DC Dutta's Textbook of OBSTETRICS Including Perinatology and Contraception
DC Dutta's Textbook of OBSTETRICS Including Perinatology and Contraception
Tenth Edition
HIRALAL KONAR
(HONS; GOLD MEDALIST) MBBS (CAL), MD (PGI), DNB MNAMS, FACS (USA), FRCOG (LONDON)
Professor and Head, Department of Obstetrics and Gynecology KPC Medical College and Hospital, Kolkata, West Bengal, India Formerly, Professor and Head, Department of Obstetrics and Gynecology Agartala Government Medical College and Hospital, Tripura; Midnapore Medical College and Hospital, West Bengal University of Health Sciences, Kolkata, West Bengal, India Rotation Registrar in Obstetrics, Gynecology and Oncology Northern and Yorkshire Region, Newcastle-upon-Tyne, UK Examiner: National—MBBS, DGO, MD and PhD of different Indian Universities National Board of Examination, New Delhi, India International—Membership of the Royal College of Obstetricians and Gynecologists, London (MRCOG) and Royal College of Physicias of Ireland (MRCPI) Vice-President: FOGSI; Indian Society of Perinatology and Reproductive Biology (ISOPARB) Recipient, “Pride of FOGSI Award” and “FOGSI Achiever Award”, for exemplary works towards upliftment of Women's Health in India FOGSI Representative to Asia Oceania Federation of Obstetricians and Gynecologists (AOFOG) Chairman, Indian College of Obstetricians and Gynecologists (ICOG–2013)
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Textbook of Obstetrics
Ninth Edition: 2018
Tenth Edition: 2023
Revised Reprint: 2023
9789356963313
Printed at
The students of obstetrics—past and present
- BB Hore MD
- Former Professor and Head
- Calcutta Medical College, Kolkata
- Consultant Anesthetist
- Kolkata, West Bengal, India
- Santanu Bag FRCPCH (UK) CCT
- Assistant Professor
- Consultant Neonatologist
- Rama Krishna Mission Seva Pratisthan
- and Vivekananda Institute of Medical Sciences
- Kolkata, West Bengal, India
- Sir Sabaratnam Arulkumaran PhD DSc FRCOG FRCS
- Professor Emeritus
- St George's University, London
- Past President–FIGO, BMA and RCOG
With great pleasure we release the tenth edition of Dutta's Textbook of Obstetrics. Obstetric care is evolving fast with the progress in science and technology. The tenth edition has come up much earlier to ensure the updated knowledge and practice for the students and practitioners.
It is more than forty years that Prof. DC Dutta, the visionary leader of education recognised the need for such a book primarily intended for the medical and nursing students, residents and the practising obstetricians.
The changes in the present edition are significant and are in accordance with the current guidelines of National Medical Commission (NMC). This edition has been updated as per the CBME curriculum. It carries the extensive use of imaging studies as it is the need of the day. The chapter outlines, good number of tables, boxes are incorporated for easy understanding and reproduction.
We are indebted to Sir, Professor Sabratnam Arulkumaran, for revising the chapters: Normal Labor (Ch. 13) and Intrapartum Fetal Monitoring (Ch. 39). We are grateful to Dr S Bag, FRCPCH (UK), CCT, Assistant Professor, Department of Neonatology, RKMSP and Vivekananda Institute of Medical Sciences (VIMS), Kolkata, for updating the chapters on perinatal care (Ch. 31, 32, 33). We sincerely acknowledge Prof. K Oswal and Dr K Mukherjee, Sonologists, for their generous support. We are indebted to Prof. BB Hore, for the revising the Ch. 34 (Analgesia and Anesthesia in Obstetrics) as before. My sincere thanks are to Dr Chandrachur Konar, Dr Roshini P and Dr Lisley Konar, for their all round support for this edition.
The uniqueness of this text lies in its presentation, which is simple, lucid and unambiguous. Summary tables, key points, algorithm and the flowcharts are for quick revision before exams. Uniformity of information in all the chapters is a special value. Contemporary guidelines of different professional and academic organizations, e.g., RCOG, ACOG, ICOG, WHO, FIGO, NICE, CDC, ESHRE, ASRM, FOGSI are incorporated. List of most frequently used abbreviations have been provided for easy navigation. This edition, in its fully colored format is profusely illustrated with more than 790 line drawings, sketches and photographs.
I had the opportunity of visiting many medical institutions in this country and abroad. The feedback that I have received form the teachers and students are invaluable. Many of the suggestions have been addressed in this edition. The editor always welcomes the views of the students and the teachers through online access to e-mail: h.kondr@gmail.com and websites: hiralalkonar.com and dcdutta.com. Regarding the video section, interested readers keen to know more could reach out at: drroshnip24@gmail.com.
Dutta's Textbook of Obstetrics has a long-standing association with its sister books: Textbook of Gynecology (8th Edition, 2020), Clinics in Obstetrics (1st Edition, 2022), Clinics in Gynecology (1st Edition, 2022) and Bedside Clinics and Viva Voice (7th Edition, 2020).
The online version of this comprehensive book has been prepared by a very young and talented team members (Dr Chandrachur Konar, Dr Roshini P and Prof. Rajiv Kumar Saxena). Online version is extensively available. It has the flexibility of using the text content and video materials for clinical and practical purposes. Its content will be revised and updated annually as necessary.
I do hope that this comprehensive textbook will continue to be of immense educational resource to the readers as ever. I am grateful to those who have taught me, most of all, the patients and my beloved students.
According to the author's desire, this book is dedicated to the students of obstetrics: past and present, who strive relentlessly to improve maternal and newborn health care wherever they work.
Hiralal Konar
P-13, New CIT Road
Kolkata–700014
India
Preface to the First Edition
Over the years, there was an absolute dearth of a single comprehensive textbook of obstetrics, worth to be prescribed to the students. Moreover, of the textbooks currently available, most have been written with an orientation for the developed countries.
