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Transcript of Pregnancy at Risk - JP Medical Publishers
Pregnancy at Risk
The Federation of Obstetric and Gynaecological Societies of India
Pregnancy at RiskA Practical Approach to High Risk
Pregnancy and Delivery
FIFTH EDITION
Editors
Usha Krishna MD DGO FICS FICOG
Past president, FOGSI, MOGS, Ex-Hon. Prof. KEM Hospital and GS Medical CollegeConsultant, Obstetrician and Gynecologist, Bhatia General Hospital
Director, Clinic for Women, Laburnum Road, Gamdevi, Mumbai, Maharashtra, India
Duru Shah MD FRCOG FCPS FICS FICOG FICMCH DGO DFPChairman: Gynaecworld
Professor and Consultant Obstetrician and GynecologistBreach Candy Hospital and Research Center
Jaslok Hospital and Research CenterSir Hurkisondas Nurrotumdas Hospital and Research Center
Mumbai, Maharashtra, India
Vinita Salvi MD DNBE FCPS DGO DFPConsultant Obstetrician and Gynecologist
SevenHills Hospital, MumbaiEx-Professor of Obstetrics and Gynecology and Officer in-Charge
ICMR Regional Center for Research in Human ReproductionSeth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
Nozer Sheriar MD DNBE FCPS DGOConsultant Obstetrician and Gynecologist
Breach Candy, Holy Family, Masina and Parsee General HospitalsGynecological Endoscopist, Bhatia and BARC Hospitals
Deputy Secretary General: FOGSIMumbai, Maharashtra, India
Kaizad R Damania MD DNBE FCPS DGO DFPProfessor of Obstetrics and Gynecology
Seth GS Medical College and Nowrosjee WadiaMaternity Hospital, Mumbai, Maharashtra, India
A FOGSI Publication
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Pregnancy at Risk: A Practical Approach to High Risk Pregnancy and Delivery
© 2010, The Federation of Obstetric and Gynaecological Societies of India
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or byany means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors andthe publisher.
This book has been published in good faith that the material provided by the contributors is original. Every effort is made toensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). Incase of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition : 1993Second Edition : 1995Third Edition : 1997Fourth Edition : 2001Reprint : 2004Fifth Edition : 2010
ISBN 978-81-8448-959-0
Typeset at JPBMP typesetting unit
Printed at
Contributors
Abhishek Pachchigar MBBS DMRDFellow in Ultrasound and DopplerDepartment of RadiologyKEM Hospital and GS Medical CollegeParel, MumbaiMaharashtra, India
Adarsh Bhargava MS (Obs/Gyn) FICOG FIMCHVisiting Faculty, Rajasthan University of Health ScienceAdvisor, Govt, IVF and Stemcell Research CenterSMS Medical College, JaipurRetired Head of Department (Obs/Gyn)SMS Medical College, JaipurRajasthan, India
Adi E Dastur MD FICOG FCPS DGO DFPMedical HeadNowrosjee Wadia Maternity Hospital and FormerHonorary Professor of Obstetrics and GynecologySeth GS Medical College and Nowrosjee WadiaMaternity HospitalMumbaiMaharashtra, India
Ajanta NarvekarConsultant Gynecologist and Infertility SpecialistNarvekar Infertility and Endoscopy ClinicPatel Chambers, Opera HouseMumbaiMaharashtra, India
Ajay Mehta MD DGOConsulting Obstetrician and Gynecologist, MumbaiVisiting SonologistNowrosjee Wadia Maternity Hospital, MumbaiMaharashtra, India
Alka Gogate MDProfessor and HeadDepartment of Microbiology, LTM Medical College andGeneral Hospital, Mumbai, Maharashtra, India
Alka Kriplani MBBS MD FICOG FICMCH FIMSAProfessor and Head Unit IIDepartment of Obstetrics and GynaecologyAll India Institute of Medical SciencesNew Delhi, India
Alokendu Chatterjee FRCOG FICSFormerly, Head, Department of Obstetricand GynecologyNRS Medical College, Kolkata, West Bengal, India
Ambrish Dalal MDHonorary SonologistBombay Hospital, Mumbai, Maharashtra, India
Ameet Patki MD DNB FCPS FICOG FRCOG (UK)Medical Director – ReGenesis, Center for AssistedReproduction, Endoscopy and Fetal MedicineReliance Life Sciences, MumbaiHon Associate ProfessorMumbai, Maharashtra, India
Ameya C Purandare MD DNBE FCPS DGO DFP MNAMSMICOGAssistant Honorary Obstetrician and GynecologistK J Somaiya Medical College and Hospital, MumbaiMasina Hospital, MumbaiNaigaon Municipal Maternity HospitalMumbai, Maharashtra, India
Amit Chakravarty MSc PhD MSCG (USA)Consultant GeneticistBirth Defects CenterMumbai, Maharashtra, India
Amit Sudhakar Kulkarni DPM DNBConsultant Psychiatrist Research officerDr RN Cooper Municipal General HospitalMumbai, Maharashtra, India
Anahita Chauhan MD DGOAssociate Professor of Obstetrics and GynecologySeth GS Medical College and KEM HospitalMumbai, Maharashtra, India
Anita Soni MD DNB FCPS DGOConsultant Obstetrician and GynecologistLH Hiranandani HospitalMumbai, Maharashtra, India
Anirudh Kohli MD DNB DMRDBreach Candy HospitalMumbai, Maharashtra, India
Ashwini Bhalerao Gandhi MD DGO DFP FCPS DNBFICOGConsultant GynecologistPD Hinduja National Hospital and Medical ResearchCenter, Mahim, Mumbai, Maharashtra, IndiaEx Associate ProfessorTN Medical College and BYL Nair HospitalChairperson, Adolescent Health Committee of FOGSI(2004-08)Secretary, Mumbai Obstetrics and Gynecology SocietyMumbai, Maharashtra, India
Ashwita Aiyer MBBSChowpatty Medical CenterMumbai, Maharashtra, India
Avan DadinaConsultant Obstetrician and GynecologistMumbai, Maharashtra, India
Basil T LyngdohSenior ResidentDepartment of Obstetrics and GynecologyAll India Institute of Medical SciencesNew Delhi, India
Bhaskar Pal MD DGO DNBE MRCOGConsultant Obstetrician and GynecologistApollo Gleneagles HospitalKolkata, West Bengal, India
Bhavisha BafnaMSc in Pharmaceutical Sciences with ManagementStudiesSenior Research OfficerChowpatty Medical CenterMumbai, Maharashtra, India
