DC Dutta's Clinics in OBSTETRICS
Cover Image
FIG: Monochorionic-monoamniotic twin placenta showing entanglement of the umbilical cords. Extremely uncommon to see such complex entanglement to cause death to both the fetuses (see discussion Chapter 9)
DC Dutta's Clinics in OBSTETRICS
DC Dutta MBBS DGO MO (Cal)
Professor and Head, Department of Obstetrics and Gynecology Nilratan Sircar Medical College and Hospital,
Kolkata, India
Edited by
Hiralal Konar (Hons; Gold Medalist) MBBS (Cal) MD (PGI) DNB (India) MNAMS FACS (USA) FRCOG (London)
Professor and Head, Department of Obstetrics and Gynecology, KPC Medical College and Hospital,
Kolkata, India
FOGSI Representative to Asia Oceania Federation of Obstetricians and Gynecologists (AOFOG)
Member, Oncology Committee of AOFOG
Chairman, Indian College of Obstetricians and Gynecologists (2013)
Formerly Professor and Head, Department of Obstetrics and Gynecology Agartala Govt. Medical College and GB Pant Hospital,
Tripura, India
Professor, Department of Obstetrics and Gynecology Calcutta National Medical College and Hospital,
Kolkata
Professor and Head, Department of Obstetrics and Gynecology Midnapore Medical College and Hospital, West Bengal University of Health Sciences,
Kolkata
Rotation Registrar in Obstetrics, Gynecology and Oncology Northern and Yorkshire Region, Newcastle-upon-Tyne,
UK
Examiner National: MBBS, DGO, MD and PhD of different Universities and National Board of Examination,
New Delhi
International: Royal College of Obstetricians and Gynaecologists (MRCOG),
London
Royal College of Physicians of Ireland (MRCPI)
Recipient, “Pride of FOGSI” award – 2019, for exemplary efforts toward upliftment of Women's Health in India
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DC Dutta's Clinics in Obstetrics
First Edition: 2022
9789354651342
Printed at:
to
those who strive relentlessly
to develop quality care
for
women's health
Professor DC Dutta
Professor DC Dutta was an Obstetrician, Gynecologist, a teacher par excellence and above all a noble human being. He came out with his first book entitled, Textbook of Obstetrics in 1983, while he was the Professor in Obstetrics and Gynecology at Sir Nil Ratan Sircar Medical College and Hospital, Kolkata, India. He was the first author in Obstetrics and Gynecology to remove the complexity of management with a most simple approach of the text information and the management flowchart, based on science and available resources. Textbook of Obstetrics soon became very popular Nationally and Internationally for which he received many accolades. DCD, as he was known to all his colleagues and students, was the doyen in Obstetrics and Gynecology in his era. His ‘Textbook of Gynecology’ was published in 1989 from the same institute and department while he was the Professor and Head. This book also fetched more name and fame.
His deep interest in emergency obstetric care, is reflected by his several publications in the national journals. Presently, the best publication award, under the Federation of Obstetric and Gynecological Societies of India (FOGSI), every year, goes by his name. He is well-known for his fast surgical skill. He retired from the same institution in 1993, after a long and distinguished career. He died on 29th December 1995. His charming personality and the profound knowledge, made him very popular to the generations of students, professionals, practitioners and the patients. His legacy continues. He is remembered with great affection and professional respect by all, who knew him.
PREFACE
Dutta's Clinics in Obstetrics is an up-to-date comprehensive review for the postgraduates. The current edition has been made more widened and prepared with recent advances in obstetrics extensively. This book was previously published as Manual of Obstetrics and Gynecology for the Postgraduates.
Approach for this book is entirely different from a standard textbook. Any attempt to cover the entire subject of obstetrics is presently impossible for anyone in the discipline. Technology driven advances from embryo biopsy to intrauterine fetal therapy, have given us a huge new insight. The topics are selected depending on the necessity to learn and practice with the available resources.
This book has been designed for all categories of medical students and the residents that they are striving to keep themselves abreast with the progress of science and technology for improved patient care. Practicing obstetricians will equally be benefitted to update themselves for the quality care. This book focuses on all the practical aspects of clinical diagnosis and management. The book covers several hundreds of problems in obstetrics, in a concise mode of discussion within a well-deigned structured framework.
