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ADVANCES IN OBSTETRICS AND GYNECOLOGY VOL 3 (pb)2011
Author: LOPE A. MEHTA
ISBN: 9789350252314
Year: 2011
Publisher: JAYPEE BROTHERS MEDICAL PUBLISHERS PVT LTD.
Category: OBSTETRICS & GYNAECOLOGY
Edition: 1
Format: Paperback
Language: English
Pages: 302
Volume: 3
 ABOUT THE TITLE
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 TABLE OF CONTENTS
SECTION 1: OBSTETRICS
1. Anemia Update in Pregnancy 3
JB Sharma, Meenakshi Shankar
Prevalence of Anemia in Pregnancy 3
Erythropoiesis in Pregnancy 3
Causes of Anemia 5
Prevention of Iron Deficiency 7
Effects of Anemia on Pregnancy 9
Clinical Features of IDA 9
Management of IDA 11
Newer Iron Preparations 13
Parenteral Iron Therapy 13
Recombinant Erythropoietin 15
Megaloblastic Anemia in Pregnancy 17
Criteria for Megaloblastic Anemia 18
Folate Deficiency 18
Vitamin B12 Deficiency 19
Hemolytic Anemias 20
Microangiopathic Hemolytic Anemia 21
Hemolytic Anemias Associated with
Hemoglobinopathies 21
Sickle Cell Trait 22
Thalassemia 24
Immune Hemolytic Anemia 25
2. Pregnancy after Corrected Heart Disease 28
Sumita Mehta, Sarika Gupta
Matermal Risks 28
Fetal Risks 28
Specific Heart Conditions 30
Left to Right Shunts 30
Right to left shunts 30
Acquired Valvular Heart Disease 32
Prosthetic Valves 34
Bioprosthetic Valves 35
Mechanical Valves 35
Dosage and Schedule of Anticoagulation 37
General Principles of Mamagement of Delivery and
Postpartum 38
Antibiotic Regimen 40
3. An Update on Viral Infections in Pregnancy 43
Shalini Rajaram, Akanksha Tripathi, Balkesh Rathi
Toxoplasmosis 43
Congenital Toxoplasmosis 44
Maternal Treatment 45
Treatment of Neonatal Infection 46
Cytomegalovirus (CMV) 46
Cytomegalovirus Inclusion Disease (CID) 46
Asymptomatic Congenital CMV 47
Treatment 49
Prevention 49
Active Immunization 49
Herpes Simplex Virus (HSV) 50
Congenital Herpes 50
Management of Women with First Episode of
Genital Herpes 51
Management of Women with Recurrent Herpes 52
Management of HIV Positive Women with
Recurrent HSV Infection (IV) 52
Neonatal Care 52
Level B Recommendations (Based on Limited or
Inconsistent Scientific Evidence) 52
Level C Recommendations (Based on Consensus or
Expert Opinion) 53
Parvovirus 53
Clinical Presentation 54
Parvovirus B19 Infection in Pregnancy 54
Fetal Effects of Parvovirus B19 Infection 54
Diagnosis of Fetal Infections 56
Management of Fetal Hydrops 56
Rubella 57
Clinical Features 57
Advances in Obstetrics and Gynecology (Vol. 3) xii
Congenital Rubella Syndrome (CRS) 57
Diagnosis of Maternal Infection 59
Diagnosis of Fetal Infection 59
Management of Rubella Exposure/Infection in Pregnant
Women 60
Recommendation 61
Treatment 61
Rubella Vaccine 61
Syphilis 62
Diagnosis 63
Screening and Testing of Pregnant Woman 64
4. Obstetric Admissions to ICU 69
Rachna Agarwal, Sandhya Agarwal
Incidence of ICU Admission 69
Indication of ICU Admission 69
Indian Scenario 70
General Principles of Cardiovascular and Respiratory
Support 70
Cardiovascular Monitoring 71
Respiratory Support on the Delivery Suite 72
Critical Care for Special Obstetric Emergencies 73
Massive Obstetric Hemorrhage 73
Maternal Collapse 75
Septic Shock 75
Disseminated Intravascular Coagulation (DIC) 76
Preeclampsia 78
Maternal Complications in ICU 78
Prognostic Scoring in Obstetrics 79
