Sakshi Arora Obstetrics PDF

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m m m m m eb eb eb eb eb oo oo oo oo oo ks ks ks ks ks fre f re fre fre f re e. e. e. e. e. co co co co co m m m m m m m m m m eb eb eb eb eb oo oo oo oo o ok ks ks ks ks s fre fre fre fre fre e. e. e. e. e. co c co co c m om m m om m m m m m eb eb eb eb eb o ok o ok oo oo oo sf s ks ks ks re fre fre fre fre e. e. e. e. e. co co co co co m m m m m m m m m m eb eb eb eb eb oo oo oo oo oo ks ks ks ks ks fre fre fre f re fre e. e. e. e. e. co co co co co m m m m m eb eb eb eb eb oo oo oo oo oo ks ks ks ks ks fre f re fre fre f re e. e. e. e. e. co co co co co m m m m m m m m m m eb eb eb eb eb oo oo oo oo o ok ks ks ks ks s fre fre fre fre fre e. e. e. e. e. co c co co c m om m m om Self Assessment & Review m m m m m eb eb eb eb eb o ok o ok oo oo oo sf s ks ks ks re fre fre fre fre e. e. e. e. e. co co co co co m m m m m Obstetrics m m m m m eb eb eb eb eb oo oo oo oo oo ks ks ks ks ks fre fre fre f re fre e. e. e. e. e. co co co co co m m m m m eb eb eb eb eb oo oo oo oo oo ks ks ks ks ks fre f re fre fre f re e. e. e. e. e. co co co co co m m m m m m m m m m eb eb eb eb eb oo oo oo oo o ok ks ks ks ks s fre fre fre fre fre e. e. e. e. e. co c co co c m om m m om m m m m m eb eb eb eb eb o ok o ok oo oo oo sf s ks ks ks re fre fre fre fre e. e. e. e. e. co co co co co m m m m m m m m m m eb eb eb eb eb oo oo oo oo oo ks ks ks ks ks fre fre fre f re fre e. e. e. e. e. co co co co co m m m m m eb eb eb eb eb oo oo oo oo oo ks ks ks ks ks fre f re fre fre f re e. e. e. e. e. co co co co co m m m m m m m m m m eb eb eb eb eb oo oo oo oo o ok ks ks ks ks s fre fre fre fre fre e. e. e. e. e. co c co co c m om m m om India m m m m m Ninth Edition eb eb eb eb eb o o Self Assessment & Review DGO (MLNMC, Allahabad) ok ok oo oo oo MBBS “Gold Medalist” (GSVM, Kanpur) SAKSHI ARORA HANS sf s ks ks ks re fre fre fre fre New Delhi | London | Philadelphia | Panama The Health Sciences Publisher Faculty of Leading PG and FMGE Coachings e. e. e. e. e. co co co co co m m m m m m m m m m Obstetrics eb eb eb eb eb oo oo oo oo oo ks ks ks ks ks fre fre fre f re fre e. e. e. e. e. co co co co co  m om m co co co c e. e. e. e. re fre fre fre f ks s ks ks ok oo oo oo Jaypee Brothers Medical Publishers (P) Ltd o eb eb eb eb Headquarters m m m m Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 m m m Fax: +91-11-43574314 Email: [email protected] co co co co e. e. e. e. Overseas Offices J.P. Medical Ltd Jaypee-Highlights Medical Publishers Inc Jaypee Medical Inc fre fre fre re 83 Victoria Street, London City of Knowledge, Bld. 235, 2nd Floor, Clayton 325 Chestnut Street f SW1H 0HW (UK) Panama City, Panama Suite 412, Philadelphia, PA 19106, USA ks ks ks ks Phone: +44 20 3170 8910 Phone: +1 507-301-0496 Phone: +1 267-519-9789 oo oo oo oo Fax: +44 (0)20 3008 6180 Fax: +1 507-301-0499 Email: [email protected] Email: [email protected] Email: [email protected] eb eb eb eb Jaypee Brothers Medical Publishers (P) Ltd Jaypee Brothers Medical Publishers (P) Ltd m m m m 17/1-B Babar Road, Block-B, Shaymali Bhotahity, Kathmandu, Nepal Mohammadpur, Dhaka-1207 Phone +977-9741283608 Bangladesh Email: [email protected] Mobile: +08801912003485 m m m Email: [email protected] co co co co Website: www.jaypeebrothers.com e. e. e. e. Website: www.jaypeedigital.com fre fre fre fre © 2016, Jaypee Brothers Medical Publishers ks ks ks ks 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. oo oo oo oo All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, eb eb eb eb 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 m m m m 