About the Book

A problem-solving guide for budding clinicians.
The book is divided into two sections, viz. obstetrics and gynecology.
Each section covers a wide spectrum of symptoms and problems related to the specialty.
Every chapter starts with a specific problem-related Differential Diagnosis, followed by History, Examination, Investigations, and Conclusion along with references.
Dedicated chapters on the minor procedures in obstetrics and gynecology, instruments, contraception, MTP and family planning.
Enriched with histopathological images, illustrations, clinical photographs, tables, flowcharts and boxes.
This book is aimed at enhancing the clinician skills of clinicians in managing their patients.

About the Author

Manju Puri MD (Obstetrics and Gynecology)

Table of Contents:
Section 1: Obstetrics 1. Approach to a Pregnant Woman Attending Antenatal Clinic 3 Richa Aggarwal*, Pooja Dwivedi Aims of Antenatal Care 3 Various Terms Used in Obstetric Practice 3 History Taking 4 Clinical Examination 8 Investigations 19 2. Approach to a Pregnant Woman Presenting with Bleeding Per Vaginam 22 Namita Differential Diagnosis 22 History 22 Examination 25 Investigations 27 3. Approach to a Pregnant Woman Presenting with Abdominal Pain 35 Richa Aggarwal** Differential Diagnosis 35 History 37 Examination 39 Investigations 41 4. Approach to a Pregnant Woman Presenting with Discharge Per Vaginam45 Sharda Patra Differential Diagnosis 45 History 46 Examination 47 Investigations 48 5. Approach to a Pregnant Woman Presenting with Vomiting 54 Puneet K Kochhar Differential Diagnosis 55 History 55 Examination 56 Investigations 57 6. Approach to a Pregnant Woman Presenting with Diarrhea 59 Pikee Saxena Causes of Diarrhea 59 Differential Diagnosis 59 History 59 Examination 60 Investigations 61 Contents Prelims.indd 15 11-03-2015 15:41:35 Clinical Methods in Obstetrics and Gynecology xvi 7. Approach to a Pregnant Woman Presenting with Fever 64 Shalini Malhotra Differential Diagnosis 64 History 66 Examination 66 Investigations 67 8. Approach to a Pregnant Woman Presenting with Headache 69 Indira Prasad Differential Diagnosis 70 History 70 Examination 71 Investigations 72 9. Approach to a Pregnant or Puerperal Woman Presenting with Convulsions 75 Prachi Dixit Differential Diagnosis 75 History 76 Examination 77 Investigations 80 10. Approach to a Pregnant Woman Presenting with Heart Disease 83 Swati Agarwal Diagnosis 83 Differential Diagnosis 83 History 84 Examination 86 Investigations 87 11. Approach to a Pregnant Women Presenting with Pruritus 91 Ritu Sharma Differential Diagnosis 91 History 93 Examination 96 Investigations 96 12. Approach to a Pregnant Woman Presenting with Breathlessness 100 Richa Aggarwal** Differential Diagnosis 100 History 100 Examination 103 Investigations 104 Prelims.indd 16 11-03-2015 15:41:35 Contents xvii 13. Approach to a Pregnant Woman Presenting with Pallor 108 Indira Prasad Differential Diagnosis 109 History 110 Examination 111 Investigations 114 14. Approach to a Pregnant Woman Presenting with Jaundice 118 Sharda Patra Differential Diagnosis 118 History 118 Examination 121 Investigations 122 15. Approach to a Pregnant Woman Presenting with Swelling Feet 128 Smiti Jain Differential Diagnosis 128 History 128 Examination 129 Investigations 131 16. Approach to a Pregnant Woman Presenting with Hypertension 133 Sarita Choudhary History 133 Examination 135 Investigations 136 17. Approach to a Pregnant Woman with Fundal Height Not Corresponding to Period of Gestation 140 Nupur Pangtey Differential Diagnosis 140 History 140 Examination 141 Investigations 143 18. Approach to a Pregnant Woman ‘Not Sure of Dates’ 145 Garima Gupta History 145 Examination 146 