As the concept of precision medicine is the trend, attempts have been made to provide a comprehensive summary of each subject under the subspecialty. My sincere attempt was to provide a global view for the standard of teaching, training and evaluation. A framework for the international standard of postgraduate examinations have been provided. This book is enriched with a good number of illustrations, numerous charts, tables, boxes, photographs of rare variety. Suggested Reading has been added for additional information to know the other management options.
Clinics in Obstetrics provides a scholarly and updated answer for any question related to the subject as discussed in the different sections of subspecialty. While writing the book, I have tried my best to analyze critically the events, researches, trials and the literatures that appeared clinically relevant. At the end, the author has expressed his experience and judgment as regard the care of an individual patient.
Hiralal Konar
ACKNOWLEDGMENTS
I am deeply indebted to my esteemed colleagues, residents and students, Department of Obstetrics and Gynecology of all the medical institutions of the country and abroad for their generous support while writing this book. I thank all the readers who have contacted me with suggestions and seeking explanations through e-mails. Their inputs have been invaluable and much appreciated. I wish I could mention their names individually.
I thank Professor Gautam Joarder, Principal, Professor Ashok Mondal, Chief Medical Director and Adviser to the Principal and Dr Saurav Ghosh, Medical Director, KPC Medical College and Hospital, Kolkata, India for the support.
I sincerely thank World Health Organization Regional Office of South-East Asia (WHO-SEARO) for supporting me to include the important chapter “Safe Abortion Service and WHO Guidelines” in “Clinics in Gynecology” book. I also sincerely acknowledge the valuable inputs and contributions of Dr Neena Raina, Senior Advisor, Maternal, Child and Adolescent Health and Aging and Dr Meera Thapa Upadhyay, Technical Officer, Reproductive Health, WHO-SEARO and technical experts from Sexual and Reproductive Health (SRH)/Prevention of Unsafe Abortion (PUA) unit at WHO, Geneva.
I sincerely acknowledge the help specially Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President) and Dr Madhu Choudhary (Publishing Head–Education) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi for all round support as and when needed. I thank, Md Jakir Hossain MSc, BEd, ADCA, Consultant Software for the technological support while composing the draft.
I am grateful to Dr Arindam Halder, Associate Professor, Dinajpur Medical College and Hospital, Dr (Mrs) Picklu Choudhury, Professor and Head, Department of Obstetrics and Gynecology, Rampurhat Medical College and Hospital, Dr Pallab Mistri, Associate Professor, Medical College, Kolkata, Prof Malabika Misra, JIMSH, Kolkata, Dr Chandrachur Konar, Assistant Professor, SDUMC, Dr Roshini P, Senior Resident, MVJ Medical College and Dr Lisley Konar, Resident, SDUMC for their tireless efforts to review the manuscripts.
I am ever grateful to Mrs Madhusri Konar for her sincere secretarial job and the all round support for this project.
At the end, I am grateful to all who have taught me most—all the patients and my beloved students.
