Preliminary Pages

FM1Ward Rounds in Obstetrics and NeonatologyFM2

FM3Ward Rounds in Obstetrics and Neonatology

Tania Gurdip Singh MS (Obs and Gyne) Fellowship in Gynecological Endoscopy Bodyline Trauma and Maternity Center New Delhi, India Earl Gaganjot Jaspal MBBS MD (Ped) PGPN (Boston, USA) Consultant Pediatrician and Head Department of Neonatology Government Hospital Ambala, Haryana, India Foreword Nutan Jain

FM4

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Ward Rounds in Obstetrics and Neonatology

First Edition: 2016

9789385891656

Printed at

FM5Dedicated to

Our daughter Aira, who is the ultimate source of motivation and is a real boost in whatever we do, including this work

FM6FM7Foreword

When I got the invitation to write foreword for this book, the first thought in my mind was “to read this book” because of very attractive name of the book. This book makes a solid base for MBBS, postgraduates, interns, and nursing students.

After reading, I was so happy about it as it was more than what I expected. The book goes in a soft flow of rounds, OPD, antenatal ward, labor room and ending up in neonatal unit. In the section of obstetric emergency, I had developed a feeling that I am present at bedside and participating in revival of the patient. Tricky situations demanding blood transfusion and proper fluid management are dictated in such a simple manner which will raise confidence of reader ‘yeah, I can also do’. The most appreciable thing of this book is its limited length and simple language. It is amazing how the whole obstetrics and neonatology is covered in around 360 pages so fluently. Students generally struggle with multiple different books, just to find out few details or some special points which they can write down or mumble in their exams.

Dr Tania Singh and Dr Earl Jaspal has reduced all their struggle and tension due in their examinations, by involving all the chapters and details in very concise form in their book. Students can go through a rapid reading and revision of this book.

I must congratulate Dr Tania Singh and Dr Earl Jaspal for this rewarding hard work which will definitely help students and nursing staff who are really in need of such guidance.

It will also have a place of honor in my library.

Nutan Jain MS (Obs and Gyne)

Vardhman Trauma and Laparoscopy Centre Pvt Ltd

Muzaffarnagar, Uttar Pradesh, India

FM8FM9Preface

Ward Rounds in Obstetrics and Neonatology extensively covers all bedside cases which are routinely met in obstetrics and neonatology, wherein main stress is laid only on diagnosis and management in wards. It does not include the time consuming etiology and pathogenesis of any disease.

The book has been presented in two sections.

Section 1: Obstetrics covers all the aspects related to OPD Rounds, Antenatal Cases in High-risk and Low-risk Patients, Labor in High-risk and Low-risk patients, Obstetric Emergencies, Infections in Obstetrics, Blood Transfusion and Fluid Management.

Section 2: Neonatology has been added to cover all current and practical approaches in management of problems encountered in neonatal care including Prematurity and Low Birth Weight, Perinatal Asphyxia, Meconium Aspiration Syndrome, Sepsis, Neonatal Seizures, Hypoglycemia, Hypocalcemia, Fluid and Electrolyte Management, Neonatal Jaundice, Bag and Mask Ventilation and routine procedures in neonatal nursery.

The book will make the ward rounds easy for students as the chapters are very small each consisting of 3–5 pages on an average. Section on OPD rounds will enable a student to counsel any patient attending obstetric OPD. A complete chapter is provided only on HIV counseling.

The basic aim of this book is to provide complete and latest information in a simplified manner with focus on quality rather than quantity.

The information provided in each chapter has been condensed in an easy-to-read format with a point-wise description and important points are highlighted in side boxes to allow quick but at the same time, proficient understanding of the material.

This book has been exclusively designed for medical students, residents, postgraduates, fellows, interns, consultants and nursing staff working in both government and private set-up.

The information provided is up-to-date and include latest protocols and clinical knowledge in fields of obstetrics and neonatology.

We hope this book will provide a better understanding of basic concepts and bedside clinical approach related to all topics in management of obstetrics and neonatology.

Tania Gurdip Singh

Earl Gaganjot Jaspal

FM10FM11Acknowledgments

We take this opportunity to thank all our teachers, friends and well-wishers, that is very much justified at this stage of the completion of our book.

It is our great privilege, though finding words inadequate to express our indebtedness and deep gratitude to Dr Nutan Jain. Her never-ending willingness to render help, loving guidance, coupled with her rich knowledge and keen interest, were a constant source of inspiration for us throughout.

We are deeply grateful to all our revered teachers and shall ever remain obliged to them.

We are very grateful to Shri Jitendar P Vij (Group Chairman) and Mr Ankit Vij (Group President) for showing trust in us and getting this book published. We are sincerely thankful to Mr Tarun Duneja (Director–Publishing), Ms Samina Khan (Executive Assistant to Director–Publishing), Ms Seema Dogra (Cover Designer), Ms Hansika Seth (Copy Editor) Ms Ritu Verma (DTP Operator) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, who rendered great help in the completion of this project.

We shall be failing in our duty if we do not acknowledge with a deep sense of gratitude, all our patients, from whom we have learnt a lot.

We cannot express in words the indebtedness we owe to our dearest parents, without whose inspiration and blessings, this work could not have been accomplished. Wholeheartedly, we are very thankful to them and entire credit goes to them.