Behram S Anklesaria MD DGO DFP ATMF (USA)Honorary Professor of Obstetrics and GynecologyLG Hospital NHL Medical College andKM School of Postgraduate MedicineAhmedabadGujarat, India
B Shakuntala Baliga MD (AIIMS) FICOGProfessor of Obstetrics and GynecologyLady Hardinge Medical CollegeNew Delhi, India
Chabra SDirector and ProfessorObstetrics and GynecologyMGIMS, SevagramWardha, Maharashtra, India
Chander LullaConsultant SonologistRia Clinic, Mumbai, Maharashtra, India
Chinmayee PatraSenior ResidentTNMC and BYL Nair Ch. HospitalMumbai, Maharashtra, India
Chittaranjan N Purandare MD (BOM), MA Obst (Ireland),DGO, DFP, D. Obst. RCPI (Dublin), FICOG, FICMCH, PGD,MLS (Law)President FOGSI, Assoc. Editor Journal FOGSIConsultant Obstetrics and GynecologySt. Elizabeth Hospital and BSES Hospital, MumbaiEx. Hon. Professor Obstetrics and GynecologyGrant Medical College and JJ HospitalMumbai, Maharashtra, India
Chopra S MBBSResident, Obstetrics and Gynecology
Dilip R Karnad MD FACP FRCP (Glasg)Consultant, Critical Care MedicineSevenHills Hospital, MumbaiAdjunct Professor of MedicineBaylor College of Medicine, Houston, Texas
Divakar H MDConsultant ObstetricianDivakars Speciality HospitalJP Nagar II PhaseBengaluru, Karnataka, India
Duru Shah MD FRCOG FCPS FICS FICOG FICMCH DGO DFPChairman: GynaecworldProfessor and Consultant Obstetrician and GynecologistBreach Candy Hospital and Research CenterJaslok Hospital and Research CenterSir Hurkisondas Nurrotumdas Hospital and ResearchCenter, Mumbai, Maharashtra, India
Feroze R Soonawala MDConsultant Obstetrician and GynecologistMumbai, Maharashtra, India
Firuza R Parikh MD DNBE FCPS DGODirector, Department of Assisted Reproductionand GeneticsJaslok Hospital and Research CenterMumbai, Maharashtra, IndiaVisiting Associate Professor of Obstetricsand GynecologyYale University School of MedicineNew Haven, USA
Pregnancy at Riskvi
Gautam N Allahbadia MD DNBE FCPS DGOHonorary Assistant Obstetrician and GynecologistBombay Hospital Institute of Medical SciencesMumbai, Maharashtra, India
Geetha Balsarkar MD FCPS DGO DNBAssociate ProfessorNowrosjee Wadia Maternity Hospital andSeth GS Medical College, ParelMumbai, Maharashtra, India
Gita Arjun FACOGChennai, India
Harshad Parasnis MD DNB FCPS DGO FICOGConsultant Gynecologic OncologistHon. Associate ProfessorBharati Vidyapeeth’s Medical CollegePuneChairman, Oncology and Trophoblastic TumoursCommittee, FOGSIVice PresidentPune Obstetrics and Gynecology Society, India
Hema Purandare MBBS MS MSCG (USA)Consultant GeneticistBirth Defects CenterMumbai, Maharashtra, India
Hetal H Parekh MD DNBAssociate ConsultantCenter for Human ReproductionDr LH Hiranandani Hospital, PowaiMumbai, Maharashtra, India
Himangi Sudhakar WarkeLecturer, Department of Obstetrics and GynecologySeth GS Medical College, KEM HospitalParel, Mumbai, Maharashtra, India
Hiralal Konar MBBS (Cal), MD (PGI), DNB MNAMS FACSFRCOG (London)Department of Obstetrics and GynecologyNRS Medical College and HospitalVice President, FOGSI, 2008Kolkata, West Bengal, India
Hosamani PClinical Research Co-ordinatorDivakars Speciality HospitalJP Nagar II PhaseBengaluru, Karnataka, India
Hrishikesh Pai MD FCPS MS Clinical Embryology (USA)Consultant Gynecologist- Babies an USIVF Centers, MumbaiConsultant GynecologistFortis La Femme HospitalDelhi, Chandigarh, India
Indrani Lodh MSSenior Consultant Gynecologist and LaparoscopicSurgeonApollo Gleneagles HospitalKolkata, West Bengal, India
Indrani Suresh MDAssociate DirectorMediscan SystemsDiagnostic Ultrasound and Research CenterChennai, TN, India
Ishita Pateria BA (Psy)Research CoordinatorDepartment of Psychiatry ResearchJaslok Hospital and Research Center
Jaideep Malhotra MD FICMCH FICOGConsultant Obstetrician and GyecologistCenter for woman Care and ResearchAgra, UP, India
Jasmine Lopez MD (BOM) DGODean, Padmashri Dr DY Patil EducationEnterprises Pvt Ltd, MumbaiEx. Associate Professor and Unit InchargeGrant Medical College andJJ Group of HospitalsMumbai, Maharashtra, India
Jaydeep D Tank MD DNBE FCPS DGOAsstt Honorary Consultant (Obstetrics and Gynecology)KJ Somaiya Medical College and Research CenterMumbaiConsultantAshwini Maternity and Surgical HospitalCenter for Endoscopy and IVFMumbai, Maharashtra, India
JB Sharma MD FRCOGAssociate ProfessorDepartment of Obstetrics and GynecologyAll India Institute of Medical Sciences9/22 AIIMSNew Delhi, India
viiContributors
Jesse M Levi MD FCPS DGO DFPConsultant Obstetrician and GynecologistMumbai, Maharashtra, India
Joshita Singh DNB DMRDBreach Candy HospitalMumbai, Maharashtra, India
Joydev Mukherjee MDFormerly, Head, Department of Obstetricsand Gynecology, RG Kar Medical CollegeKolkata, West Bengal, India
Kaizad R Damania MD DNBE FCPS DGO DFPProfessor of Obstetrics and GynecologySeth GS Medical College and Nowrosjee WadiaMaternity HospitalMumbai, Maharashtra, India
Kaushal Kadam MDRotunda-CHR, BandraMumbai, Maharashtra, India
Kedar N Ganla MD DNBE FCPS DGO DFPConsultant (Infertility), Hiranandani HospitalMumbai, Maharashtra, India
Ketan S ParikhConsultant AnesthetistMumbai, Maharashtra, India
KP SanghaviNeonatologistJaslok Hospital and Research CenterPrince Aly Khan HospitalSaifee Hospital, MumbaiMaharashtra, India
K Coyaji MDDirector and HeadDepartment of Obstetrics and GynecologyKEM Hospital Pune/Honorary ProfessorDepartment of Obstetrics and GynecologyBJ Medical CollegePune, Maharashtra, India
Krishnakumar S MD DGOConsultant, Gynecologist and ObstetricianIVF SpecialistWockhardt HospitalKumars’ Maternity and Surgical Nursing Home,Dombivli (E)Nirmiti Fertility and IVF Center, Thane (W)Mumbai, Maharashtra, India