Being constantly insisted and hard-pressed by my beloved students, I ultimately decided to write a compact, comprehensive and practically oriented textbook of obstetrics. It is an attempt to encourage the students to learn obstetrics in a comparatively easy way. The aim was to emphasize the simplicities rather than complexities of knowledge. The book is written in a clear and concise language and in author's own style, which holds the reader's interest. Controversies are avoided and the management of the obstetrical problems is being highlighted with the facilities available to most of the Third World countries. Extensive illustrations and flow charts (schemes) have been used as and when needed to add lucidity and clarity to the subject and to emphasize the practical nature of the book.
Although the book has been written primarily for the undergraduates, it should also prove to be useful to nurses (midwives), those aspiring for diploma and postgraduate degrees in obstetrics, and also to the practicing obstetricians. I, however, do not consider this book to be an ideal one but a humble attempt has been made to remove the bottlenecks, as far as possible, of the books available to the students at present.
Acknowledgments: Very little of what is worthwhile in this book could not have been brought to publication without the generous cooperation, advice and assistance of many of my colleagues, seniors and juniors.
Dr BN Chakravarty, MBBS, DGO, MO (CAL), FRCOG (Eng), Prof., Department of Obstetrics and Gynecology, Nilratan Sircar Medical College, Kolkata; Dr KM Gun, MBBS, DGO, MO (CAL), FRCOG (Eng), FRCS (Edin), FACS, Prof., Department of Obstetrics and Gynecology, Medical College, Kolkata; Dr Santosh Kr Paul, MBBS, DGO, MO (CAL), Reader, Department of Obstetrics and Gynecology, Nilratan Sircar Medical College, Kolkata; Dr B Hore, MBBS, DA, MS (CAL), Prof. and Head of the Department of Anesthesiology, North Bengal Medical College, Siliguri; Dr BC Lahari, MBBS, DGO, MO (CAL), FRCS (Edin), FRCOG (Eng), FACS (USA), FAMS (Ind), Prof., Department of Obstetrics and Gynecology, Medical College, Kolkata; Dr NN Roy Chowdhury, MBBS, DGO, MO (CAL), PhD, FRCS, FRCOG, FACS, FAMS, Prof., Department of Obstetrics and Gynecology, Medical College, Kolkata.
I have much pleasure in expressing my cordial appreciation to the house-surgeons, internees and students of Nilratan Sircar Medical College, Kolkata, for all the help they have rendered in preparation of the final drafts of the manuscripts, checking the proofs, and in compiling the Index. Without their constant encouragement and active assistance, this book could never have been published.
In preparing a textbook like this, I have utilized the knowledge of a number of stalwarts in the profession and consulted many books and publications. I wish to express my appreciation and gratitude to all of them, including the related authors and publishers.
As a teacher, I have learnt a lot from the students and, more so, while writing this book and, as such, I could not think of dedicating the book to anyone else but the students of obstetrics, for which I express my gratitude.
Mahalaya
DC Dutta
8th September, 1983
P-13, New CIT Road
Kolkata–700014
India
Acknowledgments
The job of editing such a comprehensive text is stupendous and it could never be completed without the help and advice of many experts in the field. I have consulted many of my esteemed colleagues in the profession in this country and abroad, multitude of eminent authors, many current evidence-based studies, guidelines and recommendations. I do gratefully attribute my legacy to all the teachers, related authors and the publishers.
At the outset, I am indebted wholeheartedly for the support provided by Prof. BB Hore, Consultant Anesthetist, Sir Sabaratnam Arulkumaran, Emeritus Professor, and Dr Santanu Bag, Assistant Professor and Consultant Neonatologist, for their contributions of the respective topics. I am extremely grateful to Mrs Madhusri Konar, MA, BEd, for all her insightful secretarial accomplishments in support of the book.
I gratefully thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Dr Madhu Choudhary (Director–Educational Publishing), Ms Pooja Bhandari (Production Head), Ms Sunita Katla (Executive Assistant to Group Chairman and Publishing Manager), for their all-round support as and when needed. I also acknowledge the help of Dr Aditya Tayal (Team Leader–Development Editor), Mr Rajesh Sharma (Production Coordinator), Ms Seema Dogra (Cover Visualizer), Mr Laxmidhar Padhiary (Quality Controller), Mr Ajeet Rathor (Typesetter), Mr Akshay Thakur (Typesetter), Mr Manoj Pahuja (Senior Graphic Designer), and wish to thank all others of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, who worked for this project.
International Reviewers
I am especially indebted to all the international reviewers: Sir Sabaratnam Arulkumaran, PhD, DSc, FRCOG, FRCS, Prof. Emeritus, St George's University of London, Past President–FIGO, BMA and RCOG; Dr Michael P O'Connel, Royal College of Physicians, Dublin; Prof. Colm O'Herlihy, National Maternity Hospital, Dublin; Prof. Farhana Dewan; Prof. Kohinoor Begum, Bangladesh; Prof. Rokeya Begum, Bangladesh; Prof. Rowshan Ara Begum; Prof. Sabera Khatun, Bangladesh; Prof. S Nurjahan Bhuiyan, Bangladesh; Prof. PR Pant, Tribhuvan University Teaching Hospital (TUTH), Nepal.
National Reviewers
I sincerely acknowledge the following teachers across this vast country for their valuable suggestions. Their comments and guidance have helped me enormously to shape this new edition. I hope that I have listed all of those who have contributed and apologize if any name has been left out inadvertently.
