Editors Suchitra N Pandit MD DNB FRCOG(UK) FICOG DFP MAMS BPharm Senior Consultant and Head Obstetrician and Gynecologist Kokilaben Dhirubhai Ambani Hospital and Research Center Mumbai, Maharashtra, India
President, FOGSI (2014–2015) President, MOGS (2013–2014) Vice Chairman, ICOG Chairperson, Young Talent Promotion Committee FOGSI (2003–07)
Reena J Wani MD MRCOG FICOG DNBE FCPS DGO DFP Additional Professor and Unit Head Department of Obstetrics and Gynecology Dr RN Cooper Municipal Medical College and Hospital
Chairperson, Perinatology Committee FOGSI 2015–17 Ex-Professor (Addl) I/C Family Welfare Program
Department of Obstetrics and Gynecology TN Medical College and BYL Nair Charitable Hospital Mumbai, Maharashtra, India
Co-editors Gorakh G Mandrupkar MBBS DGO FCPS FICMCH FICOG Joint Secretary, FOGSI 2014 Director and Consultant Reproductive Medicine, Mandrupkar Clinic Honorary IVF Consultant
Bharati Medical College and Hospital, Pune Shraddha Women's Hospital, Kolhapur Bichakar Nursing Home, Karad Kothawle Hospital, Miraj
Madhuri Mehendale MBBS DGO FCPS DNB
Assistant Professor Lokmanya Tilak Medical College and General Hospital Mumbai, Maharashtra, India Managing Comittee Member, MOGS
Rakhee R Sahu MD DGO FCPS Diploma in Endoscopy (Germany) Consultant Obstetrician and Gynecologist Dr LH Hiranandani Hospital Ex Associate Professor, Nowrosjee Wadia Maternity Hospital Mumbai, Maharashtra, India
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Manual for Obstetrics and Gynecology Practitioners
First Edition: 2015
9789351527626
Printed at
5Dedication to
7Contributors
-
Ameya Purandare MD DNB FICOG FCPS DGO DFP MNAMS
- Consultant Obstetrician and Gynecologist Purandare, Bombay and Masina Hospitals and KJ Somaiya Medical College
- Mumbai, Maharashtra, India
- Chairperson, Food, Drugs and Medico
- Surgical Equipment Committee, FOGSI
- Secretary, Association of MOGS
- Member, Managing Committee, MOGS
-
Anahita Chauhan MD DGO DFP
- Obstetrician and Gynecologist
- Additional Professor and Unit Head
- Seth GS Medical College and KEM Hospital
- Honorary Consultant
- Saifee and St Elizabeth Hospitals
- Mumbai, Maharashtra, India
-
Anita S Chavan MD DNB DGO FCPS (Mumbai)
- Laparoscopy and Infertility
- Training (Japan)
- Consultant Gynecologist
- Obstetrician and Laparoscopic Surgeon
- BSES, Sujay and Criticare Hospital
- Kasturi Clinic, Andheri (W)
- Mumbai, Maharashtra, India
- Ankesh R Sahetya MB DNB DGO
- Senior Registrar
-
Arun Nayak MD DGO FICOG
- Fellowship in Endoscopic
- Surgery (Korea)
- Professor, Lokmanya Tilak
- Medical College and General Hospital
- Sion, Mumbai, Maharashtra, India
- President, Association of Fellow
- Gynecologists, 2014
- Vice President, MOGS 2014
- President Elect, MOGS 2015
- Fellowship in Endoscopic Surgery (Korea)
-
Ashwini Bhalerao Gandhi MD DGO DFP FCPS DNB FICOG
- Vice President, FOGSI 2013
- President MOGS 2012–2013
- Chairperson, Adolescent
- Health Committee of FOGSI 2004–2008
- Consultant Gynecologist, PD Hinduja
- Hospital and Hinduja Healthcare Surgical
- Ex-Associate Professor, TN Medical College and BYL Nair Charitable
- Mumbai, Maharashtra, India
-
Aswath Kumar R MBBS MD FICOG
- Professor, Obstetrics and Gynecology
- Jubilee Mission Medical College
- Thrissur, Kerala, India
- Chairperson-Quiz Committee, FOGSI
- Baraturam Bhaisara MD
- Assistant Professor
- Department of Pediatrics
- Dr RN Cooper Hospital
- Mumbai, Maharashtra, India
-
Bhaskar Pal DGO MD DNBE FICOG FRCOG
- Senior Consultant
- Obstetrics and Gynecology
- Apollo Gleneagles Hospital
- Kolkata, West Bengal, India
-
Chanchal Singh MD(Ob/Gyn) MRCOG
- Clinical Fellow
- Maternal Fetal Medicine (Singapore)
- Consultant
- Fetal Medicine
- Indraprastha Apollo Hospital
- New Delhi, India
-
Charulata V Londhe