Kuldeep Singh MBBS FAUI FICMCHConsultant UltrasonologistSpecial interest in Obstetric Sonology in detailed FetalAnomalyScanning and Color Doppler for management andGynecological ScanningDr Kuldeep’s Ultrasound and Color Doppler Clinic266, Prakash MohallaEast of KailashNew Delhi, India
Kumud M IngleEx-DeanNowrosjee Wadia Maternity HospitalMumbai, Maharashtra, India
Kurush P Paghdiwalla MD DNBEHonorary Assistant Obstetrician and GynecologistParsee General Hospital and Masina HospitalMumbai, Maharashtra, India
Madhavi PanpaliaClinical AssistantDepartment of Assisted Reproduction and GeneticsJaslok Hospital and Research CenterMumbai, Maharashtra, India
Mahendra N Parikh MD DGO DA FICOGProfessor EmeritusObstetrics and GynecologySeth GS Medical College and Nowrosjee WadiaMaternity HospitalMumbai, Maharashtra, India
Mahesh Balsekar MD DCHConsultant PediatricianBreach Candy HospitalSir Hurkisondas HospitalMumbai, Maharashtra, India
Mala Arora FRCOG (UK), FICOG, FICMCH, DA (UK),D’Obst (IRE)Chairperson FOGSI Quiz CommitteePresident Faridabad Obstetrics andGynecological SocietyDirector Noble HospitalSector-14, Faridabad, Haryana, India
Mandakini Megh MDProfessor of Obstetrics and GynecologyGrant Medical CollegeMedical SuperintendentCama and Albless HospitalMumbai, Maharashtra, India
Pregnancy at Riskviii
Mangala Ketkar MBBS DGOObstetrics and GynecologistKetkar Hospital, Nagpur, Maharashtra, India
Manju PuriProfessor, Department of Obstetrics and GynecologyLady Hardinge Medical College and Smt SK HospitalNew Delhi, India
Manorama Purwar MD DGO MS (USA)Project coordinator and Liaison officerWHO PLGF TRIAL OBGYGMCH Nagpur, Maharashtra, India
Mansi Parikh MS (OBGY) DNBConsultant Obstetrician and GynecologistDr. Medhekar’s ClinicMahim, Mumbai, Maharashtra, India
Meena S Bhattacharya MSEx-Professor and HeadDepartment of Obstetrics and GynecologySeth GS Medical College and Nowrosjee WadiaMaternity Hospital, Mumbai, Maharashtra, India
Milind R Shah MD DGO DFP2nd Vice President Elect FOGSI 2001Past Chairman-Rural Obstetrics Committee of FOGSI-2004-2008Prof. and HOD, Department of OBGY, Gandhi NathaMedical College, SolapurNaval Nursing Home, 199, South KasbaSolapur, Maharashtra, India
Mirudhubashini Govindarajan FRCSCHonorary Professor of Obstetrics and GynecologyInstitute of Medical Sciences and ResearchCoimbatore, TN, India
MJ Jassawalla MD FCPS DGO DFPHonorary Assistant Professor of Obstetrics andGynecologySeth GS Medical College andNowrosjee Wadia Maternity Hospital, MumbaiHonorary Obstetrician and GynecologistParsee General Hospital and Masina HospitalMumbai, Maharashtra, India
MS Nanawati MD MNAMS FCPS DGO DFPHonorary Associate Professor of Obstetrics andGynecologySeth GS Medical College andNowrosjee Wadia Maternity HospitalMumbai, Maharashtra, India
Mumtaz Sharif MD DNBAssistant ProfessorDY Patil Medical CollegeNeural, Navi MumbaiMaharashtra, India
Nadeem Rais MDConsultant EndocrinologistBreach Candy HospitalMumbai, Maharashtra, India
Nalini S ShahProfessor and HeadDepartment of EndocrinologySeth GS Medical College and KEM HospitalMumbai, Maharashtra, India
Narendra Malhotra MD FRSHConsultant Obstetrician and GynecologistCenter for Women Care and ResearchAgraUP, India
Narhari Malegaonkar MD DGOClinical Fellow –ReGenesisReliance Life SciencesMumbai, Maharashtra, India
Nayna A Dastur MD FICOG DGO DFPFormer Professor, Obstetrics and GynecologistSeth GS Medical CollegeHonorary Consultant, Obstetrician and GynecologistNowrosjee Wadia Maternity HospitalConsultant, Sir HN HospitalBreach Candy HospitalMumbai, Maharashtra, India
Neetha N Pujari MD MRCOGLecturerDepartment of Obstetrics and GynecologySeth GS Medical College and KEM HospitalMumbai, Maharashtra, India
Nisha Sana AhmadChief of Lab ServicesMetropolis Health Services
Nitin NarvekarHon. Associate Obstetrician and GynecologistNowrosjee Wadia Maternity HospitalHon. Associate Professor of Obstetrics and GynecologySeth GS Medical CollegeHon. Endoscopic Surgeon Bhatia General Hospital andJagjivan Ram Hospital
ixContributors
NK HaseProfessor and Head Department of NephrologySeth GS Medical College and KEM HospitalParel, Mumbai, Maharashtra, India
Nozer Sheriar MD DNBE FCPS DGOConsultant Obstetrician and GynecologistBreach Candy, Holy Family, Masina and ParseeGeneral HospitalsGynecological EndoscopistBhatia and BARC HospitalsDeputy Secretary General: FOGSIMumbai, Maharashtra, India
Pakhee Aggarwal MDSenior ResidentDepartment of Obstetrics and GynecologyAll India Institute of Medical SciencesNew Delhi, India
Paresh P Choksi MDLecturer of Obstetrics and GynecologyKJ Somaiya Medical College and Research CenterMumbai, Maharashtra, India
Parikshit D Tank MD DNBE FCPS DGO DFP MNAMSMICOG MRCOGHonorary Clinical AssociateNowrosjee Wadia Maternity HospitalParel, MumbaiConsultantAshwini Maternity and Surgical Hospital, Center forEndoscopy and IVF, Mumbai, Maharashtra, India
Partha Guha Roy MD DGOSenior consultantFertility Clinic and IVF CenterMumbai, Maharashtra, India
Piclu Choudhury MDAssistant Professor, Chittaranjan Seva SadanKolkata, West Bengal, India
Piyush Jain DM NeonatologyConsultant NeonatologistDepartment of NeonatologyFortis Hiranandani HospitalNavi Mumbai, Maharashtra, India
PK Shah MD FCPS DGO DFPProfessor of Obstetrics and GynecologySeth GS Medical College and KEM HospitalMumbai, Maharashtra, India
Pradnya Parulekar MD DGOConsulting Obstetrician and GynecologistBhatia Hospital and Raheja Fortis Hospital