My sincere thanks are due to Prof. Gita B Banerjee, CRSS, Kolkata; Prof. Picklu Choudhury, RPH MCH, West Bengal; Prof. PK Biswas, CNMCH, Kolkata; Prof. Narayan Jana, CRSS, Kolkata, Prof. Habibullah, MGMC, Puducherry; Prof. Ashok Kumar, Delhi; Prof. Pranay Nath, Prof. Gita Guin, NSCBMC, Jabalpur; Prof. Tusar Kar, Cuttack; Prof. Bharati Mishra, Brahmapur, Odisha; Prof. Ava Rani Sinha, Mujaffarpur; Prof. Vinita Sharma, PGI, Chandigarh; Prof. Kiran Pandey, GSVMMCH, Kanpur; Prof. Sowjanya Kumari, Tirupati; Prof. Suyajna, VIMS, Bellary; Prof. Sampatkumari, Tamil Nadu; Prof. Muralidhar Pai, KMC, Manipal; Prof. Devinder, AFMC, New Delhi; Prof. Himadri Bal, DY Patil MCH, Pune; Prof. M Sarkar, BMCH, West Bengal; Prof. H Rahman, Gangtok; Prof. Deepa Masand, NIMS, Jaipur; Prof. Ajith, Kannur; Prof. Pratap Kumar, KMC, Manipal; Prof. Nilesh Dalal, MGMC, Indore; Prof. SS Gulati, SMC, Noida; Prof. Jaya Chaturvedi, AIIMS, Rishikesh; Dr Sujatha, AMC, Visakhapatnam; Prof. Savita C, BMC, Karnataka; Prof. RC Antaratan, Hubli; Prof. Umdi, Belagavi, IMS; Prof. Dharma Vijay MN, MVJMC&RH; Prof. Anju Agarwal, KGMC, Lucknow; Prof. Wani Aditya, BRD Medical College, Gorakhpur; Prof. MD Pant, KMC, Manipal; Prof. Pushpalata, AIIMS, Bhopal; Prof. Prativa Singh, AIIMS, Jodhpur; Prof. Nirja Bhatla, AIIMS, New Delhi; Prof. Beena Kumari R, GMC, Kattayam; Prof. Nirmala, GHC, Thiruvananthapuram; Prof. Sarina Gilvaz, JMMCH; Prof. Radhamani K, IMS, Amrita Institute of Medical Sciences; Prof. T Padmabvathi, Andhra MCH; Prof. Pradeep S, PESIMSR, Kuppam; Prof. S Vijaya, Madras MCH; Prof. K Kalaivani, Stanley MCH; Prof. Krishnapriya Banerjee, SMSMCH, Jaipur; Prof. Parmeet Kaur, GMC, Patiala; Prof. Lajya Devi Goyel, AIIMS, Bhatinda; Prof. Amrit Pal Kaur, GMC, Amritsar; Prof. Seema Grover Bhatty, GGSMCH, Faridkot; Prof. Ashoke Anand, Grant MC, Mumbai; Prof. NM Mayadeo, KEM Hospital; Prof. JK Deshmukh, GMC, Nagpur; Prof. Brig Aruna Menon, AFMC, Pune; Prof. Hemant Deshpande, DY Patil MCH, Pune; Prof. T Panchanadikar, BVPMC, Pune; Prof. AV Mehta, BJMCH, Ahmedabad; Prof. Gokhale, GMC, Baroda; Prof. Haresh Dashi, GCS MCH, Ahmedabad; Emeritus Prof. Dr Habibullah, MGMCH, Puducherry; Prof. Seetesh Ghose, Dean, MGM MCH; Prof. Gauri, JIPMER; Prof. Lata, JIPMER, Puducherry, Prof. Manidip Pal, Kalyani KMC; Prof. Sarita Agarwal, Raipur; Prof. Tripti Nagaria, JNMCH, Raipur; Prof. Uma Pandey, BHU; Prof. BM Rakshit, MCH, Kolkata; AGMC, Shimla; Prof. Pranay Phukan, Dibrugarh; Prof. J Ray, GMCH, Agartala; Prof. Debutta, RG Kar MCH, Kolkata; Prof. T Maity; Prof. A Phadikar, NRSRCH; Prof. Anuradha Chatterjee, NBMCH; Dr Pallab Mistri, Associate Professor, CMC, Kolkata; Dr Arindam Haldar, Associate Professor, Raiganj MCH; Prof. S Biswas, IGMER, Kolkata; Prof. Malbika Mishra, JIMS, Budge Budge; Prof. S Barik, Haldia Medical College; Prof. Sasavati Sanyal Choudhary; Prof. Alakananda, GMCH, Guwahati; Prof. P Das, Guwahati MCH; Prof. Kavita Mandrella Bhatti, CMC, Ludhiana; Prof. Aparajita S D'Souza, ESIC MCH, Hyderabad; Prof. BS Meena, SMSMCH, Jaipur; Prof. Seema Hakim, AMU, Aligarh; Dr AK Bhattacharya, Associate Professor, Jorhat Medical College; Prof. HK Sharma, Jorhat MCH; Prof. Panchanan Das, GMCH, Guwahati; Lt Col. Prof. Indrani Mukopopadhyay, AFMC; Dr Saumen Das Poddar, AFMC, and Col. Bidhan Ray, AFMC.
I sincerely thank Prof. Rajiv Saxena, Dr Chandrachur Konar, Dr (Mrs) Roshini P, and Dr Lisley Konar, for their untiring effort for the all-round support to this tenth edition of the book.
I express my sincere thanks to all the teachers and students of different medical institutes, midwifery institutes, and nursing colleges in India and abroad for their valued suggestions, new ideas and contribution of photographs. Their inputs have been invaluable and much appreciated.
Last but not least, I am grateful to all who have taught me, most of all the patients and my beloved students.
The editor always welcomes the views of the students and the teachers through online access to e-mail: h.kondr@gmail.com; ratulkonar@gmail.com; and, websites: hiralalkonar.com and dcdutta.com.
