Editors Mala Arora FRCOG (UK) FICOG FICMCH
Director, Noble IVF Centre, Faridabad, Haryana, India
Consultant, Fortis La Femme, Greater Kailash, New Delhi, India
Alok Sharma MD DHA MICOG
Consultant, Obstetrics and Gynecology Deen Dayal Upadhyaya Hospital Shimla, Himachal Pradesh, India
Foreword Hema Divakar
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A Practical Guide to First Trimester of Pregnancy/ Eds. Mala Arora and Alok Sharma
First Edition: 2014
9789351521785
Printed at
5Dedications
This book is dedicated to my eternal guru Sri Paramhansa Yogananda, founder of Self Realization fellowship (USA) and Yogoda Satsanga Society (India). His invisible guidance was vital for the completion of this manuscript.
My parents who have laid the foundation stone of literacy in me.
My husband Dr Narinder Pal who has not only allowed me to concentrate on my writing but has guided me at every step.
My children who have made me proud by out shining me in every aspect.
Mala Arora
My parents, Smt Dhanwanti Sharma and Shri Hansraj Sharma for shaping my character in my formative years.
My wife, Dr Pratibha Sharma for her immense patience and guidance.
My lovely daughter, Hiranya Sharma.
Alok Sharma
11Contributors
Editors
- Mala Arora frcog (uk) ficog ficmch
- Director, Noble IVF Centre, Faridabad
- Haryana, India
- Consultant, Fortis La Femme, Greater Kailash
- New Delhi, India
- Alok Sharma md dha micog
- Consultant, Obstetrics and Gynecology
- Deen Dayal Upadhyaya Hospital
- Shimla, Himachal Pradesh, India
Contributing Authors
- Prashant Acharya md ficog
- Consultant, Fetal Medicine and High Risk Obstetric care
- Paras Advanced Centre for Fetal Medicine
- Ahmedabad, Gujarat, India
- Ashini Acharya md
- Consultant, Fetal Medicine and High Risk Obstetric Care
- Paras Advanced Centre for Fetal Medicine
- Ahmedabad, Gujarat, India
- Sarita Agarwal md ficog fiams fcgp
- Professor and Head, Department of Obstetrics and Gynecology
- All India Institute of Medical Sciences
- Raipur, Chhattisgarh, India
- Maninder Ahuja dgo ficog
- Director, Ahuja Hospital and Infertility Centre
- Visiting Consultant, Asian Institute of Medical Sciences
- Faridabad, Haryana, India
- Ananya Banerjee md
- Senior Resident, Department of Obstetrics and Gynecology
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Kanthi Bansal md dgo ficog
- Director, Safal Fertility Foundation
- Ahmedabad, Gujarat, India
- Punita Bhardawaj md
- Senior Consultant, Division of Minimally Invasive Gynecology
- Institute of Minimal Access, Metabolic Surgery
- Max Hospital, Saket
- New Delhi, India
- Subhash C Biswas md ficog fimsa
- Professor and Head, Department of Obstetrics and Gynecology
- Burdwan Medical College
- Rahul Chauhan md
- Senior Resident, N Wadia Maternity Hospital
- Mumbai, Maharashtra, India
- Sagnika Dash mbbs
- Junior Resident
- CSS College of Obstetrics, Gynecology and Childhealth
- Kolkata, West Bengal, India
- Deepali Dhingra md
- Senior Resident, Department of Obstetrics and Gynecology
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Bharati Dhorepatil dnb dgo diploma endoscopy (germany) fics pgdcr
- Director and Chief IVF Consultant
- Pune Fertility Centre
- Pune, Maharashtra, India
- Yogita Dogra md
- Registrar, Kamla Nehru State Hospital for Mother and Child
- IGMC, Shimla, Himachal Pradesh, India
- Kusum G Kapoor md ficog fics
- Consultant, Obstetrics and Gynecology
- Ex Professor and Head, Department of Obstetrics and Gynecology
- Nalanda Medical College Hospital
- Patna, Bihar, India
- Anupam Gupta ms ficmu ficmch
- Consultant, Aakanksha Test Tube Baby Centre
- Agra, Uttar Pradesh, India
- Sadhana Gupta ms mnams ficog ficmu ficmch
- Senior Consultant, Jeevan Jyoti Hospital and Medical Research Centre
- Gorakhpur, Uttar Pradesh, India
- Ritu Joshi ms
- Honorary Consultant, Obstetrics and Gynecology
- Monilek Hospital and Research Centre
- Consultant, Fortis Escorts Hospital
- Jaipur, Rajasthan, India
- Ashis K Mukhopadhyay md
- Professor and Unit-in-Charge, Obstetrics and Gynecology
- Medical Superintendent-cum-Vice Principal
- CSS College of Obstetrics, Gynecology and Childhealth, Kolkata, West Bengal, India
- Anita Kaul md
- Senior Consultant, Apollo Centre for Fetal Medicine