We owe our sincere admiration and thanks to Dr Gagandeep Anand and Dr Nisha Munjal Anand, for their contribution. Their valuable and constructive suggestions were the mainstream to bring this work to the present shape.

And finally, we thank God for everything and pray for His continued blessings and success.

FM12FM13Abbreviations ACE Inhibitors

Angiotensin converting enzyme inhibitors

ADH

Antidiuretic hormone

AED

Antiepileptic drug

AFI

Amniotic fluid index

AFV

Amniotic fluid volume

AIDS

Acquired immunodeficiency syndrome

ALT

Alanine aminotransferase

Anti-TPO

Antithyroid peroxidase

APFS

Antepartum fetal surveillance

aPTT

Activated partial thromboplastin time

ARM

Artificial rupture of membrane

ART

Antiretroviral therapy

AST

Aspartate aminotransferase

BMI

Body mass index

Blood transfusion

Cholic acid

CAD

Coronary artery disease

CBC

Complete blood count

CCT

Controlled cord traction

CDCA

Chenodeoxycholic acid

CFT

Capillary filling time

CHC

Community health center

CHF

Congestive heart failure

CIN

Cervical intraepithelial neoplasia

CMV

Cytomegalovirus

COC

Combined oral contraceptive

CPAP

Continuous positive airway pressure

CPD

Cephalopelvic disproportion

CPR

Cardiopulmonary resuscitation

CTG

Cardiotocography

CVS

Chorionic villus sampling; Cardiovascular system

DBP

Diastolic blood pressure

DCA

Deoxycholic acid

DFKC

Daily fetal kick count

DIC

Disseminated intravascular coagulopathy

Diabetes milletus

DNA

Deoxyribonucleic acid

DV Doppler

Ductus venosus Doppler

DVT

Deep vein thrombosis

ECV

External cephalic version

EDD

Expected date of delivery

EEG

Electroencephalography

EFW

FM15Estimated fetal weight

FM14EPO

Erythropoietin

FHR

Fetal heart rate

gauze

G6PD

Glucose 6 phosphate dehydrogenase

GFR

Glomerular filtration rate

GGT

Gamma glutamyl transpeptidase

Gastrointestinal

GIT

Gastrointestinal tract

grams

GTCS

Generalized tonic-clonic seizure

GTN

Gestational trophoblastic neoplasia

Hemoglobin

Head circumference

hCG

Human chorionic gonadotropin

HDL

High density lipoproteins

ICT

Indirect Coomb's test

Intramuscular

INR

International normalized ratio

Intelligence quotient

International units

IUD

Intrauterine death; Intrauterine device

IUGR

Intrauterine growth restriction

Intravenous

IVF

In vitro fertilization

IWL

Insensible water loss

JVP

Jugular venous pressure

Kilogram

KMC

Kangaroo mother care

LCA

Lithocholic acid

LDH

Lactate dehydrogenase

LDL

Low density lipoproteins

LFT

Liver function test

LMP

Last menstrual period

LMWH

Low molecular weight heparin

LNG IUD

Levonorgestrel intrauterine device

LSCS

Lower segment cesarean section

Left ventricle

MAS

Meconium aspiration synrdrome

MCA

Middle cerebral artery

MCDA

Monochorionic diamniotic

mcg

Micrograms

MCH

Mean corpuscular hemoglobin

MCHC

Mean corpuscular hemoglobin concentration

MCMA

Monochorionic monoamniotic

MCV

Mean corpuscular volume

mEq

Milliequalent

Milliliter

MMR

Measles, mumps, rubella

MOA

Mechanism of action

MRI

Magnetic resonance imaging

MUFA

Monounsaturated fatty acids

NICU

Neonatal intensive care unit

NPO

Nil per os

NSAID

Nonsteroidal anti-inflammatory drugs

NST

Nonstress test

NTD

Neural tube defect

NYHA class

FM16New York Heart Association class

OCP

Oral contraceptive pill

OGTT

Oral glucose tolerance test

p.o

per os

PCV

Packed cell volume

PDA

Patent ductus arteriosus

PHC

Primary health center

Pulsatility index

PID

Pelvic inflammatory disease

PPBS

Postprandial blood sugar

PPD

Purified protein derivative

PPH

Postpartum hemorrhage

PPROM

Preterm premature rupture of membranes

PROM

Premature rupture of membranes

Prothrombin time

RBC

Red blood cell

RDS

Respiratory distress syndrome

RFT

Renal function test

RHD

Rheumatic heart disease

Resistance index

RNA

Ribonucleic acid

ROM

Rupture of membranes

RPL

Recurrent pregnancy loss

RUQ

Right upper quadrant

SBP

Systolic blood pressure

SFH

Symphysis-fundal height

SGA

Small for gestational age

SIADH

Syndrome of inappropriate secretion of antidiuretic hormone

SIDS

Sudden infant death syndrome

SLE

Systemic lupus erythematosus

STD

Sexually transmitted diseases

TAS

Transabdominal scan

TBG

Thyroxine-binding globulin

TFT

Thyroid function test

TSH

Thyroid stimulating hormone

TTTS

Twin to twin transfusion syndrome

TVS

Transvaginal scan

Umbilical artery

UPT

Urine pregnancy test

UTI

Urinary tract infection

vWF

Von Willebrand disease

FBS

Fasting blood sugar

Chapter Notes