Preface.................................................................................................................................................................................... vii-x acknowledgments ........................................................................................................................................................... xi 1
anatomy of Female reproductive Organs
1
External
Genitalia 1 Internal Genital Organs 4 Muscles and Fascia in relation to the Pelvic Organs 11 Pelvic Floor 11 Perineum 12 Pelvic Fascia 14 Pelvic Cellular Tissue 14 Female Urethra 15 The Urinary Bladder 15 Pelvic Ureter 16 The Breast 16
2
Fundamentals of reproduction Gametogenesis Ovulation
19
Oogenesis
19
19 Spermatogenesis
20
22 23 Morula 24 Blastocyst 25 Implantation 25 Trophoblast 26 The Decidua 27 Chorion and Chorionic Villi 28 of Inner Cell Mass 29 Events following Fertilization 30 Fertilization
3
Development
the Placenta and Fetal membranes
32
The
Placenta 32 Development 32 The Placenta at Term 33 Structures 34 Placental Circulation 36 Placental Aging 39 Placental Function 39 The Fetal Membranes 41 Amniotic Cavity, Amnion and Amniotic Fluid 42 The Umbilical Cord 44
4
the Fetus Fetal
5
46
Physiology 47
The
Fetal Circulation 49
Changes
of the Fetal Circulation at Birth 50
Physiological Changes During Pregnancy
52
Genital Organs 52 Breasts 56 Cutaneous Changes 56 Weight Gain 57 Body Water Metabolism 58 Hematological
Changes 62
6
Changes 58
Cardiovascular
System 60
Metabolic
Changes 61
Systemic
endocrinology in relation to reproduction
65
Maturation of Graafian Follicles and Ovulation 65 Maintenance of Corpus Luteum after Fertilization 65 P lacental
Endocrinology 66 Protein Hormones 66 Steroidal Hormones 68 Diagnostic Value of Placental Hormones 69 Changes of Endocrine Glands during Pregnancy 70 Maintenance of Lactation 72
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7 Diagnosis of Pregnancy
73
First Trimester (First 12 Weeks) 73 Second Trimester (13–28 Weeks) 78 Last Trimester (29–40 Weeks) 80 Differential
Diagnosis of Pregnancy 81 Summary of Diagnosis of Pregnancy 82 Chronological Appearance of Specific Symptoms and Signs of Pregnancy 82 Signs of Previous Child Birth 83 Estimation of Gestational Age and Prediction of Expected Date of Delivery 83 Estimation of Fetal Weight 84
8 The Fetus-in-Utero Methods
85
of Obstetrical Examination 87
9 Fetal Skull and Maternal Pelvis Fetal
94
Skull 94 Pelvis 98 Physiological Enlargement of Pelvis 105
Maternal
10 Antenatal Care, Preconceptional Counseling and Care
106
Procedure at the First Visit 106 Procedure at the Subsequent Visits 111 Antenatal Advice 112 Minor
Ailments in Pregnancy 114 Values of Antenatal Care 116 Preconceptional Counseling and Care 116
11 Antenatal Assessment of Fetal Well-Being
119
Clinical
Evaluation of Fetal Well-Being 119 Special Investigations 120 Early Pregnancy 121 Antepartum Fetal Surveillance (Late Pregnancy) 121 Other Investigations in Late Pregnancy 124
12 Prenatal Genetic Counseling, Screening and Diagnosis
of Onset of Labor 134 Contractile System of the Myometrium 136 Physiology of Normal Labor 138 Events in First Stage of Labor 140 Events in Second Stage of Labor 143 Events in Third Stage of Labor 143 Mechanism of Normal Labor 145 Anatomy of Labor 149 Clinical Course of First Stage of Labor 151 Second Stage of Labor 153 Third Stage of Labor 154 Place of Delivery 154 Management of Normal Labor 155 First Stage 157 Second Stage 158 Immediate Care of the Newborn 161 Third Stage 162 Active Management of Third Stage of Labor 164
14 Normal Puerperium
168
Involution
of the Uterus 168 Involution of Other Pelvic Structures 170 Lochia 170 General Physiological Changes 171 Lactation 172 Physiology of Lactation 173 Management of Normal Puerperium 174 Management of Ailments 176 Postnatal Care 178
