Essentials of OBSTETRICS
Third Edition
Editors Sabaratnam Arulkumaran DCH FRCS FRCOG FAMS MD PhD Hon: FACOG FSLCOG FSOGC
Emeritus Professor Department of Obstetrics and Gynecology St George's Hospital Medical School
London, United Kingdom
V Sivanesaratnam MBBS (S'pore) FRCOG FICS FACS FAMM FAOFOG
Emeritus Professor, Consultant Gynaecologist/Gynaecologic Oncologist University of Malaya Specialist Centre, Lorong University
Kuala Lumpur, Malaysia
Formerly, Professor (Chair), Head and Senior Consultant Department of Obstetrics and Gynecology University of Malaya
Kuala Lumpur, Malaysia
Alokendu Chatterjee FRCOG FICS
Formerly, Professor and Head Department of Obstetrics and Gynecology NRS Medical College and Hospital Calcutta Salt Lake City
Kolkata, West Bengal, India
Pratap Kumar MD DNB
Professor Department of Obstetrics and Gynecology Kasturba Medical College
Manipal, Karnataka, India
Foreword
Shirish S Sheth
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: jaypee@jaypeebrothers.com
Overseas Offices
J.P. Medical Ltd
83 Victoria Street, London
SW1H 0HW (UK)
Phone: +44-2031708910
Fax: +02-03-0086180
Email: info@jpmedpub.com
Jaypee-Highlights Medical Publishers Inc
City of Knowledge, Bld. 235, 2nd Floor, Clayton
Panama City, Panama
Phone: +1 507-301-0496
Fax: +1 507-301-0499
Email: cservice@jphmedical.com
Jaypee Brothers Medical Publishers (P) Ltd
17/1-B Babar Road, Block-B, Shaymali
Mohammadpur, Dhaka-1207
Bangladesh
Mobile: +08801912003485
Email: jaypeedhaka@gmail.com
Jaypee Brothers Medical Publishers (P) Ltd
Bhotahity, Kathmandu, Nepal
Phone: +977-9741283608
Email: kathmandu@jaypeebrothers.com
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2017, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names 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 contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) 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 have 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: jaypee@jaypeebrothers.com
Essentials of Obstetrics
First Edition: 2005
Second Edition: 2011
Third Edition: 2017
9789386056665
Printed at
fm4Contributors
- A Padma Rao MD DGO
- Emeritus Professor and Retired Head
- Director of Postgraduate Studies
- Department of Obstetrics and Gynecology
- Kasturba Medical College
- Manipal, Karnataka, India
- Chapter: 9
- Alokendu Chatterjee FRCOG FICS
- Formerly, Professor and Head
- Department of Obstetrics and Gynecology
- NRS Medical College and Hospital
- Calcutta Salt Lake City
- Kolkata, West Bengal, India
- Chapters: 14, 25, 37
- Amar R MS (Obst & Gyne)
- Obstetrician and Gynecologist
- Koyili Hospital
- Kannur, Kerala, India
- Chapters: 4, 5
- Anita Thomas MD
- Assistant Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College
- Manipal, Karnataka, India
- Chapter: 10
- Arup Kumar Majhi MBBS (Cal) MD (Cal) DNB (New Delhi)
- Professor and Head
- Department of Obstetrics and Gynecology
- NRS Medical College
- Kolkata, West Bengal, India
- Chapter: 23
- Asmita Muthal-Rathore MD MRCOG
- Professor
- Department of Obstetrics and Gynecology
- Maulana Azad Medical College
- New Delhi, India
- Chapter: 34
- Basab Mukherjee MD MRCOG
- Consultant Obstetrician and Gynecologist
- Calcutta Medical Research Institute
- Kolkata, West Bengal, India
- Chapter: 37
- BN Chakravarty MD FRCOG DSc (Hon)
- Professor
- Institute of Reproductive Medicine
- Salt Lake City
- Kolkata, West Bengal, India
- Chapter: 1
- Chan Yoo Kuen MBBS (Mal) FFARCS (Ireland) FAMM
- Professor and Senior Consultant
