Richa Saxena MBBS MD (Obstetrics and Gynecology)
Obstetrician and Gynecologist
New Delhi, India
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© 2015, Jaypee Brothers Medical Publishers
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A Practical Guide to Obstetrics & Gynecology
First Edition: 2015
9789351524793
Printed at
5Dedication
Dedicated to all the women, especially to the woman whom I admire the most, my mother, “Mrs Bharati Saxena”
“A woman is the full circle. Within her is the power to create, nurture and transform.”
7Preface
“If you don't believe in miracles, perhaps you have forgotten that you are one.”
—God
Childbirth can be considered as one of the most miraculous and mesmerizing processes of nature. While being extremely glorious and magnificent, it is equally intricate and complex. When undergraduate students first encounter a childbirth in the labor room, they are likely to get awestruck; even I was. To visualize how the baby's head negotiates through the delicate narrow maternal passage after undergoing a series of pre-decided movements is indeed marvellous. An undergraduate student who for the first time enters the labor room must understand that childbirth is not as difficult as may appear at the first glance, but a series of clever maneuvers which the passenger (the baby) undertakes while passing through the slender maternal passage (maternal pelvis) to complete its journey (childbirth).
Childbirth can be considered as a story illustrating the journey (process of childbirth) of a passenger (the baby), traveling via maternal passage. This is what the book, “A Practical Guide to Obstetrics & Gynecology” aims to offer by providing the complete coverage of all practical aspects of obstetrics and gynecology from both examination and viva point of view. This is not a quick-read handbook just before examinations, but a complete manual, which would serve as a comprehensive guide for undergraduate students. The book would not only be extremely useful for the undergraduates preparing for the practical/viva examination, but will also aid the postgraduate and DNB students for brushing up their basics. The book covers all important topics encountered by a student at the time of practical viva examination: history taking and examination in both obstetrics and gynecology; important clinical cases in obstetrics and gynecology; normal labor room and operation theater (OT) procedures; important drugs used in obstetrics and gynecology; contraception; imaging; instruments and specimens in obstetrics and gynecology. The book also features an appendix at the end covering useful topics such as nutritional values, biochemistry and hematological parameters.
Writing a book is a colossal task. It can never be completed without divine intervention and approval. Therefore, I have decided to end this preface with a small prayer of thanks to the Almighty, which I was taught in my childhood.
“Father, lead me day by day, ever in thy own sweet way.
Teach me to be pure and good and tell me what I ought to do.”
—Amen
Simultaneously, I would like to extend my thanks and appreciation to all the related authors and publishers whose references have been used in this book. Book creation is teamwork, and I acknowledge the way the entire staff of M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India, worked hard on this manuscript to give it a final shape. I would like to thank Shri Jitendar P Vij (Group Chairman), Jaypee Brothers Medical Publishers, for being the guiding beacon, and source of inspiration and motivation behind this book. I would also like to thank Mr Ankit Vij (President) and Mr Tarun Duneja (Director-Publishing). Last but not the least, I would also like to thank the entire staff of Jaypee Brothers, especially, Mr Nitish Kumar Dubey, Mr Amit Rai, and Mr Syed Amir Haider (Medical Editors) for editing the manuscript and coordinating the process of publication; Mr Vinod Kumar Sharma (DTP Operator) for typesetting the book; Mr Manoj Pahuja (Senior Graphic Designer) and Mr Vijay Singh (Graphic Designer) for making beautiful illustrations. May God bless them all!
I believe that writing a book involves a continuous learning process. Though extreme care has been taken to maintain accuracy while writing this book, constructive criticism would be greatly appreciated. Please e-mail me your comments at the email address: richa@drrichasaxena.com. Also, please feel free to visit my website www.drrichasaxena.com for obtaining information related to various other books written by me and to make use of the free resources available for the medical students.