Hiralal Konar
P-13, New CIT Road
Kolkata–700014
India
The Kernel
DC DUTTA
MBBS, DGO, MO (CAL)
Professor and Head, Department of Obstetrics and Gynecology
Nilratan Sircar Medical College and Hospital, Kolkata, India
List of Video Contributors
- Rajiv Kumar Saxena MBBS, MD
- Professor and Head
- Department of Obstetrics and Gynecology
- The Oxford Medical College, Hospital and Research Centre
- Bengaluru, Karnataka, India
- Roshini P MBBS MS DNB
- Assistant Professor
- Department of Obstetrics and Gynecology
- ESIC and PGIMSR
- Bengaluru, Karnataka, India
Number | Competency The student should be able to | Core (Y/N) | Teaching-Learning Methods | Chapter Number | Page Number |
OG1.1 | Define and discuss birth rate, maternal mortality and morbidity | Y | Lecture, Small group discussion | 38 | 554-564 |
OG1.2 | Define and discuss perinatal mortality and morbidity including perinatal and neonatal mortality and morbidity audit | Y | Lecture, Small group discussion | 38 | 554-564 |
OG1.3 | Define and discuss still birth and abortion | Y | Lecture, Small group discussion | 16 22 | 153-166 310-313 |
OG2.1 | Describe and discuss the development and anatomy of the female reproductive tract, relationship to other pelvic organs, applied anatomy as related to obstetrics and gynecology | Y | Lecture, Small group discussion | 1 | 1-15 |
OG3.1 | Describe the physiology of ovulation, menstruation, fertilization, implantation and gametogenesis | Y | Lecture, seminars | 2 | 16-25  |
OG4.1 | Describe and discuss the basic embryology of fetus, factors influencing fetal growth and develop-ment, anatomy and physiology of placenta, and teratogenesis | Y | Lecture, Small group discussion | 34 | 26-37 38-42 |
OG5.1 | Describe, discuss and identify pre-existing medical disorders and discuss their management; discuss evidence-based intrapartum care | Y | Lecture, Bedside clinics | 20 39 | 246-293 565-591 |
OG5.2 | Determine maternal high-risk factors and verify immunization status | Y | Lecture, Bedside clinics | 10 39 | 93 565-591 |
OG6.1 | Describe, discuss and demonstrate the clinical features of pregnancy, derive and discuss its differential diagnosis, elaborate the principles underlying and interpret pregnancy tests. | Y | Lecture, Small group discussion, Bedside clinics | 5 6 7 15 41 | 43-54 55-60 61-68 149-152 598-608 |
OG7.1 | Describe and discuss the changes in the genital tract, cardiovascular system, respiratory, hematology, renal and gastrointestinal system in pregnancy | Y | Lecture, seminars | 5 | 43-54 |
OG8.1 | Enumerate, describe and discuss the objectives of antenatal care, assessment of period of gestation; screening for high-risk factors. | Y | Small group discussion, Bedside clinics, Lecture | 10 11 12 39 | 86-94 95-101 102-107 565-570 |
OG8.2 | Elicit document and present an obstetric history including menstrual history, last menstrual period, previous obstetric history, comorbid conditions, past medical history and surgical history | Y | Small group discussion, Bedside clinics, Lecture | 810 23 | 69-75 86-94 314-330 |
OG8.3 | Describe, demonstrate, document and perform an obstetrical examination including a general and abdominal examination and clinical monitoring of maternal and fetal wellbeing; | Y | Bed side clinic, DOAP session | 810 11 | 69-75 86-94 95-101 |
OG8.4 | Describe and demonstrate clinical monitoring of maternal and fetal wellbeing | Y | Bedside clinic, DOAP session, Small group discussion | 10 11 | 86-94 95-101 |
OG8.5 | Describe and demonstrate pelvic assessment in a model | Y | DOAP session | 924 | 79-85 331-339 |
OG8.7 | Enumerate the indications for and types of vaccination in pregnancy | Y | Lecture, Small group discussion | 10 20 | 93 246-293 |
OG8.8 | Enumerate the indications and describe the inves-tigations including the use of ultrasound in the initial assessment and monitoring in pregnancy | Y | Lecture, Small group discussion | 741 | 61-66 598-608 |
OG9.1 | Classify, define and discuss the etiology and management of abortions including threatened, incomplete, inevitable, missed and septic | Y | Lecture, Small group discussion | 16 | 153-189 |
OG9.2 | Describe the steps and observe/assist in the per-formance of an MTP evacuation | Y | DOAP session, Bedside clinic | 16 | 166-169 |
OG9.3 | Discuss the etiology, clinical features, differential diagnosis of acute abdomen in early pregnancy (with a focus on ectopic pregnancy) and enumer-ate the principles of medical and surgical management | Y | Lecture, Small group discussion | 16 20 | 153-189 292-293 |
OG9.4 | Discuss the clinical features, laboratory investigations, ultrasonography, differential diagnosis, principles of management and follow up of gestational trophoblastic neoplasms | Y | Lecture, Small group discussion | 16 | 182-189 |
OG9.5 | Describe the etiopathology, impact on maternal and fetal health and principles of management of hyperemesis gravidarum | Y | Lecture, Small group discussion | 15 | 149-152 |
OG10.1 | Define, classify and describe the etiology, pathogenesis, clinical features, ultrasonography, differential diagnosis and management of antepartum hemorrhage in pregnancy | Y | Lecture, Small group disussion, Bedside clinic | 16 19 | 153-189 230-245 |
OG11.1 | Describe the etiopathology, clinical features; diag-nosis and investigations, complications, principles of management of multiple pregnancies | Y | Lecture, Small group discussion, Bedside clinics | 17 | 190-208 |