- Department of Anesthesiology
- Faculty of Medicine, University of Malaya
- Kuala Lumpur, Malaysia
- Chapter: 39
- Debasis Bhattacharyya MD PhD DNB
- Principal
- NRS Medical College
- Kolkata, West Bengal, India
- Chapter: 22
- Duru Shah MD DNB FRCOG
- Director
- Gynaecworld – the Center for Women's Health and Fertility
- Consultant Obstetrician and Gynecologist
- Breach Candy Hospital and Research Centre, and
- Jaslok Hospital and Research Centre
- Mumbai, Maharashtra, India
- Chapter: 16
- Edwin Chandraharan MBBS MS (Obs and Gyn) DFFP (UK) MRCOG
- Clinical Lecturer
- Division of Obstetrics and Gynecology
- St George's Hospital, Medical School London
- London, United Kingdom
- Chapters: 17, 26
- Eugene Leong Weng Kong MBBS (Mal) MMed O&G (Mal) FRCOG
- Associate Professor
- Department of Obstetrics and Gynecology
- Taylor's University
- School of Medicine
- Subang Jaya, Malaysia
- Formerly, Associate Professor and Consultant
- Department of Obstetrics and Gynecology
- University of Malaya
- Kuala Lumpur, Malaysia
- Gita Banerjee (Basu) DGO MD (Gyne & Obst) DNB MRCOG
- RMO/Clinical Tutor
- NRS Medical College and Hospital
- Kolkata, West Bengal, India
- Chapter: 25
- Gourisankar Kamilya DGO MD DNB
- Professor
- Department of Obstetrics and Gynecology
- Institute of Postgraduate Medical Education and Research
- Kolkata, West Bengal, India
- Chapter: 43
- Hari Muppala MBBS MRCOG
- Senior Registrar
- Department of Obstetrics and Gynecology
- Derby City General Hospital
- Derby, United Kingdom
- Chapter: 33
- Hiralal Konar MBBS MD DNB MRCOG
- Assistant Professor
- Department of Obstetrics and Gynecology
- NRS Medical College
- Kolkata, West Bengal, India
- Chapter: 32
- Jaideep Malhotra MBBS MD (Obst & Gyne) FICMCH FIAJAGO FICOG MASRM FICMU
- Malhotra Nursing and Maternity Home (P) Ltd
- Agra, Uttar Pradesh, India
- Chapter: 35
- James Leggett MB BCh
- Specialty Trainee
- West Midlands Deanery
- United Kingdom
- Chapter: 3
- Jamiyah Hassan MBBS (Mal) MMed O&G (Mal)
- Professor and Senior Consultant
- Department of Obstetrics and Gynecology
- Faculty of Medicine
- University of Malaya
- Kuala Lumpur, Malaysia
- Chapters: 18, 31
- Joydev Mukherji MD (Gyne and Obst)
- Associate Professor
- Department of Gynecology and Obstetrics
- North Bengal Medical College
- West Bengal, India
- Chapters: 8, 23, 43
- Jyothi Shetty MD
- Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College, Manipal University
- Manipal, Karnataka, India
- Chapter: 47
- K Sujatha MD
- Department of Obstetrics and Gynecology
- Kasturba Medical College, Manipal University
- Manipal, Karnataka, India
- Chapter: 38
- KK Diwakar MD
- Head, Neonatal Division
- Professor, Department of Pediatrics
- Malankara Orthodox Syrian Church Medical College
- Kochi, Kerala, India
- Chapter: 45
- Krishnendu Gupta MBBS DGO MD FICMCH FICOG
- Professor
- Department of Obstetrics and Gynecology
- Vivekananda Institute of Medical Sciences
- Kolkata, West Bengal, India
- Chapters: 40, 48
- Lauren Lacey MB BCh
- Specialty Trainee
- West Midlands Deanery
- United Kingdom
- Chapter: 15
- Lavanya Rai MD DGO
- Department of Obstetrics and Gynecology
- Kasturba Medical College, Manipal University
- Manipal, Karnataka, India
- Chapter: 21
- Lim Chin Theam MBBS (Mal) FRCP (Ireland) FRCP (Edin) FAMM
- Consultant Pediatrician and Neonatologist
- University of Malaya Specialist Centre, Lorong University
- Kuala Lumpur, Malaysia
- Formerly, Professor and Senior Consultant Neonatologist
- Department of Pediatrics
