FOGSI’s Postgraduate Obstetrics: A Textbook (Volume 2) Ameya Purandare, Parikshit Tank, Alpesh Gandhi
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Abdomen 382
acute 518fc, 522
distension of 518
lump in 416
Abdominal examination 78, 231, 232, 382, 744
auscultation 232
inspection 231
palpation 232
percussion 232
Abdominal hysterectomy 424, 450, 453, 457, 458f, 459f
contraindicated 453
incision 458
technical steps of 458
total 453
Abdominal repair, clear indications for 792
Abdominal sling surgeries 776
Abdominal striae 299
Abdominal wall 589f
fatty layer of 586f
pain 382
vascular injury 608
Abdominoperineal resection 756
Ablative technique endometrial preparation 409
Abnormal uterine bleeding, causes of 400t
Abortion 106t, 109f, 141
counseling protocol of safe 110
emergency treatment of incomplete 104
incomplete 97, 100
legal 102
medical methods of 81, 96, 97
medication 90
recurrent 101
second-trimester 83, 88, 158
septic 65, 502
services 110
surgical methods of 100, 101
unsafe 81, 87, 110, 141
Abrasions 529
Abscess
appendiceal 274
diverticular 274
formation of 530
ovarian 446, 517, 519f
perirenal 763
renal 763
tubo-ovarian 273, 502, 519, 883
Absorbable sutures 128
Acetaminophen 313
Acetic acid 242, 244, 245, 814817, 820, 826
application of 822f
solution 823
test, principles of 814
Acetowhite rims 824
Acetye salicylic acid 725
Acid
peptic disease 518
phosphatase 566
Acne 65, 298, 332
Acquired immunodeficiency syndrome 62, 90
development of 23
transmission of 707
Acridine orange test 642
Acrosome reaction 634, 642
Actinomycin-D 905, 907
Actinomycosis 497
Activated protein C resistance 721
Activins 196
Acupuncture 579
Acute dysuria, causes of 763t
Acute pelvic inflammatory disease
staging of 502
treatment of 505, 506
Acute pelvic pain, causes of 278, 279
Addison's disease 325, 721, 723
Adenocarcinoma 240, 835, 835f
endometrioid 248, 854
in situ 835
Adenofibroma 863, 865
Adenoma malignum 835, 839
Adenomatoid tumor 883
Adenomyomatous tissue, shrinkage of 435
Adenomyosis 230, 258, 260, 277, 279, 283f, 378, 391, 393f, 394t, 404, 427, 429f, 430, 430f, 431f, 432t, 433, 686
clinical presentation 429
complete extraction of 433
diagnosis 392
evaluation 429
management of 431
pathogenesis 428
pathology 428
prevalence 427
risk factors 392, 428
surgical management of 433
treatment of 393
Adenomyotic lesions 433
histopathology of 429f
Adenosarcoma 835, 855
Adhesiolysis 507
Adhesions 452
lysis of 452
Adhesive disease 129
Adipose tissue, accumulation of 301
Adjuvant hormone therapy 852
Adnexa 274f, 914
Adnexal disease 267
Adnexal mass 869t
Adolescent fertility 136f
extent of 137
Adoption 711, 735
board authorities 735
steps, process of 737
Adrenal crisis, prevention of 349
Adrenal hyperplasia, maturity-onset 325
Adrenal insufficiency, management of 349
Adrenarche 223
Adrenocorticotropic hormone 196, 223
Advanced endometrial carcinoma, management of 852
Agenesis 684
Alanine transaminase 44
Albumin 198
Alcohol 218
preparations 118
Aldosterone synthase 344
Aldrich procedure 778
Alfa-fetoprotein 519
Alkaline phosphatase 566
Alprazolam 375
Alzheimer's disease 571, 755
Ambiguous genitalia 325
formation of 171
Ambisexual stage, end of 188
Amelanotic melanoma 831
Amenorrhea 39, 44, 65, 139, 321, 323, 323t, 326fc, 327, 328t, 361
complications of 327
diagnosis of 324, 325
etiology 320
evaluation 320
experience 78
functional 321
hypoestrogenic hypothalamic 326
hypothalamic 321
management 320
pathogenesis 320
primary 297, 302, 320, 320b, 322, 324fc, 331, 346, 347, 348fc
prognosis for 327
secondary 230, 298, 302, 320, 321b, 325fc, 331
uterine causes of 327
Amino acid 196, 717
Amitriptyline 381, 405
Amniotic cavity 174f
enlarges 178
Ampicillin 506
Ampulla, site of fertilization in 171
Amsel's criteria 503
Amygdala 557
Amyloid beta 557
Anal incontinence 785, 789
diagnostic investigations 786
etiopathology 785
management 786
Anal plugs 787
Anal sphincter
injuries, repair of 531
resting tone 745
Analgesia 312
Analgesics 81, 384
Anastrozole 445
Androgen 419, 555fc, 656, 669, 670
bioactive 346
biosynthesis pathway 346
deficiency 670
excess 330
insensitivity syndrome 346, 656
polymorphisms of 631
preparations 572
receptor abnormality 656
resistance 302
role of 204b
Androstenedione 346
Anejaculation, anorgasmic 656
Anemia, severe 159
Anesthesia 603
general 98
regional 305
techniques, basic 613
Angelica sinensis 578
Angiogenesis 918
Anisokaryosis 813
Annovera ring 52f
Anogenital evidence, anal opening for 535
Anogenital squamous terminology, lower 797
Anorchia 324
Anorexia 352, 910
nervosa 321, 357, 358, 358t, 359, 360
atypical 359
Anovulation 321, 329, 331, 662, 665
classification of 663t
Anterior compartment disease 438
Antiandrogens 301, 334, 350, 631
Anti-angiogenesis factors 445
Anti-angiogenic chemotherapy 904
Anti-beta-2-glycoprotein antibodies 724
Antibiotics 81, 461
prevention of 314
Anticardiolipin antibody 724
Anticonvulsant 580
Antidepressant 392, 428
drugs 218
Anti-epileptic drugs 154
Antifibrinolytics 61, 423
Antimesenteric surface 442
Antimicrobial prophylaxis 309, 314t
Anti-Mullerian hormone 180, 189, 297, 322, 337, 546, 554, 636, 648, 665
low 721
production of 342
Antimuscarine agents, contraindication for 758
Antimuscurine drugs 759
Antiphosphatidylserine antibodies 724
Antiphospholipid antibody 151, 724
primary 721, 725
secondary 721, 725
syndrome 199
Antiplatelet therapy 433
Antiprogestin 82
Antiretroviral therapy 141
Antiseizure agents 381
Antiseptic substance 473
Antisperm antibody 114, 198, 634
Antithrombin deficiency 721
Antitubercular therapy 513
Antral follicle 203
count 554, 636, 648, 692
Anxiety 354, 382
Aorta, coarctation of 152
Aortic bifurcation 590f
Aortic injury 609f
Apoptosis 171, 202
Appendicitis 274, 381
Appendix 498
Appetite, loss of 910
Arachidonic acid, generation of 377
Arm span 231
Aromatase 345, 438
deficiency 342, 345, 349
inhibitors 367, 368, 405, 420, 445, 690
Arrhythmias 63
cardiac 603
Arsenic 722
Arterial flow 271
Arteriolar spasm 209
Arteriovenous malformations 388
Articulative Enseal 628f
Ascites 912
malignant 912
presence of 867, 914
Aseptic pyuria, causes of 762b
Asherman's syndrome 101, 323, 324, 411, 511, 614, 687, 688f
Asoprisnil 419
Asparagine 717
Aspartate aminotransferase 44
Aspermia 652, 656
Aspiration
test 585
vacuum 84, 85
Aspirin 378, 725
low-dose 688
Assisted reproductive techniques 429, 447, 652, 660, 673, 690, 699, 711, 712
complications of 709
indications of 699
Asthenozoospermia 653, 699, 705
isolated 652, 659
mild to moderate 659
practical management of 659fc
severe 659
Asthma 231
Asymmetric dissection method 433
Atherosclerosis 562, 562f, 562fc
increased risk of 114
Atopobium vaginae 482
Atrophic epithelium 824
Atropine sulfate 99
Atypia 247f, 844
Augmentation cystoplasty 758
Autocrine-paracrine peptides 201
Autoimmune
disease 713
disorders 199, 724
ovarian failure 727
polyendocrinopathy syndrome 727
thyroiditis, chronic 669
Autonomic nerves, effects of 377
Axillary hair development, stages of 226t
Ayurvedic medicine 579
Azithromycin 507
Azoles 491
Azoospermia 633, 638, 640, 643fc, 652655, 699, 734
evaluation of 633
non-obstructive 656, 657, 731
obstructive 655, 657, 731
severe 731
testicular 694
B
Bacteria 765
anaerobic 489
Bacterial colonization 761
Bacterial morphotypes, quantitation of 482
Bacterial vaginosis 476, 481, 483f, 489, 503
Bacteriuria 762
asymptomatic 764
Baden Walker's classification 768
Baldwin's technique 340
Ball point cautery 827
Barrier contraceptives 140, 145
advantages 140
usage of 490
Bartholin's cyst 528f
Bartholin's gland 498, 799
adenocarcinoma 801, 808
Basal body temperature 19, 635, 665, 705
method 19, 20
Basal cell 807, 811
carcinoma 801, 807
Basal fluid analysis 132f
Basic tissue handling techniques 793
Bazedoxifene 573
Behavioral therapy 381, 757, 787
Behçet's disease 526, 527f
Benign ovarian neoplasm 863t, 868
complications of 870
Benzene 722
Beta-human chorionic gonadotropin 62
Bethesda system 239f
Bevacizumab 879, 905
Bicornuate uterus 256f, 683, 685
surgical techniques for 340
Bicorporeal uterus, partial 255f
Billings method 18
Binge eating disorder 358t, 359
Biopsy 674
forceps 820
hysteroscopic 847
Bipolar radiofrequency endometrial ablation 409f
Bipolar tubal disease 678
Birth defects 138
Bisphenol A 547
Bladder
care 314
diary 745
dissection 467
diverticulum 274
dysfunction 839
exstrophy 342
flap dissection 466
injury 606, 607f
innervation 838
outlet obstruction 756
pain syndrome 382
Blastocyst, development of 717
Blastocystic cavity 172
Blastomere biopsy 716
Bleeding 92, 98, 217, 404, 912
abnormal 64, 378, 771
disorders, family history of 305
irregular 65, 230, 845
Blepharophimosis 727
Blood
coagulability 35
group 81
loss
signs of severe 388
symptoms of severe 388
pressure 118, 166, 564
diastolic 151
stasis 209
tests 876
transfusion postdelivery 231
vessels 179
Blunt trauma 529
Body mass index 223, 305, 314, 353, 635, 647, 665, 695
Bone 559
fracture, risk of 559
marrow transplant 727
mass density 374
mineral density 368, 385, 565, 566
loss of 196
remodeling 564, 565f
resorption 566
Bonney's gynecologic surgery 454
Bonney's test 745f
Bony metastasis 910
Botulinum
therapy 381
toxin A 758
injection 385
Bowel
care 315
disease, inflammatory 381
incontinence, types of 785
injury 464
risk of 309
warning signs of 591
invasion 443
mucosa 606f
obstruction, malignant 911
preparation 309
related history 382
sphincter, artificial 789
Brachytherapy 831, 891
principles of 894
Bradycardia 63
Brain glucose metabolism 557
BRCA1 gene mutation 916
Breast 231, 558
cancer 570, 845, 918
development 225f, 349
stages of 226f
examination 232f
malignancy of 248
milk, effect on 66
tissue, development of 295
Breastfeeding 36, 44, 49
Breathlessness 911
Brenner tumor 517, 863
Broad ligament 469
fibroid 463
Bronchospastic hypersensitivity 378
Brucellosis 721
Brushing teeth 225
Bulge, symptoms of 771
Bulimia nervosa 358, 358t, 359
Bupivacaine 313
Burch colposuspension 751, 781
Butoconazole 485
C
Cabergoline 197, 445
Caffeine 218, 373
Calcineurin inhibitors 526
Calcium 374
channel blockers 301
homeostasis 565f
Calendar methods 17
Cancer 397
antigen 512, 519, 915
detection clinics, role of 918
gastrointestinal 571
genome atlas research 848
grade of 886
invasive 815
kind of 396
surgeries 614
treatments 639
Candida albicans 474, 476, 484, 491
Candidal vaginitis 484
Candidiasis 484, 485f, 491
Capsular rupture 880
Carbamazepine 154
Carbon dioxide 409
embolism 603
laser 797
Carboplatin 892, 904
side effects 904
Carcinoma
cervix 24, 285f, 599, 834
post radiotherapy for 286f
procedures for 838
classification of 247b
endometrioid 848, 873
endometrium 599
high-risk factors for 248
in situ 796, 797, 811
invasive 837
neuroendocrine 829, 839, 887
ovary 599
prognosis in 831
verrucous 801, 808
vulva, management of 808fc
Carcinosarcoma 855
polypoid lesion 850f
Cardiac disease 150
acquired 150
Cardinal ligaments 838
Cardiovascular disease 563, 564, 570, 577
risk of 559
Cardiovascular system 179, 231, 559
Carnett test 383f
Carotid atherosclerosis, assessment of 564
Catecholamines 194
control of 195f
Catheter 316, 461
types of 697
Causative organisms 497
Cavitational ultrasonic surgical aspiration 797
Cefazolin 457f, 461
Cefotaxime 507
Ceftriaxone 470, 507
Cell
division 171
migration 171
sorting, magnetic-assisted 696
stratification of 813
Cellular injury triggers 890
Cellular rearrangement 171
Central nervous system 177, 193, 494
disease 326
Central pelvic recurrence 841
Central precocious puberty 364, 365
causes of 365, 365b
treatment 367
Central venous pressure 312
Cephalosporin, first generation 457, 461
Cerebral artery, middle 179
Cervical
anatomy 811
anomalies 338
biopsy 836
perform 820
canal, dilatation of 378
cancer 91, 248, 600, 810, 890f, 894, 918, 893
advanced 882, 892
applicators for 895f
brachytherapy 895
cause of 813
early 836, 839
management of 838t
precursors, concept of 810
recurrent 841
cycle 217
cytology 237
interpretation of 238
dilatation 498
erosions 836
factor 635, 636
subfertility 696
fibroid 462
growth 838f
incompetence 721, 723
injuries, form of 91
intraepithelial neoplasia 36, 242245, 799, 811, 814, 815, 821, 826, 827, 916
treatment of 825
lesions 264, 257
mass 266f
mucus 703
method 18
Spinnbarkeit of 19f
viscosity of 61
pathology 647
polyp 91, 262f, 836
preparation 86
punch biopsy 816f
ripening agents 63
smear 383
iodine-stained 500
softening 82
stenosis 91, 243, 279
syphilitic ulcer 836
tuberculosis 836
Cervicitis
acute 478
chronic 478
Cervicovaginal smear 236
Cervix 84, 242, 283, 498, 511, 558, 819, 839f, 892
action on 82
barrel shaped 836
cone biopsy of 838, 839f
dilatation 85
flush 453
formation of 683
intraepithelial disease of 810
leading edge of 769f
low-grade lesion of 825
neuroendocrine tumors of 835
normal double 256f, 257f
region of 812
removal of 463
repining 98
single normal 257f
uterus 837t, 894
visual inspection of 244, 245
visualization of 283
Cesarean section, abdominal wound of 316
Chancroid 493
Chemoradiation 806, 838, 906
concurrent 855, 892
primary 806
Chemoradiotherapy 898
Chemotherapeutic agents 906t
Chemotherapy 902, 903
addition of 892
adjuvant 879, 906
candidates for 841
concurrent 906
dose of 903f
iatrogenic 727
perioperative 906
platinum-based 832, 879
principles of 902
Chlamydia 383, 476, 721
antibody test 674
tests for 502
trachomatis 811
infections 497
Chlamydial heat shock protein 499
Chlorhexidine solution 309
Cholestasis, intrahepatic 35
Cholesterol level, total 728
Chorioamnionitis 65, 482
Choriocarcinoma 290
Chromopertubation 675
Chromosomal analysis 171
Chromosome 4q 194
Chronic obstructive pulmonary disease 306, 307
Chronic pelvic inflammatory disease 503
treatment of 507
Chronic pelvic pain 307, 380, 385, 395, 428, 444
causes of 380, 381fc
investigations 383
management 384
pathophysiology 380
physical examination of 382, 383fc
prevalence 380
Cimetidine 301, 631
Ciprofloxacin 507
Cirrhosis 301
Cisplatin 892, 904
side effects 904
Citrate tamoxifen 696
Clarithromycin 90
Claustrophobia 281
Clear cell
carcinoma 874
cystadenoma 865
tumors 873
Clermont-Ferrand model, modified 465
Clindamycin 484, 506
cream 490
preparations 484
Clitoral enlargement 346
Clitoris 799, 800
Clitoroplasty 349
Cloacal anomalies 342
Clobetasol propionate 526
Clomiphene 327, 696, 700
citrate 690, 710
therapy 327
Clonidine 384, 579
Clotrimazole 485, 491
Clue cells 490f
Coagulopathy 230, 397
diagnosis of 398
Coelomic theory 438
Coenzyme Q 10 723
Coexistent defects 257
Cognitive behavioral therapy 354, 361, 373, 384, 577, 578, 581
Cogwheel sign 674f
Coital dependent methods 27
Coitus
act of 25
interruptus 16, 17
Cold knife conization 825
Collins bivalve speculum 817f
Colpocleisis 783, 784f
partial 778
Colpoperineorrhaphy, posterior 774
Colpopexy 781
Colporrhaphy, anterior 774
Colposcopy 814, 816t
indications for 814
instruments in 814
trolley 817f
Colposuspension 751
Colpotomy 470
Columnar cells 812
Columnar epithelium 811, 812, 824
abnormal proliferations of 389
role of 473
Combined hormonal contraceptive 36, 148, 151, 166, 167, 444
pills 335
Combined injectable contraceptive 41
Combined oral contraceptive 45, 68, 145f, 157, 163, 164, 167, 374
pill 33, 36, 105, 138, 550, 666, 667
administration of 34
classification 33
complications 35
contraindications 36
counseling points 34
efficacy concerns 35
mechanism of action 34
monitoring 36
side effects 35
uses 33
Complete adenomyosis excision 433
Complete bicorporeal uterus 255f, 256f
Complete blood count 705
Complete genomic
hybridization 723
dysgenesis 347
Complete septum 254f
Comprehensive abortion care 104, 107, 108
Conception, products of 85, 97, 725
Condom 10, 23, 27, 429
advantages 23
disadvantages 24
distribution, school-based 25
failure rate of 24
female 27, 28, 29, 29f
latex 816f, 819
male 24f
natural latex female 27
spermicidal 23
types of 23
use of 25, 45
Condyloma 815, 817
acuminatum 834
Condylomata 819
Condylomatous lesions 824
Conjugated equine estrogen 571, 582
Constipation 381, 910
Continuous combined hormonal therapy 569t
Contraception 77t, 361
after endometrial ablation 410
after medical abortion 158
and pregnancy termination 136, 150
barrier method of 22
behavioral methods of 16
choice of 105, 137
counseling for 140, 163
forgettable 61
form of 20
injectable 41
methods of 16, 146, 147
natural methods of 16
permanent 112
prevalence 5
regular method of 72
spacing methods 16
types of 144
Contraceptive 11, 152
behavior 136
benefits 42
choices 10
drug delivery 51t
effectiveness 54
efficacy 61
emergency 56, 58, 63, 6870, 73, 140, 146
history 231
implants 47, 146
disadvantages 49
efficacy 48
insertion 48
mechanism of action 48
medical eligibility 48
recent advances 49
side effects 48
structure 47
injectable 41, 42, 139, 146, 158
intrauterine 54, 63
methods 106t, 138, 150, 151t, 153, 388
packaging, redesigned 10
patch 49, 50, 50f
adverse effects 50
efficacy 50
mechanism of action 50
structure and usage 49
time of starting 49
pills 144
practice 498
use 8
criteria for 117t
Controlled ovarian
hyperstimulation 700
stimulation 447, 696
protocols 700b
Copper intrauterine contraceptive device 54, 58, 60, 68, 148, 151
effectiveness of 69
Copper wire 54
Copper-T 380A 55f
Copper-T, loading of 57
Core body temperature 557f
Cornual fibroid 129, 463
Cornual structures, transection of 466
Corona radiata 171
Coronavirus disease 2019 (COVID-19) 108
Corpus
callosum, shape of 179
luteal cyst 270, 517, 518, 861
luteum 273, 288, 295
formation of 196, 331
function 71
Cough, chronic 231
Coumestans 578
Couple coital restriction 695
Cranial suspensory ligament 183f
Craniopharyngioma 326
C-reactive protein 383
Creatine phosphokinase 44
Crohn disease 526, 527f
Cryomyolysis 411
Cryopreservation 703
Cryoprotectant 704, 713
Cryotherapy 825
Cryptorchidism 631, 632, 656
Cuboidal columnar cells 868
Cuboidal granulosa cells 203
Cul-de-sac peritoneum 878
Culdocentesis 500, 502
Cumulative pregnancy rates 690
Cumulus cells 713
Cusco's speculum 695
Cushing's syndrome 299, 325, 398, 656
Cyclooxygenase pathway, activation of 377
Cyproterone acetate 368
Cyst
benign 269, 877f
complex 519
endometriotic 270, 271f, 865, 865f
functional 269, 516
gangrenous 523f
hemorrhagic 285, 287f, 446, 519
large 522
malignant 877f
peripheral 288
simple 288
types of 861
unilocular 273
vulval 526
wall, ablation of 443
Cystadenoma 873
benign mucinous 864f
endometriotic 865
Cystectomy 442, 869
Cystic glands, ectopic presence of 884
Cystic lesions 446
Cystic ovary, large 288
Cystic teratoma, mature 272f, 290f, 865, 866, 866f
Cystitis, acute uncomplicated 762
Cystocele 771, 771f
Cystoscopy 463, 746, 791
Cystourethrography 530
Cytochrome P450 inhibitors 90
Cytogenetics 350
Cytology 236
Cytomegalovirus 497
Cytoplasmic β-catenin and follistatin 183
Cytotrophoblast, inner 173
D
da Vinci robot 597
Daidzin 579
Danazol 374, 391, 409, 419, 445
Darifenacin 757
De Quervain's disease 199
Deaver's retractor 453f
Debulking techniques 461f
Deep dyspareunia 382
Deep fascia, level of 803
Deep infiltrating endometriosis 438, 443
Deep inguinal nodes 805f
Deep vein thrombosis 118, 139, 839, 912
prevention of 315
Defecography 786
Dehydroepiandrostenedione sulfate 723
Dehydroepiandrosterone 222f, 223, 347, 664f
production of 329
sulfate 223, 300, 329, 665
Delivery system 60
Denonvilliers’ fascia 774
Deoxyribonucleic acid 242, 834
methylation 248
Depot-medroxy-progesterone 418
acetate 38f, 41, 44, 106, 139, 146, 151, 158, 164, 166
injection 105
Depression 230, 382, 392, 428
Dermoid cyst 272f, 273, 446, 519, 866
Desogestrel 38, 40, 391
Desvenlafaxine 580, 581
Detect focal sperm production 656
Dexamethasone 82, 666
Dexapyridinoline 566
Dextran 594
Diabetes mellitus 147, 153, 199, 231, 647, 721, 755, 845
gestational 725
Diaphoresis 380
Dichlorobenzene 366
Didelphys 685
Dienogest 391
Diet 461
manipulation 218
modification 384
Diethylstilbestrol 189, 292, 686, 829
toxicity of 189
Digital rectal examination 655
Dihydrotestosterone 188, 322, 346
formation of 342
Dimethyl sulfoxide 704
Dipstick enzyme-linked immunosorbent assay 480
Direct fluorescence tests 502
Direct intraperitoneal transfer 707
Direct oocyte transfer 707
Dislodge proximal tubal block 675
Distal tubal disease 672