OG12.1 | Define, classify and describe the etiology and pathophysiology, early detection, investigations; principles of management of hypertensive disorders of pregnancy and eclampsia, complications of eclampsia. | Y | Lecture, Small group discussion, Bedside clinics | 18 | 209-229 |
OG12.2 | Define, classify and describe the etiology, patho-physiology, diagnosis, investigations, adverse effects on the mother and fetus and the management during pregnancy and labor, and complications of anemia in pregnancy | Y | Lecture, Small group discussion, Bedside clinics | 20 | 246-293 |
OG12.3 | Define, classify and describe the etiology, patho-physiology, diagnosis, investigations, criteria, adverse effects on the mother and fetus and the management during pregnancy and labor, and complications of diabetes in pregnancy | Y | Lecture, Small group discussion, Bedside clinics | 20 | 246-293 |
OG12.4 | Define, classify and describe the etiology, patho-physiology, diagnosis, investigations, criteria, adverse effects on the mother and fetus and the management during pregnancy and labor, and complications of heart diseases in pregnancy | Y | Lecture, Small group discussion, Bedside clinics | 20 | 246-293 |
OG12.5 | Describe the clinical features, detection, effect of pregnancy on the disease and impact of the disease on pregnancy complications and manage-ment of urinary tract infections in pregnancy | Y | Lecture, Small group discussion, Bedside clinics | 20 | 246-293 |
OG12.6 | Describe the clinical features, detection, effect of pregnancy on the disease and impact of the disease on pregnancy complications and manage-ment of liver disease in pregnancy | Y | Lecture, Small group discussion, Bedside clinics | 20 | 246-293 |
OG12.7 | Describe and discuss screening, risk factors, man-agement of mother and newborn with HIV | Y | Lecture, Small group discussion, Bedside clinics | 20 | 246-293 |
OG12.8 | Describe the mechanism, prophylaxis, fetal compli-cations, diagnosis and management of isoimmuni-zation in pregnancy | Y | Lecture, Small group discussion, Bedside clinics | 23 | 314-330 |
OG13.1 | Enumerate and discuss the physiology of normal labor, mechanism of labor in occipito-anterior presentation; monitoring of labor including par-togram; conduct of labor, pain relief; principles of induction and acceleration of labor; management of third stage of labor | Y | Lecture, Small group discussion (with models/ videos/ AV aids, etc.) | 13 26 27 34 35 | 108-138 347-377 378-385 479-485 487-495 |
OG13.2 | Define, describe the causes, pathophysiology, diagnosis, investigations and management of preterm labor, PROM and postdated pregnancy | Y | Lecture, Small group discussion, Bedside clinics | 22 | 300-313 |
OG13.3 | Observe/assist in the performance of an artificial rupture of membranes | N | DOAP session, Bedside clinic | 35 | 487-495 |
OG14.1 | Enumerate and discuss the diameters of maternal pelvis and types | Y | Lecture, Small group discussion DOAP session, Bedside clinic | 924 | 79-85 331-339 |
OG14.2 | Discuss the mechanism of normal labor, define and describe obstructed labor, its clinical features; prevention; and management | Y | Lecture, Small group discussion DOAP session, Bedside clinic | 13 24 25 27 | 108-138 331-339 340-346 378-385 |
OG14.3 | Describe and discuss rupture uterus, causes, diag-nosis and management | Y | Lecture, Small group discussion DOAP session, Bedside clinic | 29 | 398-406 |
OG14.4 | Describe and discuss the classification; diagnosis; management of abnormal labor | Y | Lecture, Small group discussion, Bedside clinics | 27 | 378-385 |
OG15.1 | Enumerate and describe the indications and steps of common obstetric procedures, technique and complications: Episiotomy, vacuum extraction; low forceps; cesarean section, assisted breech delivery; external cephalic version; cervical cerclage | Y | Lecture, Small group discussion, seminarsf | 26 37 | 347-377 523-553 |
OG15.2 | Observe and assist in the performance of an episiotomy and demonstrate the correct suturing technique of an episiotomy in a simulated environment. Observe/assist in operative obstetrics cases including-CS, forceps, vacuum extraction, and breech delivery | Y | DOAP session, Bedside clinic | 37 | 523-553 |
OG16.1 | Enumerate and discuss causes, prevention, diagnosis, management, appropriate use of blood and blood products in postpartum hemorrhage | Y | Lecture, Small group discussion, Bedside clinics | 28 39 | 386-397 584-585 |
OG16.2 | Describe and discuss uterine inversion-causes, prevention, diagnosis and management. | Y | Lecture, Small group discussion, Bedside clinics | 28 | 396-397 |
OG16.3 | Describe and discuss causes, clinical features, diagnosis, investigations; monitoring of fetal well-being, including ultrasound and fetal Doppler; principles of management; prevention and coun-seling in intrauterine growth retardation | Y | Lecture, Small group discussion, Bedside clinics | 33 | 441-466 |
OG17.1 | Describe and discuss the physiology of lactation | Y | Lecture, Small group discussion | 14 | 143-144 |
OG17.2 | Counsel in a simulated environment, care of the breast, importance and the technique of breastfeeding | Y | DOAP session | 31 | 419-428 |
OG17.3 | Describe and discuss the clinical features, diagnosis and management of mastitis and breast abscess | Y | Lecture, Small group discussion | 30 | 412-413 |