Investigations 146 Prelims.indd 17 11-03-2015 15:41:36 Clinical Methods in Obstetrics and Gynecology xviii 19. Approach to a Pregnant Woman Presenting with Bad Obstetric History149 Monika Bhatia Differential Diagnosis 149 History 149 Examination 150 Investigations 152 20. Approach to a Pregnant Woman with a Congenitally Malformed Fetus 155 Manisha Kumar History 155 Examination 155 Investigations 156 21. Approach to a Primigravida with Free Head at Term 161 Archana Beri Differential Diagnosis 161 History 161 Examination 162 Investigations 164 22. Approach to a Pregnant Woman with Trauma 165 Prabha Lal Physiological Changes During Pregnancy Affecting Trauma Management 165 Fetal Physiology 166 General Approach to a Pregnant Trauma Patient 166 History 167 Examination 167 Investigations 168 23. Approach to a Pregnant Woman Brought in an Unconscious State 171 Kazila Bhutia Differential Diagnosis 171 Management 171 24. Approach to a Pregnant Woman with Previous Cesarean Section 175 Aparna Sharma K, Aditi Singh Rao History 175 Examination 177 Investigations 179 Prelims.indd 18 11-03-2015 15:41:36 Contents xix 25. Approach to a Postnatal Woman 181 Sumi P Thampi History Taking 181 Examination of a Postnatal Woman 183 Investigations 186 Examination of Baby 186 26. Approach to a Woman with Specific Problems in Puerperium 188 Isha Khurana Vashisht Puerperal Pyrexia 188 Breast Problems 194 Foul-smelling Discharge Per Vaginam 196 Swelling of Leg 197 27. Approach to a Woman Presenting with Lower Abdominal Pain in Puerperium 199 Swati Sinha Differential Diagnosis 199 History 199 Examination 201 Investigations 202 28. Approach to a Woman Presenting with Urinary Complaints in Puerperium 204 Aruna Nigam Postpartum Urinary Retention 204 Postpartum Urinary Incontinence 205 Differential Diagnosis 205 History 205 Examination 206 Investigations 207 29. Approach to a Woman Presenting with Postpartum Bowel Complaints 208 Archana Mishra Differential Diagnosis 209 History 209 Examination 210 Investigations 211 30. Approach to a Woman with Abnormal Behavior in Puerperium 213 Jasmeet K Monga Differential Diagnosis 214 Evaluation of the Patient 214 Examination 215 Investigations 215 Prelims.indd 19 11-03-2015 15:41:36 Clinical Methods in Obstetrics and Gynecology xx Section 2: Gynecology 31. History Taking and Clinical Examination of a Woman Presenting with Gynecological Complaints 219 Shalini Singh History Taking 219 Examination 221 32. Approach to a Woman Presenting with Vaginal Discharge 230 Seema Singhal Differential Diagnosis 230 History 230 Examination 232 Investigations 233 33. Approach to a Woman Presenting with Abnormal Uterine Bleeding 237 Neha Gami Differential Diagnosis 237 History 238 Examination 240 Investigations 241 34. Approach to a Woman Presenting with Postmenopausal Bleeding 247 Neha Gami Differential Diagnosis 247 History 247 Examination 248 Investigations 249 35. Approach to a Woman Presenting with Infertility 251 Seema Singhal Differential Diagnosis 251 History 252 Examination 254 Investigations 255 36. Approach to a Woman Presenting with Postcoital Bleeding 261 Neha Gami Differential Diagnosis 261 History 261 Examination 262 Investigations 262 Prelims.indd 20 11-03-2015 15:41:36 Contents xxi 37. Approach to a Woman Presenting with Dysmenorrhea 265 Manisha Bajaj Differential Diagnosis 265 History 265 Examination 267 Investigations 268 38. Approach to a Woman Presenting with Dyspareunia 270 Manisha Bajaj Differential Diagnosis 271 History 271 Examination 273 Investigations 274 39. Approach to a Woman Presenting with Lower Abdominal Pain 276 Manisha Bajaj Differential Diagnosis 276 History 276 Examination 279 Investigations 281 40. Approach to a Woman Presenting with Abdominal