- University of Malaya
- Kuala Lumpur, Malaysia
- Chapter: 44
- Lubna Sheikh MB BCh
- Specialty Trainee in Obstetrics and Gynecology
- West Midlands Deanery
- United Kingdom
- Chapter 2
- Lucie Spooner MB BCh
- Specialty Trainee in Obstetrics and Gynecology
- West Midlands Deanery
- United Kingdom
- Chapter 11
- Muralidhar V Pai MBBS MD MS FICOG
- Associate Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College, Manipal University
- Manipal, Karnataka, India
- Naheed Tahir MBBS DRCOG DFSRH MRCOG
- Clinical Fellow in Colposcopy
- St George's Hospital
- London, United Kingdom
- Chapter: 26
- Narendra Malhotra MD FICOG FICMCH
- Director
- Malhotra Nursing and Maternity Home (P) Ltd
- Consultant, Apollo Pankaj Hospital
- Agra, Uttar Pradesh, India
- President, FOGSI (2008)
- Dean, ICMU (2008)
- Chapter: 35
- Neharika Malhotra Bora MBBS MD (Obst & Gyne)
- Rainbow IVF
- Agra, Uttar Pradesh, India
- Chapter: 35
- Onnig Tamizian FRCOG LLM (Medical Law)
- Consultant Obstetrician and Gynecologist, Lead Colposcopy
- Royal Derby Hospital
- Derby, United Kingdom
- Chapter: 33
- Partha Mukherjee MD
- Professor and Head
- Department of Obstetrics and Gynecology
- Institute of Postgraduate Medical Education and Research
- Kolkata, West Bengal, India
- Chapter: 14
- Partha Mukhopadhyay MBBS DGO MD
- Assistant Professor
- Department of Obstetrics and Gynecology
- NRS Medical College
- Kolkata, West Bengal, India
- Chapter: 42
- Prashant Joshi MBBS MD DNB
- Associate Professor
- Department of Obstetrics and Gynecology
- Adichunchanagiri Institute of Medical Sciences
- Bengaluru, Karnataka, India
- Chapter: 30
- Pratap Kumar MD DNB
- Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College, Manipal University
- Manipal, Karnataka, India
- Chapters: 4, 5, 6, 10, 12
- Rajendra Prasad Ganguly MD
- Assistant Professor
- Department of Obstetrics and Gynecology
- RG Kar Medical College
- Kolkata, West Bengal, India
- Chapter: 43
- Rajesh Bhakta MD
- Assistant Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College, Manipal University
- Manipal, Karnataka, India
- Chapter: 6
- Sabaratnam Arulkumaran
- DCH FRCS FRCOG FAMS MD PhD Hon: FACOG FSLCOG FSOGC
- Emeritus Professor
- Department of Obstetrics and Gynecology
- St George's Hospital, Medical School London
- London, United Kingdom
- Chapter: 33
- Sajal Datta MBBS MD DNB
- Reader
- Department of Obstetrics and Gynecology
- Vivekananda Institute of Medical Sciences
- Kolkata, West Bengal, India
- Chapters: 40, 48
- Sanjay B Rao MD DNBE DGO DFP FCPS DICOG
- Lecturer
- Department of Obstetrics and Gynecology
- LT Medical College and LT Municipal General Hospital
- Mumbai, Maharashtra, India
- Chapter: 27
- Sebanti Goswami MBBS MD (Obst and Gyne)
- Professor
- Department of Obstetrics and Gynecology
- Jagannath Gupta Institute of Medical Sciences
- Kolkata, West Bengal, India
- Chapter: 42
- Shelley Seth MBBS DGO MS (Obst & Gyne)
- Assistant Professor
- Department of Obstetrics and Gynecology
- College of Medicine and Sagore Dutta Hospital
- Kolkata, West Bengal, India
- Chapter: 22
- Shripad Hebbar MD
- Associate Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College, Manipal University
- Manipal, Karnataka, India
- Chapter: 20
- Si Lay Khaing MBBS (Yangon, Myanmar), MMed O&G (Mal)
- Associate Professor and Consultant
- Department of Obstetrics and Gynecology
- Faculty of Medicine, University of Malaya
- Kuala Lumpur, Malaysia
- Silvam Sellappan MBBS (Mal) MMed O&G (Mal)
- Consultant Obstetrician and Gynecologist