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 m om m administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. co co co 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 c related to use of material in this book. e. e. e. e. This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or re fre fre fre 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 f ks ks s ks have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. ok oo oo oo Inquiries for bulk sales may be solicited at: [email protected] o eb eb eb eb Self Assessment & Review: Obstetrics m m m m First Edition : 2007 Second Edition : 2009 Third Edition : 2010 Fourth Edition : 2011 m m m Fifth Edition : 2012 Sixth Edition : 2013 co co co co Seventh Edition : 2014 e. e. e. e. Eighth Edition : 2015 Ninth Edition : 2016 fre fre re fre ISBN: 978-93-85999-54-3 sf ks ks ks Typeset at JPBMP typesetting unit ok oo oo oo Printed at India o eb eb eb eb m m m m  m om m co co co c e. e. e. e. re fre fre fre f ks s ks ks ok oo oo oo o eb eb eb eb m m m m m m m co co co co e. e. e. e. fre fre fre fre ks ks ks ks oo oo oo oo eb eb eb eb m m m m m m m co co co co e. e. e. e. fre fre fre fre ks ks ks ks oo oo oo oo Dedicated to eb eb eb eb m m m m SAI BABA Just sitting here, reflecting on where I am and where I started, I could not have done m om m it without you Sai baba... I praise you and love you for all that you have given me... and thank you for another beautiful day... to be able to sing and praise co co co you and glorify you... you are “My Amazing God” c e. e. e. e. re fre fre fre f ks ks s ks ok oo oo oo o eb eb eb eb m m m m m m m co co co co e. e. e. e. fre fre re fre sf ks ks ks ok oo oo oo o eb eb eb eb m m m m m m m m m eb eb eb eb eb oo oo oo oo oo ks ks ks ks ks fre f re fre fre f re e. e. e. e. e. co co co co co m m m m m m m m m m eb eb eb eb eb oo oo oo oo o ok ks ks ks ks s fre fre fre fre fre e. e. e. e. e. co c co co c m om m m om m m m m m eb eb eb eb eb o ok o ok oo oo oo sf s ks ks ks re fre fre fre fre e. e. e. e. e. co co co co co m m m m m m m m m m eb eb eb eb eb oo oo oo oo oo ks ks ks ks ks fre fre fre f re fre e. e. e. e. e. co co co co co  m om m co co co c e. e. e. e. re fre fre fre f ks s ks ks ok Preface oo oo oo o eb eb eb eb m m m m Dear Students, m m m I wish to extend my thanks to all of you for your overwhelming response to all the 8 editions of my book and for making it co co co co the bestseller book on the subject. Thanks once again for the innumerable emails you have sent in appreciation of the book, a few of which I have got printed at the end of the book. I apologize to all those who have sent me mails of appreciation but due to e. e. e. e. paucity of space, I was unable to get them printed. fre fre fre re NEET continued in year 2015, but yes, this time the anxiety of the students for NEET was less. Students looked more f settled. The approach of NEET became a little clear. Image-based questions are still to being asked. Most of the questions are ks ks ks ks direct but require you to be well-versed with the theory. Reading important theory becomes absolutely essential, whether you do oo oo oo oo it from a textbook or from subjectwise help books, that’s your choice. It now gives me immense pleasure to share with you the new edition of the book. Many changes have been done in the eb eb eb eb book. Each chapter has been thoroughly revised and updated. All new guidelines have also been incorporated. m m m m Salient Features of the 9th Edition All chapters have been thoroughly revised and updated. The book has been divided into 5 sections: m m m  Section 1: General Obstetrics co co co co  Section 2: Medical, Surgical and Gynaecological Illness Complicating Pregnancy  Section 3: Abnormal Labor e. e. e. e.  