident that this FOGSI textbook will be the main textbook for postgraduates in the field of obstetrics and gynecology. Not applicable only to students, we feel the textbook will be a referral guide for the busy practitioners also.
With due humility, we present the fourth updated edition of the Principles and Practice of Obstetrics and Gynecology for Postgraduates.
Narendra Malhotra
PK Shah
Hema Divakar
Saroj Singh
Jaideep Malhotra
15Preface to the First Edition
The field of Obstetrics, Gynecology and Family Welfare is a dynamic one. The truisms of yesterday are the questions of today and hopefully, the truths of tomorrow.
In this age of rapidly growing information and technology, there have been many noteworthy advances in the recent years which have had a major impact on the practice of Obstetrics and Gynecology changing social and cultural environment has brought with it different needs and expectations of the society from our specialty.
New technologies for diagnosis, treatment and prevention of disorders of the fetus have burgeoned in modern obstetrics, which has grown from the concept of merely assisting childbirth into a highly specialized field. The fetus as a patient has now become a reality for the obstetricians. Principles and Practice of Obstetrics and Gynecology for Postgraduates is the product of our attempt to advance these objectives.
This book has been written keeping in view the latest concept in the understanding of various obstetrics and gynecological conditions as well as their management, without omitting the basic principles and their applied pathophysiology. The text covers extensively topics relevant to the Indian context, like malaria, jaundice and other infections in pregnancy, which are rampant in the developing countries. Management of obstructed labor and the art instrumental delivery is still pertinent in our set-up. These are dealt with by the masters of these old and dying skills.
The reader is also apprised of the state-of-the-art technology in modern obstetrics and gynecology involving transvaginal ultrasonography, color Doppler, fetal surveillance and intrauterine interventions. The concept of auditing maternal morbidity and mortality has also been introduced to lay a firm foundation of clinical research and promote a logical approach instead of blindly following the traditional and irrational practices.
The authors have done a meticulous survey of the current literature and have amalgamated it with their rich experience to make the text a pleasurable reading. It has been our endeavor to see that the content of the book is both current and comprehensive; and this volume serves as a basic textbook for the postgraduates and as a handy reference for the practitioners.
In order to be a teacher, one must always be a student. Compiling and editing the book has been a personal learning experience.
Kamal Buckshee
Vasant B Patwardhan
Rustom P Soonawala