- Columbia Asia Hospital
- Puchong, Malaysia
- Formerly, Lecturer
- Department of Obstetrics and Gynecology
- University of Malaya
- Kuala Lumpur, Malaysia
- Chapter: 41
- Sofiah Sulaiman MBChB (Ireland) MMed O&G (Mal)
- Associate Professor and Consultant
- Department of Obstetrics and Gynecology
- Faculty of Medicine, University of Malaya
- Kuala Lumpur, Malaysia
- Chapters: 18, 31
- Soma Mukherjee
- MBBS MRCOG DGO DNB MNAS FICOG FICMCH RCOG/RCR
- Dip Advanced Obstetric Ultrasound
- Clinical Lecturer
- Department of Obstetrics and Gynecology
- Fetal Medical Unit
- St George's University of London
- London, United Kingdom
- Chapters: 2, 3, 11, 15
- Somajita Chakrabarty MBBS DGO MS DNB
- Diploma in Gynae Endoscopy, Kiel University
- Associate Professor
- Department of Obstetrics and Gynecology
- Medical College Kolkata
- Kolkata, West Bengal, India
- Chapter: 14
- Srividhya Sankaran MBBS DNB MRCOG
- Consultant in Maternal and Fetal Medicine
- Guys and St Thomas's Hospital
- London, UK
- Chapter: 36
- Subir Kumar Bhattacharyya DGO MS
- Assistant Professor
- Department of Obstetrics and Gynecology
- Academic Director
- Westbank Hospital
- Howrah, West Bengal, India
- Chapters: 8, 23
- Subrata Lall Seal DGO MD DNB
- Assistant Professor
- Department of Obstetrics and Gynecology
- RG Kar Medical College
- Kolkata, West Bengal, India
- Chapter: 8
- Suchitra N Pandit BPharm MD DNBE DGO DFP MRCOG (UK) MICOG
- Associate Professor and Head of Unit
- Department of Obstetrics and Gynecology
- LT Medical College and LT Municipal General Hospital
- Mumbai, Maharashtra, India
- Chapter: 27
- Sudeshna Ray MD MRCOG (London)
- Consultant Obstetrician and Gynecologist
- Jaslok Hospital and Research Centre
- Mumbai, Maharashtra, India
- Chapter: 16
- Sudip Chakravarti FRCOG FRCS FICOG
- Professor
- Department of Obstetrics and Gynecology
- Vivekananda Institute of Medical Sciences
- Kolkata, West Bengal, India
- Chapters: 40, 48
- Sujata Deshpande DCH DNB
- Assistant Professor
- Department of Neonatology
- Malankara Orthodox Syrian Church Medical College
- Kochi, Kerala, India
- Chapter: 45
- Suku Mathew George MD DNB
- Assistant Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College, Manipal University
- Manipal, Karnataka, India
- Chapter: 12
- Sundararaj Raajkumar MBBS MS FRCOG FSLCOG
- Consultant Obstetrician and Gynecologist
- Southend University Hospital NHS Foundation Trust
- Prittlewell Chase
- Southend-on-sea, Essex, United Kingdom
- Chapter: 17
- Tan Peng Chiong MBBS (Lond) FRCOG PhD CCST (O&G, UK)
- Professor and Senior Consultant
- Department of Obstetrics and Gynecology
- Faculty of Medicine, University of Malaya
- Kuala Lumpur, Malaysia
- Chapter: 28
- Teresa WP Chow MBChB (Liverpool, UK) MRCOG MD (Mal)
- Consultant Obstetrician and Gynecologist
- Glenagles Ampang Specialist Centre
- Kuala Lumpur, Malaysia
- Formerly, Associate Professor and Consultant
- Department of Obstetrics and Gynecology
- University of Malaya
- Kuala Lumpur, Malaysia
- Thaneemalai Jeganathan MBBS (India) MMed O&G (Mal)
- Consultant Obstetrician and Gynecologist
- DEMC Specialist Hospital
- Shah Alam, Malaysia
- Formerly, Lecturer
- Department of Obstetrics and Gynecology
- University of Malaya
- Kuala Lumpur, Malaysia
- Chapter: 46
- V Sivanesaratnam MBBS (S'pore) FRCOG FICS FACS FAMM FAOFOG
- Emeritus Professor, Consultant Gynecologist/Gynecologic Oncologist
- University of Malaya Specialist Centre, Lorong University
- Kuala Lumpur, Malaysia
- Formerly, Professor (Chair), Head and Senior Consultant