causes of 672b
mild 679
surgery for 677
Diverticulitis 381
Diverticulosis 381
Docetaxel plus carboplatin 907
Döderlein's bacillus 473, 474
role of 475
Dominant follicle, selection of 204
Donor
and recipients, counseling of 728
insemination 657, 707, 707b
indications for 694b
oocyte 727
indications for 727
preparation of 728
Donovanosis 494
Dopamine 195, 195f
antagonists 911
receptor 2 agonists 445
Doxycycline 506, 507
Drug interactions 141
Ductus deferens 177
Duloxetine 749, 749b
Dysesthetic vulvodynia 539
Dysgerminoma 290, 291f, 873, 880
Dyslipidemia 335
Dysmenorrhea 377
congestive 229, 482
diagnosis of primary 378
management of 218fc
pathophysiology secondary 378
primary 230, 377
secondary 230, 378
treatment for 218, 218t, 378
Dyspareunia 378, 537539, 438, 542, 771
Dysphoric disorder 371
Dysplasia 811
Dysplastic cellular changes 813
Dysplastic epithelium 824
development of abnormal 811
Dystocia 254
Dysuria 378
E
Eating disorders 353, 355, 357, 359
clinical features 358
complications of 360t
diagnosis 359
epidemiology 357
etiology 357
lead to 352
management of 360
Eclipse™ system 789f
Econazole 485
Ectoderm 177
Ectopic endometrial tissue 438
Ectopic gestations 673
Ectopic pregnancy 78, 101, 274, 428, 614
diagnosis of 274
risk of 65
Ectopic prostate tissue 835
Ectropion 478
Edema
limb 912
peripheral 361
pulmonary 411
vulvar 610
Eflornithine cream 335
Egg
donation 727, 728
in vitro maturation of 728
Ehlers-Danlos syndromes 768
Eisenmenger's syndrome 152
Ejaculatory disorders 656
Ejaculatory duct 177, 656
obstruction 643, 657
treatment of 655
Ejaculatory dysfunction 631, 731
Elective single embryo transfer 548, 691
Electric vacuum aspiration 85
Electrocautery 624, 679
Electrolyte
balance 313
imbalances 353
Electrosurgical units 624f
Elephantiasis vulvae 527
Embryo
cryopreservation 713
donation 704, 727, 731
program, indications for 732
formation 171, 173f
intrafallopian transfer 707
observation of 717f
selection of 715
transfer 507, 514, 676, 699, 701f, 702, 704f
factors affecting of 703
multiple 703
recipient for 729
transmyometrial 707
tubal 707
Embryoblast 172
Embryonal carcinoma 290, 873, 880
Embryonic Müllerian duct migration 438
Embryoscope 717, 717f
Emergency contraceptive 10, 56, 58, 63, 6870, 73, 140, 146
advance provision of 72
contraindications 72
effectiveness 72
instructions for 140
mechanism of action 71
methods of 69, 69t, 146
side effects 71
use, indications for 70t
Empirical oral antimicrobial therapy 764t
Empirical therapy 658
Encephalitis 326
Endocarditis, infective 152
Endocervical cells 240
Endocervical curettage, perform 821
Endocervical gland, normal 835f
Endocervical polyp 834
Endocervical speculum 817f
Endocervical tissue 233
Endocervical type adenomyoma 835
Endocrine blood tests 634
Endocrine disorders 209, 388, 329, 639
history of 388
signs of 388
symptoms of 388
Endocrine disruptors 366, 772
Endocrine tests 636
Endoderm 177
Endodermal epithelial cells 186
Endodermal sinus tumor 290
Endodermal stromal tumors 855
Endogenous estrogens 563, 564
Endogenous opioids 194
Endometrial ablation 231, 393, 406, 406f, 435
technique of 407f
Endometrial aspiration biopsy 248
Endometrial biopsy 236, 242, 248, 314, 389, 409, 512
specimen 243, 245
evaluation of 246fc
Endometrial calcification 263, 264f
Endometrial canal 268
Endometrial cancer 231, 396, 397, 571, 850, 895, 897t, 918
Endometrial carcinoma 247, 279, 844, 847, 849fc, 853b, 854, 854b
classification of 847t
molecular classification of 848
Endometrial cavity 263, 263f, 284f, 339, 722
Endometrial cells 240
Endometrial cycle 207, 214
Endometrial cyst 283f, 285
Endometrial cystic atrophy 264
Endometrial destruction 397, 406
Endometrial glands 209
dilated 279
Endometrial hyperplasia 246, 247, 247f, 260, 262f, 247t, 390, 396, 397, 399, 844, 845
atypical 847
diagnosis of 845
management of 247
natural progression of 845t
Endometrial intraepithelial
carcinoma 845
lesion 247
neoplasia 845, 846
Endometrial laser ablation 407, 408f
Endometrial mass 265f
Endometrial metaplasia, stages of 264
Endometrial myometrial differentiation 337
Endometrial polyps 246, 246f, 260, 263f, 282, 283f, 339, 378, 391f, 428, 614, 687, 722
Endometrial preparation 410, 730fc
role of 409
Endometrial proliferation 61
Endometrial sarcoma 855
Endometrial stroma 209
sarcoma 844, 855, 856f
Endometrial thickness 281
Endometrioma 271f, 273, 285, 438, 442, 446, 517, 521
investigations 446
large 442
medical management 447
treatment 446
Endometriosis 199, 229, 232, 278, 309, 382, 437, 444, 462, 463, 696
classification of 439
deposits 381f
diagnosis 439
fertility index 439, 441f
incidence 437
medical management of 444
pathogenesis 437
risk factors 437
severe 688
signs 438
surgeries 614
surgical management 440
symptoms 438
treatment of 452
Endometritis 85, 246, 260, 279, 482
acute 260, 261f
chronic 260, 261f
Endometrium 61, 209, 215, 247f, 259, 282, 511, 892
ablation of 408f
biological functions of 208t
growth of 216
hyperplastic 844f
proteomic analysis of 718
regeneration of 209
repair of 209
sampling of 65
stromal cells of 216f, 217f
transcervical resection of 407, 407f
Endopelvic fascia 775f
connections, tearing of 771
dissection of 775f
Endorectal coil 280
Endosalpingiosis 884
Endosalpinx 511
Endoscopic surgery 618b
energy sources in 623
Endoscopy 584
surgery 619t, 620t
Endothelin 209
Endotip 588f
Endovaginal coil 280
Endovaginal ultrasound gel 280
End-to-end technique 531
Enseal 627, 627f
Enterobacteriaceae species 482
Enterocele 772, 774
ENZIAN classification 440, 442f
Enzyme 345
defects 727
dysfunction 345
linked immunosorbent assays 502
thyroid peroxidase 198
Epicanthus inversus syndrome 727
Epidermal growth factor 203
Epididymal ducts, obstruction of 631
Epididymal sperm
aspiration, advances of microsurgical 707
extraction, microsurgical 708
Epididymis 342, 656
Epididymovasostomy 132, 133f
Epigastric artery injury 608
Epilepsy 154
Epithelial cell 864
abnormalities 237
Epithelial defect 825
Epithelial growth factor receptor 902
Epithelial mesenchymal transition 433
Epithelial ovarian cancer 872
advanced 878
pathogenesis of 874
risk factors for 872
Epithelial ovarian tumors 517, 874
benign 862
Epithelial tumors 835, 872, 883
mixed 835, 883
Epithelioid granuloma 512, 514
Epithelium 525
layer of 815, 822
types of 812
Erosion 478, 812, 817
Erythrocyte sedimentation rate 383, 705
Erythromycin 82
doses of 90
Escherichia coli 497
Essure sterilization 130f
Estetrol 581
Estradiol 295, 295t, 297, 301, 364, 366, 395, 700
levels 297
low 322
potency of 580t
Estrogen 33, 189, 200, 281, 374, 385, 475, 555, 555fc, 571, 631, 656, 749
cream 749
deficiency 559
deprived of 558
falls 220
only hormonal therapy 569t
plus progesterone, continuous hormone release of 50
primed endometrium 215
production, low 345
progesterone combinations 380
progestin combination, usage of 570
receptor 557
modulators 62, 368, 405, 420, 573
reduction of 574
replacement therapy 845
role of 561
secretion leads, resumption of 209
side effects 572
therapy 419
Estrogenic microenvironment 203
Ethacridine 92
Ethacridine lactate 88
Ethambutol 514
Ethinylestradiol 49, 51f, 374
dose of 138
Ethylene oxide 722
Etonogestrel 51f
implant 445
Euthyroid 723
Exemestane 445
Exercise 384
Exogenous steroid 656
External beam irradiation 831
External beam radiotherapy
principles of 894
therapy 838, 852, 891f, 899
External genitalia 177, 186, 187, 187f, 382
androgenization of 346
development of 230
Extra-amniotic instillation 87, 88
mode of action 87
procedure 87
Extracellular matrix 413
Extracellular polymeric substances 761
Extraembryonic mesoderm 174f
Extrauterine gestation 703
F
Fallopian tube 129, 146, 267, 268, 269, 382, 511, 518, 672, 874, 883, 884, 887
adhesions 485
benign
diseases of 516
tumors of 883
bilateral 839f
classification for cancer of 887t
distal 129
fimbrial end of 916
lesions, malignant primary 884
malignant tumors of 884
neoplastic diseases of 883
pathologies, benign 517
sarcomas 887
sperm perfusion 707
spill 504
transitional cell carcinoma 887
tumors
borderline 884
classification of 883b
ultrasound evaluation of 673
Fallot tetralogy 152
Falope ring 119, 121, 122, 122f
Family planning 11, 161
counseling messages 105b
indemnity scheme 124, 158
logistic management and information system 11
natural methods of 16, 146, 154, 158
services 159
Fasting glucose level 728
Fat saturation techniques 285
Fatigue 905
loss of 910
Fatty acids, non-esterified 329
Fecal incontinence 785
management of 787fc
Female athlete triad 358
Female external genitalia 343t
formation 342
Female genital mutilation 529, 535
types of 535t
Female genital organs, external 186f
Female genital tract 337
differentiation 338f
congenital abnormalities of 337
Female genital tuberculosis 510, 511, 512f, 513f, 514, 674
diagnosis 511
etiopathogenesis 511
investigations 512
sign for 511t
symptomatology 511
treatment 513
Female infertility 634
tests for 635
Female sexual function index 540
Female sterilization 41, 47, 112, 115117, 118t, 165
certificate of 119
complications 119
counseling 117
intraoperative complications 119
postoperative complications 119
reversal of 127
Feminizing genitoplasty, principles of 349
Feminizing ovarian tumors 845
Fenofibrate, adverse effects of 44t
Fentanyl 313
Fenticonazole 485
Fenton's approach 543
Ferric subsulfate 820
Ferriman-Gallwey
classification system 332
scale 333f
score, modified 664
Fertility
analysis 712
awareness methods 16, 17, 20t
determinants of 4
future 368
indicators 4
males 302
monitors 20
pattern 5
preservation 548, 550fc, 712, 851
rate
age-specific 4, 5
general 4
total 4, 9
sparing surgery 868, 879
target numbers of 5
Fertilization 171, 173, 175, 178
Fertilized egg, preventing implantation of 71
Fertilized ovum, prevent implantation of 55, 56
Fetal
aneuploidy 721
Leydig cells, stimulation of 188
morbidity 152
mortality 152
ovary 183
Fibroblasts 867
growth factor, basic 203
Fibroid 43, 231, 232, 257, 411, 413, 415, 423
degeneration in 258
effects of 416t
etiopathogenesis of 414f
expectant management of 417
hysteroscopic resection of 411
location of 425f
management of 417, 417t, 418t, 420
mapping 417
medical management of 418
multiple 421f, 423f, 732
risk factors for 415t
size of 422
surgical management of 421
treatment of 424t
types of 259f, 415f
uterus 413
classification 414
clinical profile 414
diagnosis 416
etiology 413
large 397
risk factors 414
Fibroma 517, 527, 867, 868f
Filshie clip 122, 122f
Fimbrial phimosis 679
Fimbriectomy 131
Finger-to-thumb spinnbarkeit sign 18
Fissurectomy 786
Fistula 912
complex 794
formation 749
risk of 781
genitourinary 791
surgery 792
Fistulectomy 786
Fitz-Hugh-Curtis syndrome 499, 501f, 650
Flagella 761
Fluconazole 485
Fluid
balance 313
replacement, guidelines for 313
retention 361
Fluorescent in situ hybridization 350, 712, 714
Fluorodeoxyglucose 512f
Fluoxetine 580, 581
Foam cells 562
Focal adenomyosis, prevalence of posterior 428
Focused energy delivery systems 420
Foley's balloon 92
Foley's catheter 262, 316
Foley's tip 607f
Follicle
growth 185, 700
monitoring 706
primary 203
selection 203
stimulating hormone 33, 157, 193, 195f, 200, 200f, 205, 213f, 214f, 222f, 227, 295, 299, 300, 302, 329, 545, 554, 631, 647, 648, 657, 662, 667, 669, 692, 700f, 705, 729
functions of 200b
levels of 700
secretion of 205, 222
testing 300
Follicular cyst 269, 288, 516, 518, 861
simple 285
Follicular growth, stages of 202f
Follicular phase 201
stimulation 549
Follicular thecal cells 200
Folliculogenesis 185
Follistatin 196
Forcardiovascular disease, biological marker 561
Formononetin 579
Fothergill's 4 points 774
Fothergill's operation 453, 774
Fothergill's repair 776t
Fothergill's stitch 774, 776f
Foul-smelling vaginal discharge 100
Fragile X mental retardation gene 545
Fragile X syndrome 347, 545, 664, 713
Fragility fracture 566
Framingham heart study 563f
Frank virilization 332
Free thyroxine 559
Free tri-iodothyronine 559
Fundal hysterotomy 129
G
Gabapentin 381, 384, 580, 581
Gadolinium 288
Galactorrhea 296, 324, 325, 326fc, 327
hyperprolactinemia, causes of 326b
Galactosemia 664, 727
Gallbladder disease 36
Gamete
artificial 718
intrafallopian transfer 707
Gamma aminobutyric acid 222, 373, 375
dysfunction of 373
Gardnerella vaginalis 482, 489, 497
Gartner's duct cyst 528
Gas
embolism 610
insufflation test 585
Gastrointestinal
injury 590, 591
system 381, 382
toxicity 899
tract 177, 530
Gehrung pessary 773
Gelatin-thrombin matrix 423
Gemcitabine 905
Gender dysphoria 347
develops 348
Gene
encoding gonadotropin receptors 546
testing 350
General health
index 695
screening 647
General medical screening 728
Genetic
defects, isolated 171
tests 634
GeneXpert 512, 675
Genistein 579
Genital bacterial vaginosis 721
Genital ducts morphogenesis 190t
Genital mutilation, female 529, 535
Genital organs
direct trauma of 529
internal 177
Genital system 181
Genital tract 159
anatomy of 277
anomalies, classification of female 684f
developmental abnormalities of 337
infection 658, 722
malignancy of 230
natural defense of 498
trauma 529
Genital tubercle 186
Genital tuberculosis, female 510, 511, 512f, 513f, 514, 674
Genital virilization, mild 345
Genitalia
atypical 343
external 177, 186, 187, 187f, 382
Genitourinary fistulas 791
etiology 791
management 791
plan for treatment 792
prevention of 793
surgical treatment 792
Genitourinary tissues, changes in 558b
Genitourinary toxicity, acute 899
Genomics 717
Gentamicin 506
Germ cell 177t, 181, 185, 517
absence of 183
epithelium damage, severe 640
interaction of 181
migration 176f
numbers, changes in 203f
tumor 272, 290, 517, 873, 880, 883
benign 865
development of malignant 349
mixed 873
Germinal vesicle 549
Gestational age, advanced 92
Gestational trophoblastic
disease 829
neoplasia 62
management of 905
Gestodene 50
Gland
adrenal 329
infections, male accessory 722
Glandular abnormalities 240
Glandular cell 237, 240
abnormalities, terminology for 240
atypical 240, 244
Glandular epithelium, atypical 835f
Glandular lesions, benign 834
Glucocorticoids 656, 666
replacement of 349
Glucose tolerance test, impaired 723
Glutamate 222
Glycine 717
Glycogen 475
rich cells 824
secretion of 215
Golari's classification 709
Goldie-Coldman hypothesis 903
Gompertzian growth 903
Gonadal dysgenesis 322, 346, 727
forms of 349
pure 323, 664
Gonadal malignancy, risk of 349
Gonadal sex
cord cells 867
irrespective of 177
Gonadal steroid therapy 405
Gonadal steroidogenesis pathway 342, 344fc
Gonadal stromal cells 867
Gonadal tissue 181
Gonadarche 223
Gonadectomy 349, 350
Gonadotoxic drugs 547t
Gonadotrophs 196
Gonadotropin 195f, 205t, 222f, 295, 691, 696, 700
assessment of 196
degradation of 196
induced ovulation induction 696
low-dose 700
releasing hormone 62, 139, 193, 194, 195f, 200f, 213f, 214f, 222, 227, 321, 364, 374, 391, 418, 549, 595, 662, 664f, 669, 701f, 702, 704f
agonist 367, 374, 380, 444, 445, 700
analogs 405, 419, 523, 549
antagonist 444, 445
deficiency, congenital 321
molecule, structure of 195f
pulsatile secretion of 162, 194
pulse production, defects of 321
release of 20, 329
suppression 220
transport, defects of 321
secretion 194
surge-attenuating factor 206
Gonorrhea 230, 383, 476, 489, 495
tests for 502
Goserelin 444
Graciloplasty 788
Grand multiparity 91
Granulation tissue 464
Granulosa cells 196, 202, 517, 867
inhibiting 162
Granulosa proliferation 204
Grave's disease 198
Green-Armytage cannula 649
Groin
dissection, incision for 806f
lump 345, 346
metastases, bilateral 803
radiation, bilateral 808
Gross reproduction rate 4
Gross tumor volume 890
Growth
acceleration of 223
filling uterine cavity, large 850f
hormone 367
Guardian and Wards Act 736, 737
Gubernaculum testis 183f
Gynecological
cancers 799, 892t
radiation for 899
treatment for 893
care 229
dysfunction 380
endoscopic surgery 613
surgical training in 613
endoscopic training 613
laparoscopy, complications of 603
malignancy 904906, 906t
pelvic organs, pathology of 613
procedures, benign 597, 599
surgery 305, 306t, 307, 309
part of 309
system 380
Gynecology, ultrasound in 251, 267
Gynecomastia 295, 301, 639
H
Haemophilus
ducreyi 493
influenzae 497
Halban's operation 774
Hanging drop test 585
Harmonic hemostasis 626f
Harmonic scalpel 626f
Hashimoto's thyroiditis 198
Hasson technique 585f, 605f
Headache 36
reports of 65
Health management information system 166f
Healthcare Products Regulatory Agency 140
Heart
disease
congenital 150
coronary 561t
failure, congestive 307
rate 179
Heavy menstrual bleeding 61, 66, 404, 406t, 415, 845
investigations 389
pathophysiology 387
Hemiuterus 256, 684
Hemoglobin 79
Hemorrhage 96, 98, 159, 463, 870
causes of 98
excessive 85
intraoperative 774
postpartum 231
prevention of 422
primary 463
risk of 535
severe postpartum 688
Hemosiderosis 321
Hemostasis 128, 625
mechanism of 626
sutures for 827
Heparin 315
Hepatitis
autoimmune 153
B 492, 498
core 705
diagnosis 492
infection 492
prevention 493
surface antigen 705
treatment 493
C virus 647, 705
Herbal products 578
Hermaphrodite 342
Hernia, incisional 591
Herpes simplex virus infection 493
Hidradenoma 527
vulva, histopathology of 528f
Hindu Adoption and Maintenance Act 736, 737
Hirsutism 65, 298, 329, 332
equivalent 332
Histrelin implant 367
Homeobox gene 678
Homocysteine 564
Homologous insemination, indications for 694t
Hormonal contraceptive 152
inhibit ovulation 378
pills 22
Hormonal issues 669
Hormonal profile 655t, 700, 724
Hormonal therapy 907
Hormone 916
androgenic 380
assays 295
deficiency 656
negative breast cancers 902
on endometrium, effects of 246, 264
receptors functioning 171
replacement therapy 147, 385, 548, 550, 853, 916
concept of 568
sequential actions of 201
therapy 317
Horse-shoe incision, anterior 803f, 805f
Human chorionic gonadotropin 157, 198, 222f, 295, 297, 302, 518, 670, 700f, 701f, 704f, 729
receptor 546
Human embryo development 171
Human epididymis 876
protein 446, 915
Human Fertilisation and Embryology Act 646
Human immunodeficiency virus 34, 62, 117, 141, 154, 163, 231, 495f, 497, 514, 647, 702, 705
co-infection 510
infection 491, 495
risk of 705
Human menopausal gonadotropin 326, 729
Human papillomavirus 240244, 244f, 245, 492, 498, 813, 826, 834
high-risk 810
infection 492, 799
prevention 492
tests 241
types of 241t
treatment 492
vaccination program 44
Hydrocortisone 666
Hydrogen
peroxide douche 484
producing lactobacilli 489
Hydrosalpingeal fluid 678
Hydrosalpinges 678t, 679
Hydrosalpinx 269f, 519
appearance, atypical 673
bilateral 675f
Hydrothermal ablation 409
Hydrothermal endometrial ablation 409f
Hydrotubation, role of 129
Hydroxychloroquine 724, 725
Hydroxyprogesterone 346
Hydroxysteroid dehydrogenase 345, 346
Hydroxyzine 381
Hyperalgesia 380
Hyperandrogenemia 334, 666
features of 666
Hyperandrogenism 723
biochemical 664
Hyperchromasia 813
Hyperechoic endometrium 263
Hyperemic tube 513f
Hypergonadotropic hypogonadism 322, 347, 634
Hyperhomocysteinemia 721
Hyperinsulinemia 329, 723
Hyperkeratosis 815, 817, 819
Hypermethylation 242
Hyperosmolar urea 83
Hyperplasia 396, 835
adrenal 721
atypical 248
complex 247, 844, 846
congenital adrenal 300, 323, 342, 345, 368, 656, 663, 723
degree of 845
microglandular 834
simple 844
surgical management of 397
types of 396
Hyperplastic state 220
Hyperprolactinemia 196, 197, 197t, 296, 298, 321, 324, 325, 326fc, 636, 663, 669, 723
causes of 196, 197t
drug-induced 197, 326
effects of 199b
idiopathic 326
inhibits release 669
mild 669
moderate degrees of 669
prevalence of 196
surgery in 197
Hypersensitivity 82
Hyperstimulation, risk of 691
Hypertension 147, 153, 231
grades of 153
pregnancy induced 667, 724
Hyperthecosis 325
Hyperthermic intraperitoneal chemotherapy 878
Hyperthyroidism 198, 325
diagnosis of 199
Hypertonic solution, intrauterine instillation of 86
Hypertriglyceridemia 723
Hypertrophy, endometrial 260
Hypnosis 577
Hypoestrogenic amenorrhea, causes of 322b
Hypogonadism 300
hypogonadotropic 333, 634, 657
idiopathic hypogonadotropic 321
late-onset 301, 302
Hypomenorrhea 65, 198
Hypomethylation 242
Hypoplasia 684
Hypospadias 705
isolated 343
severe 342
Hypospermia 652
Hypothalamic defects 321
Hypothalamic dysfunction 325
mild 325
Hypothalamo-pituitary
axis, disorders of 631