- Indraprastha Apollo Hospitals
- New Delhi, India
- Krishna Kavita Ramavath md ficog
- Physician Observer Fellow, Gynec-Oncology, Doctors Hospital, Baptist Hospital
- South Florida, Miami, USA
- Pratap Kumar md dgo fics figog
- Professor, Department of Obstetrics and Gynecology
- Kasturba Medical College, Manipal University
- Manipal, Karnataka, India
- S Shantha Kumari md
- Professor, Obstetrics and Gynecology
- Deccan College of Medical Sciences
- Hyderabad, Andhra Pradesh, India
- Kiran Kurtkoti dgo dnb
- Kurtkoti Nursing Home
- Pune, Maharashtra, India
- Pooja Lodha dnb fellow, fetal medicine and fetal therapy
- Lead Consultant
- Deparment of Fetal Medicine and Fetal Therapy
- Pragya M Choudhary dffp mrcog (london) phd micog
- Consultant, Obstetrics and Gynecology
- NuLife Test Tube Baby Centre
- MGM Hospital and Research Centre
- Patna, Bihar, India
- Asmita M Rathore md mrcog
- Director, Professor, Department of Obstetrics and Gynecology, Maulana Azad Medical College and LNJP Hospital, New Delhi, India
- Nalini Mahajan md mmedsci (art ficog)
- Director, Mother and Child Hospital
- New Delhi, India
- Sujata Misra md ficog
- Associate Professor, Department of Obstetrics and Gynecology
- SCB Medical College
- Cuttack, Odisha, India
- Bhavana Mittal fnb, mnams, post doctoral fellow in reproductive medicine art
- Consultant, Shivam Surgical and Maternity Centre
- Delhi
- Pushpanjali Institute of IVF and Infertility
- Ghaziabad, Uttar Pradesh, India
- Neela Mukhopadhaya mbbs dgo (india) mrcog (uk) figog (india) drmch (uk)
- Consultant, Obstetrics and Gynecology
- Luton and Dunstable Teaching Hospital
- Lewsey Road, Luton, United Kingdom
- Sudhanshu Nanda md
- Consultant, Obstetrics and Gynecology
- Cuttack, Odisha, India
- Roza Olyai ms micog ficmch ficog
- Director, Olyai Hospital
- Gwalior, Madhya Pradesh, India
- Ram P Dey md dch micog
- Assistant Professor, Department of Obstetrics and Gynecology
- IPGMER and SSKM Hospital
- Kolkata, West Bengal, India
- Deepali P Kale dnbe fcps dgo (muhs) dgo (cps)
- Assistant Proffessor, Nowrosjee Wadia Maternity Hospital and Seth GS Medical College
- Parel, Mumbai, Maharashtra, India
- Bhaskar Pal dgo md dnb ficog frcog
- Senior Consultant, Obstetrics and Gynecology
- Apollo Gleneagles Hospital
- Kolkata, West Bengal, India
- Seetha Ramamurthy Pal dgo md mrcog rcog/rcr diploma in advanced obstetric ultrasound
- Consultant, Obstetrics and Gynecology
- Apollo Gleneagles Hospital
- Kolkata, West Bengal, India
- Suchitra N Pandit md dnbe frcog ficog dfp mnams: b pharm
- Consultant, Obstetrics and Gynecology
- Kokilaben Dhirubhai Ambani Hospital and Research Centre
- Mumbai, Maharashtra, India
- Harshad Parasnis md dnb fcps dgo ficog
- Consultant Gynecologic Oncologist
- Honorary Associate Professor
- Bharati Vidyapeeth Medical College
- Pune, Maharashtra, India
- Madhuri Patel md dgo ficog
- Honorary Consultant, N Wadia Maternity Hospital
- Mumbai, Maharashtra, India
- MC Patel md
- Gynecologist and Medicolegal Counsellor
- Niru Maternity and Nursing Home
- Deepali Patil md dgo fcps
- Consultant, Obstetrics and Gynecology
- Shri Mahalaxmi Nursing Home
- Kolhapur, Maharashtra, India
- Ameet Patki md dnb fcps ficog frcog (uk)
- Medical Director, Fertility Associates, Mumbai
- Consultant, Obstetrics and Gynecology
- Sir Harkisondas Hospital and Research Centre
- Hinduja HealthCare Surgicals
- Honorary Associate Professor, Obstetrics and Gynecology
- KJ Somaiya Medical College and Hospital
- Mumbai, Maharashtra, India
- Shashi Prateek md
- Professor and Head, Department of Obstetrics and Gynecology
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Reena Rani mbbs
- Postgraduate Student (Obstetrics and Gynecology)
- Maulana Azad Medical College
- New Delhi, India
- Aarti Rapol dnb dgo
- Assistant Consultant, Pune Fertility Centre
- Pune, Maharashtra, India
- Rajat Ray md
- Assistant Professor, Hi-Tech Medical College
- Rourkela, Odisha, India
- Suvarna S Khadilkar md dgo ficog
- Consultant, Gyne-Endocrinologist
- Bombay Hospital and Medical Research Centre
- Mumbai, Maharashtra, India
- Jayprakash Shah md ficog
- Rajni Hospital, Ahmedabad
- CIMS Hospital, Science City Road, Ahmedabad
- Akar IVF Centre Anand, Ahmedabad
- Gujrat, India