Richa Saxena
9SPECIAL ACKNOWLEDGMENTS
Saunitra Inamdar MD
Professor
Department of Obstetrics and Gynecology
Jawaharlal Nehru Medical College, Wardha, Maharshtra, India
For providing pictures for Chapter 14 (Specimens in Obstetrics and Gynecology)
Kiran Agarwal MD FICOG
Associate Professor, Rohilkhand Medical College and Hospital
Pilibhit Bypass Road, Bareilly, India
Vice President, Rohilkhand Medical College and Hospital
Institute of Dental Sciences
Rohilkhand College of Nursing, Bareilly, India
11ABBREVIATIONS
ACE | : Angiotensin-Converting-Enzyme |
ACOG | : The American Congress of Obstetricians and Gynecologists |
AHA | : American Heart Association |
AIDS | : Acquired Immunodeficiency Syndrome |
ALT | : Alanine Aminotransferase |
APGAR | : Activity, Pulse, Grimace, Appearance and Respiration |
APH | : Antepartum Hemorrhage |
ART | : Assisted Reproductive Technology |
ASRM | : American Society for Reproductive Medicine |
AST | : Aspartate Aminotransferase |
AUB | : Abnormal Uterine Bleeding |
BMI | : Body Mass Index |
BP | : Blood Pressure |
BPP | : Biophysical Profile |
CBC | : Complete Blood Count |
CDC | : Centers for Disease Control and Prevention |
CNS | : Central Nervous System |
COCP | : Combined Oral Contraceptive Pill |
COPD | : Chronic Obstructive Pulmonary Disease |
D&C | : Dilatation and Curettage |
DLC | : Differential Leukocyte Count |
DUB | : Dysfunctional Uterine Bleeding |
EB | : Endometrial Biopsy |
EDD | : Expected Date of Delivery |
ESHRE | : European Society of Human Reproduction and Embryology |
ESR | : Erythrocyte Sedimentation Rate |
FGR | : Fetal Growth Restriction |
FSH | : Follicle-Stimulating Hormone |
GA | : General Anesthesia |
GnRH | : Gonadotropin-Releasing Hormone |
GPE | : General Physical Examination |
hCG | : Human Chorionic Gonadotropin |
HIV | : Human Immunodeficiency Virus |
HPV | : Human Papillomavirus |
HRT | : Hormone-Replacement Therapy |
HSG | : Hysterosalpingography |
IDA | : Iron-Deficiency Anemia |
IM | : Intramuscular |
ISSHP | : International Society for the Study of Hypertension in Pregnancy |
IUCD | : Intrauterine Contraceptive Device |
IUD | : Intrauterine Death |
IUGR | : Intrauterine Growth Restriction |
IV | : Intravenous |
IVF | : In Vitro Fertilization |
IVP | : Intravenous Pyelography |
KFT | : Kidney Function Test |
LA | : Local Anesthesia |
LDH | : Lactate Dehydrogenase |
LFT | : Liver Function Test |
LH | : Luteinizing Hormone |
LMP | : Last Menstrual Period |
LOA | : Left Occiput Anterior |
LOP | : Left Occiput Posterior |
LOT | : Left Occiput Transverse |
LSA | : Left Sacrum Anterior |
LSP | : Left Sacrum Posterior |
MCH | : Mean Corpuscular Hemoglobin |
MCHC | : Mean Cell Hemoglobin Concentration |
MCV | : Mean Corpuscular Volume |
MTP | : Medical Termination of Pregnancy |
NHBPEP | : National High Blood Pressure Education Program |
NPO | : Nil Per Os |
NSAIDs | : Nonsteroidal Anti-Inflammatory Drugs |
NST | : Nonstress Test |
OCP | : Oral Contraceptive Pill |
OPD | : Outpatient Department |
Pap smear | : Papanicolaou smear |
PCOD | : Polycystic Ovarian Disease |
PCR | : Polymerase Chain Reaction |
PCV | : Packed Cell Volume |
PGE2 | : Prostaglandin E2 |
PID | : Pelvic Inflammatory Disease |
PMS | : Premenstrual Syndrome |
PPH | : Postpartum Hemorrhage |
PPROM | : Preterm Premature Rupture of Membranes |
PROM | : Premature Rupture of Membranes |
PUBS | : Percutaneous Umbilical Cord Blood Sampling |
RCOG | : Royal College of Obstetricians and Gynaecologists |
ROA | : Right Occiput Anterior |
ROM | : Rupture of Membranes |
ROP | : Right Occiput Posterior |
ROT | : Right Occiput Transverse |
RSA | : Right Sacrum Anterior |
RSP | : Right Sacrum Posterior |
SC | : Subcutaneous |
STDs | : Sexually Transmitted Diseases |
TAH | : Total Abdominal Hysterectomy |
TAS | : Transabdominal Sonography |
TIBC | : Total Iron-Binding Capacity |
TLC | : Total Leukocyte Count |
TOLAC | : Trial of Labor after Cesarean |
TVS | : Transvaginal Sonography |
VBAC | : Vaginal Birth after Cesarean Delivery |
WHO | : World Health Organization |
WNL | : Within Normal Limits |