I always welcome the views of the students, and the teachers through on line access to:
e-mail: h.kondr@gmail.com and websites: hirlalkonar.com and dcdutta.com
ABBREVIATIONS
AACE:
American Association of Clinical Endocrinology
AC:
Abdominal Circumference
ACA:
Anticardiolipin Antibodies
ACE:
Angiotensin Converting Enzyme
ACHOIS:
Australian Carbohydrate Intolerance Study
ACOG:
American College of Obstetricians and Gynecologists
ACS:
Acute Chest Syndrome
ACTH:
Adrenocorticotropic Hormone
ADA:
American Diabetes Association
AEDF:
Absent End-diastolic Flow
AEDs:
Antiepileptic Drugs
AFASS:
Affordable, Feasible, Accessible, Sustainable and Safe
AFE:
Amniotic Fluid Embolism
AFP:
Alpha-fetoprotein
AFS:
American Fertility Society
AI:
Aromatase Inhibitors
AIDS:
Acquired Immune Deficiency Syndrome
ALT:
Alanine Transaminase
AMH:
Anti-Müllerian Hormone
APA:
Antiphospholipid Antibody
APAS:
Antiphospholipid Antibody Syndrome
API:
Association of Physicians of India
APS:
Antiphospholipid Syndrome
ARDS:
Acute Respiratory Distress Syndrome
ARM:
Artificial Rupture of the Membranes
ART:
Assisted Reproductive Technology
ASB:
Asymptomatic Bacteriuria
ASRM:
American Society for Reproductive Medicine
AST:
Aspartate Transaminase
ATA:
American Thyroid Association
BBT:
Basal Body Temperature
BC:
Blood culture
BMI:
Body Mass Index
BP:
Blood Pressure
BPD:
Biparietal Diameter
BPM:
Beats per Minute
BPP:
Biophysical Profile
BPV:
Bioprosthetic Heart Valves
BTB:
Breakthrough Bleeding
CAH:
Congenital Adrenal Hyperplasia
C and S:
Culture and Sensitivity
CBAVD:
Congenital Bilateral Absence of Vas Deferens
CBC:
Complete Blood Count
CCU:
Clean Catch Urine
CDC:
Centers for Disease Control and Prevention
CDH:
Congenital Diaphragmatic Hernia
CDMR:
Cesarean Delivery on Maternal Request
CEE:
Conjugated Equine Estrogens
CEMACH:
Confidential Enquiry into Maternal and Child Health
cff-DNA:
Cell-free Fetal DNA
CFTR:
Cystic Fibrosis Transmembrane Regulator
CFU:
Colony-forming Unit
CGH:
Comparative Genomic Hybridization
CMV:
Cytomegalovirus
CNS:
Central Nervous System
CO:
Combined Obesity
COCs:
Combine Oral Contraceptives
COS:
Controlled Ovarian Stimulation
COX:
Cycloxygenase
CPD:
Cephalopelvic Disproportion
CPP:
Chronic Pelvic Pain
CPR:
Cardiopulmonary Resuscitation
CPT:
Complete Perineal Tear
CREST:
Calcinosis, Raynaud Phenomenon, Esophageal Dysmotility, Sclerodactyly, and Telangiectasia
CRH:
Corticotropin-releasing Hormone
CRS:
Congenital Rubella Syndrome
CS:
Cesarean Section
CSF:
Cerebrospinal Fluid
CSP:
Cesarean Scar Pregnancy
CT:
Computed Tomography
CTG:
Cardiotocography
CTPA:
Computed Tomographic Pulmonary Angiography
CVD:
Cardiovascular Disease
CVS:
Chorionic Villus Sampling
CZ:
Carbimazole
D and C:
Dilatation and Curettage
DF:
Dominant Follicle
DFMC:
Daily Fetal Movement Count
DIC:
Disseminated Intravascular Coagulation
DIPSI:
Diabetes in Pregnancy Society of India
DMPA:
Depot Medroxyprogesterone Acetate
DPG:
Diphosphoglycerate
DTIC:
Distal Tubal Intraepithelial Carcinoma
DVT:
Deep Vein Thrombosis
E:
Eclampsia
ECG:
Electrocardiogram
EGF:
Epidermal Growth Factor
EOCs:
Epithelial Ovarian Cancers
EPAU:
Early Pregnancy Assessment Unit
ESBL:
Extended-spectrum beta-lactamase
ESHRE:
European Society of Human Reproduction and Embryology
EXIT:
EXtrauterine Intrapartum Therapy
FBC:
Full Blood Count
FDP:
Fibrinogen Degradation Products
FETO:
FEtoscopic Tracheal Occlusion
FGR:
Fetal Growth Restriction
FIGO:
International Federation of Gynaecology and Obstetrics
FISH:
Fluorescence in situ Hybridization
FL:
Femur Length
FOGSI:
Federation of Obstetricians and Gynecologists of India
FSH:
Follicle Stimulating Hormone
FVS:
Fetal Varicella Syndrome
G-6PD:
Glucose-6-phosphate dehydrogenase
GAS:
Group A Streptococcus (Streptococcus pyogenes)
GBS:
Group B Streptococci
GBS:
Group B Streptococcus (Streptococcus agalactiae)
GC:
Gonococcus (Neisseria gonorrhoeae)
GDM:
Gestational Diabetes Mellitus
GIT:
Gastrointestinal Tract
GnRH:
Gonadotropin Releasing Hormone
HAPO:
Hyperglycemia and Adverse Pregnancy Outcome
HAV:
Hepatitis A Virus
HbF:
Fetal Hemoglobin
HBV:
Hepatitis B Virus
HC:
Head Circumference
hCG:
Human Chorionic Gonadotropin
HCV:
Hepatitis C Virus
HDFN:
Hemolytic Disease of the Fetus and Newborn
HDL:
High Density Lipoprotein
HDR:
High Dose Radiation
HDU:
High Dependency Unit
HELLP:
Hemolysis, Elevated Liver Enzymes, Low Platelet count
HFEA:
Human Fertilization and Embryology Authority
hGH:
Human Growth Hormone
HIV:
Human Immunodeficiency Virus
HLA:
Human Leukocyte Antigen
HPL:
Human Placental Lactogen
HRT:
Hormone Replacement Therapy
HVS:
High Vaginal Swab
HWY:
Hundred Woman Years (Pregnancy)
IADPSG:
International Association of Diabetes and Pregnancy Study Groups
IAI:
Intra-amniotic infection (Chorioamnionitis)
IAP:
Intrapartum Antibiotic Prophylaxis
ICD:
International Statistical Classification of Disease
ICU:
Intensive Care Unit
IDDM:
Insulin-dependent Diabetes Mellitus
IFA:
Immunofluorescence Assay
IGF:
Insulin-like Growth Factor
IPV:
Inactivated Polio Vaccine
ITP:
Idiopathic Thrombocytopenic Purpura
ITS:
Indian Thyroid Society
ITU:
Intensive Therapy Unit
IUCD:
Intrauterine Contraceptive Device
IUD:
Intrauterine Device
IUFD:
Intrauterine Fetal Demise
IUFT:
Intrauterine Fetal Therapy
IUGR:
Intrauterine Growth Restriction
IUI:
Intrauterine Insemination
IVC:
Inferior Vena Cava
IVF-ET:
In vitro Fertilization and Embryo Transfer
IVH:
Intraventricular Hemorrhage
IVIG:
Intravenous Immunoglobulin
LAC:
Lupus Anticoagulant
LARC:
Long-acting reversible contraceptives
LBC:
Liquid-based Cytology
LDH:
Lactate Dehydrogenase
LDL:
Low Density Lipoprotein
LE:
Leucocyte Esterase
LFT:
Liver Function Test
LMP:
Last Menstrual Period
LMWH:
Low Molecular Weight Heparin
LNG-IUD:
Levonorgestrel-intrauterine Device
LNG-IUS:
Levonorgestrel-intrauterine System
LOA:
Left Occiput Anterior
LPD:
Luteal Phase Defect
LSCS:
Lower Segment Cesarean Section
LUF:
Luteinized Unruptured Follicle
LUTO:
Lower Urinary Tract Obstruction
LVS:
Low Vaginal Swab
MAHA:
Microangiopathic Hemolytic Anemia
MAP:
Mean Arterial Pressure
MC:
Monochorionic
MCA-PSV:
Middle Cerebral Artery Peak Systolic Velocity
MCA:
Middle Cerebral Artery
MCDA:
Monochorionic Diamniotic
MCTP:
Monochorionic Twin Pregnancy
MDTA:
Multidisciplinary Team Approach
MEA:
Microwave Endometrial Ablation
MgSO4:
Magnesium Sulfate
MHV:
Mechanical Heart Valves
MM:
Maternal Mortality
MMR:
Maternal Mortality Rate
MNM:
Maternal Near Miss
MOM:
Multiple of the Median
MPGS:
Massively Parallel Genomic Sequencing
MRI:
Magnetic Resonance Imaging
MRSA:
Meticillin-resistant Staphylococcus aureus
MSAFP:
Maternal Serum Alpha-fetoprotein
MSU:
Midstream urine
MTCT:
Mother-to-child Transmission
MTHFR:
Methylenetetrahydrofolate Reductase
MTP:
Medical Termination of Pregnancy
MTX:
Methotrexate
MVA:
Manual Vacuum Aspiration
MVP:
Maximum Vertical Pocket
N:
Nitrites
NEC:
Necrotizing Enterocolitis
NICE:
National Institute for Health and Clinical Excellence
NICHD:
National Institute of Child Health and Human Development
NICU:
Neonatal Intensive Care Unit
NIPT:
Noninvasive Prenatal Testing
NSAIDs:
Nonsteroidal Antiinflammatory Drugs
NTD:
Neural Tube Defects
OA:
Occiput Anterior
OGTT:
Oral Glucose Tolerance Test
OP:
Occiput Posterior
OSCE:
Objective Structured Clinical Examination
P-PROM:
Pre-term Premature Rupture of Membranes
PAPP-A:
Pregnancy Associated Plasma Protein-A
PCR:
Polymerase Chain Reaction
PDA:
Patent Ductus Arteriosus
PE:
Pulmonary Embolism
PGD:
Prenatal Genetic Diagnosis
PID:
Pelvic Inflammatory Disease
PMB:
Postmenopausal Bleeding
POC:
Product of Conception
POD:
Pouch of Douglas
POP:
Progestin only Pill
PPIUCD:
Postpartum Intrauterine Contraceptive Devices
PR:
Pulse Rate
PRBCs:
Packed Red Blood Cells
PRES:
Posterior Reversible Encephalopathy Syndrome
PROM:
Premature Rupture of Membranes
PSOC:
Papillary Serous Ovarian Cancer
PSP1:
Pregnancy Specific Protein 1
PT:
Prothrombin Time
PTD:
Postpartum Thyroid Dysfunction
PTT:
Partial Thromboplastin Time
PTU:
Propylthiouracil
PUL:
Pregnancy of Unknown Location
PVD:
Peripheral Vascular Disease
RCOG:
Royal College of Obstetrics and Gynecology
RCTs:
Randomized Controlled Trials
RDS:
Respiratory Distress Syndrome
RFM:
Reduced Fetal Movements
RPL:
Recurrent Pregnancy Loss
SAMM:
Severe Acute Maternal Morbidity
SCCA:
Squamus Cell Carcinoma Antigen
SCD:
Sickle Cell Disease
SGA:
Small for Gestational Age
SHBG:
Sex Hormone Binding Globulin
SI:
Shock Index
SIL:
Squamous Intraepithelial Lesion
SIS:
Saline Infusion Sonography
SLE:
Systemic Lupus Erythematosus
SOFA:
Sequential Organ Failure Assessment
SSI:
Surgical Site Infection
STAN:
ST Segment ANalysis
TAH:
Total Abdominal Hysterectomy
TEC:
Thromboembolic Complications
TNFs:
Tumor Necrosis Factors
TOT:
Transobturator Tape
TPO:
Thyroid Peroxidase
TPOAbs:
Thyroid Anti-TPO Antibodies
TRAP:
Twin Reverse Arterial Perfusion
TRH:
Thyrotropin Releasing Hormone
TSHRAbs:
Thyrotropin Receptor Autoantibodies
TTN:
Transient Tachypnea of the Newborn
TTTS:
Twin-twin Transfusion Syndrome
TV:
Trichomonas Vaginalis
TVS:
Transvaginal Sonography
TOLAC:
Trial of labor After Cesarean
UAE:
Uterine Artery Embolization
UE3:
Unconjugated Estriol
UFH:
Unfractionated Heparin
UI:
Urinary Incontinence
USG:
Ultrasonography
UTI:
Urinary Tract Infection
VaIN:
Vaginal Intraepithelial Neoplasia
VAMA:
Very Advanced Maternal Age
VBAC-TOL:
Vaginal Birth After Cesarean-Trial of Labor
VBAC:
Vaginal Birth After Cesarean
VEGF:
Vascular Endothelial Growth Factor
VTE:
Venous Thromboembolism
VVF:
Vesicovaginal Fistula
VZIG:
Varicella Zoster Immunoglobulin
VZV:
Varicella Zoster Virus
WHO:
World Health Organization
WLTC:
Women with Life-threatening Condition