- Department of Obstetrics and Gynecology
- University of Malaya
- Kuala Lumpur, Malaysia
- Chapters: 41, 46
- Vijay C Pawar MD FCPS DGO
- Senior Registrar
- LT Medical College Hospital
- Mumbai, Maharashtra, India
- Chapter: 27
- Wong Yat May MBChB (Dundee, UK) MRCOG
- Consultant Obstetrician and Gynecologist
- Sunway Medical Centre
- Petaling Jaya, Malaysia
- Formerly, Lecturer
- Department of Obstetrics and Gynecology
- University of Malaya
- Kuala Lumpur, Malaysia
- Chapter: 7
It is a great honor for me to write the ‘Foreword’ for a text presented by renowned obstetricians, led by the global leader on the subject.
Obstetrics and particularly, the art of practicing it, has made spectacular advances in recent times. This book will give a completely updated revision on the subject even though its progress is chronicled through other textbooks. The book will supersaturate undergraduates, who will not have to turn to any other book for a query or reference, and also supply postgraduates with the basic knowledge and fundamentals on the subject.
It is absorbing to find the masterly treatise on the Fundamentals of Reproduction by Dr BN Chakravarty, and respect given to chapters such as Physiology, Endocrinology, History Taking and Clinical Examination, Trial Labor and Tropical Diseases in Pregnancy, etc. The chapter on ‘Principles of Drugs Used in Pregnancy’ highlights to spare from undesirable litigational consequences.
The contents are enriched by pioneers from different geographical areas with in-depth knowledge and vast experience of unexpected, unforgivable and at times iatrogenic obstetric happenings in the developing world. Digesting and implementing these subjects will reduce the maternal morbidity and much more and make the newborn prosper, which will gratify their obstetricians.
The book also teaches the ‘when’ and ‘why’ to all those who know ‘how’. The book needs to be read like the Bible and reading in-between the lines will prevent catastrophes and/or provide signal as when and how to utilize the advances, when needed.
The book is a great gift to obstetric and gynecological learners, who are ambitious and want to rise high. The book will encourage undergraduates to take obstetrics and gynecology as their postgraduate branch after graduation.
Shirish S Sheth MD FRCOG
Consultant Obstetrician and Gynecologist
Breach Candy Hospital and Research Centre
Mumbai, Maharashtra, India
fm11Preface to the Third Edition
We are pleased to present the third edition of this popular book on Essentials in Obstetrics which has expanded to 48 chapters. The book has contributors who are internationally renowned for their expertise in the area in which they have contributed the chapter. Two of the editors are Senior Professors from India and the other two are from Malaysia and the United Kingdom. Accordingly, the authors are mainly from India, Malaysia and the United Kingdom. Despite being multiauthored, we have tried to keep a consistency in the approach of tackling the subject and have insisted that the text is evidence based. The life of the book may be up to 4–6 years and in the meantime recent evidence may require us to change our practice and hence readers are encouraged to look at other source of information such as National Guidelines (e.g. in the UK – the Green Top Guidelines produced by the Royal College of Obstetricians and Gynaecologists – www.rcog.org.uk and that produced by National Institute of Clinical Excellence – www.nice.org.uk).