Prakash Pispati MD FRSM (London)Senior Consultant Rheumatologist– Jaslok(Head of the Department) and Saifee HospitalsMumbai, Maharashtra, IndiaMaster and Honorary Member- Asia Pacific League ofAssociations for Rheumatology (APLAR)Past President- APLAR and Indian RheumatologyAssociation
Prakash TrivediProf and Head of Department Rajawadi Hospital andDY Patil Medical College, MumbaiDirector: NILES and Aakar IVF ICSI CenterDr Trivedi’s Total Health Care Centre, MumbaiChief Gynaec Endoscopist: Jaslok and BARC HospitalMumbai, Maharashtra, India
Pranay Shah MD DGOConsultant Obstetrician and GynecologistMumbaiMaharashtra, India
Pratap Kumar MD DGO FICS FICOG FICMCHProfessor of Obstetrics and GynecologyKasturba HospitalManipal, Karnataka, India
Pratima Anjaria MD DGOConsultant Obstetrician and GynecologistMumbai, Maharashtra, India
Pravin N Mhatre MD FCPS DGO DFPHonorary Associate Professor of Obstetricsand GynecologySeth GS Medical College and Nowrosjee WadiaMaternity HospitalMumbai, Maharashtra, India
Prerna Gupta MD DNBSenior ResidentDepartment of Obstetrics and GynecologyAll India Institute of Medical SciencesNew Delhi, India
Purnima Satoskar MD DNBE MRCOGProfessor of Obstetrics and GynecologySeth GS Medical College and KEM HospitalMumbaiMaharashtra, India
Pregnancy at Riskx
Rachita Nanda MBBS MDAssistant ProfessorDepartment of Clinical BiochemistrySCB Medical CollegeCuttack, Orissa, India
Rajen Y Daftary MD DAConsultant Anesthesiologist, Breach Candy HospitalMasina HospitalMumbai, Maharashtra, India
Rajesh M Parikh MD DNBE DPM FICPConsultant Psychiatrist and NeuropsychiatristJaslok Hospital and Research CenterMumbai, Maharashtra, India
Rajesh V Darade DNB MD FCPS FICMCH FICS (USA),DGO DFP DGOcps (Mum) MNAMS MICOG (Ind)Associate Professor Department of Obstetrics andGynecologyGovernment Medical CollegeLatur, Maharashtra, India
Rakhi SahuLecturer, Department of Obstetrics and GynecologySeth GS Medical College, N Wadia HospitalMumbai, Maharashtra, India
Rama Vaidya MD DGO DFP PhDConsultant Reproductive EndocrinologistSPA Research CenterMumbai, Maharashtra, India
Ramesha KNKerala Registry of Epilepsy and PregnancyDepartment of NeurologySree Chitra Tirunal InstituteThiruvananthapuramKerala and Indian Epilepsy SocietyNew Delhi, India
Rana J Khan FCPS DGO DFPClinical AssistantPD Hinduja Hospital and Research Center, MahimMumbai, Maharashtra, India
Rashid Merchant MDConsulting Neonatologist, Nanavati HospitalMumbai, Maharashtra, India
Reena J Wani MD MRCOG FICOG DNBE DFP DGO FCPSAssociate Professor, I/C Family Welfare ProgramTNMC and BYLNair Ch. HospitalMumbai, Maharashtra, India
Reva Tripathi MDProfessor of Obstetrics and GynecologyMAM College, Delhi, India
Rishma Dhillon Pai MD DNB DGO FICOGConsultant GynecologistJaslok and Lilavati Hospitals, MumbaiMedical Director- Every woman CliniqsMumbai, Maharashtra, India
Ritu JoshiHead of the Department, Gynecology and ObstetricsMonilek Hospital and Research Center, JaipurChair-person Family Welfare Com. FOGSI (09-12)
Rohit V Bhatt MD DCH FAMS FICOGChief Department of Obstetrics and GynecologyBhailal Amin General HospitalVadodara, Gujarat, India
Ruchita Sarda DNB DGOObstetrician and GynecologistPlanet Women HospitalAhmedabadGujarat, India
Rupinder Kaur RupraiAss. ProfessorDepartment of Obstetrics and GynecologyKasturba HospitalManipal, Karnataka, India
Rustom P Soonawala MD FRCSEmeritus Professor of Obstetrics and GynecologySeth GS Medical College and Nowrosjee WadiaMaternity Hospital, MumbaiConsultant Obstetrician and GynecologistBreach Candy HospitalMumbai, Maharashtra, India
Sadhana Desai MD FRCOG DGOProfessor and HeadDepartment of Obstetrics and GynecologyBombay Hospital Institute of Medical SciencesMumbai, Maharashtra, India
Sakshi TomarAgra, UP, India
Samir R Shah MD DM (Gastro)Consultant GastroenterologistJaslok Hospital and Research CenterBreach Candy HospitalMumbai, Maharashtra, India
xiContributors
Samir S ShahConsultant hematologistKokilaben Dhirubhai Hospital
Sanjay Rao MD DNBE MRCOG FCPS DGOConsultant Obstetrician and Gynecologist
Sanjeev V ThomasDepartment of NeurologySree Chitra Tirunal Institute for Medical Sciencesand Technology, Thiruvananthapuram, Kerala, India
Saradha Jaganathan MD DNB FNBConsultant in ObstetricsGynecology and Feto-Maternal MedicineWomen’s Center, CoimbatoreTamil Nadu, India
Sarita Bhalerao MD DGO FCPS DNB DFP MRCOGObstetrician and GynecologistBhatia, Saifee, Wadia Maternity HospitalsMumbaiChairperson FOGSI Quiz Committee 2009 – 2010
Seeru Agarwal MBBS DGOObstetrician and GynecologistMumbai, Maharashtra, India
Shailesh Kore MD DNB MNAMS FCPS DGO DFP DICOGMICOGAssociate Professor and Unit HeadLTM Medical CollegeSion, Mumbai, Maharashtra, India
Shakun TyagiAssistant Professor, Department of GynecologyLN Hospital, New Delhi, India
Shalini Fusey MBBS MD DGOAssociate ProfessorDepartment of Obstetrics and GynecologyGovernment Medical College and HospitalNagpur, Maharashtra, India
Shamsah SonawallaConsultant, Jaslok HospitalMumbai, Maharashtra, India
Sharad Gogate MD FCPS DGO DFP FICSConsultant Obstetrician and GynecologistMumbai, Maharashtra, India
Sharda PatraAssistant ProfessorDepartment of Obstetrics and GynecologyLady Hardinge Medical College and Smt SK HospitalNew Delhi, India
Shefali PandeyGlobal hospital and Research CenterAndheri (W), MumbaiMaharashtra, India
Shyam Vijay Desai MD DGO DFP FCPS MNAMSHonorary Associate Professor of Obstetrics andGynecologyGrant Medical College and Nowrosjee Wadia MaternityHospital, Parel, MumbaiMaharashtra, India
Smriti Agarwal MD (Obs/Gyn), DNBSenior Research AssociateDepartment of Obstetric and GynecologyCSM Medical University (KGMC)Lucknow, UP, India