- Assistant Professor
- Medicine Department
- TNMC and BYL Nair Charitable Hospital
- Mumbai, Maharashtra, India
- Deepa Kala MD (OBGY)
- Associate Professor Terna
- Medical College and Hospital
- Mumbai, Maharashtra, India
-
Deepali P Kale MBBS DGO (MUHS) DGO (CPS) FCPS DNBE FMAS
- Assistant Professor
- Seth GS Medical College and Nowrosjee Wadia Maternity Hospital
- Mumbai, Maharashtra, India
- Dilip B Walke MBBS MD
- Founder Director and Consultant
- Gynecology and Obstetrics
- Aster Medipoint Hospital
- Pune, Maharashtra, India
-
Ganesh Shinde MD
- Professor and Head
- Department of Obstetrics and Gynecology
- Dr RN Cooper Medical College
- Mumbai, Maharashtra, India
-
Garima Sharma
- Senior Resident
- Department of Obstetrics and Gynecology, LTMMC
- Mumbai, Maharashtra, India
-
Gauri Karandikar MD DGO FCPS
- Karandikar Hospital
- Mumbai, Maharashtra, India
-
Geeta Malkan-Billa MBBS MD DM DNB
- Consultant Hepatologist
- Hiranandani Hospital
- Mumbai, Maharashtra, India
-
Geeta Niyogi MBBS MD
- Dean and Professor
- Department of Obstertics and Gynecology
- KJ Somaiya Medical College and Hospital
- Mumbai, Maharashtra, India
-
Girija Wagh MD FICOG
- Professor and Head
- Department of Obstetrics and Gynecology
- Bharati Vidyapeeth University
- Medical College
- Pune, Maharashtra, India
- Chairman Medical Disorders in Pregnancy Committee, FOGSI
-
Gorakh G Mandrupkar MBBS DGO FCPS FICMCH FICOG
- Joint Secretary, FOGSI 2014
- Director and Consultant
- Reproductive Medicine
- Mandrupkar Clinic
- Honorary IVF Consultant
- Bharati Medical College and Hospital, Pune
- Shraddha Women's Hospital, Kolhapur
- Bichakar Nursing Home, Karad
- Kothawle Hospital, Miraj
-
Hema Divakar MD FICMCH FICOG
- Consultant
- Divakar's Speciality Hospital
- Jatinder Kaur DNB DGO
- Clinical Associate
- Kokilaben Dhirubhai Ambani Hospital and Research Hospital
- Member Youth Council, MOGS
- Mumbai, Maharashtra, India
- Jay Mehta MBBS DNB Trainee
- Obstetrics and Gynecology
- Jubilee Mission Medical College
- Thrissur, Kerala, India
- Jyotsna Suri
- Assistant Professor
- VMMC and Safdarjung Hospital
- Delhi
-
Kartikeya Bhagat MD FICOG IBCLC
-
Kawita Bapat MBBS MS FICOG
- Bapat Hospital
- Indore, Madhya Pradesh, India
-
Kirti Bendre
- Associate Professor
- Department of Obstetrics and Gynecology
- KJ Somaiya Medical College and Research Centre
- Mumbai, Maharashtra, India
- Komal
- Clinical Assistant
- Dr LH Hiranandani Hospital
- Mumbai, Maharashtra, India
-
Kranti Kulkarni DGO DNB FCPS
- Assistant Professor
- Terna Medical College and Hospital
- Mumbai, Maharashtra, India
- KR Damania MD DNB DGO FCPS DFP
- Professor and Unit Head
- Department of Obstetrics and Gynecology
- Nowrosjee Wadia Maternity Hospital and Seth GS Medical College
- Mumbai, Maharashtra, India
-
KV Malini
- Professor and Head
- Deparment of Obstetrics and Gynecology, BMCRI
- Bengaluru, Karnataka, India
- M Padmaja DGO MD MRCOG
- Consultant Obstetrics and Gynecology
- Apollo Gleneagles Hospital
- Kolkata, West Bengal, India
-
Madhuri Chandra MD DNB FICOG
- Professor
- Obstetrics and Gynecology
- Gandhi Medical College
- Bhopal, Madhya Pradesh, India
- Chairperson, HIV AIDS
- Committee, FOGSI
-
Madhuri Mehendale MBBS DGO FCPS DNB
- Assistant Professor
- Lokmanya Tilak Medical College and General Hospital
- Mumbai, Maharashtra, India
- Managing Comittee Member, MOGS
-
Madhushri Pandey MS (OBG)
- Clinical Associate
- PD Hinduja Hospital and Hinduja Healthcare Surgical
- Mumbai, Maharashtra, India
- Mahija Sahu
- Associate Professor
- Department of Obstetrics and Gynecology
- SCB Medical College
- Cuttack, Odisha, India
-
Mala Arora MBBS D’Obst DA MRCOG FRCOG
- Consultant Gynecologist and Specialist
- Infertility and IVF, Noble Hospital
- Faridabad, Haryana, India
-