Measures Towards Reduction of ICU Admission 80
High Dependency Unit 80
5. Liver Disorders in Pregnancy: Current Evidence for
Management 84
Balkesh Rathi, Phani Madhuri Kini, Neerja Goel
Hyperemesis Gravidarum 85
Etiopathogenesis 86
Complications 86
Contents xiii
Hemolysis, Elevated Liver Enzymes and Low Ppatelets
(HELLP) 87
Mississippi Classification 87
Tennessee Classification 88
Acute Fatty Liver of Pregnancy 89
Etiopathogenesis 90
Clinical Features 90
Diagnosis 91
Management 92
Intrahepatic Cholestasis of Pregnancy 92
Etiopathogenesis 92
Clinical Features 93
Investigations 93
Management 94
Hepatitis A 94
Clinical Presentation 94
Investigations 95
Treatment 95
Hepatitis E 95
Hepatitis B 95
Clinical Presentation 96
Hepatitis C (HCV) 97
Liver Cirrhosis 98
Primary Sclerosing Cholangitis 98
Portal Hypertension 98
Budd-Chiari Syndrome (BCS) 99
Wilson’s Disease 99
6. Changing Scenario in the Management of Placenta
Previa/Accreta 104
Bindiya Gupta, Shalini Rajaram
Placenta previa 105
Risk Factors 105
Clinical Presentation 105
Localization of the Placenta 106
Management 107
Delivery of the Fetus 108
Maternal and Perinatal Outcome 110
Advances in Obstetrics and Gynecology (Vol. 3) xiv
Placenta Accreta 110
Risk Factors 110
Diagnosis 110
Treatment 111
Conservative Management 111
Cesarean Scar Pregnancy 113
Prevention Strategies 113
7. Postpartum Complications 117
Alpana Singh, Sumita Mehta, Parul Arora
Puerperal Infections 117
Risk Factors for Puerperal Sepsis 118
Causal Organisms 118
Clinical Course 118
Investigations 119
Management of Puerperal Sepsis 119
Breast Complications 121
Deep Vein Thrombosis and Venous
Thromboembolism (VTE) 122
Peripartum Cardiomyopathy 124
Postpartum Thyroiditis (PPT) 125
Postpartum Depression (PPD) 127
Postpartum Psychosis 129
Gaped Episiotomy 129
8. Anesthetic Considerations and Obstetric Outcomes 133
Poonam Motiani
Physiologic Changes of Pregnancy 133
Cardiovascular System 134
Respiratory System 134
Gastrointestinal System 135
Central Nervous System 135
Other Changes 136
Analgesia for Labor and Vaginal Delivery 136
Regional Analgesia 136
Anesthesia for Cesarean Section 139
Problems with General Anesthesia 140
Preparation for General Anesthesia in a
Pregnant Patient 141
Contents xv
Mendelson Syndrome 141
Treatment 142
Postdural Puncture Headache (PDPH) 143
9. Ultrasonography: Special Situations 147
Vinita Rathi, Monica Agarwal
Leiomyoma 147
Endometrial Carcinoma 148
Endometriosis 149
Dermoid Cyst 150
Bicornuate Uterus with Pregnancy 151
Rh Isoimmunization 151
Omphalocele 152
Hydrocephalus 154
Spina Bifida 154
Cephalocele 156
Hydatidiform Mole 156
Ovarian Neoplasms 157
SECTION 2: GYNECOLOGY
10. Menstrual Disorders in Adolescents 163
Anshul Grover, Amita Suneja
Premenstrual Syndrome 163
Etiology 163
Symptoms 164
Diagnosis 164
Management 165
Dysmenorrhea 167
Prevalence 167
Etiology of Primary Dysmenorrhea 168
Secondary Dysmenorrhea 168
Clinical Evaluation 170
Treatment 171
Nonsteroidal Anti-inflammatory Drugs 171
Treatment of Secondary Dysmenorrhea 175
Abnormal Uterine Bleeding 175
Assessment and Diagnosis 178
Laboratory Investigations 179
Treatment 179
Advances in Obstetrics and Gynecology (Vol. 3) xvi
11. Evaluation of Postmenopausal Bleeding 184
Sumita Mehta, Ria Malik
Imaging Studies 186
Ultrasonography 186
Doppler Studies 187