OG18.1 | Describe and discuss the assessment of maturity of the newborn, diagnosis of birth asphyxia, principles of resuscitation, common problems. | Y | Lecture, Small group discussion | 31 32 33 | 419-428 429-440 441-466 |
OG18.3 | Describe and discuss the diagnosis of birth asphyxia | Y | Lecture, Small group discussion | 33 | 441-466 |
OG18.4 | Describe the principles of resuscitation of the newborn and enumerate the common problems encountered | Y | Lecture, Small group discussion | 33 | 441-466 |
OG19.1 | Describe and discuss the physiology of puerperium, its complications, diagnosis and management; counseling for contraception, puerperal sterilization | Y | Lecture, Small group discussion, Bedside clinics | 14 30 36 | 139-148 407-418 497-523 |
OG19.2 | Counsel in a simulated environment, contraception and puerperal sterilization | Y | DOAP session | 36 | 496-522 |
OG19.3 | Observe/assist in the performance of tubal ligation | Y | DOAP session, intra-operative | 36 | 496-522 |
OG19.4 | Enumerate the indications for, describe the steps in and insert and remove an intrauterine device in a simulated environment | Y | DOAP session | 36 | 496-522 |
OG20.1 | Enumerate the indications and describe and discuss the legal aspects, indications, methods for first and second trimester MTP; complications and management of complications of Medical Termination of Pregnancy | Y | Lecture, Small group discussion | 16 | 166-169 |
OG20.2 | In a simulated environment administer informed consent to a person wishing to undergo Medical Termination of Pregnancy | Y | DOAP session | 16 40 | 166-169 592-597 |
OG20.3 | Discuss Preconception and Prenatal Diagnostic Techniques (PC & PNDT) Act 1994 and its amend-ments | Y | Lecture, Small group discussion | 40 | 595 |
OG21.1 | Describe and discuss the temporary and per-manent methods of contraception, indications, technique and complications; selection of patients, side effects and failure rate including OCs, male contraception, emergency contraception and IUCD | Y | Lecture, Small group discussion, Bedside clinics | 36 | 496-522 |
American Academy of Pediatrics
AC:Abdominal Circumference
ACHOIS:Australian Carbohydrate Intolerance in Pregnancy Study
ACA:Anti-cardiolipin Antibodies
ACOG:American College of Obstetricians and Gynecologists
ACOR:American College of Radiology
ADA:American Diabetes Association
AED:Antiepileptic Drug
AFI:Amniotic Fluid Index
AFP:Alpha-fetoprotein
AFV:Amniotic Fluid Volume
AGA:Average for Gestational Age
AGS:Anti-gas Gangrene Serum
ALT:Alanine Amniotransferase
AMTSL:Active Management of Third Stage of Labor
ANF:Atrial Natriuretic Factor
APH:Antepartum Hemorrhage
aPLs:Anti-phospholipid Antibodies
APTT:Activated Partial Thromboplastin Time
ARDS:Acute Respiratory Distress Syndrome
AREDV:Absent or Reversed End-diastolic Velocity
ARM:Artificial Rupture of Membranes
ART:Assisted Reproductive Technology
ASD:Atrial Septal Defect
ASRM:American Society of Reproductive Medicine
AST:Aspartate Amniotransferase
ATP:Adenosine Triphosphate
ATS:Anti-tetanus Serum
AUA:Abnormal Uterine Action
β2GP-1:β2 Glycoprotein-1
BMI:Body Mass Index
BPD:Biparietal Diameter
BPD:Broncho-pulmonary Dysplasia
BPP:Biophysical Profile
CBG:Corticosteroid-binding Globulin
CCF:Congestive Cardiac Failure
CDC:Centers for Disease Control
cff-DNA:Cell-free fetal DNA
CIN:Cervical Intraepithelial Neoplasia
CIRCI:Critical Illness-related Corticosteroid Insufficiency
CMQCC:California Maternal Quality Care Collaboration
CMV:Cytomegalovirus
CO:Cardiac Output
COCs:Combined Oral Contraceptives
COX:Cyclo-oxygenase
CP:Cerebral Palsy
CPAP:Continuous Positive Airway Pressure
CPD:Cephalopelvic Disproportion
CPK:Creatinine Phosphokinase
CPR:Cerebroplacental Ratio
CPT:Complete Perineal Tear
CRH:Corticotropin-releasing Hormone
CRL:Crown-rump Length
CRP:C-reactive Protein
CRS:Congenital Rubella Syndrome
CS:Cesarean Section
CSE:Combined Spinal Epidural
CST:Contraction Stress Test
CT:Computed Tomography
CTG:Cardiotocography
CTPA:Computed Tomographic Pulmonary Angiography
CUS:Cranial Ultrasonography
CVP:Central Venous Pressure
CVS:Chorionic Villus Sampling
CVS:Congenital Vericella Syndrome
CXR:Chest X-ray
D&E:Dilatation and Evacuation
D/D:Diamniotic–Dichorionic
D/M:Diamniotic–Monochorionic
DBP:Diastolic Blood Pressure
DFMC:Daily Fetal Movement Counting
DFMCR:Daily Fetal Movement Counting Rate
DIC:Disseminated Intravascular Coagulopathy
DIPSI:Diabetes in Pregnancy Societies of India
DMPA:Depot Medroxyprogesterone Acetate
DTA:Deep Transverse Arrest
DV:Ductus Venosus
DVP:Deepest Vertical Pocket
DVT:Deep Vein Thrombosis
EACA:Epsilon Aminocaproic Acid
EAS:External Anal Sphincter
ECG:Electrocardiography
ECV:External Cephalic Version
EDD:Expected Date of Delivery
EFM:Electronic Fetal Monitoring
EFW:Estimated Fetal Weight
EmOC:Emergency Obstetric Care
EmONC:Emergency Obstetric and Newborn Care
ENG:Etonogestrel
EPF:Early Pregnancy Factor
ERPC:Evacuation of Retained Products of Conception
ESC:Embryonic Stem Cell
ESI:Endocrine Society of India
ESRE:European Society of Reproductive and Endocrinology
EUA:Examination under Anesthesia
FBS:Fetal Blood Sampling
FDA:Food and Drug Administration
FDP:Fibrin Degradation Products
FFA:Free Fatty Acid
ffDNA:free-fetal DNA
FFP:Fresh-frozen Plasma
FGR:Fetal Growth Restriction
FHR:Fetal Heart Rate
FHS:Fetal Heart Sound
FIGO:International Federation of Gynecology and Obstetrics