Previa 282 Clinical Features 284 Placentography 286 Differential Diagnosis 287 Complications 288 Management 289 Practical Guideline for Cesarean Delivery 291 Practical Guide to Lower Segment Approach for Placenta Previa 293 Practical Guidelines to Lower Segment Approach for Placenta Previa Accreta 293 Abruptio Placentae 294 Clinical Features 297 Complications 297 Treatment 299 Indeterminate Bleeding 301
20 Medical and Surgical Illness Complicating Pregnancy
303
Hematological
Disorders in Pregnancy 303 Anemia in Pregnancy 303 Hemoglobinopathies 316 Sickle Cell Hemoglobinopathies 316 Thalassemia Syndromes 317 Platelet Disorders 318 Heart Disease in Pregnancy 319 Diabetes Mellitus and Pregnancy 325 Gestational Diabetes Mellitus (Gdm) 326 Overt Diabetes 327 Thyroid Dysfunction and Pregnancy 334 Jaundice in Pregnancy 335 Cholestasis 336 Viral Hepatitis 336 Epilepsy in Pregnancy 338 Asthma in Pregnancy 339 Systemic Lupus Erythematosus (Sle) 340 Tuberculosis in Pregnancy 341 Syphilis in Pregnancy 342 Parasitic and Protozoal Infestations in Pregnancy 344 Malaria 344 Toxoplasmosis 345 Listeriosis 346 Intestinal Worms 346 Pyelonephritis in Pregnancy 346 Asymptomatic Bacteriuria (Asb) 347 Viral Infections in Pregnancy 348 Rubella 348 Measles 349 Influenza 349 Chickenpox (Varicella) 349 Cytomegalovirus (CMV) 349 Parvoviruses 349 Mumps (RNA) 350 Herpes Simplex (DNA) Virus (HSV) 350 Dengue 350 Human Immunodeficiency Virus Infection (Hiv) and Acquired Immunodeficiency Syndrome (AidS) 350 Surgical Illness during Pregnancy 353 Acute Pain in Abdomen during Pregnancy 355
21 Gynecological Disorders in Pregnancy
356
Abdominal
Vaginal Discharge 356 Congenital Malformation 356 Carcinoma Cervix with Pregnancy 357 Leiomyomas with Pregnancy 359 Ovarian Tumor in Pregnancy 360 Retroverted Gravid Uterus 361 Morbid Anatomic Changes if Left Uncared for 362 Genital Prolapse in Pregnancy 363
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22 Preterm Labor, Preterm Rupture of the Membranes, Postmaturity, Intrauterine Fetal Death
365
Preterm Labor 365 Prelabor Rupture of the Membrane (PROM) 369 Management 369 Prolonged
and Post-term Pregnancy 371
Intrauterine
Fetal Death (Iufd) 375
23 Complicated Pregnancy
381
Pregnancy
with Prior Cesarean Delivery 381 Integrity of the Scar 381 Evidences of Scar Rupture (or Scar Dehiscence) during Labor 383 Management of a Pregnancy with Prior Cesarean Delivery 383 Vaginal Birth After Previous Cesarean (Vbac) 384 Pregnancy in a Rh-negative Woman 386 Red Cell Alloimmunization 387 Fetal Affection by the Rh-antibody 388 Manifestations of the Hemolytic Disease of the Fetus and Newborn (Hdfn) 388 Prevention of Rh-immunization 389 Antenatal Investigation Protocol of Rh-negative Mothers 391 Plan of Delivery 393 Exchange Transfusion in the Newborn 396 Prognosis 397 Elderly Primigravida 398 Grand Multipara 398 Bad Obstetric History (Boh) 399 Obesity in Pregnancy 400
24 Contracted Pelvis
402
Valiation of Female Pelvis 402 Asymmetrical or Obliquely Contracted Pelvis 405 Mechanism of Labor in Contracted Pelvis with Vertex Presentation 405 Diagnosis of Contracted Pelvis 406 Disproportion 409 Diagnosis of Cephalopelvic Disproportion (Cpd) 410 Effects of Contracted Pelvis on Pregnancy and Labor 412 Management 412 Trial Labor 412 Midpelvic and Outlet Disproportion 414
Contents 30 Abnormalities of the Puerperium Puerperal
Pyrexia 500 Puerperal Sepsis 500
500 Subinvolution
505 Urinary Complications 505
Breast Complications 506 Puerperal Venous Thrombosis and Pulmonary Embolism 508 Pulmonary
Embolism (Pe) 510 Obstetric Palsies 511 Puerperal Emergencies 511 Psychiatric Disorders during Puerperium 512 Psychological Response to Perinatal Deaths and Management 513
