A PRACTICAL GUIDE TO OBSTETRICS & GYNECOLOGY / r i . s s n a i s r e p . p i v / / : p t t h tahir99 - UnitedVRG / r i . s s n a i s r e p . p i v / / : p t t h tahir99 - UnitedVRG A PRACTICAL GUIDE TO OBSTETRICS & GYNECOLOGY / r i . s s Richa Saxena n MBBS MD (Obstetrics and Gynecoloagy) PG Diploma in Clinical Research i Obstetrician and Gynecologist s New Delhi, India r e p . p i v / / : p t t h The Health Sciences Publisher New Delhi | London | Philadelphia | Panama tahir99 - UnitedVRG Jaypee Brothers Medical Publishers (P) Ltd. Headquarters Jaypee Brothers Medical Publishers (P) Ltd. / 4838/24, Ansari Road, Daryaganj r New Delhi 110 002, India i Phone: +91-11-43574357 . Fax: +91-11-43574314 s E-mail: [email protected] s Overseas Offices n J.P. Medical Ltd. Jaypee-Highlights Medical Publishers Inc. Jaypee Medical Inc. 83, Victoria Street, London City of Knowledge, Bld. 237, Clayton The Bourse a SW1H 0HW (UK) Panama City, Panama 111, South Independence Mall East Phone: +44-20 3170 8910 Phone: +1 507-301-0496 i Suite 835, Philadelphia, PA 19106, USA Fax: +44(0)20 3008 6180 Fax: +1 507-301-0499 s Phone: +1 267-519-9789 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] r Jaypee Brothers Medical Publishers (P) Ltd. Jaypee Brothers Medicale Publishers (P) Ltd. 17/1-B, Babar Road, Block-B, Shaymali Bhotahity, Kathmandu, Nepal Mohammadpur, Dhaka-1207 Phone: +977-97412p83608 Bangladesh E-mail: [email protected] Mobile: +08801912003485 . E-mail: [email protected] p Website: www.jaypeebrothers.com i Website: www.jaypeedigital.com v © 2015, Jaypee Brothers Medical Publishers / / The views and opinions expressed in this bo:ok are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book. p All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, t photo copying, recording or otherwise, without the prior permission in writing of the publishers. t All brand names and product nahmes used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contra indications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book. This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought. Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any has been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. Inquiries for bulk sales may be solicited at: [email protected] A Practical Guide to Obstetrics & Gynecology First Edition: 2015 ISBN: 978-93-5152-479-3 Printed at tahir99 - UnitedVRG / r i . s s Dedication n Dedicated to all the women, especially tao the woman whom I admire the most, my mother, “iMrs Bharati Saxena” s r “A woman is the full circle. Within her is the power to create, nurture and transform.” e —Diane Mariechild p . p i v / / : p t t h tahir99 - UnitedVRG / r i . s s n a i s r e p . p i v / / : p t t h tahir99 - UnitedVRG PREFACE “If you don’t believe in miracles, perhaps you have forgotten that you are one.” —God Childbirth can be considered as one of the most miraculous and mesmerizing processes of nature. While being extremely glorious and magnificent, it is equally intricate and complex. When undergraduate students first encounter a childbirth in the labor room, they are likely to get awestruck; even I was. To visualize how the baby’s head negotiates through the delicate narrow maternal passage after undergoing a series of pre-decided movements is indeed marvellous. An undergraduate student who for the first time enters the labor room must understand that childbirth is not as difficult as may appear at the/ first glance, but a series of clever maneuvers which the passenger (the baby) undertakes while passing through the slenderr maternal passage (maternal pelvis) to complete its journey (childbirth). i . Childbirth can be considered as a story illustrating the journey (process of childbirth) ofs a passenger (the baby), traveling via maternal passage. This is what the book, “A Practical Guide to Obstetrics & Gynecology” saims to offer by providing the complete coverage of all practical aspects of obstetrics and gynecology from both examination and viva point of view. This is not a quick- n read handbook just before examinations, but a complete manual, which would serve as a comprehensive guide for undergraduate students. The book would not only be extremely useful for the undergraduatesa preparing for the practical/viva examination, but will also aid the postgraduate and DNB students for brushing up their basics. The book covers all important topics encountered by i a student at the time of practical viva examination: history taking and exasmination in both obstetrics and gynecology; important clinical cases in obstetrics and gynecology; normal labor room and operation theater (OT) procedures; important drugs used r in obstetrics and gynecology; contraception; imaging; instruments and specimens in obstetrics and gynecology. The book also e features an appendix at the end covering useful topics such as nutritional values, biochemistry and hematological parameters. p Writing a book is a colossal task. It can never be completed without divine intervention and approval. Therefore, I have decided to end this preface with a small prayer of thanks to the Al.mighty, which I was taught in my childhood. p “Father, lead me day by day, ever in thy own sweet way. Teach me to be piure and good and tell me what I ought to do.” v —Amen / Simultaneously, I would like to extend my thanks and appreciation to all the related authors and publishers whose references / have been used in this book. Book cre:ation is teamwork, and I acknowledge the way the entire staff of M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delphi, India, worked hard on this manuscript to give it a final shape. I would like to thank Shri Jitendar P Vij (Group Chairman), Jaypee Brothers Medical Publishers, for being the guiding beacon, and source of t inspiration and motivation behind this book. I would also like to thank Mr Ankit Vij (President) and Mr Tarun Duneja (Director- t Publishing). Last but not the hleast, I would also like to thank the entire staff of Jaypee Brothers, especially, Mr Nitish Kumar Dubey, Mr Amit Rai, and Mr Syed Amir Haider (Medical Editors) for editing the manuscript and coordinating the process of publication; Mr Vinod Kumar Sharma (DTP Operator) for typesetting the book; Mr Manoj Pahuja (Senior Graphic Designer) and Mr Vijay Singh (Graphic Designer) for making beautiful illustrations. May God bless them all! I believe that writing a book involves a continuous learning process. Though extreme care has been taken to maintain accuracy while writing this book, constructive criticism would be greatly appreciated. Please e-mail me your comments at the email address: [email protected]. Also, please feel free to visit my website www.drrichasaxena.com for obtaining information related to various other books written by me and to make use of the free resources available for the medical students. Richa Saxena ([email protected]) www.drrichasaxena.com tahir99 - UnitedVRG / r i . s s n a i s r e p . p i v / / : p t t h tahir99 - UnitedVRG SPECIAL ACKNOWLEDGMENTS Saunitra Inamdar MD Professor Department of Obstetrics and Gynecology Jawaharlal Nehru Medical College, Wardha, Maharshtra, India For providing pictures for Chapter 14 (Specimens in Obstetrics and Gynecology) / Kiran Agarwal MD FICOG r i Associate Professor, Rohilkhand Medical College and Hospital . Pilibhit Bypass Road, Bareilly, India s Vice President, Rohilkhand Medical College and Hospital s Institute of Dental Sciences n Rohilkhand College of Nursing, Bareilly, India a For providing pictures for Chapter 13 (Instruments in Obstetrics and Gynecology) i s r e p . p i v / / : p t t h tahir99 - UnitedVRG / r i . s s n a i s r e p . p i v / / : p t t h tahir99 - UnitedVRG