dysfunction 325
gonadal axis 555
ovarian
axis 200, 200f, 201, 213, 398, 662f
development of 221
thyroid axis 559
Hypothalamus 193, 193t
Hypothesis 885
Hypothyroid 723
Hypothyroidism 197, 325, 326, 670
causes of 198
subclinical 198
Hypotonic fluid media 595
Hysterectomy 316, 394, 423, 435, 450, 457, 614, 688, 838, 847
abdominal 457
complications of 463
emergency 411
intrafascial 459
postpartum 435
route of 424
specimen, evaluation of 428
total 463
types of 840t
vaginal 457
Hysterolaparoscopy 433
Hysterosalpingography 127, 649, 649f, 650, 673, 675
Hysteroscopic procedures 393, 435
Hysteroscopy 390, 513, 592, 593f, 650
field of 592
instruments for 592
preoperative 409
Hysterotomy 87
complications 87
postprocedure care 87
I
Iatrogenic autoimmune ovarian failure 727
Ibuprofen 313
Iliac vein injury, internal 609f
Immature cyclic follicular development 331
Immune
system 559
thrombocytopenic purpura 139
Immunotherapy, principles of 904
Imperforate hymen 323
Implantation failure, treatment of 688
In utero implantation 173f
In vitro activation 548
In vitro fertilization 447, 507, 514, 546, 654, 667, 691, 693, 699, 700, 701f, 706
advent of 126
indications for 447b
program 676
results 714, 714f
stages of third party 727
In vitro maturation 549, 714,
Indwelling catheters 314
Infections 100, 631, 870
chronic 484
parasitic 493
screening 724
signs of 382
types of 498fc, 499
Inferior epigastric artery injury 608f
management of 609f
Infertile
euthyroid 199
female 433, 647b
male 643fc
Infertility 101, 138, 230, 378, 389, 416, 430, 511, 631, 635, 666, 669, 670, 692, 695, 711, 722
anovulatory 696
causes of 416, 646f
duration of 695
etiology 631, 695
evaluation 636
female 634
immunologic 658
management of 702fc
mild male factor 695
surgeries 614
tests, basic 127
treatment 709
of unexplained 691t
unexplained 690, 691
uterine factor 688
workup 647b
Inflammation 279
Inflammatory cell infiltrate 246
Inflammatory disease 438
Infracolic omentectomy 887
Infundibulopelvic ligament
coagulation of 466
ligation of 452
transection of 466
Inguinal nodes, superficial 805f
Inguinofemoral lymph node dissection 803, 804
Inhibin 196, 555
blocks synthesis 196
Injectable contraceptive 41, 42, 139, 146, 158
clinical assessment 42
contraindications 42
disadvantage 139
health benefits 139
mechanism of action 41
Injury
genital 534f
types of 530
Inner cell mass 172, 174f
Insemination 697, 702
artificial 673
number of 697
Instruments 588
navigation 621
sterilization of 593
Insulin
resistance 331, 516
role of 299b
sensitizers 335
Intact scar, normal 265f
Intensity-modulated radiation therapy 806, 891f
Interleukin 559
Intermittent pneumatic compression 316
Internal female genital organs, development of 186f
Intersex 342
Interstitial implantation 173f
Interstitial tuberculosis salpingitis 511
Interval minilap tubectomy 118
Interventional pain techniques 381
Intestinal injury 605
Intra-abdominal pressure 585, 783
Intra-amniotic
complications 87
contraindications 87
instillation 86
mode of action 86
precautions 87
procedure 86
Intracellular adhesion molecule-1 563f
Intracellular calcium, changes in 82
Intracytoplasmic sperm injection 640, 654, 657, 667, 692, 693, 694, 706, 707, 712
indications of 708fc
Intraembryonic mesoderm, formation of 178
Intraepithelial lesion 240
negative for 242244
Intraepithelial preneoplasia 815
Intrafallopian insemination 707
Intralesional vessels 258
Intramural isthmic anastomosis 129
Intramural myomas 722
Intrauterine adhesions 339, 687
classification of 687t
degrees of 101
Intrauterine contraceptive device 22, 24, 41, 47, 48, 54, 58, 62, 63, 69, 70, 77, 106, 139, 144, 145, 157, 162, 164, 165, 167, 399, 497, 508, 666, 667
advantages of 58
adverse effects 57, 139
complications 57
insertion of 157
management of 508fc
methods of 10
placement 263
postpartum 58, 164
Intrauterine fetal death 724
Intrauterine growth
restriction 704
retardation 724
Intrauterine insemination 447, 514, 654, 667, 673, 676, 690, 695, 697, 705, 705b, 706
cannula for 695f
cycle
number of 696
steps of 694
indications of 705b
principle of 694
rationale of 694
steps of 705b
Intrauterine polyps 678
Intrauterine pregnancy 131
Intrauterine pressure 595
Intrauterine system 61, 66, 152, 166
insertion 62
removal of 66
Intravaginal lactobacillus preparations, role of 490
Intravenous immunoglobulins therapy 724
Intrinsic sphincter deficiency 748, 750f
Invasive cervical cancer, advanced 283
Iodide 198
Irinotecan 905, 907
Iris scissors 128
Iron deposition 321
Irritable bowel syndrome 381, 502
Ischemia 209
syndrome evaluation 562
Ischial spine 783
Isoflavones 578
Isoniazid 514
Isopropyl alcohol 309
Isothermal amplification process, loop-mediated 512
Isotonic fluid media 595
Isthmic-ampullary anastomosis 129f
Isthmic-isthmic anastomosis 129, 131
Isthmus 209, 281, 678
reanastomosis 678
Itraconazole 82, 485
J
Janasankhya Sthirata Kosh 11
Jansankhya visphot 7
Jeffcoate's classification 768
Juvenile Justice Act 736, 738
K
Kallmann's syndrome 321
Kartagener syndrome 631
Kegel's exercise 748, 748b, 773
Kegel's muscles 773
Ketamine 910
Ketoconazole 82, 90, 485
Khanna's sling operation 777
Kisspeptin 195, 223
administration of 196
neurons 195
Klebsiella
granulomatis 494
pneumoniae 762
Klinefelter's yndrome 656, 712
Kroener sterilization 131
L
Labia
majora 188, 498, 799
minora 800
Labioscrotal swellings 188
Lactational amenorrhea
method 20, 63, 163, 164, 167
producing 162
Lactic acid 475
Lactobacillus 473, 474, 489
acidophilus 473, 474
alteration of 475fc
amounts of 582
crispatus 474
dominated vaginal flora, amount of 474
flora, failure of 484
jensenii 474
morphology of 473
morphotypes, absence of 473
Laparo-pelvic trainer 617f
Laparoscopic
adenomyosis surgery 435
adrenolysis 385
bipolar coagulation 411
colposuspension 751
gynecologic surgery 604t
hysterectomy 424, 450, 451b, 452, 453, 465
instrumentation 465
total 465, 622
instruments 606
ligation 158
myolysis 411, 411f
myomectomy 410, 422
ovarian
drilling 327, 546
syndrome 667
presacral neurectomy 378
radical hysterectomy 599, 600
repair 607
sacrocolpopexy 599, 783
sacrohysteropexy 778
salpingectomy 679
surgery 618b, 690
tubal occlusion 119
steps for 119
uterine nerve ablation 378, 380
uterosacral nerve ablation 444
Laparoscopy 439, 513, 650, 675, 679f, 869
role of 507
Laparotomy 433, 507
conversion to 411
laparoscopy-assisted 433
L-arginine 688
Laser therapy 582
Laser-assisted hatching 708
Last menstrual period 49
Laws governing adoption 736
Lee Huang point 587f, 588
Left uterine artery 469f
Left ventricular dysfunction 152
Leiomyoma 230, 282, 282f, 378, 394, 413, 686, 884
classification of 415f
clinical presentation 395
epidemiology 395
growth of 395
incidences of 395
sign for 277
treatment 395
Leiomyomatosis, diffuse 258, 259f
Leiomyosarcoma 417, 844, 855, 856f
Letrozole 368, 445, 690, 691, 696, 700
Leucine 717
Leukocytes 209
Leukoplakia 815, 817
Leukorrhea 475
causes of 476
clinical history 476
etiology of 475
physiologic 477
symptoms of 476
Leukotriene 377
Leuprolide 317, 697
acetate 444
Levator plate 292
Levonorgestrel 38, 40, 47, 61, 66, 69, 70, 140, 145, 146
chemical composition of 60f
intrauterine 385
device 375
system 38f, 60, 61, 61f, 62, 62t, 63, 64f, 65, 65t, 418, 419
releasing intrauterine
devices 378
system 151, 158, 846
Leydig cells 185, 342, 867, 868
Li technique 112, 113
Lichen
planus 526f
sclerosus 526f, 796, 796f
management of 796
simplex chronic 526
Lidocaine 381
Ligament, opening broad 467f
Ligasure 629
Light-emitting diode 816
Lignans 578
Lipid
lowering medications 335
profile 562
Lipoleiomyoma 278
Lipoma 528
Lipoprotein, oxidized low-density 563f
Lippes loop 54
Liquefaction 217
Lithotomy position 305
Live birth rate 690
Live sperm morphology 716t
analysis 715f
Liver
diseases 35
disorders, chronic 139
function test 44, 514
Lomefloxacin 507
Loop electrosurgical excision procedure 244
Lopinavir 90
Low bone mineral density 360
management of 361
Low malignant
potential tumors 872
tumors of 272
Low-density lipoprotein 205, 563f
cholesterol 52
Lower urinary tract 743, 743f
dysfunction 743
function 743
symptoms 743, 744b, 744t, 748
classification of 743, 743t
history of 744
Low-molecular-weight heparin 316, 725
Lugol's iodine 812
solution 820, 824, 825
application of 824
test 816
Lumen, cautery occlusion of 113
Lupus anticoagulant 724, 725
Luteal follicular transition 206
Luteal phase 206, 208
stimulation 549
support 697
Luteinizing hormone 193, 195, 199, 200, 205, 213, 213f, 214f, 222, 222f, 227, 295, 299, 300, 302, 364, 398, 546, 647, 662, 664f, 665, 667, 700, 700f, 705
releasing hormone 194
Luteolysis 71
Lyme's disease 721
Lymph node 512, 808
assessment 292
dissection 804, 808fc
bilateral 803, 805
unilateral 803, 805
enlarged 880
inguinal 830
management of 803
metastasis 874, 837
palpable 830
para-aortic 837, 878
regional 830
small number of 806
status 840
Lymph vascular space invasion 851, 886
Lymphadenectomy 850, 851t
para-aortic 887
role of 850
systematic 850
Lymphadenopathy 494
Lymphogranuloma venereum 494
Lymphovascular space
invasion, absence of 893
involvement 840
Lynch syndrome 918
Lysosomal proteolytic enzymes 209
Lysosomes 217
M
Mackenrodt's ligaments 768
Macroadenoma 322, 327
Macroprolactinemia 196
Maintenance therapy 906
Male barrier methods 22
Male condom 24f
application of 24f
Male external genitalia 188, 343t
Male infertility 631, 639, 641, 695, 707
causes of 638
etiology 631, 652, 656
evaluation of 632
management 656, 652
tests for 632, 712
Male pattern baldness 298
Male sex determination 181f
Male sexual characteristics 296
Male sterilization 47, 115, 132, 165
postoperative care 113
reversal of 127
surgical anatomy 112
Malecot catheter 316
Malignancy 398
algorithm score, risk of 869b
index, risk of 869, 915
score, risk of 876
types of 906, 907
Malignant diseases, end-stage 911
Malignant gynaecological procedures, robotic-assisted surgery for 599
Malignant obstruction 911
Malignant ovarian
neoplasia 872
neoplasm 863t
Malnutrition, screening for 315
Malpas’ classification 768
Manchester's operation 774
Manipulators 444
Mantoux test 512
Manual vacuum aspiration 88, 96, 104
apparatus 84f
equipment, types of 85t
Martius flap 793
Mass
abdominal 230
descending per vaginum 230
index 231
Maternal complications 703
Matrix metalloproteinase 206
Maturation, final stages of 204
Mayer-Rokitansky-Kuöster-Hauser syndrome 257, 732
McCall culdoplasty 774, 781
McCall's sutures, external 461
McCune-Albright syndrome 368
Mc-Indoe's vaginoplasty 543
Mechanical bowel preparation 309
MeCkel diverticulum 381
Medical abortion 83
drugs in 82
Medical disorders 150
Medical method, complications of 96
Medical Termination of Pregnancy Act 12, 75, 92, 96, 107, 141
Medium signal intensity, structure of 281
Medroxy-progesterone acetate 368, 569
Megestrol acetate 569
Meig's syndrome 869, 870
Melanoma 801, 807
malignant 829, 831
Melengestrol 366
Membranes, rupture of 92
Menopausal hormone therapy 564, 568, 568b, 572b, 572t, 573
Menopausal transition, biochemical changes in 571
Menopause 231, 299, 302, 554, 554t, 559t, 562, 564
age 555
alternative medicine for 577
consequences of 555
diagnosis of 556b
genitourinary syndrome of 557, 569
hormone therapy in 568
implications of 561
management of 147
medicine for 577
on bone health, implications of 564
physiology 554
symptoms 556
vaginal symptoms of 581
Menorrhagia 385
Menses 320
Menstrual abnormalities 87
Menstrual bleeding
heavy 61
high 387
irregular 398
mechanism of 216
Menstrual cramps 230
Menstrual cycle 200b, 201f, 207f, 209, 210f, 213, 215t, 320, 382, 730f
absence of 353
assessment of 382
normal 213
physiology of 201
spans, follicular phase of 201
Menstrual Disorders Committee 388
Menstrual disturbances 101, 415, 518
Menstrual hygiene 218
management 219f
poor 220t
Menstrual irregularity 334, 666
Menstrual outlet obstruction 378
Menstrual pattern 229
Menstrual period
delayed 64
final 554, 576f
Menstrual phase 209, 216
Menstrual problems 43
Menstrual regulation 84
Menstrual symptoms 218
Menstruation 213
cessation of 209
failure of 230
irregular 398, 635
Mental disorders
diagnostic and statistical manual of 371, 372
statistical manual of 353
Mental health 78, 93
Mesenchymal neoplasm, malignant 844
Mesenchymal tumors, mixed 835, 883
Mesh extrusion 777f
Mesoderm 177
Mesonephric ducts 682
Mesonephric epithelium develop 183
Mesonephric functional activity, loss of 182
Mesonephric remnants 835
Mesonephric type-adenomyoma 835
Mesosalpinx 128
Mesothelial tumor 883
Metabolic disorders 153
Metabolic syndrome 153, 335
comorbidities of 334
prevalence of 563
Metabolite pregnanediol-3-glucuronide 20
Metallic Hegar cervical dilators 84f
Metaphase oocytes, fragility of 713
Metaplastic endometrial tissues 438
Metaplastic epithelium 811
Metaplastic papillary
lesion 883
tumor 883
Metaplastic squamous epithelium 812
Metastasis, port-site 610
Metastatic tumors 799
Metformin 327, 335, 666
Methotrexate 82, 905, 907
Methylation 242
Methyltetrahydrofolate gene homozygosity 721
Metronidazole 301, 480, 481, 484, 490, 491, 507
Metronomic chemotherapy, principles of 903
Metroplasty 685
Miconazole 90, 485
Micro-Babcock forceps 128
Microbiological tests 512
Microneedle electrode 128
Micronutrient deficiency 811
Microvessel disease 562
Microwave endometrial ablation 409, 410f
Midurethral sling 750, 750f, 751, 753
Mifepristone 69, 82, 83, 88, 90, 444
combination of 87
metabolism of 82
Migrainous headaches 154
Mineralocorticoids, replacement of 349
Minilaparotomy 158
Minimal deviation adenocarcinoma 835
Minimally invasive
surgery 444, 599, 600
technique 753
Mirabegron 757
Miscarriage 199
recurrent 654, 724
risk of 723
Misconceptions 25
Misoprostol 82, 83, 86, 88, 423
Missed pill 34, 138
Mission Parivar Vikas 10
Mitosis 215
Mobiluncus 483
Moh's micrographic surgery 808
Molecular techniques, novel 753
Monoclonal antibodies 905
Monoclonal growth 845
Monocyte chemo-attractant protein 446
Monodermal teratoma 866
Monofilament suture 128
Monogenic disorders 709, 716
Monopolar cautery 793
Monosomy 721
Monsel's paste 820, 827
Monsel's solution 820, 821
Mood 558
swings 65
Morphological uterus sonographic assessment 404, 417
Moskowitz operation 774
Mucinous borderline tumors 873
Mucinous cystadenocarcinoma 290f, 874
Mucinous cystadenoma 272, 272f, 519, 862
Mucinous metaplasia 883
Mucinous tumor 288, 289, 864t, 873
Mucous
membranes 539
polyps 478
secretion 473
Müllerian abnormalities 252f, 292f, 323t, 721
Müllerian agenesis 298, 323
Müllerian anomaly 91, 291, 338f
classification of 339t, 683f, 683t
clinical presentation of 339
detection of 339
diagnosis of 339
investigations for 340t
isolated 337
pregnancy complications of 339t
treatment for 340
Müllerian duct 177, 183, 188, 685
abnormality 251, 291f
classification of 252f, 253f
anomaly 291, 292, 340
development, unilateral 256
formation 186
regression 181
Müllerian fusion, defects of 722
Müllerian papilloma 834
Müllerian rests theory 438
Müllerian structures 323, 342, 347
status of 349
Müllerian tubercle demarcates 186
Müllerian tumor, malignant mixed 847
Müllerian-inhibiting
factor 323
hormones 177
Multikinase inhibitors 832
Multiload 375 55f
pack of 55f
Multilocular cystic mass 886
Multilocular simple cyst 273
Multiparity 915
Multiple pregnancy 696
risk of 691, 697
Muscle tumor, smooth 855
Musculoskeletal diseases 768
Musculoskeletal system 385
Mycobacterium
bovis 511
tuberculosis 511
Mycoplasma 489
genitalium 497
hominis 482, 497
Myocardial infarction 561
Myofibroblast transdifferentiation 433
Myolysis 411
Myoma 413, 422, 423f, 686, 721
enucleation of 423f
multiple 282f
Myomectomy 231, 410, 421423, 614
conventional 422, 423f
hysteroscopic 391, 421
laparoscopic-assisted 410
Myometrial adenoma resection 393
Myometrial anatomy, abnormal 377
Myometrial cells 82
Myometrial contraction 82
Myometrial cycle 217
Myometrial cysts 258
Myometrial electrocoagulation 394, 435
Myometrial lesions 257
Myometrial reduction 393
Myometritis 85
Myometrium 399
outer 428
posterior 393f
superficial 409
N
Nabothian cyst 834
Nafarelin 444
Nasogastric tube 606
National AIDS Control Organization 477, 489
National Cancer Institute 237
National Commission for Protection of Child Rights 94
National Commission on Population 4
National Comprehensive Cancer Network 910, 916, 918
National Crime Records Bureau 532
National Family Health Survey 161, 162
National Family Planning Indemnity Scheme 11
National Family Planning Program 9
National Health and Nutrition Examination Survey 566
National Institute for Health and Care Excellence guidelines 48, 691, 693
National Population Policy 3, 9
Natural contraceptive options 17
Natural family planning, candidates for 17
Natural rubber latex 27
Necrotizing arteriti, isolated s 884
Necrotizing fasciitis 316
Necrozoospermia 653
Neisseria gonorrhoeae 497
infection 495
Neliparib 905
Neoadjuvant chemotherapy 878, 906
radiation therapy of 898
Neoplasia 145f, 240, 914
Neoplasms
benign 413
malignant 238
Neoplastic growths 883
Neosalpingostomy 677
infundibular 130
Nerve
injury 603
sheath tumor 274
sparing radical hysterectomy 838
Neural stimulation, peripheral 326
Neural tube defect 647
Neurobiology 357
Neuroendocrine switch 222
Neuroendocrinology 193
Neurofibroma 528
Neurogenic voiding dysfunction 756
Neurohormone 194
Neurokinin 3 receptor antagonist 581
Neuropeptide Y 195, 222
Neutropenia 905
Neutrophils 480
Nexplanon 38f
Nipple stimulation 326
Nitric oxide 559
Nitrous oxide 722
N-methyl-D-aspartate 313
Nonaromatizable anabolic steroids 367
Nonclassical congenital adrenal hyperplasia 666
Nonepithelial neoplasm, pure 855
Non-gestational choriocarcinoma 873
Non-hormonal pharmaceutical therapy 579
Non-hormonal therapy 576
indications for 577
Non-hormonal treatments 581
Noninvasive chromosome screening 714, 717
Non-neoplastic cellular variations 240
Non-neoplastic ovarian tumors 861t
Non-obstructive anomaly 339
Nonovarian lesions 273
Nonscalpel vasectomy 112, 113, 114f
effectiveness of 114
instruments 113f
Nonsteroidal anti-inflammatory drugs 61, 139, 218t, 312, 313, 378, 380, 418, 445, 910
Nonsteroidal ovarian substance, activity of 206
Nontraumatic traction 442
Noradrenaline reuptake inhibitors 580
Norepinephrine 557
reuptake inhibitors 581
Norethisterone 38
enanthate 45
injections 158
Norfloxacin 507
Normal puberty, physiology of 223
Normogonadotropic normogonadism 634
Norton-Simon model 903
Nortriptyline 405
Nuclear abnormality 813
Nuclear atypia, moderate 835f
Nuclear polarity, loss of 885
Nuclear protein 815
Nuclear staining, intensity of 813
Nucleic acid amplification 674
test 480, 490, 502
cartridge-based 512
Nugent scores 483t
Nulliparity 845
Nulliparous prolapse 777
Nutrition 315
O
Obesity 153, 331, 366, 389, 451, 663, 845
complications of 358
effect of 589
Obliterative surgery, types of 778
Olaparib 905
Oligoasthenoteratozoospermia, severe 694
Oligoasthenozoospermia 652, 653, 657, 660
practical management of 660fc
Oligomenorrhea 139, 198, 298, 302, 331, 664, 669
Oligospermia 633
severe 731
Oligozoospermia 699
isolated 652, 659
severe 638
Oliguria 314
Omental biopsy 850, 880
Omental deposits 877
Omental injury 591
Omentectomy 850
Onapristone 444
Oocyte 549
assessment of 714
cell membrane 171
cryopreservation 549f
mature 712
donation 704
complications with 730fc
indications for 705b
donor 704f, 728
freezing 549
handling of 693
in vitro maturation of 714
maturity evaluation 715
quality, scoring of 714
recipient, evaluation of 705b
recovery 702
retrieval 700
vitrification 728
with sperm, fertilization of 172f
Oogenesis 171, 172f, 185, 210
Oogonial stem cells 548
Oophore 548
Oophorectomy 452, 457
indications for 457, 461
unilateral 880
Open radical hysterectomy 599, 600
Optical trocar
entry with 586f
sheath 587f
Oral antibiotics 309
Oral contraceptive 41, 49, 144, 157, 302, 523
effect of 145f
pill 10, 34, 36, 42, 51, 153, 218, 477, 704f, 729, 915
use 834
Oral estrogen therapy 551
Oral fluconazole 490
Oral hypoglycemic agent 327
Oral progestins 61
Oral tricyclic antidepressants 381
Organ
abdominal 452
development 171
Osmotic dilator 85, 86
Ospemifene 573
Osteocalcin 566
Osteoclasts 559
Osteopathic manipulations 385
Osteopenia 566t
Osteoporosis 565, 566, 569, 570t, 755