Section 4: Fetus fre fre fre fre  Section 5: Diagnosis in Obstetrics  Section 6: Recent Papers ks ks ks ks Theory is present before the following chapters: oo oo oo oo  Pelvis and fetal skull  Placenta and amniotic fluid eb eb eb eb  Normal labor  Abortion and MTP m m m m  Trophoblastic diseases including choriocarcinoma  Antepartum haemorrhage  Postpartum haemorrhage, uterine inversion and shock m om m  Anemia in pregnancy Heart disease in pregnancy co co co  c  Diabetes in thyroid pregnancy e. e. e. e.  Hypertensive disorders in pregnancy re fre fre  Pregnancy in Rh-negative women Infections in pregnancy fre f  ks ks s ks  Gynaecological disorders in pregnancy ok Fetus growth disorders oo oo oo  o  Fetal malformations eb eb eb eb Keeping in mind the apprehension of students towards NEET, I have added many new pattern questions with their explanations. The chapterwise distribution of new questions has been given on the back cover. m m m m For the first time ever annexures, have been added for last-minute revision. Total annexures added are 15 in number:  Color of amniotic fluid and conditions seen m m m  Causes of oligohydramnios co co co co  Causes of polyhydramnios  Types of pelvis and important points on them e. e. e. e.  Definitive signs of early pregnancy fre fre re fre  USG in pregnancy Recommended daily allowance in pregnancy sf  ks ks ks ok oo oo oo o eb eb eb eb m m m m  m om m co co co c e. e. e. e. re fre fre fre viii Self Assessment & Review: Obstetrics f ks s ks ks ok oo oo oo  Vaccines in pregnancy o Important time-table of events eb eb eb eb   Named structures and their locations m m m m  Recommended weight gain as per BMI in singleton and twin pregnancy  Fetal heart rate traces—NICE guidelines  Management algorithm for PPH–HEMOSTASIS  Conditions affecting levels of AFP m m m  Conditions affecting levels of bhCG co co co co CTG is one of the topics which is generally not very well understood by undergraduate students. With the recent trend of image-based questions coming in the exam, it becomes important to understand it well. For your convenience in color e. e. e. e. plates, I have added important CTG strips along with a user manual. fre fre fre re Many image-based questions have been added at the end. f ks ks ks ks Many new USGs and Doppler images have been given in color plates for last-minute revision. All important diagrams on which figure-based questions could be formed are given in color plates. oo oo oo oo All instruments used in obstetrics with their uses have been given in color plates. eb eb eb eb Important specimens of obstetrics are included in color plates. Recent questions of AIIMS (November and May 2015) and PGI (May 2015 and November 2014) have been added with m m m m their explanations in the respective chapters. Along with this edition, I am again providing a live lecture on basics of reproduction and APH to strengthen your fundamental concepts. m m m I hope all of you appreciate the changes and accept the book in this new format, like you have done for the previous editions. Remember there is no substitute to theory books, but hopefully you will find all relevant theory in this user-friendly book co co co co of Obstetrics. I must admit hereby that despite keeping an eagle’s eye for any inaccuracy regarding factual information or e. e. e. e. typographical errors, some mistakes must have crept in inadvertently. You are requested to communicate these errors and send fre fre fre fre your valuable