Mandakini Pradhan MD (OBG) DNB (OBG) DM (Med Genetics)
- Professor and Head
- Department of Maternal and Reproductive Health, SGPGIMS
- Lucknow, UP, India
-
Maninder Ahuja MBBS DGO FICOG
- President, IMS 2014-2015
- Vice President
- FOGSI 2013-2014
- Deputy Secretary General, SAFOMS
- Director, Ahuja Hospital and Infertility Center
- Faridabad, Haryana, India
-
Manpreet Kaur J Tehalia MBBS MS (OBG)
- Professor, Obstetrics and Gynecology
- Shri BM Patil Medical College
- Bijapur, Karnataka, India
- Maya Padhi
- Professor
- Department of Obstetrics and Gynecology
- SCB Medical College
- Cuttack, Odisha, India
- Minal Wade MD DCH
- Associate Professor
- Incharge
- Department of Pediatrics
- Dr RN Cooper Medical College and Municipal General Hospital
- Mumbai, Maharashtra, India
- Mukesh R Rathi MD DNB DGO FCPS FICMCH
- LM Hospital
- Akola, Maharashtra, India
-
Namrata Mehta Rajput MS DGO DNB
- Consultant Obstetrician and Gynecologist
-
Nidhi Kalkal
- 3rd Year MS Resident
- Lokmanya Tilak Municipal
- Medical College
- Mumbai, Maharashtra, India
- Nishita Parekh DNB
- Lecturer
- Nowrosjee Wadia Maternity Hospital
- Mumbai, Maharashtra, India
-
Nozer Sheriar MD DNB FICOG FCPS DGO
- Consultant Obstetrician and Gynecologist
- Breach Candy Hinduja Healthcare
- Holy Family, and Masina Hospitals
- Secretary General and Past Chairperson
- MTP Committee, FOGSI
- Past President, MOGS
- Member, Board of Directors
- Ipas and CEDPA India
- Member, Medical Advisory Panel, FPA India
-
Parag Biniwale MD FICOG FICMCH
- Consultant Obstetrics and Gynecology
- Pune, Maharashtra, India
-
PD Tank MD DNBE FCPS DGO DFP MNAMS MICOG MRCOG
- Honorary Clinical Associate
- Nowrosjee Wadia
- Maternity Hospital
- Ashwini Maternity and Surgical Hospital
- Center for Endoscopy and IVF
- Mumbai, Maharashtra, India
-
Prasad Yeshwant Deshmukh
- Assistant Professor
- Obstetrics and Gynecology
- LTMG Hospital and Medical College Sion
- Mumbai, Maharashtra, India
-
Prashant Gangal MD DCH IBCLC
- Consultant Pediatrician
- Pratima Mittal
- HOD and Consultant
- VMMC and Safdarjung Hospital
- New Delhi, India
-
Priti Vyas MD (OBGY) FCPS FICOG MSc (Psychological Counseling and Therapy)
- Consultant, Laparoscopic Surgeon and Fertility Specialist
- Expert in Women's Intimacy Issues
- National Coordinator, FOGSI Youth Mela
-
Priyanka Singh MS
- Registrar
- Gynecological Oncology
- Chittaranjan National Cancer
- Institute
- Kolkata, West Bengal, India
- Purnima Satoskar MD DNB MRCOG
- Professor and Head of Unit
- Nowrosjee Wadia Maternity Hospital and Seth GS Medical College
- Consultant, Jaslok Hospital and Research Center
- Mumbai, Maharashtra, India
-
Rachna Bhagat MD DGO IBCLC
- Consultant
- Grace Maternity and Nursing Home
- Raju R Sahetya
-
Rakhee R Sahu MD DGO FCPS
- Diploma in Endoscopy (Germany)
- Consultant Obstetrician and Gynecologist
- Dr LH Hiranandani Hospital
- Ex Associate Professor
- Nowrosjee Wadia Maternity Hospital
- Mumbai, Maharashtra, India
-
Rashmi Khadkikar MD DGO
- Assistant Professor
- Seth GS Medical College and KEM Hospital
- Mumbai, Maharashtra, India
-
Reena J Wani MD MRCOG FICOG DNBE FCPS DGO DFP
- Additional Professor and Unit Head
- Department of Obstetrics and Gynecology
- Dr RN Cooper Municipal
- Medical College and Hospital
- Chairperson, Perinatology Committee
- FOGSI 2015–17
- Ex-Professor (Addl), I/C Family Welfare
- Program
- Department of Obstetrics and Gynecology
- TN Medical College and BYL Nair Charitable Hospital
- Mumbai, Maharashtra, India
- Ritu Joshi
- Honorary Consultant
- Monilek Hospital and Fortis Escorts
- Vice President, FOGSI 2014
- Jaipur, Rajasthan, India
-
Sadhana Gupta MS FNAMS FICMU FICOG FICMCH
- Chairperson
- Safe Motherhood Committee
- FOGSI 2011–2013
- Senior Consultant, Obstetrics and Gynecology