Each chapter has headings and subheadings which are provided at the beginning of the chapter for easy navigation. Adequate number of tables and good illustrations are provided in each of the chapters and should make it easy for the reader to understand the subject. It is difficult to provide far too many figures and illustrations due to the limitation of pages in a hard copy book. We encourage those readers who want to learn more on any particular topic to utilize a free web resources including one endorsed by the FIGO – the ‘Global Library of Women's Medicine’ – www.glowm.com which not only provides a comprehensive postgraduate textbook but also color atlases, videos and masterclasses. The students have limited time to study for the examinations and this textbook is produced to cover the core (all emergencies and the conditions met almost in daily practice), peripheral (conditions seen infrequently but knowledge is needed and there is time to read up before executing treatment) and advanced knowledge (the latest advances) in obstetrics. Reading this book alone should be more than adequate to do well in undergraduate examinations and should give the basis for postgraduate studies.
Being multicountry authored book, there may be subtle differences in management of certain conditions. These need to be learnt in the clinical settings with your own teachers who will be the best guides for provision of good knowledge. The publishers, editors and authors are keen to hear from you if there are any mistakes or differences in opinion so that we can rectify these in the next reprint. To enable this, we have provided the addresses of the authors and editors. Your feedback will help us to improve on the quality of the book.
Sabaratnam Arulkumaran
V Sivanesaratnam
Alokendu Chatterjee
Pratap Kumar
fm13Preface to the First Edition
The knowledge in obstetrics is expanding and one finds it difficult to keep pace with recent research. Research findings of today form the basis of practice in years to come. The core knowledge keeps changing and forms the basis of understanding of the disease process and management and is covered in this book. One may think of obstetrics as childbirth and its complications, but the expansion of knowledge in this area is exemplified by 46 chapters under 2 subsections. The book starts with issues related to conception, implantation and growth of the fetus and placenta. From this point, it expands to the knowledge needed for prenatal care followed by normal pregnancy and childbirth. The various obstetric and medical complications in the antenatal period are covered followed by normal and abnormal labor including operative deliveries. It ends with normal and complicated puerperium.
This book is multiauthored and hence the tendency for some overlap and repetition of knowledge. The editors have taken great effort in avoiding such duplications, but where it is felt that it may enhance continuity of reading an individual chapter, little change has been made. The editors have been selected based on their individual expertise, which has been useful to provide the best knowledge. This has led to the standards set high for many chapters. The knowledge provided straddles between what is needed for an undergraduate and a postgraduate. The editors had the difficult task of trimming down many chapters to make this book a reference source for undergraduates. In addition, it will form a basic reading book for postgraduates. The editors are from a variety of backgrounds and countries. This has led to some differences in the style and reporting of incidence of disease, but it does not alter the subject material.
We believe that this will be a good reference source for undergraduates and would welcome any comments or criticism that will help us to make this book better in the next edition. Your suggestions can be sent to any one of the editors or the publishers.
Sabaratnam Arulkumaran
V Sivanesaratnam
Alokendu Chatterjee
Pratap Kumar
fm15Acknowledgments
We strongly believe that no task whatsoever in this world can be achieved without God's permission and divine intervention. So, our first words of thanks go to the Almighty for helping us in the initiation and completion of this challenging task.
We would like to thank all our patients without whose support and endurance this task would not have been possible. We acknowledge the patience, support, guidance and blessings of our families for their consistent help and inspiration.
Last but not least, we would like to thank the entire staff of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, especially Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President) and Mr Tarun Duneja (Director–Publishing), for their assistance and support. We are simply overwhelmed with gratitude for their commendable enthusiasm and encouragement in support of this book.