FISH:Fluorescence in situ Hybridization
FL:Femur Length
FMH:Fetomaternal Hemorrhage
FOGSI:Federation of Obstetrics and Gynaecological Societies of India
FRU:First Referral Unit
FSH:Follicle-stimulating Hormone
GA:Gestational Age
GBS:Group B Streptococcus
GDM:Gestational Diabetes Mellitus
GH-PE:Gestational Hypertension–Pre-eclampsia
GLUT:Glucose Transporter
GMH:Germinal Matrix Hemorrhage
GnRH:Gonadotropin-releasing Hormone
GTN:Gestational Trophoblastic Neoplasia
GTN:Glyceryl Trinitrate
GTT:Glucose Tolerance Test
HAART:Highly Active Anti-retroviral Therapy
Hb:Hemoglobin
HC:Head Circumference
hCG:Human Chorionic Gonadotropin
HCS:Hemopoietic Stem Cells
hCT:Human Chorionic Thyrotropin
HDFN:Hemolytic Disease of the Fetus and Newborn
HDL:High-density Lipoprotein
HELLP:Hemolysis, Elevated Liver Enzymes, Low Platelet Counts
HIE:Hypoxic-ischemic Encephalopathy
HIV:Human Immunodeficiency Virus
HLA:Human Leukocyte Antigen
HMD:Hyaline Membrane Disease
HPL:Human Placental Lactogen
HR:Heart Rate
IAS:Internal Anal Sphincter
IUA:Incoordinate Uterine Action
ICF:Intracellular Fluid
ICH:Intracranial Hemorrhage
ICOG:Indian College of Obstetricians & Gynaecologists
ICU:Intensive Care Unit
IFM:Intrapartum Fetal Monitoring
IGF-1:Insulin Growth Factor-1
IgG:Immunoglobulin G
IMP:Injectable Muscular Progesterone
IOL:Induction of Labor
IPS:Intrapartum Ultrasonography
IPT:Intraperitoneal Transfusion
ITS:Indian Thyroid Society
ITU:Intensive Care Unit
IUCD:Intrauterine Contraceptive Device
IUD:Intrauterine Device
IUFD:Intrauterine Fetal Death
IUGR:Intrauterine Growth Restriction
IUT:Intrauterine Transfusion
IVC:Inferior Vena Cava
IVH:Intraventricular Hemorrhage
IVIg:Intravenous Immunoglobulin
IVS:Intervillous Space
IVT:Intravascular Transfusion
JSY:Janani Suraksha Yojana
KB:Kleihauer-Betke
KMC:Kangaroo Mother Care
L:S Ratio:Lecithin-Sphingomyelin Ratio
LA:Lupus Anticoagulant
LAM:Lactational Amenorrhea
LARC:Long-acting Reversible Contraception
LBW:Low Birth Weight
LDH:Lactic Dehydrogenase
LDL:Low-density Lipoprotein
LGA:Large for Gestational Age
LH:Luteinizing Hormone
LMA:Left Mentoanterior
LMP:Last Menstrual Period
LMWH:Low Molecular Weight Heparin
LNG-IUS:Levonorgestrel-Intrauterine System
LOA:Left Occiput Anterior
LOP:Left Occiput Posterior
LOT:Left Occiput Transverse
LPD:Luteal Phase Defect
LSA:Left Sacrum Anterior
LSCS:Lower Segment Cesarean Section
LVP:Largest Vertical Pocket
M/M:Monoamniotic–Monochorionic
MAP:Mean Arterial Pressure
MCA:Middle Cerebral Artery
MCU:Microcirculatory Unit
MDGs:Millennium Development Goals
MFMU:Maternal Fetal Medicine Unit
MLCK:Myocin Light Chain Kinase
MMR:Maternal Mortality Ratio
MOMs:Multiples of the Medians
MODS:Multi-Organ Dysfunction Syndrome
MPSS:Massively Parallel DNA Shotgun Sequencing
MRA:Magnetic Resonance Angiography
MRI:Magnetic Resonance Imaging
MRP:Manual Removal of Placenta
MSAFP:Maternal Serum Alphafeto-protein
MTHFR:Methylenetetrahydrofolate Reductase
MVA:Manual Vacuum Aspiration
NCDs:Non-communicable Diseases
NEC:Necrotizing Enterocolitis
NICE:National Institute of Clinical Excellence
NICHD:National Institute of Child Health and Development
NICU:Neonatal Intensive Care Unit
NIPT:Noninvasive Prenatal Test
NK:Natural Killer Cells
NO:Nitric Oxide
NPN:Non-protein Nitrogen
NREM:Non-rapid Eye Movement
NRFS:Non-reassuring Fetal Status
NST:Non-stress Test
NSV:No-scalpel Vasectomy
NT:Nuchal Translucency
NTD:Neural Tube Defect
OA:Occiput Anterior
OC:Oral Contraceptive
OP:Occiput Posterior
OT:Occiput Transverse
OVD:Operative Vaginal Delivery
PAPP-A:Pregnancy-associated Plasma Protein-A
PBI:Protein-bound Iodine
PCA:Patient-controlled Analgesia
PCOS:Polycystic Ovarian Syndrome
PCR:Polymerase Chain Reaction
PCWP:Pulmonary Capillary Wedge Pressure
PDA:Patent Ductus Arteriosus
PDS:Polydioxanone
PE:Pulmonary Embolism
PG:Phosphatidylglycerol
PGD:Pre-implantation Genetic Diagnosis
PGN:Progestin
PGs:Prostaglandins
PI:Pulsatility Index
PID:Pelvic Inflammatory Disease
PIH:Pregnancy-induced Hypertension
PO:Per Oral
POD:Pouch of Douglas
POP:Persistent Occiput Posterior
PPBs:Postprandial Blood Sugar
PPH:Postpartum Hemorrhage
PPIUCD:Postpartum Intrauterine Contraceptive Device
PPTCT:Prevention of Parent-to-child Transmission
PRES:Posterior Reversible Encephalopathy Syndrome
PROM:Prelabor Rupture of Membranes
PSV:Peak Systolic Velocity
PT:Prothrombin Time
PTB:Preterm Birth
PTH:Parathyroid Hormone
PTL:Preterm Labor
PVL:Periventricular Leukomalacia
PVR:Pulmonary Vascular Resistance
RAAS:Renin-Angiotensin-Aldosterone System
RBC:Red Blood Cells
RCOG:Royal College of Obstetricians and Gynaecologists
RDS:Respiratory Distress Syndrome
REDF:Reversed End Diastolic Flow
REM:Rapid Eye Movement
RFA:Radiofrequency Ablation
RhIg:Rhesus Immunoglobulin
RI:Resistance Index
RMNCH:Reproductive, Maternal, Newborn, Child Health
RNTCP:Revised National Tuberculosis Control Programme
ROA:Right Occiput Anterior
ROP:Right Occiput-Posterior
ROS:Reactive Oxygen Species
ROT:Right Occiput Transverse
RR:Respiratory Rate
RSP:Right Sacroposterior
SBP:Systolic Blood Pressure
SC:Subcutaneous
SCJ:Squamocolumnar Junction
SDG:Sustainable Development Goals
SDH:Subdural Hemorrhage
S/D Ratio:Systolic/Diastolic Ratio
SFH:Symphysio-fundal Height
SGA:Small for Gestational Age
SIRS:Systemic Inflammatory Response Syndrome
SLE:Systemic Lupus Erythematosus
SMI:Safe Motherhood Initiative
SV:Stroke Volume
SVR:Systemic Vascular Resistance
SVD:Spontaneous Vaginal Delivery