- Jeevan Jyoti Hospital and Medical Research Center
- Gorakhpur, Uttar Pradesh, India
- Sanjay B Rao MBBS DNBE MD MRCOG MRCPI FCPS DGO DFP MICOG PG Dip Med Ed
- Consultant Obstetrician and Gynecologist
- College Tutor, The James Cook University
- Hospital, South Tees NHS Foundation Trust
- Middlesbrough, United Kingdom
- Sanjay Gupte MD DGO FICOG LLB FRCOG
- President, FOGSI 2010
- President, DIPSI 2013
- National Convener “Save the Mother and Newborn National Initiative”
- Secretary, General World Gestosis
- Organization
- Member, Central Supervisory Board of PCPNDT Act
- Member Ethics Committee
- Medical Council India
- Chairman, Ethics Committee of Maharashtra
- Medical Council
- Ex-Honorary Associate Professor
- BJ Medical College
- Director, Gupte Hospital and Center for Research in Reproduction
- National Consultant in Medicolegal and Ethical Issues in Obstetrics and Gynecology
-
Saswati Sanyal Choudhury MD FICOG FICMCH
- Associate Professor
- Gauhati Medical College
- Guwahati, Assam, India
- Seema Jain
- Honorary Consultant
- Cocoon Hospital
- Jaipur, Rajasthan, India
-
Seetha Pal DGO MD MRCOG
- Dip in Obstetric Ultrasound
- Consultant
- Apollo Gleneagles Hospital
- Kolkata, West Bengal, India
-
Sheela Mane MD FICOG FICMCH
- Consultant
- Anugraha Nursing Home
- Bengaluru, Karnataka, India
- Vice President, FOGSI 2014
- Chairperson, Safe Motherhood Committee
- FOGSI 2008-2011
- Past President, BSOG 2005-2006
- National Facilitator Adolescent Health (WHO)
- Secretary, IMS, Bangalore Chapter 2012–2014
- National Corresponding Editor
- Journal of Obstetrics and Gynecology of India
-
Sneha Trivedi DNB OBGY
- Assistant Professor
- Department of Obstetrics and Gynecology
- Kashibai Navale Medical College
- Pune, Maharashtra, India
-
Sonal Bathla MBBS (Gold Medalist) MD FICOG FICMCH FIMSA
- Joint Secretary, IMS
- Co-ordinator Project Prolapse
- OKTI
- Foundation
- Senior Consultant, Sant Parmanand Hospital
- Delhi, India
-
Suchitra N Pandit MD DNB FRCOG(UK) FICOG DFP MAMS BPharm
- Senior Consultant and Head
- Obstetrician and Gynecologist
- Kokilaben Dhirubhai Ambani Hospital and Research Center
- Mumbai, Maharashtra, India
- President, FOGSI (2014–2015)
- President, MOGS (2013–2014)
- Vice Chairman, ICOG
- Chairperson, Young Talent
- Promotion Committee
- FOGSI (2003–07)
-
Sujata Sharma
- Professor and Head
- Department of Obstetrics and Gynecology
- Government Medical College
- Amritsar, Punjab, India
-
Sushma Malik MD IBCLC FIAP
- Professor
- Incharge, Neonatology
- Division of Neonatology
- Department of Pediatrics
- TN Medical College and BYL Nair
- Charitable Hospital
- Mumbai, Maharashtra, India
-
Tanvi Tuteja
- Assistant Professor
- Department of Obstetrics and Gynecology
- KJ Somaiya Medical College and Hospital
- Mumbai, Maharashtra, India
-
Uday Thanawala MD FCPS DNB
- Chairman
- Thanawala's Materity Home
- Vashi, Navi Mumbai
- Maharashtra, India
- Vandana Bansal MD DGO DNB MRCOG FNB
- (High Risk Pregnancy and Perinatology)
- Associate Professor
- Department of Obstetrics and Gynecology
- Nowrosjee Wadia Maternity Hospital, and Seth GS Medical College
- Mumbai, Maharashtra, India
- Vanita S Raut MD DGO
- Consultant Gynecologist and Obstetrician
- Dr LH Hiranandani Hospital
- Mumbai, Maharashtra, India
-
Vidya A Thobbi MD
- Professor and Head
- Department of Obstetrics and Gynecology
- Al Ameen Medical College
- Bijapur, Karnataka, India
- Vijay Pawar MBBS MD (Gyn and Obs) DNB (Gyn and Obs) DFP DGO FCPS MNAMS
- Assistant Professor
- Department of Obstetrics and Gynecology
- Dr VM Goverment Medical College
- Solapur, Maharashtra, India
-
Vikram A Londhe
- Associate Professor
- Medicine Department and Rheumatology Clinic
- TNMC and BYL Nair
- Charitable Hospital
- Visiting Consultant Rheumatologist
- Mumbai, Maharashtra, India