Subhas Nargolkar MD DGO FICOG FICMCHConsultant Obstetrician and GynecologistPune, Maharashtra, India
Suchitra N Pandit MD DNBE FRCOG FICOG MNAMSConsultant Kokilaben Dhirubhai Ambani Hospital
Suhas OtivAssociate Consultant Obstetrician and GynecologistKEM Hospital, PuneMaharashtra, India
Sukhpreet Patel MD DNB FCPS DGO PGDMLSProgram Director, Gynaecworld Assisted Fertility UnitConsultant Obstetrician and GynecologistGynaecworld
Sukirti Jain MBBS DNB (Obstetrics and Gynecology)Assistant ProfessorDepartment of Obstetrics and Gynecology at TernaMedical College and Mother and Child HospitalNavi Mumbai, Maharashtra, India
Sulbha AroraDeccan Fertility Clinic and Keyhole Surgery CenterShivaji Park, MumbaiMaharashtra, India
Pregnancy at Riskxii
Suneeta Mittal MD FAMS FICOG FRCOG FIMSA FICMCHHead, Department of Obstetrics and Gynecology andDirector In-chargeWHO-CCR in Human ReproductionAll India Institute of Medical SciencesNew Delhi, India
S Suresh MDDirectorMediscan SystemsDiagnostic Ultrasound and Research CenterChennai, Tamil Nadu, India
Sushil Shah MD DPBFellow of Cornell Medical Centre (USA)Consultant PathologistBreach Candy Hospital and Research Center, MumbaiChairman, Metropolis Health Services
Suvarna S Khadilkar MD DGO FICOGAssociate Professor and Head of the Unit in Obstetricsand GynecologyGrant Medical College and Cama and Albless HospitalMumbaiSecretary, Mumbai Chapter, Indian Menopause SocietyAssistant Secretary, Editorial BoardJournal of Obstetrics and Gynecology of India, FOGSIChairperson Menopause Committee, MOGSJoint Secretary AMWI, MumbaiMaharashtra, India
SV Kotwaliwale MS FAIMSConsultant GeneticistGenetic Diagnostic CenterMumbai, Maharashtra, India
Swati G Allahbadia MD DGONWMH, Parel, MumbaiAsian Heart Research Institute, BKCBandra (E), MumbaiRotunda Nursing Home, WadalaMumbai, Maharashtra, India
Swati R Daftary MD DAConsultant AnaesthesiologistJaslok Hospital, Mumbai, Maharashtra, India
Tambe P MDConsultant, Gynecologist and ObstetricianIVF SpecialistNirmiti Fertility and IVF Center, Thane (W)Kumars’ Maternity and Surgical Nursing Home,Dombivli (E)Mumbai, Maharashtra, India
xiiiContributors
Tejas C PurandareObstetrician and GynecologistBhatia Hospital, TardeoMumbai, Maharashtra, India
Trupti Nadkarni MD DNB DGO FCPSLecturer – Nowrosjee Wadia Maternity HospitalMumbai, Maharashtra, India
Tushar R BandgarAssociate ProfessorDepartment of EndocrinologySeth G S Medical College and KEM HospitalMumbai, Maharashtra, India
Umakanta Nanda MBBS MS FICS FICMCHFormer Professor and HeadDepartment of Obstetrics and GynecologyMedical College of CuttackBehrampur and Burla, Orissa, India
Usha B Saraiya MD DGO FIAC FICS FICOGFormer Professor of Obstetrics and GynecoloyCama and Albless Hospital, MumbaiPresident FOGSI 2002Chairman ICOG 2006-9
Usha Krishna MD DGO FICS FICOGPast president, FOGSI, MOGSEx-Hon. Prof. KEM Hospital and GS Medical CollegeConsultant, Obstetrician and GynecologistBhatia General HospitalDirector, Clinic for WomenLaburnum Road, GamdeviMumbai, Maharashtra, India
Vanaj MathurConsultantAgra, UP, India
Vandana Bansal MD DGO DNB MRCOG FNB(High Risk Pregnancy and Perinatology)Lecturer, Obstetrics and GynecologySeth GS Medical College andNowrosjee Wadia Maternity HospitalMumbai, Maharashtra, India
Vandana R WalvekarFormer Dean Nowrosjee Wadia Maternity HospitalProfessor, Seth GS Medical College, ParelMumbaiHonorary Consultant, Bhatia HospitalTardeoMumbai, Maharashtra, India
Pregnancy at Riskxiv
Vanita S Raut MD DGOConsultant Obstetrician and GynecologistHiranandani HospitalEx Professor of Obstetrics and GynecologySeth GS Medical College and KEM HospitalMumbai, Maharashtra, India
Vasanthi Jayaraj MDConsultant Mother HospitalThrissur 12, Kerala, India
Veerbala N Parikh MD FICOGConsultant Obstetrician and GynecologistNM Wadia Charitable Hospital, SolapurMaharashtra, India
Vihang N Vahia MD DPM MAPAConsultant Psychiatrist Breach CandyLilavati and Hurkisondas Hospitals, MumbaiFormerly Professor and HOD PsychiatryDr RN Cooper Hospital and Seth GS Medical CollegeMumbai, Maharashtra, India
Vinita DasProfessor and Head of Department of Obstetrics andGynecologyKing George Medical CollegeLucknow, UP, India
Vinita Salvi MD DNBE FCPS DGO DFPConsultant Obstetrician and GynecologistSevenHills Hospital, MumbaiEx-Professor of Obstetrics and Gynecology and Officerin-charge, ICMR Regional Center for Research inHuman ReproductionSeth GS Medical College and KEM HospitalMumbai, Maharashtra, India
Vinod Saxena MDMedical AdvisorReckitt and Colman of India LtdNew Delhi, India
VN Purandare MD FRCS (EDIN) FICOGProfessor Emeritus Obstetrics and GynecologySeth G S Medical College and KEM HospitalMumbaiEditor Emeritus Journal of Obstetrics andGynecology of India
VP Paily MD FRCOGProfessor of Obstetrics and GynecologyJubilee Mission Medical College HospitalThrissur, KeralaConsultant Mother HospitalThrissur 12, Kerala
Yasmin KaziConsultant Obstetrician and GynecologistMumbai, Maharashtra, India
YS NandanwarProfessor and HeadDepartment of Obstetrics and Gynecology(ISO 9001-2000 Certified), LTMMG CollegeSion, Mumbai, Maharashtra, India
Preface to the Fifth Edition
While pregnancies and child birth are natural events, they often require medical interaction and intervention. It wouldbe fair to say that every pregnancy has some degree of potential risk. To paraphrase George Orwell, in clinical practicesome pregnancies are more at risk than others. This book is about these Pregnancies at Risk, where medical understanding,vigilance and care is the difference between safety and catastrophe.