diagnosis of 565
Osteoporotic fracture, predictor of 565
Outer cell mass 172
Ovarian artery anastomosing, branch of 466
Ovarian cancer 231, 571, 875, 876t, 898, 914, 918
algorithm, risk of 869, 915, 918
development of 916
diagnosis of 875
early-stage 877
high grade 916
risk factors for 915
screening of 914, 915, 918, 918fc
staging of 877t
treatment of 880fc
Ovarian cycle 193, 213, 213f, 216f, 522
Ovarian cyst 286f, 518fc, 519, 522
complex 520fc
complications of 502
hemorrhagic 270, 270f
management of simple 520fc
postmenopausal 270
simple 269f, 285, 518
teratomas 290
torsion of 229, 522
twist of twisted 522f
types of 288
ultrasound features of 518
Ovarian dimensions, measurement of 268f
Ovarian dysfunction 322, 727
Ovarian dysgenesis 322
Ovarian dysmenorrhea 379
Ovarian endometrioma 287f, 381f, 443f
Ovarian endometriosis 442, 865
Ovarian factor 635, 647
Ovarian failure
familial 727
premature 199, 322, 727
primary 322, 325
secondary 322
Ovarian feedback 200
Ovarian fibromas 417, 519
Ovarian follicular fluid 199
Ovarian folliculogenesis 185
Ovarian function 420
control of 200f
Ovarian germ cell tumors 872
Ovarian hormones 216f
Ovarian hyperandrogenism, functional 329
Ovarian hyperstimulation syndrome 676, 696, 702, 704f, 709, 729, 861
developing 667
late 710t
risk of 700
Ovarian insufficiency, primary 727
Ovarian insulin, stimulation of 323
Ovarian lesions 269
Ovarian malignancy 232, 279, 880
algorithm, risk of 869, 876, 915
Ovarian malignant germ cell tumors 880
Ovarian mass 232, 861
infection of 870
Ovarian morphogenesis 183
Ovarian neoplasia, benign 861
Ovarian neoplasms, types of 290
Ovarian pathology 519
benign 521
diagnosis of 518
differential diagnosis of 519
Ovarian rejuvenation techniques 548, 728
Ovarian remnant syndrome 380, 523
Ovarian reserve
poor 721, 723
tests 648, 710
interpretation of 636
Ovarian resistance syndrome 323, 727
Ovarian steroids 373, 395
Ovarian stimulation 691, 696
long protocol 700f
regimens of 704f
Ovarian surface 916f
Ovarian tissue 548
cryopreservation of 549, 713
Ovarian torsion 271, 288
Ovarian tumor 325, 519, 663, 877t
benign 518
classification of 861, 873b
Ovariopexy 444
Ovary 270, 271f, 285, 558, 884, 892
benign diseases of 516, 516t
benign tumors of 862t
classification for cancer of 887t
corpus luteum of 270f
hemorrhagic cyst of 279
neoplasms of 517
postmenopausal 277
tenderness 271
torsion of 279, 517
Overactive bladder 755
diagnosis of 756
investigations 756
management of 756
pathophysiology 755
Ovulation 205
detection monitors 19
induction 327, 514, 667
method 18
sign for 216
suppression, persistence of 43
tests for 635
Ovulatory disorders 647
Ovulatory dysfunction 230, 322, 398, 723
Ovulatory luteinizing hormone 33
Ovum
donation 548
sperm, transport of 71
Oxcarbazepine 154
Oxybutynin 581, 757
Oxytocin 84, 85
mode of action of 84
Oxyuris vermicularis 476
P
P450 enzymes 199
P53 gene mutation 916
P53 protein expression 845
Paclitaxel 904
plus carboplatin 907
Paget's disease 797, 798f, 808
extramammary 526, 801
management of 798
Pain 416, 518, 771, 910
abdominal 100, 229, 230, 476, 856
exacerbate 382
management of 911t
neuromusculoskeletal 382
nociceptive 910
sex related 384
Palliative care 909, 910
principles of 909
Palliative chemotherapy 906
Palliative surgery 879
Palmers point 587f
Pap smear 233, 238f, 728
normal 237f
Pap test 248
Papillary projections, number of 914
Papillary squamotransitional cell carcinomas 829
Parabasal cells 811
Paracetamol 312
Parametria 894
Parametrium 839f
Paraovarian cyst 270, 271f
Parathyroid hormone 565f
secretion 565
Paratubal cysts 883
Paraurethral bulking injections 753f
Paravaginal tissue 751
Parkinson's disease 571
Paroxetine 580, 581
Patency
bilateral 676
unilateral 676
Patent ductus arteriosus 152
Pearl index 35
Pediculosis pubis 493
Pefloxacin 507
Pegylated liposomal doxorubicin 904
Pelvic
adhesions 381f, 501f
anatomy, normal 281
congestion syndrome 380, 382
disease 911
exenteration 841, 854
fractures, severe 529
irradiation 806
kidney 275
lymph nodes, calcified 260
lymphadenectomy 831, 839, 842, 856f
malformations 383
malignancy, radiation for 791
mass, management of 521fc
muscle spasm 382
musculature 282
nodes 898
pathology 91, 91t, 92
surgery 452
thrombosis 292
Pelvic abscess 100f, 279f, 504
management of 506
Pelvic examination 78, 233
external 233
rectal 233
speculum 233
Pelvic floor
exercise 748, 773
imaging of 292, 772
multidisciplinary team 781
musculature 382
physical therapy 773
physiotherapy 787
prolapse 779f
Pelvic floor muscle
function 745
strength 745
tenderness 382, 384
therapy 384
training 757, 773, 781
Pelvic infection
evaluating for 673
symptoms of 64
Pelvic inflammatory disease 56, 62, 65, 139, 151, 229, 273, 274f, 278, 278f, 378, 490, 497, 498fc, 499t, 501f, 508, 539, 650, 672, 674, 679, 697
clinical features 499
complications 502
diagnosis of 500fc, 503fc
differential diagnosis 502
epidemiology of 497
indicative of 78
investigations 500
management for 508fc
pathogenesis 504
prevention 502
risk for 479
treatment 504
Pelvic organ prolapse
documentation of 780
etiology of 768
physiotherapy trial 781
quantification 770
grid 780
Pelvic pain 688
chronic 307, 380, 385, 395, 428, 444
mapping of 382
Pelvis 382
anatomy of 277f, 281f
neurobiology of 538
Pembrolizumab 879
Penicillin 305
Pentane polysulfate sodium 381
Percutaneous endoscopic gastrostomy 879
Percutaneous epididymal sperm aspiration 657, 707
Percutaneous testicular sperm 708
Perihepatitis, acute 499
Perimenopause 554
diagnosis of 556b
hormonal changes during 144
Perineal body 770
Perineal deficiency 772
Perineal descent 772
Perineal muscles, superficial 531
Perineal sensation 745
Perineal tears 530
classification of 531t
Perineum 800
Perinodal extension 898
Periodic abstinence 163
Peripheral precocious puberty 365
causes of 365, 366b
treatment 368
Peritoneal adhesions 485
Peritoneal biopsy 887
Peritoneal cyst 275
Peritoneal endometriosis, signs of 650
Peritoneal entry 587f
Peritoneal implants 442
Peritoneal irritation 232
Peritoneal oocyte sperm transfer 707
Peritoneal pathology 647
Peritoneal pseudocyst 273, 274f
Peritoneal tissue 438
Peritoneal washing 880
Peritoneum 498, 511
classification for cancer of 887t
entry into 603
posterior 459
Peritonitis 502
acute 499
Perrault syndrome 727
Persistent acne 330
Pessary
types of 773f
use of 772
Peutz-Jeghars syndrome 886
Pfannenstiel incision 458
Phenotypes 440f
Phenton's operation 543
Phenytoin 154
Phosphodiesterase enzyme action 189
Phospholipids, release of 377
Physiotherapy 385
Phytoestrogens 578, 579, 580t, 581
potency of 580t
Pill, morning-after 69
Pineal tumors 326
Pituitary adenoma 663
Pituitary defects 321
Pituitary gland disorders, anterior 663
Pituitary macroadenoma 322, 327
Pituitary necrosis secondary, postpartum 321
Pituitary responsiveness 201
Pituitary secretions, ovarian control of 201f
Pituitary tumors secreting prolactin 326
Placenta 101
genesis of 174f
Placental thrombosis 724
Planning target volume 890
Plasma
cell vulvitis 526
kinetics gyrus 627
Plastic intrauterine devices 164
Pneumoperitoneum
complications 609
creating 119
persistence of 610
Polar body biopsy 714
Poly-arteritis nodosa 884
Polycomb repressive complex 185
Polycyclic hydrocarbons 546
Polycystic ovarian disease 141, 230, 398
strategy for 696
Polycystic ovarian morphology 271f
ultrasound for 664
Polycystic ovarian syndrome 17, 199, 288, 296, 298300, 323, 329, 331, 335, 389, 477, 518, 546, 663, 670, 700, 721, 723, 845
diagnostic criteria for 331b
endocrinology in 300b
presenting features of 298b
Polycystic ovary 270, 325, 329, 332, 665, 861
drilling 667f
morphology 329
poor predictor of 299
syndrome 516, 647, 664f, 665
pathophysiology of 330fc
Polydioxanone 128, 422
Polyembryomas 880
Polyethylene 54
Polyglactin 422
Polyglyconate 128
Polymerase chain reaction 490, 674
Polypectomy, hysteroscopic 390
Polyploidies 721
Polypoid friable mass, large 856
Polyps 260, 389, 721
Pomeroy's method 122, 123f
Population Control Bill 11
Population control, policy of 8
Population dynamics 3
Population explosion 7
Population Policy 5
Population Regulation Bill 5, 11
Population stabilization 10
Population trends 4f
Postabortion contraception 159, 163
counseling for 157
Postabortion family planning 105
Postcesarean section 317
Postcoital tests 636
Postembolization syndrome 420
Posterior compartment disease 438
Postgraduate Residency Program 613
Postinsertion counseling 64
Postmenopausal bleeding 845
Postmenopausal hormone therapy, effects of 568
Postmenopause 554
Postorchitis 656
Postpartum
contraception 163, 164f
family planning 161, 165, 166f
sterilization 117
Postvoid urine, measurement of 744
Potassium hydroxide whiff test, positive 483
Pouch of Douglas 233, 462, 772, 774
Power Doppler technology 176
Preabortion counseling 96
Preanesthesia medications 308
Preantral follicle 203
Precocious puberty 298, 343, 345, 364
classification of 365
complications 366
diagnosis 366
prevention 366
progression of 349
signs of 365
symptoms of 365
treatment 367
Preconception and Prenatal Diagnostic Technique Act 9, 94, 107
Prednisone 666
Pregabalin 381, 384, 581
Pregnancy 44, 480, 491, 492
accidental 65
colposcopy during 818
continuation of 85, 97, 101
first-trimester medical termination of 158
high-risk 69
hypothyroidism of 199
interruption of 152
laparoscopy in 589
loss, recurrent 199, 721, 725fc
luteoma of 861
medical termination of 12, 49, 91f, 108
methods in termination of 81, 147
prevented fraction of 72
prevention of 22
rates 127
second-trimester medical termination of 86b
signs of 78
surgical methods of termination of 88t
termination of 75, 90, 91, 91t, 147, 152, 154
unintended 109
Pregnancy termination 78, 81, 90f, 90t, 157
challenge for 92
difficult situations in 90
first-trimester 92t
gestational age for 93t
safe 107
second-trimester 92
unsafe 100f
Preimplantation genetic
diagnosis 657, 707, 708, 714, 725, 733
screening 725
use of 728
testing 708, 709, 716, 716
Premature clot lysis 399
Premature deliveries 254
Premature ovarian insufficiency 347, 545, 547t
clinical presentation 547
diagnosis 547
etiology 545
management 547
pathophysiology 545
psychological support 551
Premenstrual dysphoric disorder 371, 375
diagnostic criteria for 373b
Premenstrual endometria aspiration 674
Premenstrual syndrome 371
Premenstrual syndrome
classification 372
degrees of 372
diagnosis of 218, 372
differential diagnosis of 372, 372b
etiopathology 373
symptoms 371
treatment 373
Premenstrual tension syndrome 372
Prenatal androgen exposure 348
Preovulatory follicle 205
Prepubertal vulvovaginitis 477
Prerna scheme 11
Presacral neurectomy 380, 444
Primary health center 102
Primary ovarian failure, causes of 322b, 333
Primary tumor, management of 803
Primidone 154
Primitive germ cells 323
Primordial follicle 202
Primordial mullerian cells 183
Primordial pharynx 176
Procidentia 772
Procollagen peptides 566
Proctoscopy 530
Progenitor cells 183
Progesterone 193, 201, 281, 295, 296t, 366, 374, 385, 409, 700, 700f
levels, effects of 377
micronized 52
only implant 148
only injectable 148
only pills 38, 38f, 148, 395
discussions on 40
only therapy 419
ovulation tests 20
preparations 399
promote 395
receptor 215
modulators, selective 405, 419, 432, 444, 445
reduction of 574
releasing vaginal ring 52
role of 398
therapy 419, 724
vaginal suppositories 703
Progestin 33, 380, 572, 847
only methods 164
only pill 151
preparations, injectable 378
replacement study 568
types of 38
Progestin only contraceptives
advantages 39
disadvantages 39
failure rate 39
mechanism of action 39
side effects 40
Progestogen
exposure 51
only compounds 246
only contraceptive 36
only injectable 41, 44
only methods 158
only oral contraceptives 144
only pill 48, 105, 164, 166, 167, 667
types of 398
Prolactin 162, 196, 296, 297, 656, 669
elevated levels of 162
production 196
Prolapse, treatment for 773
Prophylactic antibiotic 457, 470
Prostaglandin 83, 313, 377
effects of 377
liberation of 86
synthase inhibitors 378
Prostate
cancer, risk of 114
transrectal ultrasound of 655, 657
Protection of Children from Sexual Offence 102
Protein 189t
C, deficiency of 721
S, deficiency of 721
Protensin 579
Proteolytic enzymes 217
Prothrombin gene 712, 722
mutation 721
Proximal tubal cannulation 677
Proximal tubal clipping 679
Proximal tubal disease
causes of 672t
surgery for 677
Pseudo gestational sac 274
Pseudoestrogens 189
Pseudo-Meigs syndrome 867
Pseudomyxoma peritonei 874
Pseudotumor cerebri 326
Psychiatric disorder 360
Psychological counseling 728
Psychosocial pressures 659
Ptosis 727
Pubertal development, stages of 223
Pubertal growth, normal 223
Pubertal virilization 346fc
risk of 349
Puberty 221, 224t, 320, 812
delayed 300, 302, 346
development in 364b
endocrinology of normal 221
explain effects of 354
heterosexual precocious 365
isosexual precocious 365
sign for 223, 297
timing of 223
Pubic hair 226f
development of 224, 226f
Pubic symphysis 453f
Pubocervical fascia 775f
detachment of 771
Pubovaginal sling 748, 750, 750f
Pulmonary capillary wedge pressure 312
Pulmonary embolism 118, 839
Pulmonary hypertension 150
severe 152
Punch biopsy 836
Pungent smell 481
Pyelonephritis 764t
acute 763
Pyrazinamide 514
Pyridinoline 566
Pyridoxine 218
Pyuria 762
Q
Quinagolide 445
R
Radiation 382, 631, 831
techniques, newer 891f
Radiation therapy 831, 889, 895, 897, 898
oncology group 892
primary 805
principles of 889
Radical hysterectomy 756, 838
complications of 839
modified 831
Radical local excision 804
Radical surgery 898
procedures 394
Radical vulvectomy 803, 804f
incisions for 803f
Radiofrequency energy
delivery 788
sources, properties of 625
Radiofrequency volumetric thermal ablation 420
Radiological tests 512
Raloxifene 573
Rape and sexual violence 535
Reconstructive surgery 677, 758, 759
Rectal examination 745
Rectal mucosa 531
Rectocele 772
Rectovaginal examination 234, 235f
Rectovaginal fistula
etiology 794
management 794
simple 794
Rectovaginal nodules 443
Rectovaginal septum 234
Rectum, prolapse of 786
Recurrent disease, management of 856
Recurrent miscarriages, causes of 721
Red blood cells 209
Refeeding syndrome 361
Refractory seminal infection, treatment of 652
Regular menstruation 302
Reid's colposcopic index 821
Renal abnormalities 291
Renal failure, chronic 325
Renal vein 856f
Renin angiotensin system 373
Reoxygenation 890
Reproduction, female 194
Reproductive age group, advanced 875
Reproductive cycle 193
Reproductive endocrinology 631
Reproductive function, female 199b
Reproductive hormones 297
Reproductive medicine 718
Reproductive organs, female 682f
Reproductive physiology 171
Reproductive technology 679
Reproductive tourism 733
Reproductive tract 182f, 688
female 682
infection 117
Resectoscope 390, 593
types of 593
Residual cells 438
Respiratory distress 482
Respiratory system 231
Restorative surgeries 773
Rete pegs 823f
Rete testis aspiration 708
Retinaldehyde dehydrogenase isoform 185
Retinoic acid
binding of 185
receptor 185
Retrograde menstruation 437
Retropubic midurethral slings 748, 750, 750b
Rett syndrome 721
Reversible contraceptive, long-acting 49, 60, 144, 165, 419
Rhesus blood group typing, tests for 79
Rheumatoid arthritis 721
Rh-immunoprophylaxis 87
Rhomboid flap, bilateral 804f
Ribonucleic acid, messenger 242
Rifampicin 82, 514
Right infundibulopelvic ligament 467f
Right round ligament, coagulation of 467f
Ritonavir 90
Robotic radical hysterectomy 599, 600
Robotic surgery 596, 597, 613
economic impact of 600
platform 596
procedure 851
role of 600t
training 601
Robotic technology 597
Robotic-assisted video endoscopic inguinal lymphadenectomy 600
Rokitansky nodule 272
Rokitansky-Kustner-Hauser syndrome 188
Rollerball endometrial ablation 407, 408f
Ropivacaine 313
Rotterdam consensus 298b
Round ligaments, transection of 466
Roxithromycin 507
Rucaparib 905
Rudimentary vagina 543
Rumination disorder 359
S
Sacral nerve stimulation 788
Sacral neuromodulation 758
Sacrocolpopexy, abdominal 783f
Sacrohysteropexy procedure 778, 778f
Sacrospinous fixation 781, 782, 782f
Safe period method 163
Safety test 584
Saline
infiltration of 460
solution, normal 819, 822
Saline infusion
sonography 269, 390
sonohysterography 263f
Saliva 20
Salpingectomy 621, 673, 678, 884
unilateral 507
Salpingitis
chronic 129
isthmica nodosa 129, 511, 518, 672, 883, 884
mild 675
moderate 675
severe 675
Salpingo-oophorectomy 507, 887, 918
bilateral 375, 380, 846, 849
Salpingostomy 621
Salpinitis, grading of 675
Salt restriction 218
Sample registration system 161
Sampson's artery 466
Saquinavir 90
Sarcoidosis 321
Sarcoma 801, 808, 856
uterus 855
Sarcoptes scabiei sensitization 493
Satellite lesions 825f
Savage's syndrome 323
Scabies 493
Scar endometriosis 87, 285, 288f
Schiller's iodine test, principles of 816
Scrotal fungal dermatitis, chronic 658
Scrotal ultrasound 655
Scrubs, povidone-iodine based 309
Second trimester 153
Second-generation
ablation 407
techniques 407
Secretory phase 208
Seizure disorder 39
Semen
azoospermic 640
collection, timing of 697
factors 722
freezing of 703
testing 731
values of 640, 642t
volume, low 653
washing techniques 696
Semen analysis 652, 653t, 667, 724
abnormal 656
computer assisted 634, 641
routine 640
Semen parameters 695, 697, 702, 706, 706b
normal 653
Semen preparation
essential requirements for 706b
methods for 706b
techniques 696
Semen sample 695
collection of 640
Seminal vesicles 177
development of 342
Seminal vesiculitis 722
Sensory innervation 380
Sentinel lymph node 838, 853
biopsy 803
concept 806f
identification 839
mapping 850
Sepsis 58, 85, 100
prevention of 314
Septal resorption 682, 683
Septate uterus 253, 254, 254f, 340, 684, 721, 722
Septicemia 530
Septum 614
partial 254f
resection 543
Seromucinous tumor 865
Serosal distortion, amount of 405
Serosal mesothelial inclusion cyst 884
Serotonin 580, 581
levels, low 373
reuptake inhibitors, selective 218, 374, 580, 582
Serotonin-norepinephrine reuptake inhibitors 375, 384, 581, 582, 910
Serous
carcinoma, high grade 873
cystadenocarcinoma 289f
cystadenoma 272, 272f, 288, 519, 862, 863f
epithelial cystadenocarcinoma 873
epithelial tumors 872
tubal intraepithelial cancer 885, 916, 916f
tumors 288, 864t, 873
Serous ovarian cancer 874
high-grade 873
low-grade 873
Sertaconazole 485
Sertoli cells 180, 185, 517, 867
tumors 873
Sertoli-Leydig cell tumor 867, 868
Serum
beta-human chorionic gonadotropin levels, estimation of 83
follicle stimulating hormone 364, 648
free thyroxine concentration 669
luteinizing hormone, normal 669
markers 446
progesterone levels 648
prolactin 640
sex hormone-binding globulin 669
testosterone 333
thyroid-stimulating hormone concentration 669
Severe acute respiratory syndrome coronavirus 670
Sex cord 517, 873
stromal tumor 517, 867, 872
classification of 867t
mixed 517, 873
pure 873
Sex determination 342, 343f
female 184f
Sex develop
disorders of 342
female 177
Sex differentiation 177, 182f, 344f
female 189
hormonal control of 188
Sex hormone
action of 525
binding globulin 295, 299, 323, 555, 663, 664f
concentrations 632
serum levels of 349
Sex organs, growth of abnormal 171
Sex partners, management of 480, 506
Sex reversion 712
Sex steroids 196
low dose of 144
Sex-determining gene, absence of 337
Sexual abstinence 505
Sexual abuse, childhood 357
Sexual and reproductive healthcare, faculty of 66fc
Sexual assault 529, 532, 534f
Sexual behavior, patterns of 141
Sexual development, tracking chronology of 189t
Sexual dysfunction 699
Sexual freedom 39
Sexual health 78
Sexual intercourse 697
unprotected 66, 146
Sexual offences, protection of 93
Sexual pain 539, 540
disorders 539
secondary 539t
Sexual partners
multiple 498, 834
number of 811
Sexual symptoms 771
Sexual violence 532, 533fc, 534
history 533
Sexually transmitted
disease 31, 34, 72, 154, 231, 497
infection 27, 62, 104, 110, 163, 117, 388, 489
Shaw's classification 768
Sheehan's syndrome 321
Shirodkar's repair 776t
Shirodkar's sling surgery 777f, 777t
Shirodkar's uterosacral advancement 774
Shock 99
signs of 99
Shoulder pain 99
postoperative 610
Sickle cell
anemia 39
disease 36
Sigmoid 895
colon
mobilization of 444
patch of 794
Sims speculum 233
Single gene