TA:Transabdominal
TAS:Transabdominal Sonography
TBG:Thyroxin-binding Globulin
TC:Transcervical
TDI:Total Dose Infusion
TDO:Transverse Diameter of the Outlet
TGFβ:Transforming Growth Factor-β
TNFα:Tumor Necrosis Factor-α
TOLAC:Trial of Labor after Cesarean
TPS:Transperineal Sonography
TRAP:Twin Reverse Arterial Perfusion
TSH:Thyroid-stimulating Hormone
TTN:Transient Tachypnea of the Newborn
TTTS:Twin-to-Twin Transfusion Syndrome
TVS:Transvaginal Sonography
UAE:Uterine Artery Embolization
UE:Unconjugated Estriol
UHC:Universal Health Coverage
USG:Ultrasonography
UTI:Urinary Tract Infection
UV:Umbilical Vein
V/Q:Ventilation/Perfusion Ratio
VBAC:Vaginal Birth after Cesarean
VBAC-TOL:VBAC–Trial of Labor
VEGF:Vascular Endothelial Growth Factor
VLBW:Very Low Birth Weight
VSD:Ventricular Septal Defect
VUS:Venous Ultrasonography
VVF:Vesicovaginal Fistula
WHO:World Health Organization
WAPM:World Association of Perinatal Medicine
Atlas: Steps of LSCS
Operation trolley with all the instruments for cesarean section. (1) Towels for drapping, (2) Suction tube (with cannula), (3) Electrodiathermy set, (4) Mops (large swabs), (5) Towel clips, (6) Kidney dish, gauze pieces, (7) Bowl with povidone iodine, (8) Empty bowl, (9) Needle holders (curved and straight variety), (10) Sponge holding forceps, (11) Knives, (12) Dissecting forceps (toothed and non-toothed), (13) Scissors (3), (14) Artery forceps (short variety), (15) Kocher's forceps, (16) Allis tissue forceps, (17) Lanes tissue forceps, (18) Little Wood's forceps, (19) Green Armytage forceps, (20) Obstetric forceps, (21) Doyen's retractor, (22) Suture packets (vicryl and chromic catgut, p. 629).
Step 1: Abdomen is painted with povidone iodine solution and is draped with sterile towels. Only the area of operation is exposed.
Step 2: Abdomen is opened by modified Pfannenstiel incision. Loose peritoneum of the uterovesical pouch is being stretched out and shown. It is incised transversely.
Step 3: Uterine muscle incision (low transverse) is made on the lower segment of the uterus (LSCS). The amniotic membrane is seen to bulge out with the pressure of amniotic fluid. This amniotic membrane needs to be ruptured to deliver the baby. Doyen's retractor is seen in place.
Step 4: Delivery of the head. The amniotic fluid is sucked out following rupture of the membranes. Doyen's retractor is removed. The head is delivered slowly with the fingers of the right hand, insinuated between the head and the lower uterine flap. Assistant applies some pressure on the fundus at this time.
Step 5: Delivery of the baby is on progress. It is to be done slowly. The head is delivered by elevation and flexion using the fingers to act as a fulcrum. Note that Doyen's retractor has been taken out.
Step 6: Delivery of the head in cesarean section. Suctioning of the mouth, pharynx, are being done gently before delivery of the trunk.
Step 7: Baby is delivered slowly. The cord is clamped and cut in between. Baby is handed over to the neonatologist for immediate care of the newborn.
Step 8: Delivery of the placenta and membranes: Placenta is allowed to separate spontaneously. Placenta is delivered by traction on the cord (right hand). Simultaneously, the uterus is pushed upwards using the left hand. Note the abdominal retractor (Doyen's) is reintroduced.
Step 9: The uterine wound is seen following delivery. Usually four Allis's tissue forceps (Green Armytage forceps) are used to hold the incision margins, two (one each) on the angles of incision. Another two (one each) on the upper and lower uterine flap.
Step 10: Suturing of the uterine wound. It is done in two or three layers. It may be done keeping the uterus in the abdominal cavity or delivering it out (eventration). Suture material is No. ‘0’ chromic catgut or Vicryl-0 with round bodied needle. A continuous running suture taking deeper muscles is made. A similar suture is placed taking the superficial muscles overlapping the first layer. Nonclosure of the visceral peritoneum is preferred.
Step 11: Closure of the abdomen. The mops are removed and the number verified. Peritoneal toileting is done. Doyen's retractor is removed. The abdomen is closed in layers. The vagina is cleaned of blood and blood clots. A sterile vulval pad is placed.
Atlas: Steps of Low Forceps Delivery
Step 1: Left blade of the forceps is introduced first. The left handle is hold by the three fingers (index, middle and the thumb) of the left hand. Thumb pressure is used to introduce the blade under guidance of the fingers of the right hand.
Step 2: Locking of the blades. Blades are locked easily when applied correctly (bimalar, biparietal placement).
Step 3: Direction of pull: First—downwards and backwards until the head is in perineum → Straight and horizontal (seen) towards the operator.
Step 4: Pull is now changed and directed upwards and forwards towards the mother's abdomen. The head is delivered slowly by extension.
Step 5: The blades are removed. Head is delivered slowly. Ritgen's maneuver is performed.
Step 6: Delivery of the shoulder. Note that the bisacromial diameter lies in the anteroposterior diameter of the outlet of the pelvis. Also note that the anterior shoulder is being released slowly from under the symphysis pubis.
Step 7: Delivery of the trunk and that of the baby is done completely.
Step 8: Immediate care of the newborn is done. Cord clamping and Apgar rating is done.