Manual of Postpartum Hemorrhage and High-Risk Pregnancy SN Tripathy, KC Mahapatra, SK Giri, Sheela Mane, Palaniappan, Sasmita Swain
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fm1Manual of Postpartum Hemorrhage and High-Risk Pregnancy
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Manual of Postpartum Hemorrhage and High-Risk Pregnancy
Editors SN Tripathy KC Mahapatra SK Giri Sheela Mane Palaniappan Sasmita Swain
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Manual of Postpartum Hemorrhage and High-Risk Pregnancy
First Edition: 2018
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fm4Contributors fm7Message
Rishma Dhillon Pai
MD DNB FCPS DGO FICOG
President, FOGSI—2017
Consultant Gynecologist
Jaslok Hospital, Lilavati Hospital and Hinduja Healthcare (Khar),
Bloom IVF Centre,
The Every Woman Clinic,
Mumbai, Maharashtra, India
“Wisdom…. comes not from age, but from education and learning.”
Life is a continuous process of learning. Especially in the field of medicine, which is constantly changing, it is very important to keep oneself abreast with the latest developments. It is heartening to note that academic workshop manuals are being released at the AICOG, Bhubaneswar, Odisha, India, for the benefit of the participating delegates and present varied updates in the field. Many different Manuals are being released on important subjects such as 3D Laparoscopy and Operative Oncology, Genetics, Fetal Medicine and Color Doppler, Postpartum Hemorrhage and High-Risk Pregnancy, Hysteroscopy, etc.
I thank all the authors, for their immense contributions in building up the content for the manuals for Federation of Obstetric and Gynaecological Societies of India (FOGSI) by sharing their rich experiences in the field. These will be a big help to young gynecologists, who are still acquiring skills in various aspects of obstetrics and gynecology and a quick update for the seniors.
I extend congratulations to the organizing team of the AICOG 2018 and the editors of these manuals and wish you all success for this mega event.
“You cannot open a book without learning something.”
Confucius
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Jaideep Malhotra
MD FICMCH FICS FMAS FRCOG FlCOG FRCPI FIAJAGO
Consultant ART (IVF)
President Elect, FOGSI—2018
Director, Rainbow IVF
Agra, Uttar Pradesh, India
“Education is greatest gift of life, it should never stop.”
The subject of obstetrics and gynecology needs extreme proficiency as it deals with the medical specialties that focus on two different aspects. First one includes the care of pregnant women, the unborn baby, labor and delivery, as well as the immediate period following childbirth. Second aspect includes dealing with any ailment concerning the female reproductive organs. Hence, the manuals will help all those who are looking forward to gain excellence in the field of woman health. The manuals have tried to address all the issues a doctor needs.
With increasing expertise in all fields, the surgeon therefore while exercising a choice needs to follow the Hippocratic dictum—“First, do no harm.”
We are thankful to all those who have incorporated their contribution by providing chapters from their research and collected scientific material and have shared their fruitful experiences for the delegates of the workshop.
As a part of my agenda for 2018, I as FOGSI President 2018, plan to work actively on QED (Quality, Ethics and Dignity) among our profession and also work towards HER (Health, Empowerment and Respect) towards our patients.
“Knowledge is of no value unless you put it into practices.”
fm9Message
Hrishikesh Pai
Secretary General, FOGSI
It is my proud privilege to invite and welcome all delegates to the 61st All India Congress of Obstetrics and Gynaecology (AICOG) from 17th–21st January, 2018 at the Temple City of India, Bhubaneswar, Odisha, India.
It is propitious to note that the academic workshop manuals are being released which will reap beneficial reward to all the participating delegates.
I thank all the authors, for their immense contributions in building up the content for the manuals for Federation of Obstetric and Gynaecological Societies of India (FOGSI) by sharing their rich experiences in the field. These will be a big help to young gynecologists, who are still acquiring skills in various aspects of obstetrics and gynecology and a quick update for the seniors.
I forward my heartiest congratulations to all the contributors, the editors and the delegates of the workshop.
fm10Message
PC Mahapatra
Professor
Department of Obstetrics and Gynecology
SCB Medical College
Cuttack, Odisha, India
President, FOGSI—2011
Organising Chairperson
It is my proud privilege to invite and welcome all delegates to the 61st All India Congress of Obstetrics and Gynaecology (AICOG) from 17th–21st January, 2018 at the Temple City of India, Bhubaneswar, Odisha, India.