Pregnancy at Risk – Current Concepts was first published in 1993 as a companion volume to a landmark conferenceof the same name organized by FOGSI. The volume had a series of upgrades over the years that also expanded itsscope and coverage of topics. That it is in its fifth edition, stands testimony to its continued relevance and popularityfor practitioners and students of obstetrics. It aims to cover a focused clinical area—high-risk pregnancy—byamalgamating evidence and practices, giving the benefits of a monogram and handbook rolled into one.
This fifth edition of Pregnancy at Risk – A Practical Approach to High Risk Pregnancy and Delivery is published to keepour readers, practicing colleagues and postgraduate students alike updated with the most recent developments in whatis now differentiated and defined as perinatology. Its purpose is to provide and ensure pregnant women under ourcare the very best of available treatment. The scope of the book continues to extend beyond routine obstetrics. It continuesthis by a coverage of various subjects such as genetics, infections, and medical complications as also problems andrisks related to labor and delivery. It does this with a special emphasis on understanding their most recent clinicalconcepts and technological advances that are applicable for diagnosis and management.
In spite of the rapid technological progress in recent years, the role of interpersonal interaction and clinical acumenremains central to patient care. The importance of an insightful history, thorough examination and proper counselingwith genuine involvement of patients and their families is even more essential as we deal with high-risk pregnancyand delivery. Technology is no substitute for a caring, empathetic and conscientious physician. Interaction starts earlywith preconception counseling, continues with vigilant antepartum care and carries forward to appropriate and judiciousintrapartum management of normal and abnormal labor. A team approach with selected professional colleagues isan asset in providing multidimensional care and is essential to manage potential medical and surgical complications.The team could include physicians and intensivists, surgeons and anesthetists, neonatologists and perinatologists,endocrinologists and immunologists, pathologists and sonologists, psychiatrists and counselors as required. Theirexperience and inputs help to give the best well-rounded professional care in Pregnancies at Risk.
We owe this publication to and are most grateful to each of our handpicked contributors who have put in unstintedeffort to contribute chapters, appropriately referenced and embellished with personal experiences. This is a multiauthoredbook and the views expressed herein are those of the authors. We acknowledge the support and commitment of ourpublishers over the years for making this, one of their first publications for FOGSI so successful. We would also liketo acknowledge the support of our families for allowing us to take time away from them to give to this academic endeavor.
For us, editing this volume has been a labor of love. It is our tribute to the brave women who put themselves atrisk as they give birth to the next generation. To them, we dedicate this book.
Usha KrishnaDuru Shah
Vinita SalviNozer Sheriar
Kaizad R Damania
Preface to the First Edition
Pregnancy and childbearing are attended by certain risks to the mother as well as the fetus. The aim is to improveour management of the high risk situations and optimize the outcome of pregnancy. This book covers various factorswhich put the fetus at risk and presents the current concepts in evaluation, monitoring and management of variousmedical disorders in pregnancy, perinatal infections, placental insufficiency and the immunological, endocrine andanatomical disorders.
Fetomaternal medicine is under constant discussion, experimentation and evaluation. There is a revolution in thecare of the fetus and the newborn. New options are being developed in gene control, drug therapy and immunotherapy.The womb is no longer considered an isolated dark chamber. The fetus is accessible today with increasing clarity withsophisticated monitoring tools such as ultrasonography, magnetic resonance imaging, chorion villus sampling, amnioticfluid studies, Doppler blood flow studies, etc. The concept of the fetus as “The unborn patient” has elevated theimportance of prenatal diagnosis and treatment.
There are many ethical considerations in the practice of fetomaternal medicine. Our objective is to avoid preventabledeath, disease or disability in children. However, we have to remember that the benefit to the mother will remain ourprimary obligation. It is only with the agreement of the pregnant woman that the physician should make the decisions.
We must also remember that diagnostic machines cannot substitute a good physician. A pregnant patient is ina sensitive phase of her life, therefore, an excellent rapport and an empathetic attitude are most essential. Counselingis an important aspect of management of a high risk pregnancy. It is not only the investigations and assessment butthe compliance and cooperation of the patient which are necessary for good results.
In most of the high risk pregnancies, good antenatal care and close monitoring of the factors arising during laborand just after, give rewarding results. In the better equipped centers with sophisticated monitoring tools, thecardiovascular status—both structural and functional can be assessed. Biomarkers for assessing fetal and maternaltherapy can be studied.
Low dose aspirin for prophylaxis in pre-eclampsia and intrauterine growth retardation, glucocorticoid therapy forfetal lung maturation, maternal immunization to prevent fetal and neonatal infection and pharmacologic therapy forfetal arrhythmias are now well established. However, we still have limitations to fetal therapy specially in the areaof fetal surgery. The greatest success of fetal therapy is in the area of rhesus immunization.
Rapid progress in the understanding of the etiopathology, neonatal management and prophylaxis in high riskpregnancy is due to the teamwork of hematologists, sonologists as well as obstetricians and pediatricians. Successin fetomaternal medicine can be achieved only by the collaborative efforts of physicians, microbiologists, biochemistsas well as the experts in imaging science and laboratory medicine.
In spite of the technical developments there has been some disillusionment with the results of their clinicalapplication. Proper interpretation with clinical correlation and consideration of many factors are necessary for decisionmaking. We must therefore consider each case carefully and individually before undertaking any aggressive managementor invasive procedure.
We are conscious that in a developing country like ours, the majority of the deliveries are conducted by traditionalbirth attendants. The “Safe Motherhood” programs therefore envisage training and equipping these traditional birthattendants, so that they become able to identify high risk pregnancies and refer them in time to the appropriate hospitals.
We are most grateful to all the contributors for sparing their valuable time to write these chapters. This ismultiauthored book and the views expressed herein are those of the authors. We have tried to select the chapters andcontributors to offer the reader a comprehensive view of the growing experience in investigations and management.