defects 721, 723
disorders 716
Single spermatozoan fertilizes oocyte 171
Skin
rashes 494
vulvectomy 797
Skipper's laws 903
Sleep 384, 558
disturbances 382
Sling procedures 749
Small bowel perforation 606f
Small tubular uterine cavity 723
Soft tissue
density 278
parametrial 279
sarcoma 801
tumor 884
Solid components, absence of 273
Solid organ transplantation 141
Solifenacin 757
Solitary submucus fibroid 421f
Somatic cells 181
Somatic mutation therapy 903
Sonavala's sling operation 777
Sonoembryology 171
Sonohysterogram 725
Sonohysterography 390
Sonohysterosalpingography 675
Sorafenib 832
SOX9 expression 180
Spasmodic dysmenorrhea 229, 377
Speculum 819
examination 78, 305
Sperm 712
assessment of 715
autoimmunity 641
capacitation 61
chromatin
dispersion test 642, 654
structure assay 642
concentration 633
count 640
deoxyribonucleic acid
damage 641, 654
fragmentation 654
donation 727, 731
indications for 731
donors
selection of 731
testing of 731
function
disorders of 656
tests, special 660
injection 654
meiotic studies 712
morphology of 633, 641
motility of 633, 641, 706, 716
nuclear chromatin 660
penetration 700
assay 634, 642
transport
disorders of 631
secondary 632
viability 633
wash 706
Spermatic cord 112
Spermatic ducts 177
Spermatid injection 718
Spermatocele aspiration 708
Spermatogenesis 210
disorders of 656
focal areas of 657
Spermatozoa
agglutination of 640
head 171
penetration of 171
Spermicidal agents 25
advantages 25
disadvantages 25
efficacy 25
Spermicides, use of 31
Sphincter augmentation 788
procedure 788
Sphincter injury 530
Sphincter reinforcement 789
Sphincter replacement methods 788
Sphincterotomy, internal 786
Spina bifida 756
Spinal cord lesion 326
Spine 231, 756
Spironolactone 301, 334, 374
Spontaneous abortion
chance of 65
risk of 429
Squamocolumnar junction 811, 812
Squamous abnormality, terminology for 239
Squamous cell 237, 240
atypical 237, 239, 242244, 814, 826
cancer 830, 832
carcinoma 238f, 801, 829, 834, 835f, 866
treatment of 804
high-grade 240
Squamous cellularity criteria, minimum 238
Squamous epithelium 815
stains mahogany 817
Squamous intraepithelial lesion 834
high-grade 237, 238f, 239, 243, 244, 797
low-grade 239, 243
Staphylococcus saprophyticus 762
Statins 445
Stem cell therapy 548
Stents, use of 129
Sterilization 146, 158
female 41, 47, 112, 115117, 118t, 165
form for 158
guidelines 126
reversal of 126, 127t, 165
surgeries 133
types of 133
Sterilization failure 121
mechanism of 121
relative risk of 121
risk of 121t
Steroid
cell autoantibodies 546
enzyme defects 322
hormone synthesis 171
local injection of 385
release 195f
Steroidogenic acute regulatory protein 344, 345
Stoma, creation of 789
Stool, leakage of 785, 789
Stratum compactum 207
Stratum spongiosum 173f, 207
Stress 354
incontinence 745f, 755
management 218
severe 321
Stress urinary incontinence 747, 748b, 749, 750f, 751, 753, 780
management of 747
postoperative 782
surgical treatment of 747
Stroke 570
risk of 570
Stroma 268
hyperplastic 288
Stromal capillaries 823f
Stromal cells 215, 216, 216f, 217f
Stromal nodule 855
Stromal sarcoma
high-grade 855
low-grade 855
Stromal tumors 873
Struma ovarii 867
Sturmdorf suture 774
Subfertile male 652
evaluation of 652
Subfertility 199, 301
secondary 638
Submucous fibroids 339, 411, 415
treatment of 411
Submucous leiomyomas 404
Subnuclear glycogen 217f
Subnuclear vacuolation 216
Subserosal fibroid 278f, 422
Subserosal leiomyomas 404
Sulbactam 506
Surgery, types of 441
Surgical abortion
complications of 98
management of 98
Surgical methods, complications of 86b
Surgical robot, components of 598f
Surgical site infection, risk of 314b
Surrogacy 704, 732
gestational 732
indications in 732
steps in 732
Surrogate
counseling for 733
immunohistochemical markers 897
screening of 732
Swan Ganz catheter 312
Swayer syndrome 347
Swede score 825t
Symptomatic pelvic inflammatory disease 43
Symptomatic vaginitis, evaluation of 477fc
Symptothermal method 16
Symptothermal technique 19
Syncope 99
Syndrome treatment, disadvantages of 486
Synthetic estrogens 571
Synthetic progesterone 41
Syphilis 494
primary 494
secondary 494
tertiary 494
Sysmenorrhea, clinical features secondary 378
System alternative medicine approaches 579
Systemic autoimmune disorder 721
Systemic disease 325
Systemic estrogen therapy 569
Systemic hormonal therapy 395
Systemic lupus erythematosus 151, 199, 724
Systemic oxidative stress 670
Systemic syphilis 721
Systemic therapy 852
Systemic toxic reactions 98
Systolic blood pressure 151
T
Tadalafil 659
Talcum powder, use of 915
Tamoxifen 82, 368, 392, 854
therapy 845
Tanner's breast development staging 226t
Tanner's pubic hair staging 224, 226t
Tanner's stages 226, 226f, 227
Tansvaginal sonography 728
Tazobactum 470
Teeth, enamel of 177
Telemedicine 109
Telescope 592
sheath 592
Teletherapy 890
Telopeptides 566
Tenaculum, use of 697
Tenderness 518
Teratoma 517, 865, 873
benign 285, 865
immature 290, 865
mature 290, 519, 835
Teratozoospermia 652, 699, 705
isolated 659
Terconazole 485
Terminal hair, absence of 333f
Termination of pregnancy
complications of 96
counseling after 104
incomplete 100f
Testicular biopsy 641, 655
indications for 633
Testicular causes, primary 632
Testicular descent 183f
Testicular development 180
Testicular differentiation 179, 180
Testicular disorders, primary 631
Testicular failure, primary 658
Testicular feminization syndrome 323
Testicular germ cells, in vitro maturation of 718
Testicular hormones, theory of 191
Testicular size, enlargement of 346
Testicular sperm extraction 657, 707, 708
Testicular steroid enzyme defects 324
Testicular tumors 656
Testosterone 177, 188, 295, 296, 297, 322, 323, 346, 366
amount of 296
production of 188, 342
reference ranges 296
replacement 670
Tetanus 101
immunization, status of 78
Tetracycline 507
Theca cells 185, 867
Theca lutein cyst 517, 861
Thelarche 224
Thermablate external anal sphincter 408f
Thermacoagulation 825, 828
Thermal balloon ablation 407
Thermal ligating shears 619, 629f
Third-party reproduction 727
types of 727
Thrombocytopenia 905
Thromboembolism 305
Thrombophilia, inherited 721, 722
Thromboprophylaxis 310, 461
Thromboxane 209, 377, 433
Thunderbeat 628, 628f
Thyroid 198, 199, 669
antibodies, screening for 546
binding globulin 198
disease 199
autoimmune 723
disorders 198, 199, 231, 636
effect on 559
examination of 389
function 198
abnormal maternal 723
tests 364
gland, inflammation of 199
hormone 199
releasing hormone 326
Thyroiditis, subacute 199
Thyroid-stimulating hormone 297, 300, 302, 546, 559, 647, 705, 725
levels of 324
testing for 395
Thyrotropin-releasing hormone, levels of 197, 296
Thyroxine 198
Tibial nerve stimulation, peripheral 758
Tibolone 572
Ticonazole 485
Tinidazole 480, 490
Tissue
growth 171
handling technique, principles of 792
injury, role of 428
necrosis 209
Tolterodine 757
Torsion 870
ovary, diagnosis of 271
Tough hymen 543
Toxicity 806, 893
acute 899
Toxins, environmental 631, 727
Toxoplasmosis 721
Trachelectomy 838, 839, 840t
prerequisites for 839
Tramadol 313
Tranexamic acid 418
Tranquilizers 218
Transabdomen sonography 268
Transabdominal scan 251
Transabdominal ultrasound 92, 635
Transdermal contraceptive patch 139, 378
Transferred embryo, implantation of 678
Transitional cell tumors 517, 873
Transobturator midurethral sling 751
Transobturator tape 751, 751f, 752b, 752f
Transrectal ultrasound 643, 655, 657
Transthyretin 198
Transurethral resection syndrome 407, 655
Transvaginal hydrolaparoscopy 676
Transvaginal mesh 783
Transvaginal oophorectomy clamp 461f
Transvaginal sonography 383, 446
Transvaginal ultrasound 248, 268, 389, 501, 635, 636, 648, 650, 700, 845
measurement 389
Trauma, genital 529
Trenbolone acetate 366
Trendelenburg position 99
Treponema pallidum 494
Trichloroacetic acid, application of 492
Trichomonas 476
vaginalis 476, 478f, 490, 491f, 497
infections 476
vaginitis 478
Trichomoniasis 490
diagnosis 490
pathogenesis of 479f
recurrent 480
treatment 491
Tricyclic antidepressants 301, 405, 910
Triglycerides 563
Triiodothyronine 198
Trilaminar disc 178
Triple-flap method 433, 434f
Triptorelin 697
Trocar
insertion 590f
placements 466
radially expanding 584
site bleeding 591
site infection 591
tips, types of 588f
Trophoblast 172
Trospium chloride 757
Tubal assessment tests 673
Tubal block, bilateral 649f
Tubal blockage 507
Tubal catheterization 674, 675
Tubal disease 676
incidence of 672
mid 672
mild 676
moderate 676
severe 676
Tubal epithelium, hyperplasia of 884
Tubal factor 635, 636, 648
infertility 672
evaluation for 673
Tubal hyperplasia 883
Tubal infertility 673
in vitro fertilization for 676
management of 676
reconstructive surgery for 677
Tubal inflammation, chronic 884
Tubal ligation 115, 115t, 126
Tubal occlusion 115, 621
laparoscope-guided 119
secondary 649t
Tubal patency 679
categories of 676t
evaluation of 339
tests 675
Tubal pathology 269
diagnosis of 518
differential diagnosis of 519
preexisting 703
ultrasound features of 519
Tubal reanastomosis
pregnancy rates for 131t
surgical methods for 127
Tubal reconstructive surgery 676, 679
Tubal resection 677
Tubal segments 128
Tubal sterilization 126, 672
microsurgical 679
seeking reversal of 126
Tubal subfertility
acquired 672
causes for 672
congenital 672
Tuberculin test 512
Tuberculosis 321, 510
development of drug-resistant 510
extrapulmonary 510
genital 511
genitourinary 674
history of 230
latent 721
testing for 674
Tuberculous endosalpingitis 511
Tuboendometrioid metaplasia 835
Tubo-ovarian
adhesions 501f
mass 512, 512f
Tuboplasty 507
Tubotubal anastomosis 128f, 133
types of 129
Tubouterine
anastomosis 129, 130f
implantation 130
Tubular structure 621
Tumor
adrenal 325
benign 272, 865, 866, 884
mucinous 862
seromucinous 866f
serous 862
borderline 272, 273f, 873
characteristics 875, 876
endometrioid 864, 873
borderline 873
epithelial benign 883
excision 884
fragmentation 600
hypothalamic 326
like lesions 883, 884
malignant 855
markers 519, 880, 886, 914, 915
necrosis factor alpha 204, 559
thickness 831
Tunnel clusters 834
Turner's syndrome 298, 347, 664, 712, 727
U
Ulcers, gastrointestinal 378
Ulipristal acetate 69, 146, 419, 444
Ultrapotent steroids 526
Ultraviolet radiation 713
Umbilical entry 586, 587f
Upper genital tract infection 476
Upper tract post menses 476
Upper urinary tract 756
deterioration, risk of 756
Ureaplasma 489
Ureter, transection of 608f
Ureteral diverticulum 275
Ureteral injury 607
Ureteral reconstruction 608
Ureteric injury 463, 606
Ureteric obstruction 912
Ureteric reimplantation 608f
Ureteric stent 608f
Ureterovaginal fistulas 792
Urethral bulking agents 753, 753b
Urethral mucosal closure pressure, low 748
Urge incontinence 755
Urinary complications 839
Urinary diversion 758
Urinary frequency 771
Urinary human chorionic gonadotropin 697
Urinary incontinence 745t
Urinary injuries 463
Urinary reduction efforts 781
Urinary retention 531
Urinary sphincter, artificial 750f, 753
Urinary storage 743
Urinary stream 771
Urinary system 181
Urinary tract 530, 765
injury, incidence of 752
Urinary tract infection 502, 760, 760b
catheter-associated 765
classification 760
complicated 764
epidemiology 761
etiology 760
pathogenesis 761
recurrent 382, 764
urinalysis for 383
Urinary urgency 771
Urine
analysis 745
culture 756, 762
indications for 762b
cytology 756
incontinence of 771
inhibitors 761
microscopic examination of 762
pregnancy test 66
routine 745
specimen, collection of 762b
Urodynamic evaluation 748
Urodynamic stress incontinence, incidence of 781
Urodynamic study, indications for 756
Urogenital atrophy 554, 569
Urogenital development, growth factors in 189t
Urogenital diaphragm 803
fascia of 803
Urogenital prolapse 773f
differential diagnosis 772
management 772
pathophysiology 767
symptoms 771
Urogenital sinus 186, 187f, 682
Urogynaecology 743
Uterine 99f, 207
abnormality 251, 323, 647
acquired 257
anomaly 684
classification of 684t
congenital 682, 683
aplasia 257
balloon therapy system 408
blood vessels 411
cancers 907
conservative surgeries 405
contractions 82
cornua 129, 292
cycle, stages of 208f, 208t, 209f
defense 498
disease 251
factor 634, 636, 650, 682
fundus, level of 256
impairment of 420
leiomyoma 395
leiomyomata, management of 452
lipoleiomyomata 394
lumen 678
mass 232
papillary serous carcinoma 848
pathology, secondary 650t
perforation 58, 98
prolapse 292, 768, 772
rupture 92, 411, 435
scar 263
septum 339, 722f
smooth muscle, benign tumors of 394
sound 58, 84f, 85, 697
surgery 428
transplantation 688
tumors 43
volume, estimation of total 405
Uterine artery 420
embolization 231, 394, 411, 420, 435
role of 399
ligation 394, 435, 469
occlusion 423
vaginal occlusion of 425
Uterine bleeding
abnormal 62, 66, 229, 242, 331, 387, 399, 400, 404, 405, 435, 556, 845
classification of abnormal 427
excessive 331
Uterine cavity 98, 434, 650, 676, 724, 834, 835
banana-shaped 256
opening 434f
size of 595
Uterine cervix 835
adenoid basal carcinoma of 835
adenomyoma of 835
atrophy of 834
cancer of 842
carcinoma of 835
endocervicosis of 835
Uterine fibroid 91, 277, 394, 686
classification of 686f
subclassification 395
Uterine muscle 413
activity 217
Uterine sarcoma 282, 857, 857t
classification of 855t
clinical features of 856
distribution of 855t
Uterine synechiae 263f, 721, 722
formation of 411
Uterine vessel 469
left ascending 469f
Uterine wall
removal, wedge-shaped 433
wedge resection of 433
Uterosacral cardinal ligament 770
Uterosacral ligaments 233, 438, 768, 783
Uterovesical fold, division of 468f
Uterus 282, 347, 459, 462, 513f, 558, 839f
action on 82
adenomyotic 429f, 430f
aplastic 257
arcuate 292f, 338, 340, 685
bicornuate 256f, 683, 685
bicorporeal 254, 338, 684
septate 255f
body of 281
conservation of 507
contraction of 86
didelphys 291, 340, 683
dissecting 434f
dysmorphic 252, 254f, 684
epithelium of 844
formation of 683
hypoplasia of 682
hypoplastic 254f
in utero, development of 251f
landmarks of 466
malignant diseases of 844, 847
mesenchymal
elements of 855
tissue of 844
normal 253f, 649f, 684
premalignant diseases of 844, 846fc, 847
rudimentary horn of 256f
septate 255
size of 466
supports of 767
T-shaped 254f, 721, 732
unicornuate 338, 340, 682, 732
V
Vagina 51t, 290, 498, 511, 558, 892, 894
access 793
administration 50
agenesis 291, 323
anatomy of 473
anlage 188
anomalies 338
apex of 780
aplasia 257
approach, contraindications for 459
atresia of 188
lower one third of 291f
benign lesions of 525, 528
bleeding 530, 781, 831
bowel control system 788
candidiasis, therapy for 485t
clear-cell carcinoma, risk of 686
compensatory surgeries 777
cycle 217
delivery 381
dilators 543f
dryness, symptoms of 554
ecology 761
epithelial cells 490
epithelium 474
estrogen 757
examination 85, 534, 744, 836
flora, part of 484
fluid, pH of 482
infection of 19, 481, 771
inflammation 498
irradiation 851
lacerations 530, 531
lubricants 581
malignancies 831
malignant
diseases of 829, 834
melanoma of 831
melanoma 831
microbial flora 475b
microbiome of 722
microflora 473
moisturizers 581
morcellation techniques 471
myomectomy 410
over abdominal approach, advantages of 459
pessaries 781
physiology of 473
preparation 457
prevents pregnancy 17
products 475
ring 51, 51f, 52, 138, 378
sacrospinous fixation 782
septum, longitudinal 540f
side wall retractor 817f
speculum 816f, 819
stenosis 898, 900
tract, cells of 474
vault of 461
Vaginal cancer 829, 830, 830t, 831, 897
causative factor for 829
primary 897
risk factors of 829b
Vaginal contraceptive ring 50
efficacy 51
side effects 51
structure 50
usage 50
Vaginal cuff 471f, 839f
closure 470
suturing 471f
Vaginal discharge 230, 473, 485, 831
abnormal 491, 845
classification of abnormal 477
defense mechanism 474
diagnosis 477
investigations 477
management of 486fc
Vaginal ecosystem 474
factors maintaining 475
Vaginal hysterectomy 424, 450, 453, 454, 457, 459, 460f, 461f, 781, 851
contraindication for 460
laparoscopic-assisted 451b, 453
preoperative preparation 457
Vaginal infections, recurrent 485
Vaginal lacerations, extensive 530f
Vaginal pain 384
syndrome 380
Vaginal pH 473, 490
assessment 503
Vaginal prolapse 768
anterior 768
middle 768
types of 769f, 781
Vaginal secretions, normal 475b
Vaginal septum, transverse 323
Vaginal speculum, posterior 84
Vaginal spermicides 25, 31
advantages 31
contraindications 32
disadvantages 31
mechanism of action 31
Vaginal tape, tension-free 750
Vaginal vault prolapse, posthysterectomy 780
Vaginal wall 531
anterior 771, 775f
cysts 528
posterior 453f
prolapsing 782
Vaginismus 537, 538, 539, 543
Vaginoplasty 349, 543
Vaginoscopy 530
Varicoceles 631, 632, 656
Vas deferens 656
congenital bilateral absence of 631, 632, 656, 657
Vas occlusion
alternative methods of 115
methods of 114f
Vasal fascia, interposition of 113
Vascular cell adhesion molecule-1 563f
Vascular dysfunction 564
Vascular injury 589, 591
major 609
Vascular smooth muscle, relaxation of 562
Vascularization flow index 177, 179
Vasectomy 112, 115t, 631
early complications 114
late complications 114
reversal 115
Vasoepididymal anastomosis 657
Vasoepididymostomy 657
Vasomotor symptoms 556, 558, 569, 581
pathophysiology of 556
Vasopressin 423
dilated 442
effects of 377
Vasovagal reaction 63
Vasovasal anastomosis 657
Vasovasostomy 132, 132f
surgical techniques 132
Vault closure 459, 471
Vault prolapse 599
management of recurrent 784
surgeries for 778
Venereal disease research laboratory 534, 647, 705
Venlafaxine 375, 384, 580, 581
Venous thromboembolic disease 35
Venous thromboembolism 153, 166
lower rates of 50
prevention of 315
prophylaxis 316t
Venous thrombosis 279, 610
Venting procedures 911
Veress needle 584, 584f, 585, 588
insertion of 588f
parts of 588f
placement of 585
technique 584
Vesicovaginal fistula 791f, 792, 839
repair 793f
Vesicular mole 263, 264f
Vessel sealing device 625
Vestibulitis 539
Villus, primary 174f
Viral markers 81
Virkud's composite sling 777
Virus like particles 813
Visceral injury 591
Visual access method 585, 586
Visual entry system 584
Visual inspection 242, 492, 816
Vital signs 231, 380
Vitamin 373, 578
D, deficiency of 721
D3 deficiency 724
E 578
Voiding disorders, risk of 751
Voiding, dysfunctional 756
Volumetric arc therapy 891
Voluntary anal contraction 745
Vomiting, opioid-induced 911
von Recklinghausen's disease 528
Vulva 498, 511, 527f, 558, 797, 798, 798f, 892
benign
lesions of 525
tumors of 527
cancer of 802t, 899f
candidiasis 526
neoplastic diseases of 796
Paget disease of 808
systematic inspection of 534
Vulval carcinoma 799
clinical features 800
types 801
Vulval dermatitis, chronic 526
Vulval endometriosis 528
Vulval fibroma 527f
Vulval hematoma, large 532f
Vulval lipoma 528f
Vulval pain syndrome 527
Vulval psoriasis 526, 527f
Vulval skin, general care of 528
Vulval ulcers 527
Vulval varicosities 526
Vulvar atypia 796
Vulvar cancer 801, 898
advanced 800f
incidence of 800t
relapses of 807
Vulvar dystrophy 800
Vulvar intraepithelial neoplasia 796, 797, 800, 800f
high grade 797f
management of 797, 797b
Vulvar lesion
biopsy of 802
high-grade 797
Vulvar malignancy 382
Vulvar vestibulitis syndrome 539, 539
Vulvectomy, simple 797
Vulvodynia 382, 539
Vulvovaginal atrophy 582
Vulvovaginal candidiasis 484fc, 491
W
Waist sign 519
Warren flap 787
Warts 492
anogenital 492
Weight gain 138, 563
Weight loss, extreme 321
Whiff test 503
Whirlpool sign 271
White blood cell 482
White discharges 485
Wilms tumor 180
gene 181
Wiper jaw mechanism 628f
Wolffian ducts 177, 182, 182f, 186, 682
Wolffian structures, stabilization of 342
Wound
dressings 316
fluids 316
infection, diagnosis of 316
management 316
X
X chromosome 180, 322, 545
Xenoestrogens 189
X-linked inherited condition 545
XX chromosomal complement 342
XX germ cells 181
XY germ cells 181
XYY karyotype 712
Y
Y chromatin 322
Y chromosome 177, 180
deletions 631
microdeletions 656
Yeast infections 476
Yoga 218
Yolk sac 274
primary 174f
secondary 174f
tumor 835, 873, 880
volume 178
Yuzpe method 69, 140
Z
Zalain 485
Zeranol 366
Zinc acetate 52
Zona dissection, partial 707
Zona pellucida 171
Zona thinning 708
Zygote
division of 171
intrafallopian transfer 707
×
Chapter Notes