Lump 285 Shilpa Dhingra Differential Diagnosis 285 History 286 Examination 286 Investigations 288 41. Approach to a Woman Presenting with Pelvic Organ Prolapse 290 Nidhi Malhotra Differential Diagnosis 290 History 290 Examination 292 Investigations 299 42. Approach to a Woman Presenting with Urinary Incontinence 301 Nidhi Malhotra Differential Diagnosis 301 History 302 Examination 305 Investigations 308 43. Approach to a Woman Presenting with Anal Incontinence 313 Harvinder Kaur Differential Diagnosis 313 History 314 Examination 316 Investigations 318 Prelims.indd 21 11-03-2015 15:41:36 Clinical Methods in Obstetrics and Gynecology xxii 44. Approach to a Woman Presenting with Vulval Lesion 321 Shilpa Singla Differential Diagnosis 321 History 321 Examination 323 Investigations 326 45. Approach to a Woman Presenting with Pruritus Vulvae 329 Shalini Singh Differential Diagnosis 329 History 330 Examination 331 Investigations 331 46. Approach to a Woman Presenting with Amenorrhea 333 Ritu Sharma, Jasmeet K Monga Differential Diagnosis 334 History 334 Examination 337 Investigations 339 47. Approach to a Woman Presenting with Hirsutism 345 Jasmeet K Monga Differential Diagnosis 345 History 345 Examination 346 Investigations 347 48. Approach to a Girl Presenting with Precocious Puberty 351 Aparna Sharma K Differential Diagnosis 353 History 354 Examination 354 Investigations 355 49. Approach to a Girl Presenting with Delayed Puberty 357 Aparna Sharma K Differential Diagnosis 357 History 357 Examination 358 Investigations 359 Prelims.indd 22 11-03-2015 15:41:36 Contents xxiii 50. Approach to a Woman Presenting with Breast Lump 362 Vishrut Narang Differential Diagnosis 362 History 362 Examination 363 Investigations 365 51. Approach to a Woman Presenting with Nipple Discharge 368 Laxmi Goel Differential Diagnosis 368 History 369 Examination 370 Investigations 371 52. Approach to a Victim of Sexual Assault 374 Monika Madaan Assessment of a Rape Victim 374 Consent 375 History 375 Examination 376 Investigations 378 53. Minor Procedures in Gynecology 380 Kirti Kishore Sharma, Richa Aggarwal* Endometrial Biopsy 380 Hysterosalpingography 383 Hysteroscopy 386 Culdocentesis 391 Vaginal Wet Mount 392 Fern Test 394 Postcoital Test 395 54. Minor Procedures for Screening and Diagnosis of Cervical Cancer 397 Tahmina S Procedures for Screening of Cervical Cancer 397 Procedures for Diagnosis of Cervical Cancer 404 Cervical Biopsy 410 Endocervical Curettage 412 Cone Biopsy/Cervical Conization 412 Prelims.indd 23 11-03-2015 15:41:36 Clinical Methods in Obstetrics and Gynecology xxiv 55. Obstetrical and Gynecological Instruments 417 Archana Kumari Abdominal Retractors 417 Allis Forceps 418 Aneurysm Needle 419 Anterior Vaginal Wall Retractor 419 Artery Forceps 420 Ayre’s Spatula 420 Bladder Catheters 421 Cervical Dilators 424 Curettes 426 Episiotomy Scissors 427 Green Armytage Forceps 427 Karman Cannula 428 Lane’s Tissue Forceps 428 Leech Wilkinson Cannula 428 Myoma Screw 429 Needle Holder 429 Ovum Forceps 429 Pedicle Clamps 430 Tenaculum 433 Uterine Sound 433 Vaginal Speculums 434 56. Forceps and Ventouse 439 Anuradha Singh Indications 439 Contraindications 439 Ventouse vs Forceps Extraction 440 Forceps Delivery 440 Ventouse Delivery 442 57. Contraception 445 Harkiran Kaur Narang, Anju Devi Yadav Prescribing a Contraceptive: What to Bear in Mind? 445 58. Medical Termination of Pregnancy and Sterilization 461 Raina Chawla Medical Termination of Pregnancy 461 First Trimester MTP 462 Second Trimester MTP 468 Sterilization 469 Female Sterilization 470 Male Sterilization 475 59. Doctor-Patient Interaction 481 Monika Rana Datta Communication 482 Index 485 Prelims.indd 24 11-03-2015 15:41:36