Pregnancy at Riskxviii
We specially thank the co-editors, Duru Shah, Nozer Sheriar, Vinita Salvi and Kaizad R Damania who have sparedno pains to help us with all the aspects of publication of this book. It is the cooperation and goodwill of all our colleaguesand some silent workers which has made it possible to compile this book. We hope this book will stimulate the interestof the readers in minimizing every possible risk in pregnancy and childbirth. We also hope that the book is constantlyupdated as “current concepts” will always keep changing.
Usha KrishnaShirish Daftary
Contents
SECTION ONE: EARLY PREGNANCY AT RISK1. Physiology of the Luteal Phase ................................................................................................................................... 3
Shakun Tyagi, Reva Tripathi
2. Cytogenetics of Early Pregnancy Wastage ................................................................................................................ 8SV Kotwaliwale, Mangala Ketkar
3. Early Pregnancy Wastage in Assisted Reproduction ........................................................................................... 14Kedar N Ganla, Hetal H Parekh
4. Pregnancies after Embryo Reduction ...................................................................................................................... 21Nitin Narvekar, Ajanta Narvekar
5. Current Status of Surgical and Nonsurgical Management of Ectopic Pregnancy ......................................... 26Gautam N Allahbadia, Kaushal Kadam, Sulbha Arora, Swati G Allahbadia
6. Ovarian Hyperstimulation Syndrome in Pregnancy ............................................................................................ 34Rishma Dhillon Pai, Hrishikesh Pai
SECTION TWO: RECURRENT PREGNANCY LOSS7. Management of Congenital Uterine Abnormalities ............................................................................................. 41
Nozer Sheriar
8. Acquired Uterine Abnormalities Leading to Pregnancy Risk ............................................................................ 49Krishnakumar S, Tambe P
9. The Incompetent Cervix ............................................................................................................................................. 59VN Purandare, Ameya C Purandare
10. Antiphospholipid Syndrome ...................................................................................................................................... 68Mala Arora
11. Immunotherapy for Recurrent Abortion ................................................................................................................. 77Pranay Shah
SECTION THREE: INFECTIONS IN PREGNANCY12. Toxoplasmosis in Pregnancy ..................................................................................................................................... 85
Anita Soni, Seeru Agarwal
13. Rubella in Pregnancy .................................................................................................................................................. 92JB Sharma, Prerna Gupta
14. Perinatal Viral Infections ........................................................................................................................................... 96Shyam Vijay Desai, Jesse M Levi, Pradnya M Parulekar
15. Syphilis ......................................................................................................................................................................... 106MS Nanavati, Jesse M Levi
16. Mycoplasma and Chlamydia in Pregnancy ......................................................................................................... 109Alka Gogate, Sharad Gogate
17. AIDS: Its Effects on Pregnancy and the Newborn ............................................................................................ 113Mandakini Megh
18. Maternal Infections: A Laboratory Review .......................................................................................................... 122Nisha Sana Ahmad, Sushil Shah
Pregnancy at Riskxx
19. Malaria in Pregnancy ................................................................................................................................................ 127Manorama Purwar, Shalini Fusey
20. Amebiasis, Giardiasis and Intestinal Helminthic Infections ........................................................................... 138Umakanta Nanda, Rachita Nanda
21. Hepatitis in Pregnancy .............................................................................................................................................. 146Samir R Shah
22. Pregnancy and Tuberculosis ................................................................................................................................... 151Suvarna S Khadilkar, Usha B Saraiya
SECTION FOUR: INVESTIGATIONS IN THE PREGNANCY AT RISK23. Early Pregnancy Assessment ................................................................................................................................... 163
Pratap Kumar, Rupinder Kaur Ruprai
24. Role of Genetic Investigations and Counseling .................................................................................................. 172Hema Purandarey, Amit Chakravarty
25. Transvaginal Obstetric Ultrasound ........................................................................................................................ 183PK Shah, Neetha N Pujari
26. Color Flow Imaging in Obstetrics: Understanding its Art, Science and Technology ................................. 196Narendra Malhotra, Jaideep Malhotra, Vanaj Mathur, Kuldeep Singh, Sakshi Tomar
27. Clinical Applications of Color Doppler ................................................................................................................. 208Adi E Dastur, Nayna A Dastur, Parikshit D Tank
28. Biophysical Methods for Assessing Fetal Well-being ........................................................................................ 212Kaizad R Damania, Vandana Bansal
29. Intrapartum Monitoring ............................................................................................................................................ 223Pravin N Mhatre
30. Antenatal Ultrasound Screening for Fetal Malformations ................................................................................ 228S Suresh, Indrani Suresh
31. Fetal MRI ..................................................................................................................................................................... 232Anirudh Kohli
SECTION FIVE: ENDOCRINE DISORDERS IN PREGNANCY32. Pregnancy Complications Associated with PCOS............................................................................................... 237
Duru Shah, Ruchita Sarda
33. Gestational Diabetes Mellitus ................................................................................................................................. 245Tushar R Bandgar, Nalini S Shah
34. Thyroid Disorders in Pregnancy ............................................................................................................................. 252Nadeem Rais, Ashwita Aiyer, Bhavisha Bafna
35. Adrenal Diseases in Pregnancy .............................................................................................................................. 262Rama Vaidya, Shefali Pandey
SECTION SIX: MEDICAL DISORDERS IN PREGNANCY36. Anemia in Pregnancy ................................................................................................................................................ 271
Suneeta Mittal, Pakhee Aggarwal
37. Maternal and Fetal Outcome in Heart Disease .................................................................................................. 280Kurush P Paghdiwalla
38. Management of Seizures during Pregnancy ........................................................................................................ 285Ramesha KN, Sanjeev V Thomas, Vinod Saxena
xxiContents
39. Nutritional Deficiency in Pregnancy ..................................................................................................................... 295Hiralal Konar, Piclu Choudhury
40. Liver Disease in Pregnancy ..................................................................................................................................... 301Adarsh Bhargava
41. Pregnancy in Underlying Renal Disease .............................................................................................................. 311NK Hase
42. Psychiatric Disorders in Pregnancy ....................................................................................................................... 319Vihang N Vahia, Amit Sudhakar Kulkarni
43. Collagen Vascular Disorders and Pregnancy ...................................................................................................... 324Prakash Pispati
44. Pregnancy Complicated by Malignancy ................................................................................................................ 330Saradha Jaganathan, Mirudhubashini Govindarajan
45. Thalassemia and Sickle Cell Disease in Pregnancy ......................................................................................... 338Samir S Shah
SECTION SEVEN: PLACENTAL INSUFFICIENCY46. Management of Hypertension in Pregnancy ....................................................................................................... 347
Meena S Bhattacharya, Vanita S Raut, Parikshit D Tank
47. Fetal Growth Restriction ........................................................................................................................................... 354Suhas Otiv, K Coyaji
48. Prophylaxis for Pregnancy-induced Hypertension andIntrauterine Growth Restriction with Low-Dose Aspirin .................................................................................. 368Usha Krishna, Pradnya M Parulekar
49. Postdatism .................................................................................................................................................................... 374Pratima Anjaria