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1Contraception and Termination of Pregnancy
  • General
  • Contraception: Spacing Methods
  • Termination of Pregnancy
  • Permanent Contraception
  • Contraception and Pregnancy Termination for Special Groups2

GeneralSECTION 1

1.1 POPULATION DYNAMICS: THE INDIAN PERSPECTIVE
Anita Soni, Seeru Garg, Ruchi Shah
 
DEFINITION
Population dynamics is a portion of ecology that deals with the variation in time and space of population in size and density for one or more species.
 
INTRODUCTION
In population dynamics, we study short- and long-term changes in the composition, size, and age of the population along with the biological and environmental processes influencing those changes. Fundamentally, it is the study of how population changes over time.
Population dynamics overlaps with other branches of research in mathematical epidemiology (the study of infectious disease affecting population). Over the past years, population dynamics has been complemented by the evolutionary game theory, which was first developed by John Maynard Smith.
With abundant resources and favorable growing conditions, a population has the potential to increase in number from generation to generation. The population's intrinsic growth rate (“r”) is considered exponential, if each generation increase is a constant percentage of the total population size. As population size approaches the carrying capacity:
  • There may be increase in mortality rate and decline in the birth rate.
  • The population may stabilize below the carrying capacity, known as a logistic or sigmoid (S-shape) growth curve.
  • The population may overshoot the carrying capacity and then crash, resulting in repeated cycles of “boom” and “bust.”
  • The population may oscillate around (or below) the carrying capacity.
 
POPULATION TRENDS IN INDIA
Population of India is currently growing at a rate of 1.44% per year. Hence, it has been projected that India would have a total of 2 billion, i.e., 16% of world's population. As per the 2011 Census, the population was noted as 1,210 million with a percent change of 17.7%. The National Population Policy (NPP)— 2000 states that India contributes 58% to population growth on account of demographic momentum and 20% of unwanted fertility due to unmet need of contraception. As a result, a “bulge” or baby boom is moving through the age structure of population (Fig. 1).
While global population has increased three times during this century from 2 to 6 billion, the population of India has increased nearly five times from 238 million to 1 billion in the same period. India's current annual increase in population of 15.5 million is large enough to neutralize efforts to conserve the resource endowment and environment.
 
COMPOSITION OF POPULATION
Population dynamics include birth rate (BR), death rate (DR), immigration (I), emigration (E), and age and sex composition. Birth and death rates are the most important determinants of population growth.
zoom view
The annual growth rate for India was 1.19 in 2018. If the annual growth rate of a population is 1%, it doubles in 70 years. This law is called Malthusian model.
zoom view
4Annual growth rate:
  • <0.5%: Slow growing population
  • 0.5–1%: Moderately growing population
  • 1–1.5%: Rapidly growing population
  • 1.5–2%: Very rapidly growing population
  • >2%: Explosively growing population.
zoom view
Fig. 1: Population trends in India.Source: Tradingeconomics.com: Ministry of Statistics and Programme Implementation.
After the formulation of the national family welfare program, India has reduced CBR from 28.3 (1995) to 21.4 (SRS bulletin, 2013). The maximum CBR has been reported in respect of Bihar (27.7) and the minimum in respect of Kerala (14.9) (SRS Bulletin, 2013). The CDR for the country has declined from 7.1 in 2011 to 7.0 in 2012 and 2013. The maximum CDR has been reported for Odisha (8.5) and minimum for Delhi (4.2). The IMR declined from 74 per 1,000 live births (SRS bulletin, 1995) to 40 (SRS bulletin, 2013). The maximum IMR has been observed in Madhya Pradesh (56) and the minimum in Kerala (12).
 
DETERMINANTS OF FERTILITY IN INDIA
Education plays a very important role in population control, especially women education that affects socioeconomic and demographic indicators, which are essential for population stabilization. The Task Force of the National Commission on Population (NCP) has identified these social, economic, and demographic indicators for population stabilization in India, which are directly or indirectly affected by women education.
  • Total fertility rate
  • Sex ratio
  • Percentage of couples using family planning methods
  • Child mortality up to the age of 2 years
  • Maternal mortality rate
  • Percentage of women receiving skilled attention during deliveries
  • Percentage of children (12–24 months) getting complete immunization
  • Nutritional status of children below 6 years
  • Percentage of girls marrying below 18 years of age
  • Percentage of births, deaths, and marriages registered
  • Literacy rate—males and females
  • Enrollment of children in schools up to the age of 14 years and the rate of dropouts
  • Percentage of households with safe drinking water
  • Percentage of villages connected by paved roads.
There are four fertility indicators, which help in demographic analysis:
  1. General fertility rate (GFR): Total number of live births in an area among the females in reproductive age group:
    WRA = Women of reproductive age (15–49 years)
  2. Total fertility rate (TFR): Total number of live births a female will bear during her reproductive years, assuming:
    The age-specific fertility rate (ASFR):
    Age-specific fertility rate (ASFR):
  3. Gross reproduction rate (GRR): Total number of daughters a female will bear during her reproductive years assuming the age-specific fertility pattern:
    zoom view
  4. Net reproduction rate (NRR): Total number of daughters a newborn girl child will bear during her entire life assuming the age-specific fertility and mortality pattern.
 