31 The Term Newborn Infant
514
Physical
Features of the Newborn 514 Immediate Care of the Newborn 517 Infant Feeding 519 Breastfeeding 519 Artificial Feeding 524 Childhood Immunization Program 526
32 Low Birth Weight Baby Preterm
Baby 528
Fetal
527 Growth Restriction (Fgr) 533
33 Disease of the Fetus and the Newborn Perinatal
Asphyxia 541 Fetal Respiration 541
541
Respiratory Distress in the Newborn 547 Idiopathic Respiratory Distress Syndrome 547 Meconium
Aspiration Syndrome (Mas) 550 Jaundice of the Newborn 551 Hyperbilirubinemia of the Newborn 552 Kernicterus 553 Hemolytic Disease of the Newborn 554 Abo Group Incompatibility 555 Bleeding Disorders in the Newborn 555 Anemia in the Newborn 556 Seizures in Newborn 557 Birth Injuries of the Newborn 558 Intracranial Hemorrhage (ICH) 559 Other Injuries 561 Perinatal Infections 563 Ophthalmia Neonatorum (Conjunctivitis) 564 Skin Infections 565 Necrotizing Enterocolitis 566 Mucocutaneous Candidiasis 567 Congenital Malformations and Prenatal Diagnosis 567 Down’s Syndrome (Trisomy 21) 568 Congenital Malformations in Newborn and the Surgical Emergencies 569 Nonimmune Fetal Hydrops (Nifh) 571
34 Pharmacotherapeutics in Obstetrics
573
Oxytocics
in Obstetrics 573 Oxytocin 573 Ergot Derivatives 577 Prostaglandins (Pgs) 578 Antihypertensive Therapy 581 Diuretics 582 Tocolytic Agents 583 Anticonvulsants 584 Anticoagulants 585 Maternal Drug Intake and Breastfeeding 586 Fetal Hazards on Maternal Medication during Pregnancy 587 Analgesia and Anesthesia in Obstetrics 590 Anatomical and Physiological Considerations 590 Analgesia during Labor and Delivery 591 Sedatives and Analgesics 592 Inhalation Methods 592 Regional (Neuraxial) Anesthesia 593 Infiltration Analgesia 595 General Anesthesia for Cesarean Section 596
35 Induction of Labor
598
Indications
and Contraindications 598 Parameters to Assess Prior to Induction 599 Methods of Cervical Ripening 599 Methods of Induction of Labor 600 Medical 600 Surgical 601 Combined 604 Active Management of Labor 605 Partograph 607
36 Population Dynamics and Control of Conception Population
Care Following Destructive Operations 669 Section (Cs) 669 Lower Segment 671 Classical 676 Section 677 Measures to Reduce Cesarean Births 679 Symphysiotomy 679 Cesarean
Complication
of Cesarean
38 Safe Motherhood, Epidemiology of Obstetrics
680
Safe Motherhood 680 Obstetric Care and the Society 681 Reproductive and Child Health (Rch) Care 681 Epidemiology of Obstetrics 683 Maternal Mortality 683 Maternal Near Miss 687 Maternal Morbidity 687 Perinatal Mortality 687 Stillbirths 690 Neonatal Deaths 690 Women’s Health (MDGs) Beyond 2015; 690
(Nrfs) 697 in Obstetrics 699 Classification 702 Hemorrhagic Shock 704 Endotoxic Shock 705 Acute Kidney Injury (Aki) 706 Blood Coagulation Disorders in Obstetrics 711 High-risk Pregnancy 716 Immunology in Obstetrics 719 Critical Care in Obstetrics 722 Icu 723 Shock
40 Current Topics in Obstetrics
726
Antibiotic Prophylaxis in Cesarean Section 726 Day Care Obstetrics 726 Legal and Ethical Issues in Obstetric Practice 727 Audit In Obstetrics 728 The Preconception and Prenatal Diagnostic Techniques and PNDT Act 729 Umbilical Cord Blood Banking 729 Stem Cells and Therapies in Obstetrics 730
41 Imaging in Obstetrics (USG, MRI, CT, Radiology), Amniocentesis and Guides to Clinical Tests
732
Ultrasound
In Obstetrics 732 Three-dimensional Ultrasonography (3D Scanning) 733 First Trimester 734 Midtrimester 735 Doppler 737 Third Trimester 739 Magnetic Resonance Imaging (Mri) in Obstetrics 739 Computed Tomography (CT) 740 Radiology in Obstetrics 740 Amniocentesis 741 Guides to Clinical Tests 742 Urine 742 Tests for Blood Coagulation Disorders 743 Collection of Blood Sample 744 Cervical and Vaginal Cytology 746