- Parth Shah md dgo fige
- Laproscopist and Fetal Medicine Expert
- Rajni Hospital
- Ahmedabad, Gujrat, India
- Shivani Singh md dnb fnb (reproductive medicine)
- Associate Consultant, Mother and Child Hospital
- New Delhi, India
- Sunita Tandulwadkar md (obgy) fics ficog dip in endoscopy (usa and germany)
- Head of the Department (Obstetrics and Gynecology), Ruby Hall Clinic
- Pune, Maharashtra, India
- Sangeeta Tejpuria md
- Consultant, Gynecologist and Infertility Specialist
- Rajashree Nursing Home
- Nagpur, Maharashtra, India
- Ajay V Valia md
- Consultant, Isha Hospital, Krishna Hospital
- Vadodra, Gujarat, India
- D Vidyadhari md
- Professor, Obstetrics and Gynecology
- Mediciti Medical College
- Hyderabad, Andhra Pradesh, India
Hema Divakar dgo md ficmch ficog pgdmle
President, FOGSI 2013
Senior Consultant, Divakar Speciality Hospital
JP Nagar, Bengaluru, India
Director, Mediscan Divakar's Ultrasound Training Program, Bengaluru, India
Eccentricity was once a prized attribute of famous clinicians. However, aberrations in obstetrics such as use of thalidomide resulting in tens and thousands of children with phocomelia have led to widespread reluctance on the part of couples to accept bland reassurances from the doctors. In these days of ready access to internet, one needs to justify one's choice of management.
Fortunately help is at hand. Dr Mala Arora and Dr Alok Sharma have done a superb job in persuading top class clinicians to summarize for us topics related to crucial issues in first trimester of pregnancy. This book is a collection and expansion of the very popular management options, to inform the reader and guide their practice. Our patients deserve it.
This book on “A Practical Guide to First Trimester of Pregnancy” is an essential read for all clinicians to help their patients embark on healthy foundations for the journey through a safe pregnancy and successful outcome. I congratulate Dr Mala Arora and Dr Alok Sharma, and all the authors for providing practical and insightful information for best practices in managing routine and complex situations in the first trimester.
17Preface
“The magical moment of creation of a new life ushers the first trimester”
It gives us immense pleasure to bring forth this ‘A Practical Guide to First Trimester of Pregnancy’. The first trimester is fraught with danger, with a 20% risk of losing the fetus during this time. It requires careful vigilance in patients with assisted conceptions, recurrent miscarriages, advanced maternal age, and preexisting medical disorders. Events of the first trimester lay the foundation, as well as seal the fate of a pregnancy. The booking visit is the most crucial visit for the obstetrician and the triaging of antenatal care is decided in the first trimester. We believe that if the first trimester is handled competently, it can save many adverse pregnancy outcomes for both, the mother and the baby.
In this issue, we have touched on all relevant aspects of the first trimester where the obstetrician may need guidance in decision making. First trimester is the platform on which obstetricians, fetomaternal specialists, endocrinologists, geneticists, sonologists, medical and surgical specialists, dieticians, endoscopists and IVF specialists converge, to ensure a healthy pregnancy.
This book is a practical guide to management of first trimester and its complications and incorporates a blend of accepted guidelines, practical inputs and recent advances. On the journey of pregnancy ‘Well Begun is half done!’
Mala Arora
Alok Sharma
19Acknowledgments
We are indebted to all the authors for their contribution to this book, who despite their busy schedule have provided outstanding, up-to-date, and evidence-based chapters on various aspects of first trimester of pregnancy.
We are especially thankful to Dr Surveen Ghumman who has helped us at the conception of the book in elaborating and refining the content list.
We wish to thank Mr JP Vij, CEO Jaypee Brothers Medical Publishers for his encouragement in bringing out this book. The editorial team under the able leadership of Dr Madhu Choudhary has extended excellent support to me and worked untiringly to shape up this manuscript.
Mala Arora
Alok Sharma