About the Book

• Management of Labour & Puerperium is a combination of practical and theoretical knowledge from experts across the fields of obstetrics and gynaecology.
• The book is divided into two sections, the first covering labour, and the second covering puerpium.
• The first section covers not only the physiological aspects of labour and delivery, but also all the current evidence regarding management of complications during this critical period.
• The second section covers normal puerperium and also the common problems occurring during this phase.
• Twenty-seven chapters comprehensively cover the various policies and programs which promote safe motherhood, and the standards for making healthcare facilities mother and new-born friendly.
• Chapters dedicated to new-born care and postpartum contraception have also been included.
• An essential reference work for both students and obstetricians.

About the Author

Madhavi M Gupta MS Shakun Tyagi MD Sudha Prasad MD FICOG

Table of Contents:
CONTENTS Section 1 LABOUR 1. Mechanisms Controlling the Onset of Labour 1 Reva Tripathi, Prachi Benara Myometrial Changes 1 Cervical Changes 2 Endocrinology of Parturition 3 Role of Autonomic Nervous System 5 Role of Prostaglandins 6 Role of Nitric Oxide 6 Mechanical Factors 7 Preterm Labour 7 Clinical Application 8 2. Induction of Labour 10 Usha Manaktala, Anita Poonia Definition 10 Indications 10 Factors Affecting Success 11 Preinduction Cervical Ripening 11 Methods 11 Risks and Complications 15 Special Care in Previous Cesarean 15 Failed Induction 16 Trial of Labour 16 3. Management of First Stage of Labour 18 Renu Tanwar, Neha Varun Definition of the First Stage 18 Duration of Labour 18 Management 18 Delay in the Established First Stage of Labour 24 Prelims.indd 15 8/4/2014 5:25:40 PMManagement of Labour and Puerperium xvi 4. Management of Second Stage of Labour 28 Ashok Kumar, Priyanka Chaudhary, Madhur Kumar Mechanism of Labour 28 Management of Second Stage of Labour 29 Episiotomy 32 Perineal Tears 33 5. Management of Third Stage of Labour 37 Latika Sahu, Priyanka Thakur Definition 37 Duration 38 Management 38 6. Complications of Third Stage: Postpartum Hemorrhage, Retained Placenta and Uterine Inversion 44 Krishna Agarwal, Anubhuti Rana Postpartum Hemorrhage 44 Secondary PPH 48 Retained Placenta 49 Morbidly Adherent Placenta 50 Puerperal Uterine Inversion 51 7. Operative Vaginal Delivery 54 YM Mala, Niharika Yedla Indications 54 ACOG Classification 54 Ventouse Delivery 55 Forceps Delivery 57 8. Intrapartum Fetal Monitoring 60 Shailja Singh, Asmita M Rathore Diagnosis 60 Fetal Heart Rate Monitoring 60 Clinical Signs 63 Fetal ECG 65 Fetal Pulse Oximetry (FPO) 65 Intrapartum Fetal Stimulation Tests 65 Fetal Scalp Blood Sampling 65 Neonatal Management 67 Prelims.indd 16 8/4/2014 5:25:40 PMContents xvii 9. Special Obstetric Scenarios: Twin Pregnancy and Women with Previous Cesarean Section 69 Gauri Gandhi, Shweta Tahlan, Jyoti Sharma Labour in Twin Pregnancy 69 Labour with Previous Cesarean Section 72 10. Special Obstetric Scenarios: Management of Breech, Preterm Labour, Prelabour Rupture of Membranes 78 Bindiya Gupta, Rajlaxmi Mundra Breech Delivery 78 Preterm Labour 80 Prelabour Rupture of Membranes 83 Chorioamnionitis 87 11. Labour Management in Associated Medical Disorders 89 Sangeeta Gupta, Priya Mehta, Megha Jindal Anemia 89 Hypertension 90 Cardiac Disease 91 Diabetes 93 Hepatitis B Positive Pregnancy 93 HIV Positive Pregnancy 93 12. Labour Abnormalities 97 Devender Kumar, Jyotsana Bajaj Objectives 97 Protraction Disorder 99 Arrest Disorder 99 The Partograph 100 Cephalopelvic Disproportion 100 Breech Presentation or Transverse lie 104 Face or Brow Presentation 104 Occipitoposterior Position 105 Obstructed Labour 105 Obstetrics “Tales”: Points to Ponder 106 Management of Obstructed Labour 106 Cesarean Section 107 Prelims.indd 17 8/4/2014 5:25:40 PMManagement of Labour and Puerperium xviii 