The five days of academic extravaganza will certainly enrich the scientific knowledge of all participating delegates and faculty. The precongress workshop on various aspects of this specialty will be held on 17th January 2018.
A quote by Edwin Louis Cole says that “Winners are not those who never fail but those who never quit” is apt for all the clinicians who are determined enough to see and overcome all the difficulties that are faced in the field of obstetrics and gynecology.
Today, with the advancement in the field of obstetrics and gynecology, everyone requires an in-depth knowledge of the complex subjects associated with the field so as to gain excellence in it.
This manual will prove to be a boon to all those who are associated with the field and wants to gain more knowledge in the subject matter.
fm11Message
HP Pattanaik
Head
Department of Obstetrics and Gynecology
City Hospital
Cuttack, Odisha, India
Vice President, FOGSI—2009
Organising Secretary
Greetings from 61st AICOG 2018!
It is a matter of great pleasure to invite you all to 61st AICOG, from 17th–21st January, 2018 at the Temple City of India, Bhubaneswar, Odisha, India. The 11th Precongress workshops will be held on 17th January, 2018 in three medical colleges of Bhubaneswar.
It is propitious to note that the academic workshop manuals are being released which will reap beneficial reward to all the participating delegates.
It will also prove to be beneficial to the members of Federation of Obstetric and Gynaecological Societies of India (FOGSI), those who were unable to register themselves for the academic workshops.
I forward my heartiest congratulations to all the contributors, the editors and the delegates of the workshop.
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fm13Preface
The basic fact of today is the tremendous pace of change in human life.
Jawaharlal Nehru.
So also science is progressing in leaps and bounds. Still we are not able to predict postpartum hemorrhage (PPH). It is not very clear why some women develop atonic PPH and why some women do not? PPH affects approximately 2% of all women who give birth and is associated with nearly one quarter of all maternal deaths globally. The reported incidence of PPH in India is 2%–4% after vaginal delivery and 6% after cesarean section with uterine atony being the most common cause (50%).
The only management strategy even today is ‘watchful expectancy’ and act immediately when the problem arises. Simpler techniques like uterine massage, uterotonic drugs, and uterine packing and balloon tamponade can be practiced in low resource settings. Techniques like B-Lynch suturing, stepwise devascularization, internal iliac ligation and uterine artery embolization are available only at higher medical centers. These higher techniques are not within the reach of every parturient woman when simpler techniques fail. In low resource settings, unpredictable sudden massive bleeding makes it difficult to organize competent manpower, compatible blood and transport to higher medical center. Many times mothers die on roads while being transported to higher medical centers due to hypovolemic shock. Sometimes, women succumb to death just within 1–1.5 hours after the onset of bleeding. There is every need for a simpler and sure technique which can stop bleeding, or at least stop bleeding temporarily to buy some time to tide over the crisis.
To be frank, there is no high-risk group, but all pregnancies are at risk. Amongst them, there is a group who require a little more attention. Cardiovascular disease (CVD) affects 0.2–4% of pregnant women but account for one-third of all pregnancy-related deaths. The maternal mortality in CVD patients is about 1% which is 100 times more than the normal pregnant population. While modern medicine enables an increasing number of CHD patients to attain childbearing age, ischemic heart disease incidence is also rising due to advancing maternal age and risk factors (smoking, obesity, diabetes and hypertension. The magnitude of the problem is so great that it demand is the attention of all health care personnel involved in maternal and child care. Membrane rupture before labor and before 37 weeks of gestation is referred to as preterm prematrue rupture of membranes (PROM). Preterm prematrue rupture of membranes (PPROM) is far more difficult to manage than premature rupture of membranes at term. The condition increases fetal mortality and maternal morbidity. The management of PPROM depends on the balance between the risks for fetal and neonatal complications with immediate delivery versus the risks and benefits of conservative treatment.fm14 Jaundice in pregnancy has many etiologies. The condition must be properly evaluated. Proper management may improve maternal and fetal outcome. Twin pregnancy always poses problems, The problem anticipated and should be managed properly. As obstetrician are the first person to receive a baby during delivery, all of them should be trained in the art of neonatal resuscitation. Many such topics are included in the workshop and stalwarts in the field will enlighten us about the subjects. Listening, participating in a close group enhances our knowledge to a great extent. Knowledge is the key to success and our success means caring for the suffering diseased women in a better way. Happy reading.
Editors