suggestions for the improvement of this book. Your suggestions, appreciation and criticism are most welcome. ks ks ks ks New Delhi Dr Sakshi Arora Hans oo oo oo oo May 2016 [email protected] eb eb eb eb m m m m m om m co co co c e. e. e. e. re fre fre fre f ks ks s ks ok oo oo oo o eb eb eb eb m m m m m m m co co co co e. e. e. e. fre fre re fre sf ks ks ks ok oo oo oo o eb eb eb eb m m m m  m om m co co co c e. e. e. e. re fre fre fre f ks s ks ks ok Acknowledgments oo oo oo o eb eb eb eb m m m m Everything what we are is the outcome of a series of factors and circumstances, in addition to ourselves. m m m co co co co It would not be fair, therefore, to ignore the people who have played an important part in making me known as “Dr Sakshi Arora” and to whom I am deeply grateful. e. e. e. e. fre fre fre re My Teachers f ks ks ks ks ¾¾Dr Manju Verma (Prof & Head, Dept. of Obstetrics and Gynecology, MLNMC, Allahabad) and Dr Gauri Ganguli (Prof & Ex-Head, Dept. of Obstetrics and Gynecology, MLNMC, Allahabad) for teaching me to focus on the basic concepts of any oo oo oo oo subject. eb eb eb eb My Family m m m m ¾¾Dr Pankaj Hans, my better-half, who has always been a mountain of support and who is, to a large measure, responsible for what I am today. He has always encouraged me to deliver my best. No words are enough to thank him for all that he does. m m m ¾¾My Father: Shri HC Arora, who has overcome all odds with his discipline, hard work, and perfection. ¾¾My Mother: Smt. Sunita Arora, who has always believed in my abilities and supported me in all my ventures – be it co co co co authoring a book or teaching. e. e. e. e. ¾¾My in-laws (Hans family): For happily accepting my maiden surname ‘Arora’ and taking pride in all my achievements. fre fre fre fre ¾¾My Brothers: Mr Bhupesh Arora and Mr Sachit Arora, who encouraged me to write books and have always thought (wrong although) that their sister is a perfectionist. ks ks ks ks ¾¾My Daughter: Shreya Hans (A priceless gift of god): For accepting my books and work as her siblings (and is now showing signs of intense sibling rivalry!!) and letting me use her share of my time. Thanks ‘betu‘ for everything—your oo oo oo oo smile, your hugs, and tantrums. eb eb eb eb My Colleagues: I am grateful to all my seniors, friends and colleagues of past and present for their moral support. m m m m  Dr Manoj Rawal  Dr Pooja Aggrawal  Dr Parul Aggrawal Jain  Dr Ruchi Aggrawal  Dr Shalini Tripathi  Dr Kushant Gupta  Dr Parminder Sehgal  Dr Amit Jain  Dr Sonika Lamba Rawal m om m Directors of PG Entrance coaching, who helped me in realizing my potential as an academician (and bore with my sudden resignation from teaching). co co co c ¾¾Mr Rajesh Sharma: Director, PGDIAMS/DIAMS Coaching Institute e. e. e. e. ¾¾Dr Sushanta Bhanja: Director, PGEI Coaching Institute re fre fre fre ¾¾Dr Muthu Kumar: Director, Pulse PG (Kanpur) Coaching Institute f ks ks s ks Students ok oo oo oo ¾¾Dr Ahmed Savani—Surat, Gujarat o ¾¾Dr Nazir Ahmad eb eb eb eb ¾¾Dr Sachin Paparikar ¾¾Dr Rakshit Chakravarty m m m m ¾¾Dr Linkan Verma, Intern, Gandhi Medical College, Bhopal ¾¾Dr Asharam Panda, MKCG Medical College, Behrampur district, Odisha ¾¾Dr Hamik Patel m m m ¾¾Dr Pankaj Zanwar co co co co ¾¾Dr Sreedhanya Sreedharan, Final year MBBS, Jubilee Mission Medical College, Thrissur ¾¾Dr Vinit Singh, Intern, RG Kar Medical College, Kolkata e. e. e. e. ¾¾Dr Junaid Shaikh, CU Shah Medical College, Gujarat fre fre re fre ¾¾Dr Niraj R Shah (Student of DIAMS), Academy—Smolensk State Medical Academy, Russia sf ¾¾Dr Aarti Dalwani, Baroda Medical College, Gujarat ks ks ks ok oo oo