5Fertility Pattern in India
The fertility levels of women in urban India are much lower in comparison to rural areas of India. The main factors behind this change are ranging between children, age of marriage, education and better healthcare, widespread acceptance of family planning measures, and socioeconomic conditions. Age-specific fertility rate (ASFR) during 1981–2011 in India has fallen for women at all ages, indicating that fertility is increasingly being controlled through adoption of family planning measures.
At the younger age group of 15–19 years, fertility decline suggests a rise in the age at marriage of girls which increased from 17 years in 1971 to 21.2 years in 2012. Moreover, earlier fertility peaked at 20–24 and 25–29 years, but now it has peaked at only 20–24 years. This shows that the average span of childbearing has declined considerably, which is due to improvement in women education level and improvement in socioeconomic condition of women.
 
Contraception Prevalence
Contraceptive prevalence rate is the percentage of women of age 15–49 years who are practicing any form of contraception or whose sexual partners are practicing any form of contraception. It is usually measured for women aged 15–49 years who are married or are in union. Contraceptive prevalence rate in India was reported at 53.5% in 2016, according to the World Bank collection of development indicators.
According to the data published in The Lancet, approximately 15.6 million abortions (range: 14.1–17.3 million) took place in India in 2015, giving an abortion rate of 47 (42.2–52.1) per 1,000 women of reproductive age of 15–49 years. They estimated 48.1 million pregnancies, a rate of 144.7 pregnancies per 1,000 women and a rate of 70.1 unintended pregnancies per 1,000 women. Abortions accounted for one-third of all pregnancies, while nearly half of pregnancies were unintended.
Target numbers of fertility and reproduction rates as a part of National Health Policy, 2017:
Target of NRR = 1
It gives replacement level and indicates population stabilization. To attain NRR of 1, we need TFR of 2.1 (due to unequal gender biased mortality) for which a couple protection rate desired is 60%.
 
SEX RATIO AND LIFE EXPECTANCY IN INDIA
Sex ratio is defined as the number of females per 1,000 males. It is one of the basic demographic characteristics of a population. The sex composition is affected by the differentials in mortality conditions of males and females, sex selective migration, and sex ratio at birth. “Female deficit syndrome” is considered adverse. A low sex ratio indicates strong male child preference and consequent gender inequalities, neglect of the girl child resulting in higher mortality at a younger age, female infanticide and feticide, higher maternal mortality, and male bias. Sex determination test, abortion services, and preconception sex services being easily available enhance this process.
Sex ratio of India has shown an increasing trend from 1991 to 2011. According to the 2011 Census, the overall sex ratio is 940 females per 1,000 males. There has been an increase in sex ratio recorded in 29 states and UTs whereas Bihar, Gujarat, and Jammu and Kashmir have shown a decline in sex ratio as compared to the 2011 Census. Kerala has the highest sex ratio of 1,084 followed by Pondicherry having 1,038. The sex ratio is lowest in Daman and Diu at 618. In 1950, the life expectancy in India (31 years) was less than half of the US (68 years). The life expectancy in India also differs by sex, which varies from state to state. In 1951, life expectancies for male and female were 38.7 and 37.1 years, respectively. However, by 2005, the life expectancy in India (64 years) was not far behind the US (77 years). The life expectancy of male and female in India reversed in recent years. In 2012, the life expectancy at birth for women was 67.7 years and for men it was 64.6 years. The overall current life expectancy for India in 2020 is 69.73 years, a 0.33% increase from 2019.
 
POPULATION POLICY IN INDIA
Population policies are formulated to address the unmet needs for contraception, healthcare infrastructure, and health personnel and to provide integrated service delivery for basic reproductive and child healthcare. The main objective is to achieve a stable population at a level consistent with the requirements of sustainable economic growth, social development, and environmental protection.
 
Five-Year Plans by the Government of India for Population Control
The central government formulated the “new national population policy” in February 2000.
The latest 12th 5-year plan (2012–2017) objectives are:
  • To create 50 million new work opportunities in nonfarm sector
  • To remove gender and social gap in school environment
  • To enhance access to higher education
  • To reduce malnutrition among children of 0–3 years
  • To provide electricity to all rural areas
  • To ensure 50% rural population to have accesses to safe drinking water
  • To increase green cover by 1 million hectare every year
  • To provide access to banking services to 90% of households.
The Population Regulation Bill, 2019, was a proposed bill introduced in the Rajya Sabha in July 2019 by Rakesh Sinha to control the population growth of India. According to the World Population Prospects 2019 report by the United Nations, the population of India is set to overtake that of China within 6a decade. The 2020 bill proposes to introduce a two-child policy per couple and aims to incentivize its adoption through various measures such as educational benefits, taxation cuts, home loans, free healthcare, and better employment opportunities. The 2019 bill proposed by Sinha talks about introducing penalties for couples not adhering to the two-child policy such as debarment from contesting in elections and ineligibility for government jobs.
The complex status of the India's population dynamics is at some point of demographic transition, in the process and moving to its final stage. India has already achieved the target of some demographic indicators, namely reduction of crude death rate to (7.0) and crude birth rate to (21.4) per thousand and TFR is 2.4. The cohort comprises mainly the working age group as compared with the dependent population. Hence, there can be accelerated skilled development and economic growth of India.
 
FURTHER READING
  1. Begon M, Harper JL, Townsend CR. Ecology. Individuals, populations and communities. Oxford: Blackwell Scientific Publications;  1986.
  1. Bloom DE, Canning D, Fink G. (2008). Urbanization and the wealth of nations. Science. 2008;319(5864):772–5.
  1. Bloom DE. (2011). Population dynamics in India and implications for economic growth. [online] Available from: https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1288/2013/10/PGDA_WP_65.pdf. [Last accessed November, 2021].
  1. Census India. (2011). Decadal growth: 2011 Census of India. [online] Available from: www.censusindia.gov.in. [Last accessed November, 2021]
  1. Government of India, Planning Commission. An approach to 12th five-year plan. New Delhi, India. 2011.
  1. Manjul P, Rupam T. Population dynamics in India. Int J Sci Eng Res. 2016;6(1):
  1. Ministry of Health and Family Welfare. (2015). Health and Family Welfare Statistics of India, 2015. [online] Available from: http://mospi.nic.in/statistical-year-book-india/2015/199. [Last accessed November, 2021]
  1. Ministry of Statistics and Programme Implementation (MOSPI). Population trends in India. [online] Available from: http://mospi.nic.in. [Last accessed November, 2021].
  1. Park K. Park's Textbook of Preventive and Social Medicine, 23rd edition. India: Bhanot Publishers;  2015.
  1. Pritchett L. Desired fertility and impact of population policies. Popul Dev Rev. 1994;20(1):1–55.
 
LONG QUESTION
1. What is population policy? Describe the population policy in the Indian context and the main events or factors that have shaped it since independence.
SHORT QUESTIONS
1. What are the determinants of fertility in India?
2. What are the main fertility indicators?
3. What is contraceptive prevalence and what factors affect it?
MULTIPLE CHOICE QUESTIONS
1. If annual growth rate of a population is 1.5%, how many years will it take to double?
  1. 105 years
  2. 70 years
  3. 100 years
  4. 110 years
2. New parameter added in 2020 population regulation bill is:
  1. Unmet needs for contraception
  2. Healthcare infrastructure
  3. Health personnel
  4. Two-child policy
3. The twelfth 5-year plan includes the following objectives, except:
  1. To remove gender and social gap in school environment
  2. To enhance access to higher education
  3. To reduce malnutrition among children aged 0–3 years
  4. To ensure all rural areas to have access to safe drinking water
4. The current life expectancy for India is:
  1. 67.9
  2. 64.6
  3. 69.7
  4. 67.7
5. Crude birth rate is defined as:
6. Sex ratio of India is:
  1. 618
  2. 940
  3. 943
  4. 1,048
7. All are fertility indicators, except:
  1. General fertility rate
  2. Total fertility rate
  3. Gross fertility rate
  4. Gross reproductive rate
8. Determinants of fertility in India are all, except:
  1. Total fertility rate
  2. Sex ratio
  3. Infant mortality rate
  4. Maternal mortality rate
Answers
1. a
2. d
3. d
4. c
5. a
6. b
7. c
8. c
71.2 GOVERNMENT POLICIES AND POPULATION STABILIZATION
Mandakini Megh, Bhumika Kotecha Mundhe
 
INTRODUCTION
This chapter considers the past, present, and future perspectives of the population stabilization and the government policies projected with regard to the same. India was the first country in the world to have launched a national program for family planning in 1952 under India's first Prime Minister Mr Jawaharlal Nehru. Over the decades, the program has undergone transformation in terms of policy and actual program implementation and currently being repositioned to not only achieve population stabilization goals but also promote reproductive health and reduce maternal, infant, and child mortality and morbidity. However, the severity of the current situation can be understood by the mere fact that India has 17% of the world's population on 2.4% of the global land. If the current trend continues, India will overtake China by 2045 and will become the most populous country of the world.1
A very rapid increase in the population for a long time may be termed population explosion (i.e., if the birth rate is much more than the death rate for a long time, it may lead to a population explosion).1 The Prime Minister of India, Shri Narendra Modi, in his speech on Independence Day said that Jansankhya Visphot (Population Explosion) may affect the future of our children (Fig. 1).
There are evidences of the following effects due to population explosion:1
  • Living standards of people drop
  • Rise in crime and violence
  • High level of unemployment
  • Thousands go hungry due to poverty and one-third of the population are below the poverty line
  • Famine: Lack of food and cooking fuel
  • Poor health
  • Poor sanitation services
  • Environmental degradation in terms of air, water, and soil pollution
  • Deforestation and ecology modification and distribution of agriculture holdings
  • 8Dissolution of family: More divorces, separation, suicides, etc., due to unhappiness.
zoom view
Fig. 2: Birth rate and death rate of India from 1901-2001.Source: Registrar General of India.
Bare facts1
  • Every sixth person on the globe is an Indian and by the turn of this century, every fifth living person will be an Indian
  • 49% of the increase in India's population is from four states: Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh.
The history of growth of India's population can be divided into four distinct phases: (1) the stagnant growth stage (1901–1921), (2) the steady growth stage (1921–1951), (3) the rapid growth stage (1951–1981), and (4) the high growth stage with definite signs of slowing down (1981–2011). Over the period of time, India has moved from a high stationary stage to a late expanding stage of demographic transition (Fig. 2).2
 
ASSOCIATED CHALLENGES WITH THE POPULATION STABILIZATION
  • Level of education: Lack of education in women results in their early marriages. Not only does early marriage increase the likelihood of more children, but it also puts the woman's health at risk.
  • Socioeconomic factors: The desire for larger families, particularly preference for a male child, also leads to higher birth rates.
  • Inadequate use of contraceptive: Women in rural areas of northern states, such as UP and Bihar, are still giving birth to four or more children. This is because the contraceptive prevalence rate is <10%.
    The development of the present policy of population control by the government of India falls into following distinguishable periods:
  • The period of “indifference” (before 1947): The colonial government of Britain was largely indifferent to population growth. Though the British Government was indifferent to population control policy in India, the enlightened section of Indian public along with some politicians urged the government to develop a population control policy.
    PK Wattal was the pioneer who wrote a book on Population Problem in India in 1916. Among Indian politicians and political parties, it was supported by Jawaharlal Nehru, Mahatma Gandhi, Shubhash Chandra Bose, and Bhore Committee.
  • The period of “neutrality” (1947–1952): Postindependence, the early apathy of the Government to develop population policy was attributed to its preoccupation in drafting the constitution and finding India's way in international relations. Finally, 3 years after independence, the National Family Planning Program was launched in 1952.
  • The period of “experimentation” (1952–1961): The first 5-year plan (1951–1956) was laid with the objective of “reducing birth rate to the extent necessary to stabilize the population at a level consistent with the requirement of the national economy.” One of the national sample survey reports revealed that the population of India had grown substantially, which was confirmed in 1961 census.
  • The beginning of policy of population control (1961–2000):
    • Second and third 5-year plans (1956–1961 and 1961–1966): The population growth from 1951 to 1961 was rapid accounting to 21.5%. To overcome such a national issue, the government adopted the extension approach to family planning in the third plan. This plan also included a separate Department of Family Welfare in the Ministry of Health and Family Planning in 1966.
    • Fourth 5-year plan (1969–1974): An important measure was the integration of family planning services with health, maternity, and child healthcare and nutrition. The main aim here was to reduce the birth rate to 25 per 1,000 persons by 1980–81. The steps taken were in the following areas: social acceptability for a small family, increasing information and knowledge about family planning methods in both urban and rural areas, and making available the various devices and equipment to the couples. A more selective approach was adopted wherein couples in the reproductive age group of 25–35 years were persuaded to undergo sterilization as a matter of national emergency. Also, monetary incentive was given to couples undergoing sterilization.
      Since the birth rate was varied in different states, targets of sterilization were fixed in various states. The number of sterilizations rose from 9.4 lakh in 1973–1974 to 82.6 lakh in 1976–1977. Under the banner of national emergency, many states resorted to unfair and coercive methods to sterilize people of all ages. This led to mass resentment and unrest among the people. As a result, the family planning program became very unpopular.
    • 9Fifth 5-year plan (1974–1979): The 1971 census showed a rapid growth in population by 24.6%. To control this, the fifth plan laid down the ambitious target of reducing the birth rate to 30 per 1,000 by the end of the plan (1978–79) and to 25 per 1,000 by 1983–84.
In 1977, post national emergency, the government announced the new population policy renaming the family planning program to the family welfare program. This program did have a leeway to the common man. The main features of this policy were:
  • Fixing the marriage age for girls at 18 years and for boys at 21 years. This has been implemented by the Child Marriage Restraint (Amendment) Act, 1978
  • Making sterilization voluntary
  • Including population education as part of normal course of study
  • Monetary incentive to those who go in for sterilization and tubectomy
  • Private companies to be exempted in corporate taxes if they popularize birth-control measures among employees
  • Use of media for spreading family planning in rural areas, etc.; this policy put an end to compulsory sterilization and laid emphasis on voluntary sterilization.
    However, this slowed down the family planning program. As a result, the number of sterilizations fell from 82.6 lakh in 1976–1977 to 9 lakh in 1977–1978.
    • Sixth, seventh, and eighth 5-year plans (1980–1985, 1985–1990, and 1990–1995): The efforts were done to control population by determining long-term demographic aims such as net reproduction rate, crude birth rate (CBR), crude death rate, and couple protection rate.
      The government replaced the earlier Population Control Approach by the Reproductive and Child Health Approach in October 1997 with the intention to decentralize area-specific macroplanning. It led to several new schemes for improving quality and coverage of welfare services for women, children, and adolescents such as child survival, safe motherhood program, and universal immunization program (UIP), and reproductive tract infections (RTI).
    • Ninth 5-year plan (1997–2002): During the ninth plan, the earlier approach of using NRR (Net Reproduction Rate) of 1.0 was changed to a total fertility rate (TFR) of 2.1. This level of TFR been projected to be achieved by 2026 in the plan. One of the important strategies of this plan was to undertake area-specific microplanning, i.e., at the primary health care (PHC) level.
      In 2001, the National Policy for Empowerment of Women was adopted with the ultimate objective of ensuring women their rightful place in society by empowering them as agents of socioeconomic change and development.
 
National Population Policy, 2000
The population of India on May 11, 2000, had risen to 100 crores from 23 crores over a period of 100 years. This meant that all efforts of population stabilization taken so far seemed to be elusive.
The National Population Policy (NPP) was announced in 2000. It had three types of objectives:
  1. The immediate objective:
    • To address the unmet needs for contraception, healthcare infrastructure, and health personnel
    • To provide integrated service delivery for basic reproductive and child healthcare
  2. The medium-term objective: Bring TFR to the replacement level by 2010.
  3. The long-term objective: To achieve a stable population by 2045.
The NPP 2000 relies more on persuasive and positive measures rather than on coercive methods. It lays emphasis on both the qualitative and the quantitative aspects of population.
A major cause for worry for policy makers is that the sex ratio of children has declined for all age groups as compared to 2001. The decline is more pronounced in the younger age groups, especially below 20 years. There has been a constant decline in child sex ratio (CSR) over the last four to five censuses and there is a particularly steep decline in the report of 2011, which registered a fall from 927 girls per 1,000 boys in the age group of 0–6 years to 918 per 1,000 boys. This led to the aggressive implementation of the Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act, rules and regulations by the government to improve the skewed ratios. While the sex ratio has seen a decrease, the silver lining is that there is an improvement in survival ratio and there is an upward shift for all age groups during Census 2001–2011.
The National Family Planning Program of the Ministry of Health and Family Welfare is guided by the tenets of the NPP 2000 and oversees its implementation. Under this program, the service delivery data are regularly reviewed through annual review meetings, supportive supervision visits, common review missions, etc.
As a result of the government's efforts, the successes achieved as on February, 2020 are enumerated below:3,4
  • The TFR has declined from 2.9 in 2005 to 2.2 in 2017 (SRS)
  • 25 out of 37 states/UTs have already achieved replacement level fertility of 2.1 or less
  • The decadal growth rate has declined from 21.54% in 1999–2000 to 17.64% during 2001–2011
  • The CBR has declined from 23.8 to 20.2 from 2005 to 2017 (SRS)
  • The teenage birth rate has halved from 16% (NFHS III) to 8% (NFHS IV).
 
10CURRENT ISSUES AND TRENDS IN POPULATION STABILIZATION
 
Current Issues
Population stabilization is a stage when the size of the population remains unchanged. Census data released by the Office of the Registrar General shows that at the national level, the TFR has declined from 2.5 to 2.2 during 2001–2011.3,4 So, India has begun moving toward population stabilization showing a drop of 0.3 points in the TFR. (The TFR is the number of children born or likely to be born to a woman in her lifetime.)3,4
Data with the Health Ministry shows that so far, only 24 out of 35 states have achieved the TFR of 2.1 (2019) that are yet to reach the targeted TFR and 10 big states still have a higher TFR. Bihar leads at (3.4), UP (3.1), MP (2.9), Rajasthan (2.8), Jharkhand (3), Chhattisgarh (2.6), Assam and Gujarat (2.5), and Haryana and Odisha (2.3).
The proportion of married women to total number of women is at 49.9% in Census 2011 as against 47.7% in Census 2001. The corresponding figure in case of males has increased to 46% from 43.6% during the same period. For women, the average marriage age has increased from 18.3 to 19.3 years and for men from 22.6 to 23.3 years during Census 2001–2011. There are 30 million currently married women in the age group of 15–49 years.5 The desired fertility rate is 1.8 which indicates that women in India prefer to have no more than two children.6
According to the NPP 2000, India should have reached a replacement-level fertility rate of 2.1 by 2010 to attain population stabilization at 145 crores by 2045. However, India expects to reach population stabilization of 2.1 TFR at 165 crores by 2040.6
 
Current Trends in Population Stabilization
 
NITI Aayog7
NITI Aayog is responsible for charting India's road map toward attaining the commitments under the Sustainable Development Goals, particularly in critical social sectors such as health and education. A 3-year action agenda and a 7-year strategy have already been prepared by the NITI Aayog and placed in the public domain.
The federal policy think tank of NITI Aayog consults subject specialists and officials to find ways of strengthening the country's population policy and family planning programs. The consultation is expected to result in recommendations that will address the regional disparities in the outcome of population stabilization programs. The NITI Aayog move comes in the wake of Prime Minister Narendra Modi flagging, in his Independence Day speech 2019, the need for controlling the explosive growth in population.
The key recommendations are likely to include helping women make informed choices about delaying pregnancy and ensuring there was a sufficient gap between childbirths, stepping up access to contraceptive choices, addressing sociocultural barriers toward contraception, increasing public spending on family planning, investing in behavior-change communication strategies, and treating population stabilization and family planning as a national priority. The NITI Aayog said that India is at a stage where birth rates are falling but population continues to grow due to the fact that >30% of the population is young and in the reproductive age group.
 