SECTION EIGHT: DRUGS AND ENVIRONMENT50. Teratology .................................................................................................................................................................... 381
Shailesh Kore, Mansi Parikh
51. Hazards of Drug Usage in Pregnancy and Lactation ........................................................................................ 392MJ Jassawalla, Geetha Balsarkar
52. Substance Abuse in Pregnancy .............................................................................................................................. 403Ritu Joshi
53. Fetal Dysmorphology ................................................................................................................................................. 411Ajay Mehta
54. Impact of Environment on Reproductive Health ................................................................................................ 426Rohit V Bhatt
SECTION NINE: FETAL THERAPY55. Medical Therapy to the Fetus ................................................................................................................................. 437
Rashid Merchant, Mumtaz Sharif
56. Fetal Surgery ............................................................................................................................................................... 444Chittaranjan N Purandare, Jasmine Lopez
57. Prenatal Interventional Procedures ........................................................................................................................ 460S Suresh, Indrani Suresh
58. Obstetric Decisions for Fetal Malformations ....................................................................................................... 476B Shakuntala Baliga
Pregnancy at Riskxxii
SECTION TEN: OBSTETRIC COMPLICATIONS59. Pregnancies at Extremes of Reproductive Age ................................................................................................... 487
Reena J Wani, Chinmayee Patra
60. Placenta Previa ........................................................................................................................................................... 493Anahita Chauhan
61. Pregnancy Following ART ........................................................................................................................................ 501Sadhana Desai, Partha Guha Roy
62. Abruptio Placentae ..................................................................................................................................................... 505Geetha Balsarkar, Kumud M Ingle, Ajay Mehta
63. Preterm Premature Rupture of Membranes ........................................................................................................ 512Manju Puri, Sharda Patra
64. Etiology and Early Diagnosis of Preterm Labor .................................................................................................. 519Parikshit D Tank
65. Prevention of Preterm Labor ................................................................................................................................... 525Divakar H, Hosamani P
66. Pregnancy Loss in the Second Half of Gestation ............................................................................................... 535Himangi Sudhakar Warke
67. Hydramnios ................................................................................................................................................................. 543Vinita Das, Smriti Agarwal
68. Rh-Isoimmunization .................................................................................................................................................. 549Vinita Salvi
69. Nonimmune Hydrops Fetalis .................................................................................................................................. 556Ashwini Bhalerao Gandhi, Bhaskar Pal
70. Pregnancy with Prolapse .......................................................................................................................................... 563YS Nandanwar
71. Benign Adnexal Masses in Pregnancy ................................................................................................................. 566Basil T Lyngdoh, Alka Kriplani
SECTION ELEVEN: LABOR AND DELIVERY IN PREGNANCY AT RISK72. Induction of Labor ..................................................................................................................................................... 573
Suchitra N Pandit, Sanjay Rao, Rana J Khan
73. Labor Analgesia in High-Risk Pregnancy ............................................................................................................ 583Rustom P Soonawala, Ketan S Parikh, Feroze R Soonawala
74. Intrapartum Fetal Distress ....................................................................................................................................... 591Jaydeep D Tank
75. Dysfunctional Labor .................................................................................................................................................. 597Vandana Bansal, Kaizad R Damania
76. Contemporary Instrumental Delivery .................................................................................................................... 608Subhash Nargolkar, Nozer Sheriar
77. Breech Presentation ................................................................................................................................................... 618VP Paily, Vasanthi Jayaraj
78. Cesarean Section in Present Day Practice .......................................................................................................... 628Ameet Patki, Narhari Malegaonkar
79. Modern Management of Obstructed Labor ......................................................................................................... 632Mahendra N Parikh, Veerbala N Parikh, Paresh P Choksi
80. Postpartum Hemorrhage ........................................................................................................................................... 641Sarita Bhalerao, Trupti Nadkarni
81. Sudden Postpartum Collapse .................................................................................................................................. 646Purnima Satoskar, Yasmin Kazi
xxiiiContents
82. Rupture Uterus ........................................................................................................................................................... 655Behram S Anklesaria, Indrani Lodh
83. Management of Critically Ill Patients in Labor .................................................................................................. 662Alokendu Chatterjee, Joydev Mukherjee
84. Obstetric Patient in ICU ........................................................................................................................................... 671Rajen Y Daftary, Swati R Daftary
85. Fluid and Electrolyte Balance in Pregnancy and Labor .................................................................................... 679Dilip R Karnad
SECTION TWELVE: MULTIPLE PREGNANCIES86. Embryo Reduction ...................................................................................................................................................... 687
Ambrish Dalal
87. Managing Multiple Pregnancies ............................................................................................................................. 690Vandana R Walvekar, Geetha Balsarkar, Tejas C Purandare
88. Twin to Twin Transfusion Syndrome ................................................................................................................... 695Chander Lulla, Abhishek Pachchigar
89. High Order Pregnancy .............................................................................................................................................. 701Madhavi Panpalia, Firuza R Parikh
90. Rural Obstetrics .......................................................................................................................................................... 709Milind R Shah, Rajesh V Darade
91. High-Risk Pregnancy in Low Resource Settings ................................................................................................. 718Chabra S, Chopra S
SECTION THIRTEEN: MISCELLANEOUS92. Preconceptional Counseling and Antenatal Care ............................................................................................... 727
Gita Arjun
93. High-Risk Neonate ..................................................................................................................................................... 734Mahesh Balsekar
94. Gestational Trophoblastic Disease ......................................................................................................................... 741Harshad Parasnis
95. The Role of Stress in First Trimester Miscarriage ............................................................................................. 751Ishita Pateria, Rajesh M Parikh, Shamsah Sonawalla, Firuza R Parikh
96. Surrogacy ...................................................................................................................................................................... 754Sukhpreet Patel, Duru Shah
97. Perinatal Asphyxia and Hypoxic-ischemic Encephalopathy ............................................................................ 757KP Sanghvi
98. Neurologic Outcome and Fetal Well-Being .......................................................................................................... 765Sukirti Jain, Vinita Salvi, Piyush Jain
99. Management of Autoimmune Thrombocytopenic Purpura in Pregnancy .................................................... 771Avan Dadina
100. Fetal Monitoring—Revisited ..................................................................................................................................... 778Pravin N Mhatre, Rakhi Sahu
101. Laparoscopy in Pregnancy ....................................................................................................................................... 790Prakash Trivedi
Index .............................................................................................................................................................................. 799