-
Zenab H Tambawala MS DGO(CPS)
- Honorary Consultant
- Obstetrics and Gynecology
- Reproductive Endocrinology and Infertility Clinic
- National Institute of Research in Reproductive Health
- Ex-Assistant Professor
- Nowrosjee Wadia Maternity Hospital
- Mumbai, Maharashtra, India
“It is a most gratifying sign of the rapid progress of our time that our best textbooks become antiquated so quickly”
—Theodore Billroth
It has been found that in day-to-day practice, there are common clinical situations and scenarios that the practitioner encounters but often there is no clear-cut consensus on what should be done for the given situation. Hence, we felt the need to come up with a handbook of standard investigation and treatment protocols which can be applied in practice. This should serve as a ready reckoner which can help quick decision making in common situations, and as a guide to what should be done when things do not go well.
“ Only he that has travelled the road, knows where the holes are deep…”
—Old Chinese Proverb
Development of subspecialities like infertility, fetal medicine or urogynecology or endoscopy is now the norm in most institutes. Most budding gynecologists want to superspecialize—Whom does the average female patient approach for “gynecological” problems? Similarly should the average practitioner deal with specific situations where further expertise may be available? In this handbook, we have tried to cover both common and certain special situations with the help of experts in their fields. The attempt is also to suggest when a case should be referred.
Medicolegal issues and challenges faced by practitioners are becoming more common and practice today is more defensive. Should bodies like FOGSI have guidelines for practice? The implications of laying down guidelines are heavy and since medicine is not an exact science, what may apply to one case may not be relevant to another. Hence, friends we offer this handbook merely as a framework for your good clinical practice, but remember that individual cases may throw situations where you can modify the treatment as needed.
“ Nothing is permanent other than change….”
—Heraclitus
Finally, we the editorial team would like to say that we have put together the best and latest information available at the present time…this may need to be changed a few years down the line. Till then friends, Happy Reading!!!
Editors
Suchitra N Pandit
Reena J Wani
Co-Editors
Gorakh G Mandrupkar
Madhuri Mehendale
Rakhee R Sahu
15Acknowledgments
“The longer you can look back, the further you can look forward…”
—Sir Winston Churchill
FOGSI is a body of now nearly 30,000 obstetricians and gynecologists, but from the inception there have been so many brilliant teachers, masterful surgeons and gifted clinicians who have been leading lights in our field. As editors, we acknowledge the vast contributions of all our seniors, mentors and teachers who have helped shape the academic aspects of FOGSI and inspired us to put together this handbook.
In particular we would like to thank the following people without whom this book would not have been possible:
- Our contributors who put in time and effort for putting together evidence-based guidelines
- Our co-editors, Dr Gorakh G Madrupkar, Dr Madhuri Mehendale and Dr Rakhee R Sahu who worked hard chasing deadlines
- Team Jaypee especially Sabarish who helped co-ordinate everything
- Colleagues who bore with the increased demand on our time and covered for us at work
- In particular, our families who patiently (most of the time!) tolerated us spending extra personal time on this venture namely:
- Dr Jatin Wani, Varun and Komal Wani
- Mrs Shailaja N Pandit
- Last but not least, you dear reader who is the reason the handbook came into existence!!