GOVERNMENT INITIATIVES
The government is taking several steps to sensitize people and generate awareness of the need for population control. Some of the important initiatives are as follows:5
  • 360° media campaign: The first phase of the campaign was launched in 2016 and the present second phase comprising TV commercials, posters and hoardings, year-long radio show, and a dedicated website on family planning was launched in 2017
  • World Population Day and fortnight as well as Vasectomy Fortnight are observed every year to boost awareness.
  • Promotional activities such as Saas Bahu Sammelans, Nayi Pehel Kits, mobile publicity vans, and advocacy meetings are undertaken to increase awareness in high-fertility Mission Parivar Vikas districts.
The government is implementing various schemes for improving access to quality family planning services, details of which are given below.
Steps being taken by the government for population control:
  1. Mission Parivar Vikas: This was launched to increase access to contraceptive and family planning services in 146 high-fertility districts with TFR of 3 and above in seven high focus states. These districts are from the states of Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, Chhattisgarh, Jharkhand, and Assam that itself constitute 44% of the country's population.
  2. New contraceptive choices: New contraceptives, namely injectable contraceptive and centchroman, have been added to the existing basket of choices.
  3. A new method of intrauterine contraceptive device (IUCD) insertion immediately after delivery, i.e., postpartum IUCD (PPIUCD), has been introduced.
  4. Redesigned contraceptive packaging: The packaging for condoms, oral contraceptive pills (OCPs), and emergency contraception pills (ECPs) has now been improved and redesigned so as to increase the demand for these commodities.
  5. Compensation scheme for sterilization acceptors: Under this scheme, the Ministry of Health and Family Welfare (MoHFW) provides compensation for loss of wages to the beneficiary and also to the service provider (and team) for conducting sterilizations.
  6. 11Clinical Outreach Teams (COT) scheme: The scheme has been launched in 146 Mission Parivar Vikas districts for providing family planning services through mobile teams from accredited organizations in far-flung, underserved, and geographically difficult areas.
  7. Scheme for home delivery of contraceptives by ASHAs at the doorstep of beneficiaries.
  8. Scheme for ASHAs to ensure spacing in births.
  9. Scheme for provision of pregnancy testing kits in the drug kits of ASHAs for use in communities.
  10. Family planning logistic management and information system (FP-LMIS): This is dedicated software to ensure smooth forecasting, procurement, and distribution of family planning commodities across all the levels of health facilities.
  11. National family planning indemnity scheme (NFPIS) under which clients are insured in the eventualities of death, complication, and failure following sterilization.
  12. Ensuring quality of care in family planning services by establishing quality assurance committees in all states and districts.
  13. Appointment of dedicated RMNCH+A (Reproductive, Maternal, Newborn, Child and Adolescent Health) counselors at high-case load facilities.
  14. Improved demand generation activities through a 360° media campaign.
As a result of these efforts, the country is knocking on the door of replacement level fertility and is on track to achieve TFR 2.1 by 2025.
The Population Control Bill, 2019 (or Population Regulation Bill, 2019), is a proposed bill introduced in the Rajya Sabha in July 2019. The purpose of the bill is to control the population growth of India.
The 2020 bill proposes to introduce a two-child policy per couple and aims to incentivize its adoption through various measures such as educational benefits, taxation cuts, home loans, free healthcare, and better employment opportunities. Penalties for couples are not adhering to the two-child policy such as debarment from contesting in elections and ineligibility for government jobs.
Family Planning, 2020: Family planning division is working on the national and state-wise action plans so as to achieve Family Planning 2020 goals. The key commitments of Family Planning 2020 are as follows:
  • Increasing financial commitment on family planning whereby India commits an allocation of 2 billion USD from 2012 to 2020
  • Ensuring access to family planning services to 48 million (4.8 crore) additional women by 2020 (40% of the total Family Planning, 2020 goal)
  • Sustaining the coverage of 100 million (10 crore) women currently using contraceptives
  • Reducing the unmet need by an improved access to voluntary family planning services, supplies, and information.
 
Janasankhya Sthirata Kosh
The Jansankhya Sthirata Kosh (JSK) (National Population Stabilization Fund) has been registered in 2004–2005 as an autonomous society established under the Societies Registration Act of 1860 with Rs 100 crore grant from the government. This had an aim to promote and undertake activities aimed at achieving population stabilization at a level consistent with the needs of sustainable economic growth, social development, and environment protection by 2045.
It implemented the following schemes:
  • Prerna Scheme (for delaying marriage, childbirth, and spacing)
  • Santushti Scheme (Public Private Partnership for sterilization services)
  • National Helpline (for information on family planning).
However, the JSK has been discontinued on 08/02/2019 vide the cabinet decision on 07/02/2018 and various schemes for population control are being supported under the National Health Mission.8
 
REFERENCES
  1. Kishore J. National Health Program of India. New Delhi: Century Publication;  2012.
  1. Saroha J. Demographic transition in India. IJRAR. 2017; 4(4): 193–8.
  1. Ministry of Health and Family Welfare. (2020). National Population Policy. [online] Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=1601839#:~:text=National%20Population%20Policy%20formulated%20in,maternal%20health%20and%20child%20survival. [Last accessed November, 2021].
  1. The Pioneer. (2015). India begins population stabilization. [online] Available from: http://www.dailypioneer.com/2015/page1/india-begins-population-stabilization- [Last accessed November, 2021].
  1. Ministry of Health and Family Welfare. (2019). Population control. [online] https://pib.gov.in/PressReleseDetailm.aspx?PRID=1593004. [Last accessed November, 2021].
  1. Press Information Bureau. [online] Available from: http://pib.gov.in/PressReleseDetailm.aspx?prid=133018 [Last accessed November, 2021].
  1. India Today. [online] Available from: http://www.indiatoday.in/business/story/niti-aayog-to-draft-roadmap-for- [Last accessed November, 2021].
  1. Journals of India. (2019). Jansankhya Sthirata Kosh. [online] Available from: https://journalsofindia.com/jansankhya-sthirata-kosh/. [Last accessed November, 2021].
 
LONG QUESTION
1. What precautions should the doctor take so that the MTP is safe medicolegally?
SHORT QUESTIONS
1. Who can perform MTP?
2. What are the pre-requisites for MTP approved center?
123. What are the indications to perform MTP.
4. Discuss: consent in MTP.
5. Judicial activism in abortion law in India: Dr Nikhil Datar Vs Union of India. Discuss
MULTIPLE CHOICE QUESTIONS
1 Inj Anti-D ______ mg should be administered in ABO incompatibility after first trimester MTP.
  1. 300 µg
  2. 150 µg
  3. 50 µg
  4. 200 µg
2 The permissible legal limit for MTP (under MTP Act 1971) in case of abnormal fetus is:
  1. 19 weeks
  2. 24 weeks
  3. 20 weeks
  4. 22 weeks
3 The amendment in 2002 in MTP Act dealt with:
  1. Increasing the permissible limit to 24 weeks
  2. Validating use of mifepristone and misoprostol
  3. Both a and b
  4. None of the above
4 The forms to be filled up in a case of MTP are:
  1. Form A + Form B
  2. Form I
  3. Form I + Form C
  4. All of the above
5 Medical MTP can be done uptil:
  1. 35 days
  2. 49 days
  3. 63 days
  4. 52 days
6 Second trimester MTP requires:
  1. Opinion of 2 RMPs
  2. Form 2
  3. Government hospital only
  4. Medical management
Answers
1. c
2. c
3. d
4. c
5. b
6. a
1.3 LEGAL ASPECTS IN MEDICAL TERMINATION OF PREGNANCY AND CONTRACEPTION
Nikhil Datar, Meghana Shedge
 
INTRODUCTION
Contraception and abortion are two important health rights of a woman. Social structure of male dominance, religious beliefs, and lack of health education change the outlook toward these issues. Thus, they do not remain to be pure medical issues.
In India, abortions are governed by a specific Act of the parliament, namely “Medical Termination of Pregnancy Act (MTP Act).” Contraception is not specifically covered by any law yet general principles of medical ethics, namely autonomy, justice, beneficence, and nonmaleficence, must be kept in mind by the healthcare provider.
 
LEGAL ASPECTS OF MEDICAL TERMINATION OF PREGNANCY
Abortion is a criminal offence according to the Indian Penal Code. This code was drafted in 1860 by the British, which is still the law of the land.
Sections 312 to 316 deal with the offences against unborn. Both a woman seeking abortion and the person helping her can be punished for this offence. Many women lost their lives while undergoing illegal abortions. In order to prevent this maternal mortality, India passed the MTP Act in 1971. It decriminalized the abortions in a limited manner. It carved out an exception to the general law, namely the Indian Penal code. Thus, abortions strictly done under the norms laid down by the MTP Act are not illegal anymore. However, if one transgresses the limits laid down by the MTP Act, a doctor can face criminal charges and may get prescribed punishment, which could be fine and/or imprisonment.1
The MTP Act was further amended in 2002 to introduce medical abortion by giving medications. Judicial activism by the author who filed the case, Dr Nikhil Datar Vs. Union of India, and series of cases filed in various High Courts and Supreme Court has paved way to another amendment. While this chapter is being written, the amendment to the MTP Act has been passed in both the houses of the parliament and has received the assent from the President of India. Yet the rules and regulations have not been amended and the amended law has not yet been applied. This amendment has upwardly revised the gestational age for termination to 24 weeks and above.2
Thus, for this article, MTP Act (1971 and 1992) and rules and regulations (1975 and 1992) have been taken into consideration.
A gynecologist must know the exact provisions of the MTP Act so as to stay clear of the potential medicolegal implications. The Act has eight sections and rules and regulations.
Section 2: Who can do MTP?
According to Section 2 of MTP Act and MTP Rules 2002, the registered medical practitioner (RMP) must be registered with state medical council and have qualification in accordance with section 2 of the Indian Medical Council Act (1956). The RMP adequate training/experience is as follows:
  • Training house surgery post of 6 months in obstetrics and gynecology (OB-GYN)
  • 13Experience of 1 year in a hospital in OB-GYN department
  • RMP should have assisted 25 cases and done five cases independently in any institute which is approved as training center (for this experience, the RMP is eligible to do MTP only up to 12 weeks)
  • Postgraduate degree/diploma in OB-GYN.
Section 3: In which conditions can the MTP be done?
MTP can be done:
  • If there is a risk to the life of a woman
  • If there is a grave injury to the physical or mental health of the mother
    The law further defines the “grave injury to mental health.” It states that the below situations will be considered as grave injury:
    • Anguish caused by pregnancy alleged out of rape
    • Anguish causes by pregnancy caused due to failure of contraception by a married woman or her husband.
    While determining the risk of injury to health, “actual and reasonably foreseeable environment” should be taken into account.
  • If there is a substantial risk that if the child were born, he/she shall suffer such serious mental or physical abnormalities as to be seriously handicapped.
Till what weeks of gestation can the MTP be done?
If the MTP is done to immediately to save the life of the woman, there is no upper limit on gestational age (Section 5).
For all other indications, the MTP can be done only up to 20 weeks of gestation.
Consent-taking for MTP
A written consent of the woman is mandatory. It should be taken in FORM C. The consent of the guardian is taken, if she is <18 years or lunatic. (This word is replaced by mentally ill in the amendment of 2002.)
An RMP must form his opinion in good faith while conducting the procedure.
For MTP to be done up to 12 weeks, one RMP can opine. For MTP beyond 12–20 weeks, opinion of two RMPs is required.
When MTP is done beyond 20 weeks as an “immediate necessity to save the mother's life”, one RMP is enough to opine.
Section 4: Where can one do MTP?
MTP can be done only at a government hospital or hospitals approved by the government.
For medical MTP, approval of place is not required but the RMP must satisfy the criteria of qualification and experience. An RMP can provide the medical MTP only if the patients have an access to the approved center. Thus, the place must display the letter from the owner of approved place stating that the patients will be provided with the emergency services at the approved place 24 by 7.
How should nongovernmental clinics/hospitals get approval for MTP?
Approval of place is mandatory for surgical MTP.
The owner should apply in Form A to the Chief Medical Officer (CMO). The CMO inspects the place within 2 months of application and then recommends to committee, which gives an approval in form B within 2 months of inspection.
The owner has to display the certificate at a prominent place within the premises.
Section 6: The central government can make rules, which have to be passed in the parliament.
These rules are about the qualification of RMPs and the procedural aspect of approval of the place.
Section 7: States can make regulations related to MTP.
Contravention of any regulation attracts penalty of 1,000 rupees.
The regulations deal with the following:
  1. There is a prescribed form in which the RMP has to register the details of cases:
    • Form I: The RMP/RMPs should certify his/her opinion regarding the MTP in Form I within 3 hours of such termination.
    • Custody of forms: The RMP has to make a sealed envelope of forms I and C and handover to the owner/head of the hospital/CMO of the state.
      • The RMP should write the serial number from the admission register and name of the RMP/RMPs. The word “Secret” should be written.
      • The owner should keep in safe custody. He/she shall make a monthly report in Form II.
      • In case MTP is done under Section 5 at a place not approved for MTP, the serial number and place shall be kept blank.
    • Admission register: Form III.
It is important that the register has all the 14 columns as described.
The admission register needs to be kept for 5 years from the end of the calendar year it relates to.
A fresh serial number for a new calendar year is given. The serial number will be in this format—5/2020.
It is confidential and not open for inspection except for any person under the authority of law; on application by an employed woman, the RMP can grant a certificate for the same.
The name is not to be entered in any case-sheet, operation theater register, follow-up card, or any other document or any other register. Only the serial number must be entered.
Section 8: It provides protection to the RMP from any suit related to MTP.
When MTP is done diligently and in good faith, the RMP enjoys the protection of law. Thus, if the RMP follows all the rules and regulations correctly, it can be said that the MTP is done in good faith and conscientiously. Thus, it is vital that 14standards laid down by the ministry are followed by the RMP while doing the MTP cases.1
 
EXAMINATION AND INVESTIGATIONS
Elaborate history should be elicited with proper examination; ultrasonography as a routine is not mandatory.
Basic blood investigation such as Hb, blood group, and urine testing to be done.
In cases of Rh incompatibility, injection Anti-D—50 µg in the first trimester and 300 µg in the second trimester should be administered.
  • Another important aspect is to provide counseling before and after the MTP.
  • Medical management: MTP can be done up to 7 weeks of gestation with mifepristone and misoprostol regimen: On day 1, mifepristone 200 mg oral tablet followed by 400 µg misoprostol oral/vaginal/sublingual on day 3. The Drug Controller of India has allowed use of combipack of mifepristone and misoprostol until 63 days of gestation. It is expected that the amendment to the rules will take into consideration this discrepancy and resolve the same.
    Also, symptomatic treatment for abdominal pain/nausea/vomiting/loose motions should be provided.
  • Treatment of failure: If POCs are seen in cervix, digital evacuation or vacuum aspiration (VA) can be done.
    If USG suggests incomplete evacuation, additional 600 µg of misoprostol can be given.
    If no sac seen, “wait and watch” approach can be followed.
 
SURGICAL METHOD FOR MEDICAL TERMINATION OF PREGNANCY
  • Vacuum aspiration or dilatation and evacuation:
    • Vacuum aspiration is preferred over the traditional dilatation and curettage. The evidence shows that there is 3–4 times higher chances of excessive bleeding, infection, and perforation as compared to D&C.
    • The need for dilatation is lesser in VA and the recovery is faster.
    • Vacuum aspiration should be done in case up to 12 weeks size for MTP/miscarriage/incomplete abortion and retained products of conceptions (RPOCs).
Priming of the cervix: Tablet misoprostol 400 µg 3–4 hours prior oral or vaginally and injection prostaglandin F2α (PGF2α) can be administered 45 minutes before.
  • Methods of second-trimester MTP: Surgical, medical, and miscellaneous: Surgical method is not commonly used, but when required priming can be done by tablet misoprostol 400 µg; per vaginum 3–4 hours prior or per oral route 2–3 hours prior is preferred. Few prefer to use osmotic dilators before evacuation of uterus.
    A hysterotomy can be attempted in case of failure of medical method or if an associated gynecological procedure needs to be carried out.
    The medical method uses tablet mifepristone + misoprostol, but it is not yet approved in India.
    By the WHO regimen, misoprostol 400 µg can be given every 3 hourly for five doses.
  • Second-trimester MTP: Mifepristone + misoprostol for second trimester is not currently recommended in India.
    Permitted methods are:
    1. Ethacridine lactate
    2. Dilatation and evacuation (maximum 16 weeks) and hysterotomy
    3. Adjuvant therapy which includes tablet misoprostol for priming and PGF2α/20 units of oxytocin for hastening the termination.
  • Postabortion advice: 75% women ovulate and 6% conceive within 2–6 weeks of abortion.
    All contraceptives can be offered after first-trimester MTP including laparoscopic tubal ligation (TL).
    A laparoscopic TL cannot be done after second-trimester MTP, but abdominal TL can be done.
 
MTP beyond 20 Weeks: Judicial Activism
  • In 2008, Dr Nikhil Datar filed his first case against the Union of India where he helped a woman with 24 weeks period of gestation with severely abnormal fetus for termination and ever since then he has helped more than 150 women to file cases for termination of pregnancy beyond 20 weeks.
  • These cases paved way for the proposed amendment to the existing Act. The amendment has been formally passed in both the houses of parliament and received the assent of the President of India. It is expected that the government will notify the application of the amended Act any time in near future.
 
LEGAL ASPECTS IN CONTRACEPTION
As stated earlier, although there is no specific law governing the subject of contraception, the general framework of ethics and law needs to be followed. The general principles of reproductive rights include:
  • The rights of men and women to be informed and to have access to safe, effective, affordable, and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility, which are not against the law.
  • The right of access to appropriate healthcare services that will enable women to safely go through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.
Reproductive health problems can be prevented and solved by offering an array of contraceptive methods, techniques, and services. The couples should be empowered to select, change, and discontinue a method as per their needs. Proper screening, provision of contraceptive services in adherence with guidelines, management of side effects, and follow-up 15procedures for specific contraceptive methods are the key elements in reproductive health.
Current trends in family planning in India show a high level of knowledge among eligible couples, yet the acceptance remains low, especially for spacing methods. Female sterilization remains the most widely used family planning method in spite of efforts to popularize male sterilization.
Counseling is the cornerstone:
  • A single method of family planning cannot be recommended to everyone. Family planning counseling can help a woman and/or her partner to choose which method best suits him or her.
  • Counseling facilitates decision-making, promoting continuation of contraceptive, counseling about side effects, prevention of unwanted pregnancy, and also sex education.
 
CONCLUSION
A gynecologist plays a vital role in ensuring the reproductive health of the society. This subject is not purely medical in nature. It has ramifications into rights, ethics, and law. While treating the patients, the doctor should also stay safe and within the limits of law.
 
REFERENCES
  1. Ministry of Health and Family Welfare. The Medical Termination of Pregnancy Act, 1971. [online] Available from: https://main.mohfw.gov.in/acts-rules-and-standards-health-sector/acts/mtp-act-1971. [Last accessed November, 2021].
  1. Ministry of Health and Family Welfare. The Medical Termination of Pregnancy Amendment Act, 2002. [online] Available from: https://main.mohfw.gov.in/acts-rules-and-standards-health-sector/acts/mtp-act-amendment-2002. [Last accessed November, 2021].
 
LONG QUESTION
1. What precautions should the doctor take so that the MTP is safe medicolegally?
SHORT QUESTIONS
1. Who can perform MTP?
2. What are the prerequisites for an MTP-approved center?
3. What are the indications to perform MTP?
4. Discuss consent in MTP.
5. Discuss judicial activism in abortion law in India: Dr Nikhil Datar Vs Union of India.
MULTIPLE CHOICE QUESTIONS
1. Injection Anti-D ______ mg should be administered in ABO incompatibility after first trimester MTP.
  1. 300 µg
  2. 150 µg
  3. 50 µg
  4. 200 µg
2. The permissible legal limit for MTP (under MTP Act 1971) in case of an abnormal fetus is:
  1. 19 weeks
  2. 24 weeks
  3. 20 weeks
  4. 22 weeks
3. The amendment in 2002 in MTP Act dealt with:
  1. Increasing the permissible limit to 24 weeks
  2. Validating use of mifepristone and misoprostol
  3. Both a and b
  4. None of the above
4. The forms to be filled up in a case of MTP are:
  1. Form A + Form B
  2. Form I
  3. Form I + Form C
  4. All of the above
5. Medical MTP can be done until:
  1. 35 days
  2. 49 days
  3. 63 days
  4. 52 days
6. Second-trimester MTP requires:
  1. Opinion of two RMPs
  2. Form 2
  3. Government hospital only
  4. Medical management
Answers
1. c
2. c
3. d
4. c
5. b
6. a