13. Unexpected Fetal Complications During Labour 109 Shakun Tyagi, Shirly Kurien Shoulder Dystocia 109 Cord Prolapse 113 Unexplained Intrapartum Stillbirth 115 14. Postpartum Collapse 118 Anjali Tempe Epidemiology 118 Pathophysiology 119 Management 119 Problems in the Management of a Pregnant and Postpartum Woman 121 Other Conditions 121 15. Common Drugs Used in Labour Room 123 Sudha Prasad, Neha Varun Oxytocin 123 Methergine 124 Prostaglandin E2 125 Carboprost Tromethamine PGF2a 126 Misoprostol 126 Magnesium Sulphate 127 Labetalol 128 Methyldopa 129 Lidocaine Hydrochloride 130 Morphine 131 Pethidine 131 Hyoscine Butylbromide (Buscopan) 133 Terbutaline Sulphate 134 Phytomenadione (Vitamin K) 134 16. Labour Analgesia 137 Kirti N Saxena Effects of Labour Pain on the Mother and Baby 137 Labour Analgesia Techniques 138 Nonpharmacological Techniques 138 Pharmacological Techniques 143 Prelims.indd 18 8/4/2014 5:25:40 PMContents xix Epidural Analgesia 147 Caudal Analgesia 147 Combined Spinal Epidural Analgesia (CSEA) 148 Newer Local Anesthetics and Adjuvants 149 17. Cesarean Section: Changing Scenario 153 Deepti Goswami Indications 153 Urgency 154 Perioperative Care 155 Surgical Technique 156 How to Reduce the Cesarean Rate? 158 Audit 160 18. Medicolegal Aspects of Labour Management 163 Sanjay Gupte, Arati Shah Personnel 164 Checklists and Drills 164 Medicolegal Aspects of Cerebral Palsy 165 Cerebral Palsy and Intrapartum Injury 166 Brachial Plexus Palsy 166 19. Making Labour Safe and Mother and Baby Friendly 168 Suneeta Mittal Standards 168 20. Government Policies to Promote Safe Motherhood 175 Shalini Singh Definition of Safe Motherhood 175 Evolution of Initiatives towards Safe Motherhood in India 175 RCH-Phase II 177 Child Health 179 Family Welfare 180 Adolescent Health 180 Reproductive Health 180 Monitoring and Evaluation of RCH Programme 180 National Health Mission 180 Prelims.indd 19 8/4/2014 5:25:40 PMManagement of Labour and Puerperium xx Section 2 PUERPERIUM 21. Normal Puerperium and Associated Problems 183 Sangeeta Bhasin, Aishwarya Kapur Involution of the Uterus 183 Involution of other Pelvic Structures 184 General Physiological Changes in Puerperium 184 Management of Normal Puerperium 185 Abnormalities of Puerperium 187 Puerperal Sepsis 187 Urinary Complications 190 Breast Complications 190 Puerperal Venous Thrombosis 191 Psychiatric Disorders in Puerperium 191 22. Care of Newborn Infant at Birth 193 S Ramji Essential Newborn Care 193 Immediate Care at Birth 193 Birth Asphyxia and Resuscitation 195 History and Examination of the Newborn 195 Breastfeeding 199 23. Common Problems Related to Lactation in the Puerperium 201 Poonam Sachdeva, Sumati Saini, Harveen Kaur Physiology of Lactation 201 Problems Related to Lactation 203 Suppression of Lactation 207 24. Puerperium in Associated Medical Disorders 208 Kamna Datta Gestational Diabetes Mellitus 208 Hypertension in Pregnancy 209 Anemia 210 Heart Disease 210 HIV 212 Hepatitis B 213 Prelims.indd 20 8/4/2014 5:25:40 PMContents xxi 25. Thromboprophylaxis and Acute Thromboembolism in Puerperium 216 Madhavi M Gupta, Priya Mehta Pathophysiology 216 Risk Stratification 216 Clinical Presentation 217 Diagnostic Tests 217, 219 Treatment Modalities 220 Regional Anesthesia 223 Summary of Treatment 223 Prevention of Post-thrombotic Leg Syndrome 224 Postnatal Review 224 When to do Thrombophilia Screening? 224 26. Psychological and Psychiatric Aspects of Pregnancy and Puerperium 227 Rhythm Ahuja, Chandan Dubey Risk Factors for Poor Postpartum Mental Health and Early Parenting Difficulties 227 Depression 227 Postpartum Blues 227 Postpartum Depression 228 Postpartum Psychosis 229 Bipolar and Related Disorder 230 Mania 231 Anxiety Disorders 231 Obsessive Compulsive Disorder 232 Post-traumatic Stress Disorder 233 Psychotic Disorders 234 27. Postpartum Contraception 238 Rachna Sharma, Jahnavi Sharma Temporary Methods 238 Permanent Methods 242 Index 245