Saline Infusion Hysterosonography 187
MRI/CT 188
Endometrial Sampling 188
Fractional Curettage 188
Endometrial Aspiration 188
Hysteroscopy 189
Special Situations 189
Women on Tamoxifen 189
Hormone Therapy in Menopause 191
12. HPV Carcinogenesis in Cancer Cervix 195
Shalini Rajaram, Shaili Nigam
Low Risk HPV 196
High Risk HPV 196
Risk Factors for Acquiring HPV Infection 196
Genome of HPV 197
Mechanism of Carcinogenesis by HPV 198
HPV Infection 199
Establishment of Infection 199
Viral Multiplication 200
Host Cell Proliferation and Malignant Transformation 200
Viral Persistence 203
Development of Precancer and Cancer 204
Clinical Implications of HPV Oncogenesis 205
Role of HPV Detection in Screening and follow-up in
Cancer Cervix 205
HPV Vaccine 206
13. Alternative Therapies for Menopause 212
Neerja Goel, Rachna Agarwal, Upasna Pandit
Pharmokinetics 214
Types of Phytoestrogen 215
Physiological Effects 217
Contents xvii
Various Studies 217
Herbalism 218
Complementary Interventions 219
Prescribing Notes 222
14. Recent Concepts in Management of Urinary
Incontinence in Women 226
Sumita Mehta, Sarika Gupta, Shalini Rajaram
Continence and Physiology of Micturition 227
Causes of Urinary Incontinence 227
Neural Pathways 227
Sphincteric Mechanism and Anatomic Support 228
Diagnostic Evaluation 229
Physical Examination 229
Investigations 230
Eyeball Urodynamics 231
Multichannel Urodynamics 232
Filling/Storage Phase 232
Management of Stress Incontinence 233
Conservative Techniques 233
Pharmacologic Treatment 234
Surgery for Stress Incontinence 236
Traditional Procedures 236
Newer Procedures 236
Traditional Procedures 236
Newer Procedures 237
15. Management of Adolescent PCOS 244
Richa Sharma, Neerja Goel, Sumita Mehta
Physical Examination 244
Investigations 245
For Hyperandrogenism 245
Ovarian Morphology 245
Insulin Resistance 245
Ovulatory Functions 246
Metabolic Dysfunction 246
Treatment 247
Management of Hyperandrogenism 247
Treatment for Oligomenorrhea 250
Treatment of Metabolic Correction 251
Long-term Health Consequences of PCOS 252
Advances in Obstetrics and Gynecology (Vol. 3) xviii
16. Troubleshooting in Laparoscopy 256
Puneeta Bhardwaj
Prolonging Life of Laparoscopic Instruments 256
Laparoscope—Camera Setting 258
View Setting 258
Camera—Monitor Setting 258
Surgeon Setting and Ergonomics 258
The Laparoscope 259
The Connectors 262
The Screen 262
Electric Current in Laparoscopy 264
Electrosurgery Circuits 265
Management and Prevention of Complications of Pelvic
Laparoscopic Surgery 266
Management 268
Troubleshooting in Specific Surgeries 274
Adenexal Surgery 274
Laparoscopic Hysterectomy 275
Laparoscopic Surgery for Symptomatic Endometriosis 278
Ovarian Endometriosis 278
Adhesiolysis 278
Laparoscopic Management of Dermoid (Ovarian Cyst) 278
Laparoscopic Adhesiolysis 279
Effective and Safe Adhesiolysis 279
Laparoscopic Myomectomy 279
Technique 280
17. Intractable Chronic Malignant Pelvic and
Perineal Pain 285
Ashok Saxena, Nitin Jain
Superior Hypogastric Plexus Block: A New Treatment
Modality for Chronic Malignant Pelvic Pain 287
Technique 287
Ganglion Impar (Ganglion of Walther) Block for
Intractable Pelvic Pain 291
Technique 291
Invasive Neurosurgical Approach 293
Psychological Supportive Adjuncts 293
• Index 297
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